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Home My WebLink About0161 OXFORD DRIVE - Health t1-0 1 6 x d b -e- AA`�, Ap NO. PARCEL LOCATION 't--l(ol . SEWAGE PERMIT NO. ' VILLAGE INSTALLER'S NAME a ADDRESS Shea e Sri �e U i L D E R OR OWNER o �r�es Ajell i *7 S,7/0� DATE PERMIT ISSUEDS_ DATE COMPLIANCE ISSUEDy2�-� �� %ijk w a T, v c Lv 6� w C� A r I ASSESSORS MAP NO: 0Z PARCEL NO.- go- 'K Fiml ....... ................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -- OF...........................................I................................................ --- ------------- Applira'fivnJor Disposal Worku Toulitrurtion Prrmit Application is hereby made,for a Permit to Construct (V or Repair an Individual Sewage Disposal System at: W I-ORD Dc,�� 6�-lilq- ......Lj/ Q�Y ... .. ................................................ at' n,Address *.. ...... or Lot No. L C --------- -------------------------------------------------------------------------------------------------- ------------------- -------- ----------------------- Owner Address r X ....... ..................................................... .................................................................................................. Installer Address PQ : (7 VO 0 -.11 Type of.BuildinF Size Lot_......_ -----------------Sq. feet U a Dwelling-3 No. of Bedrooms............................................Expansion Attic Garbage Grinder ( Other—Type of Building ............................ No. of persons............................ Showers Cafeteria ( Ot4crfixturek ------------_------_--- ............................................................................................................................ Design Flow..__....... J110---gallons per person per day. Total daily flow__......... .................gallons. 04 Septic Tank—Liquid capacity............gallons Length................ Width.._.._..__....__ Diameter._........_..... Depth.............._. Disposal Trench—No..................... Width.................... Total Length._.................. Total leaching area---------_--------sq. ft. Seepage Pit No---------I-----------_Diameter-------------------- Depth below inlet.................... Total leaching area....E�..sq. ft. Z Other Distribution box ( ) ' Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. I....Aa`__rninutes per inch Depth of Test Pit.................... Depth to ground water------------------------ Test Pit No. 2....../,..—,.u_minutes per inch Depth of Test Pit.................... Depth to ground water.-__..____..........__.. ......................................... ....... ------------------------------------------------------------- C) Description of Soil....................... M. .............................................................................................................................. U .................................................................................................................................. ..................................................................... ........................................................................................................................................................................................................ U Nature of Repairs or Alterations-Answer when applicable.............................................................................................. ........................................ja4sw........................................................................................................................................................ Agreement: `The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TL!_`_1.E 5 ol the State Sanitary Code— The undersigned further agrees not to place the system in operation til a C rt `cane of Comp fiance has bee sued by the board of heal%th. igne:d......... 1PIU, ... .... .Aj ........)1�3 4 A.............. ----------- I A --7? a Applion Ap roved y............................................ ................................................... ........................7. ............ Date Application Disapproved for thefollowing reason ......................................................................................................... ......................................................................................................................................................................................................... Date PermitNo........................................................ Issued....................................................... Date OZ I P ""'No------------------------ THE COMMONWEALTH OF MASSACHUSETTS 1 6 BOARD OF HEALTH ............ ........ --------............OF.......................................................................................... t Appliratiou for Disposal Worka Tonstrurtion rautit Application is hereby made'for a Permit to Construct (y) or Repair an Individual Sewage Disposal SYSW'VI 0>( �0 DC- �k (67 V r7- .......... -------------------------------------------------------------------------------------------------- wz-z�y�; or Lot No. ............ ------------------------*-------- Owner Address ......................................y • .......................................................................... ------•Instal-l-er-----------------------------------..... ------------------------ Address Size Lo '?o C/o'U 14 Type of Burg ;...................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder Other—T e of Building ............................ No. of persons...._................__.____ Showers Cafeteria 04 Orh e --- ------------------------------------------------------------------------------------------------------------------------------------------- Design Flow............................................gallons;� per person per day. Total daily flow-------- P....................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length................ Width..............._ Diameter...-___..._..... Depth.....__..._..__. W Disposal Trench—Vo. .................... Width.................... Total Length.............-__.._. Total leaching area....................sq. f t. :V4 Seepage Pit No--------------------- Diameter-__--__--___-__---_- Depth below inlet.................... Total leaching area.1.71.....sq. f t. Z Other Distribution box 'Dosing tank Percolation Test Resot-!,> Performed by.......................................................................... Date...................................... Test Pit No. I... ....minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.__............._._. Depth to ground water._...._.._......._..__.. ...........(:; -!:5VV1----------VVKx;Z .._...-------S-- ----------------------------------------------------------------- 0 Description of Soil------------------------------------------------------------------------------------------------------------------------------------------------------------------------ x U ........................................................................................................................................................................................................ .........................................................................................................................................................:............................................ U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ...................................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'11`=4 5:of the State Sanitary Code ' The undersigned further agrees not to place the system in operation ugl- il a Ce n�i e Cate of Co pliance has issjUd by the b a,rd of hValth. V, I I , A& :� I Signed..............1 4........e. ................17) ....................... .../ ... Applica?Jon Approved ............................................................................................... ............. ---- --- ............. D to Application Disapproved for the following reas ................................................................................................................ ......................................................................................................................................................................................................... Date PermitNo-------------------------------------------------------- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........................-................OF..................................................................................... Tatifiratr of Toutpliatta ;: %J?,T, FY, That the Individual Sewage Disposal System constructeK or Repaired ---------O.V�- ---------- .. ................................................................................................................. rCI )V J)t ( �51 L/r1tstaller at.................................................................../-------------------------------------------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of l i The State Sanitary Code Isdesscribed in the application for Disposal Works Construction Permit No......................................... dated-74 .................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUN SAT17SP-ACTORY. �A DATE................................ ........ ............................ Inspector..:------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -701 ................... ......................OF..................................................................................... N 0......................... FEE....................... ...................... Permigri n is hereby granted.............. ..... ---------- X-------------------------------------------------------------------------------------- to C (adfi0j, ", — - 1-1 16 / .,=, (�? J��r Ref*.I( Sew��(D�sey& Syst!!tit Lj )T at Ntt .. ...... .................. ................................................................................................................................................................... Sueet as shown on the application for Disposal Works Construction Permit Xb6--. ....... .................... ...................................... ................................. ----------------- .......- DATE----------------------------------7.1 513.c................ Board of Healt FORM 1255 HOBBS & WARREN, INC.. 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