HomeMy WebLinkAbout0212 OXFORD DRIVE - Health ��
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LOCATION SEWAGE PERMIT 130•
430
VILLAGE
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INSTALLER'S NAME i ADDRESS
B U I L D E R OR OWNER
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DATE . PERMIT ISSUED f / hw
DAT E COMPLIANCE ISSUED be g,
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
U ... ...OF..........V 34
...........................................
Appliration for Disposal Works Tonstrurtiun - rrntit t`
Application is hereby made for a Permit to Construct (pt) or Repair ( ) an Individual Sewage Disposal
System at
........ 5 ��. ......Dr;.'s...................................... �v .4�-v "{- o;: •�
i ,---cation-Address or Lo No.
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...\�i..._-.. ................................•------------- ..4 !'1�. 4�.�b.... �- .:...
ne Address
w �. ............. �.�� �..St.---•=--.1_,j ...._ tZ
fie..,....:.
InstallAddress
UType of Bu dipg Size Lot_.��TC'2P�_......Sq. feet
Dwelling L No. of Bedrooms_._...I...........................:....Expansion Attic Garbage Grinder (vto)
'4 Other—T e of Building -No. of persons............................ Showers — Cafeteria
04 Other fixture ------------ -----------
w Design Flow.............. ..._...................gallons per person per day. Total daily flow....... .........._U......_.............
gallons.
WSeptic Tank—Liquid capacity.\,gallons Length................ Width...._.. .._..._ Diameter............ Depth___..___._..._.
x Disposal Trench—No. .................... Width..../0........ Total Length..;...... ......Total leaching area_.
Seepage Pit No...../.............. Diameter.................:.. Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by_.VAOS.... '1.___ 4.:. S0C.7Z—� ........ Date.��^`^ ....� ......�V
.....minutes per inch Depth of lest Pit....�_ .�.t.... Depth to ground water.._._._:!!��? _ :: ..
,.a Test Pit _No. 1__...,;Z. .
(i Test Pit No. 2...... ......minutes per inch Depth of Test Pit.....1 Via........ Depth to groun water........
___._�O�-A___-
C�i
........ ..t.
O Description of Soil.....--- .:i-,l ..../.�...................... ._ ...... ....... -
x
w
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 iIT1 IE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
ation unttill a Certificate of Compliance has been issued by the board of health.
/ w Sig ,d � .... --------.••--
Date
pplication Approved By_________
__/ _te
Date
Application Disapproved for the following reasons-----------------------------•-------------------------------------------------------------------------........_
---------------------•----------------•-----------------------------...-----------------•--•--------------------•---------•..............................------------------------•.Date
Permit No......................................... Issued....._....--------
•------•---••--- ----•..------------------------•---•
Date
THE COMMONWEALTH OF MASSACHUSETTS
_ BOARD OF HEALTH
.a F
�QSq......................OF.........
ApplirFation for Dhipaii al Works Tanstrur#ion runfit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System,at: ,[ 9
...................................... ......I., ...... .. v' :•:�,.
_�catwn Address or Lo4 No.
n Addres
Installtf Address
Type of Buni d'pg �; ? Size Lot.: QaQ.......Sq. feet
U Dwelli L No. of Bedrooms:_ ..__ .Expansion Attic vt0 Garbage Grinder lap
p., Other—Type of Building 9 +04;- t _... No. of persons............................ Showers ( ) — Cafeteria ( )
Other fi�t-u;.�.*.,::::::::::*,-..gallons
s ®- •------------------------
---•------- •----- -•----------------
wW Design Flow_............. per person per day.'Total daily flow------- ......................gallons.
WSeptic Tank—Liquid'ca.pacityXCQQgallons Length................ Width Diameter................ Depth...../............
x /IIg-_----•. Total Length Total leaching area_. ...t :fi�._sq. ft.'j Disposal Trench—No..................... Width_._
Seepage Pit No....I.............. Diameter.................... Depth below inlet .: Total leaching area_..................sq. ft.
Z Other Distribution box ( ) Dosin tank )
'-' Percolation Test Results Performed by. ai4...t�s � � 50C...1 Date+ �tlg0.--- ----
Wa Test Pit.:No. 1....a.......minutes per inch Depth of lest Pit----t-5 d....... Depth-to ground water........ Q!�._.
minutes per inch Depth of Test Pit....'!_j.9."._.. Depth to group water.......f� Test Pit No. 2-----�------- �`�'-----•-------
7.
Description of Soil.. d a _.._.... a.. -- .
x
W
UNature of Repairs or Alterations—Answer when applicable.............................:...............................................................:..
............•---•----------------------------------------------------------------------------------
Agreement:
4
The undersigned agrees to install"the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITA TIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system;_in
p� ation until a Certificate of Compliance has been issued by the board of health.
�L Slg d. ..........................................;O& 4l ....•-......Date ............
1,= PPlication Approved By.._.. - .... -_'._ p�_-_------
9 Date -
Application Disapproved for the following reasons:-----•---------•--......----•---------------•---------•-------•---------...---------------------....._------_...
....-----•-------------------------------------------------------•------.....--------------•-------------.....-•--•-•----•--•------------=--...........................................................
Date
PermitNo................................. ---------------------. Issued.....................................................-
Date
a• THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEALTH
...............................OF.......... ... ... ....................................
Trrtif iratr of TontpliFanre
T S IS TO CER Y, That,the Ind• ual Awa e Disposal System constructed ( or Repaired ( )
by-- -•-� --- -•- �m
has been installed in accordance with the provisions of 5 of The State 4-kiry-Code as desc ib d the.
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application for Disposal Works Construction Permit No � G Y............. dated-.... _.... ..
-.THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE,THAT THE
SYSTEM WILL FUNCTION `SATiSFA TORY.
DATE. ...........................................,. .'a`A&� J l.1----. Inspector--------......._.. �. •--- ..................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD QF HEALTH
.......... .41V.'.'I.........OF.......... .. --------------------------------------------- "�/� d
.... .. FEE�u1,!�---....
Map work �r ani
Permission is reby granted..... ............. _...`f�"? .. _ .. ......................................
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to Cons uc Rea ( ) an I ual Seyr e gos tern ,.
��y
f,+} :
Street
as shown on the application for Disposal Works Construction Pe No. _ Dated__ `.. ........................
�
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l
Board of Health
DATE........... .......................... ..................................
FORM 1258 HOBBS & WARREN. INC.. PUBLISHERS
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