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Home My WebLink About0260 OXFORD DRIVE - Health 0?(p6 LOCATION SWAGE PERMIT NO. VILLAGE i INSTALLER'S N ME_eLADDRESS BUILDER OR OWNER DA T E P ERMIT ISSU E D Z DATE COMPLIANCE ISSUED �� V p ` 19 it 61 X v�l. �� -• iS! v y } F�a... ............... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ...................... ....------...--OF.-....-.................................... ----•-•--................................ Appliration for 11iipuutal Works Tonstrurtion ami# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: of . Locat' n-Add s or Lot 1J., Owner /'y p Address W .... Installer Address d ype o ui ding Size Lot............................Sq. feet V Dwelling—No. of Bedrooms....... _______________________________Expansion Attic ( ) Garbage Grinder ( ) p-� Other—T e of Building g ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ---------------------------•-•-- . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity......._....gallons Length................ Width................ Diameter---------------- Depth................ Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.........._............................................................... Date........................................ ,.� Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (i Test Pit No. 2..._............minutes per inch Depth of Test Pit.................... Depth to ground water........................ •-------•-------------------------------------•-------------------...._..._.._.........-•----------......................................................... 0 Description of Soil........................................................................................................................................................................ x V 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 TITLE 5 of the'State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health,,,,? - C Signed I -•-------------- ----- Date Application Approved By.... .......... ....... ........ .......... Date Application Disapproved for the following reasons______________________________•_-___._--___.____-_._...................................••--- ___-_.......__ •...............•--•---•------------••....-•-•--...•••-••---------•-••••...---•••---••---...-••-•-•---------...-•--•-••-------•---------•-----•-------------------------------------------------•----- Date PermitNo......................................................... Issued•....................................................... Pate ...........Fim THE COMMONWEALTH OF/MASSACHUSETTS .BOARD OF HEALTH ...........................................OF........................................ Appliration for Mipaaal Works Tonstrurtion Prrutit Application is hereby made for, a Permit to Construct or Repair an Individual Sewage Disposal System at: 7.........OA��A ............ I.............. .................................................................................................. L t* Add kr Lot.N .......... ...... 'e4v------- ... ..W...... . .. Owner dd 4A res.s.....1p Address Installer 14�1' ype 64eU 6 uilding Size Lot............................Sq. feet Dwelling No. of Bedrooms.______3............................._Ex ansion Attic Garbage Grinder ply Other—Type of Building ............................ No. of persons__._________._.__._.___._.__ Showers Cafeteria Otherfixtures ..................................................................................................................................................... Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity............gallons Length________________ Width_.._..._.._.___. Diameter_____-___._..___ Depth................ Disposal Trench—No_ .................... Width_______.__._._______ Total Length__.________.________ Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter.__._.__._..._.__.__ Depth below inlet____._._..._._._.___ Total leaching area..................sq. f t. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Per-formed by.......................................................................... Date........................................ Test Pit No. 1................minutesperinch Depth of Test Pit._____._._.__.__.__. Depth to ground water..__.......______.__.__. GX4 Test Pit No. 2................minutes per inch Depth of Test Pit._._._..__._____._.. Depth to ground water.-_______._.___._._..___ ........................... ................................................................................................................................ 0 Description of Soil...................................................................................... ................................................................................ U ........................................................................................................................................................................................................ 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 TITLE 5 of the State Sanitary Code— The undersigned f--ifther agrees not to place the system in operation until a Certificate of Compliance has been issued b the board f-health Signed-----.. .. .......... .... -- ------ .... . Date Application Approved By ,,,....4,, .... .....✓ .. . ................................ r� .......................... ........ Date Application Disapproved for the following reasons:...................................I............................................................................. ........................................................................................................................................................................................................ Date PermitNo......................................................... IssuedL....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF...................................................................................... fit THIS IS TO C Y That the Ind,vidual Sewage Disposal I...S..ysteyconstructed or Repaired by ��. ............................................... stalle J, OP at.............. ........ .....2........... le I . .. . ........ ....... .............................................. has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit .......... dated...----------------------------I ................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION S TISFICTORY. DATE..................................... ................. Inspector............... .....�-��- ------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HVALTH ............ ....OF........................11 --- ............... 1510- No......................... FEE---...___...._.......... Mapnoal Morkq__ ongtr ion "amit Permission is hereby granted------ .................. ... —0...... .. .._..._.....-----a-.. .....aA, .......--- to ConstruQ r Repair ap Individual Sewage Dis System atNo. ............2Li...... - ------------------------------------------------------------------------------------------------ Street as shown on the application for Disposal Works Construction Permit No.i'I'47A& e ---- 2 ----------- `��ee�il?� ; t ------------------------------------ e? 0_ --a DATE................ . .................................. FORM 1255 HOBBS & WARREN, INC.. 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