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Home My WebLink About0062 EASTWOOD LANE - Health 62"EYtwa6di an� COtlllt • t fit" 1 0 - - A= 025 - 039 0;�erd /�— Fa.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7.4-w l--..__....OF........A :/.!n..S.1rdli.................................. �v Apphration -fur 43hipuiia1 Works Tomtrurttou Vrrnift Application is hereby'made for a Permit to Construct (L-Y or Repair ( ) an Individual Sewage Disposal System at: 45 Po�tion.Address r Lot No n. w. ---�-- r' ........ ----_-----------�� Address 5 Installer Address Q Type mg Size Lot.2ft.9-9-6----Sq. feet U Dw —No. of Bedrooms_--__-_ _______________________________Expansion ttic 0,0) Garbage Grinder®(.#� per, Other—Type of Building ---------------------------• No. of persons........ _............. Showers ( ) — Cafeteria ( ) W Other fi. tres ----•-----------•-•----------- w Design Flow------------ . :......................gallons per person per day. Total daily flow----- ----_-___-_----......_.gallons. WSeptic Tank—Liquid capacity 0P -gallons Length---------------- Width---------------- Diameter---------------- Depth................ x Disposal Trench—No. ................... Width-------------------- Total Length-------------------- Total leaching area..........._.-------sq. ft. Seepage Pit No__________ _______ Diameter-----A 1X_9_. Depth belo inlet ......_ _.. 1. �}�' .__. Total leachin area__._._.._._____.sc it. Z Other Distribution box ( /) Dosing tank ( ) 0 - 7C ' - y- `` � Percolation Test Results Performed by--------------- ------------------------••---------------•-----•---------- Date--------------------------------------- ,� Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water...-----.--------------- �14 . Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water---------------.-------- 4 ----- --- -- ............... --- ,r..i Description of S il. '-� ° `mil-��"' ? ------. x _ � , ----------------- ---- 1 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 Article YI 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. igne - --- -- - ------ ------ �o ./...I'J J /i ??.._._.... ' ate Application Approved B --------- ! ✓� elew � -D? PP PP f following ----------------------------------------------------------------------------------------------------- Application Disapproved the oldowzn reasons:._._._____. I� -----•--••----------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------- Date PermitNo......................................................... Issued........................................................ Date j✓ ;2 !(j NO......................... Faa... ....................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ". .. .....OF......... ......k..d?!t S. -- Appliratiun -fur Mi ipwial Workii Tomilrurtiun Vrrnift Application is hereby'made for a Permit to Construct 0�' or Repair ( ) an Individual Sewage Disposal System at: �'`� ) ... !i(.................9 y ..ea'?�le�c-i----..L Apra ----- Y''-r--� (---- (•---•----•-----�l....leff i.-...---... ^/� f Loestion Address Lot t' ' l f j erd� pa# R r No ��X � i✓r l iI '" Owner / Address !� -------OC.0 "'.---�-�--t-�---------••-•-----.... ---- _l.• d " l..J r i . . .. Installer Address UType, mg Size Lot_ y._ _ ---Sq. feet DN —No. of Bedrooms____________________________________________Expansion�ttic (1;o) Garbage Grinder 1(.e Other—Type of Building ____________________________ No. of persons._._________................ Showers ( ) — Cafeteria ( ) Q' Other fi_ tres -----------------------------._ _ . W Design Flow_ ...... ______________________gallons per person per day. Total daily flow..... _ ................----------gallons. USeptic Tank—Qquid capacity_MPAgallons Length--_------------ Width................ Diameter---------.------ Depth._______.__... xDisposal Trench—No...................... Width_----------------- Total Length.................... Total leaching area...............-----sq. ft. .__.. Diameter..... ._ _ __ Depth beloy inle _ Total leachin� Seepage Pia No__________ ___ � p ._ __ area------------------ it. Z Other Distribution box ( Dosing tank ( ) ��` � " '�' ' T O a Percolation Tgff Results Performed by------ -- --------------------------------------------------------------- Date------_------------------- ----------- Test Pit No 1 ... - ;_,_minutes per inch Depth of "Pest Pit.................... Depth to ground water_______._.___.._.._---- f14 Test Pit No. 2-------------`___minutes per inch Depth of Test Pit-------------------- Depth to ground water__._.______-_-.-__-_--- k wo O Description of S ill ~ ---' W -------------------�`- �. - ----- - .. ... � _. .... � U Nature of Repairs or Alterations—Answer when applicable..___________________ _______-____.--_-____________----__-____-_.__.._-_.____________--- .- Agreement The undersigned agrees to,install the aforedescribed Individual"4kage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Cegtficate of Compliance has been issued by the board of health. _ -- .� t_c._ . igne ,� -" -- - ---- y�s� ate r 7APPlicati Approved BY . �' ..... �_.. 7. _ Date ---------- •--- -----------------------Application Disapproved for the following reasons: Date Permit No........................................... , Issued. ................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH a., ` .. ...........:O F. . .. ... . Cnrrtifiratr of f�omp haurr THI IS TO CERTIFY, That the Individual Sewage Disposal System constructed (4) or Repaired ( ) by...._..f8L. g a^.• n --------------------------•------------------------------------- -----------------•-------•---•- taller at /v / ., J :_ A ------- ----------i✓°�!✓�"�/tr.=�-- � "� � ---- f'O�_� -tt�� ( �� ..�7ls.j has been installed in accordance with the provisions of A YI V,The State Sanitary Cf de as d sjuibed in the t application for Disposal Works Construction Permit No.l .........-740-"--_----------------- dated---Gr.-_..7_"_"__-___/_.________________•. THE ISSUANCE OF THIS CERTIRCATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM wi L FUNCTION SATISFACTORY. DATE. t ' r 7 1 -V 4-- il_._._1.X_Za. 1. Inspector----...... -----• -------------•---•------- f'A THE COMMONWEALTH OF MASSACHUSETTS �..... BOARD OF HEALTH .9e," � 'S ....................................................... No. ............. FEE--- `. u�rk,� �uBt�trnrttult �rrnttt Permission is hereby granted------. --•--- -•-••- ram!^------ - ------------------------------------------------------------------•-----••- to Construct (Iol or Repair ( d}}vidual S wag Disposal Syst m atNo....... ` ....................................... t / r at& r Street as shown on the application for Disposal Works Construction Pe No.__ ._ ___ Dated_'____ _________________________________ ---- -- - ---------------------------- DATE------------------ �/'� FORM 1255 HOBBS & WARREN, INC., PUBLISHERS ;0 s LZ Lc 'D F'tLoi C-D TCJ / j _ t � 7f3C �� /• ✓ram_..�i[_G � ;f !` . ��4 7-�. l� 7- �`) ` / �i r r j� ,ri..fi G1 7 Tf•/ /— :vxj/uL)A / /OAJ f l�)/A T—)- 7..� `•✓!_ / . ._ i 7-� t... tom.` f ... 1/.f '_ J4� 7 r 4. 1 LOCATION l EWAGE PERMIT NO. VILLAGE Co %Ul %~ INSTA LLER'S NAME & ADDRESS B UILDE R OR /OWNER DATE PERMIT ISSUED DATE COMPLIANCE , ISSUED r�X,� 77 13AcK L � �i�ri fc -A L22, ' f�,3�2 �. v0,,�(-G