35-221 (4) Fxs....... ... ............
_
AH OF MgSS THE COMMONWEALTH OF MASSACHUSETTS
ay` q�yG BOARD OF HEALTH
GARY R.
SWANSON CITY NORTHAMPTON
°v
o.2 9
F01SRER� �� p iration for Diopoout Warks Tonotrurtion "ermit
S/p
tion is hereby made for a Permit to Construct O(X) or Repair ( ) an Individual Sewage Disposal
S
LADYSLIPPER LANE LOT NO. 18 _
LAWRENCE .............................. .............................................65 WHITELOAF RLjr Lot tOUTHAMPTON��.MA.
.............................._........ .. Owner Address.............. ......... .... ..
W .....-•...... ........................ ... ................................................................ ._.._..........................
Installer Address
39 560
Type of Building Size Lot............................5q. feet
U Dwelling— No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder (X )
p, Other—Type of Building No. of persons............................ Showers ( ) — Cafeteria ( )
a+ t ree,,
d � �
Design Flow............................................gallons per person per day. Total daily flow.......-................._-.................gallons.
Septic Tank—Li uid ca acit 1 500 aIIons Len th-_�.��6"... Width..E2$........ Diameter_................ Depth__._.._48��.
p 9 P Y........ g g
x Disposal Trench—N . .................... Width.................... Total Length.............._..... Total leaching area....................sq. ft.
3 Seepage Pit No..................... Diameterl 2_..5�.X.8.•Depth below inlet._._5 i.3......_ Total leaching ar 336_...._..sq. ft.
Z Other Distribution box ( ) Dosingg tank ( ) LEACHING CAPACITY = 64 GPD
'" Percolation Test Result Performed by ..e?ARY R. $WANSONJJHW _.___. Date_.6-1.-84j5.-29-84
1-1 Test Pit No. 1................minutes per inch Depth of Test Pit..._1P......... Depth to ground water ------_NE._..__--.
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---------1..........
._..
GG ............•• ............................................................................................•--•-----........-----•-----............._.......
D Descri tion of Soil..............•.. .'.....I.QI? O l�f--._.1 ..'. I..IY--- ANpX..5.0501L,........�'---M•EJ)Vt ....SA ND4...
U .........I'....F.ENE...GR.EY...SA ND...........................................................................
w --•--•-•------------.................................--......-----...._._....................--•-_............---------•-----..........._...-=-------•---•-••-----------------------•-------------------------
VNature 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.
Signed........"............................................................................. ................................
Date
ApplicationApproved By.................................................................................................. ....................Da._..t ..............
Application Disapproved for the following reasons:................................................................................................................
......"---"-".....--"-"..................................••--•--.............................-----....._..---•------------.........-------- ........................................................
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........I.............CITY....OF.......NORTHAMPTO N.............................
..............
Tertifirate of TomptWure
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed �(X) or Repaired ( )
by----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
nt u
at....................LOT...NO.._...18,....LADYSLIPPER. L ---•----------••-•-•-•-•..................................................................
..........."-"..
has been installed in accordance with the provisions of TITIE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No---------------------------"----.--..---- dat ed.--..----------................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE..................................."-...............................-----•..•--- Inspector......................-------------------------------------------------------------