35-220 (6) .... FES..........................._.
OFM�ssc— THE COMMONWEALTH OF MASSACHUSETTS
qy BOARD OF HEALTH
.g°
GARY R,SWANSO CITY NORTHAMPTON
`=+
o -1 -..............OF........... _...--..............................................
Q No.279 y
0 Fc/ TE °�� tion for Ditipusat Works Tnn,itrur#inn Permit
Fss/0 p
n is hereby made for a Permit to Construct ( X) or Repair ( ) an Individual Sewage Disposal
s
LADYSLIPPER LANE LOT NO. 30
-. --...-•--••..............•........-•-••------....................•••................._......_ ..........---•--.....•--..............................•-••-•...._....._._................_..•---•-
R & LOVAL` Y TRUST 66 INDUSTRY AVE° VrLD MA 01104
•..... ....__....-••............ ...........•.............__......._............ .............._...................._--•---...•• -•----........-c....._......__.............
Owner Address
Installer Address
0.88 ACRES f
Type of Building Size Lot............................................... q. eV
Dwelling—No. of Bedrooms......................4
....................... Attic ( ) Garbage Grinder (X)
....__.._. No. of persons............................ Showers — Cafeteria
a Other—Type of Building .................. p ( ) ( )
a Other fixtures ...........
................•---••--•-•--.....--•---...............¢ ............._._... ....
4 0---------- ------ -
Design Flow...... / .....gallons ----
per person per day. Total daily flow........_...._........_....___._...._____...gallons.
Septic Tank—Liquid capacity1.50Q.galIons Length..1.26.11.... Width.....b8_...... Diameter---------------- Depth.._.........
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................
sq. ft.
Seepage Pit No.......I............. Diameterl.2..3X_8_3hepth below inlet....5. ..3......... Total leaching area....336.....sq. ft.
Z Other Distribution box ( ) Dosin tank ( )
Percolation Test Results Performed b tank .6..,...S�I N ON ..•-P -E,1JHW Date..b-1 84/5-29-84
a y.... . -
Test Pit No. 1..1;.2..._.minutes per inch Depth of Test Pit....... ......... Depth to ground water.... NE_.._.....
w Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
•.............•--------------.....-----•---.......-•-•--•--••-------•----------•--........•................-•-•--••----....................._......-----.....
D Description of Soil.............. '.-.TQF QI.i�f$ANQY..SUBSOIL;- 8_. -FINE TO COARSE SAND
U ............................................................. ----•----•-•------............._...... ....------------...... . ..-••-•-• ... .. .. ---- -•---•. •• ••--- ----•••--
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 TITL>". 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.................................................................................................. .............................-..........
Date
Application Disapproved for the following reasons:.......................................-......................................................................-
.............•--................_.....--•....-••-------•-•-••--•..............---....---........................------••.....•-• ...................................................................
Date
PermitNo...................................................-.... Issued.....................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
......................CITY.......oF...........NORTHAMPTON...............
........................
Tertifi atle of Tompliatta
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (X ) or Repaired ( )
by------------------------ ------------------------------------------------------------------------------------------•-----••-•--------..--------------•-------_-----------------•---•------------
I sc u
at..........................,OT -I4�?�...3�_,...LA DYSL I P P ER..... --V----•------------•--------------
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 No------------------------------•---------. dated-------_...........-.-.........................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE......................................•-----........................_••••......_ Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
T'r` k Ll^.�ll A.0:.i iA'1 AiJ i..'S.^J.A1.7I
No......................... ..................... .........v .........,.. n
................_.....................
FEE........................
"Dinposal Varka 10-111notrnrtion Permit
Permission is hereby granted...................... .. 8t_L...REALTY.-TRUS................................................................._...
to Construct ( or Re it ( an Individual Sewa a Disposal System
atNo. LOT...I�0................-LA DYS L I P P E ---LANE ----•-----------------------------------------------------------------------------
Street
as shown on the application for Disposal Works Construction Permit No__................ Dated---------.................................
.........................................----•-......._..---•••--••--•..................................
-
Board of Health
DATE__.........................................................................
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS