Misc. Septic Application 4 ERE APPLICABLE
ECK OR FILL IN
No u
THE COMMONWEALTH OF MASSACHUSETTS
Fey 0
BOARD OF HEALTH
Appliratinn for Oinpnnal rr;'irks Tonstrurtinn Permit
OK;
Application is hereby made for a Permit to Construct (O' ) or Repair ( ) an Individual Sewage Disposal
System at:
Location-Addree. or Lot Na
Owner Address
IoaWlee Address
Type of Building Size Lot Sq. feet
Dwelling—No. of Bedrooms Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building No. of persons Showers ( ) — Cafeteria ( )
Other fixtures
Design Flow gallons per person per day. Total daily flow gallons.
Septic Tank—Liquid capacity.::k: :..gallons Length Width Diameter Depth
Disposal Trench—No. Width Total Length Total leaching area_...v sq.ft.
Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft.
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by Date
Test Pit No. I minutes per inch Depth of Test Pit Depth to ground water
Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water
Description of Soil
Nature of Repairs or Alterations—Answer when applicable
Agreement:
The undersigned agrees to install the aforedeseribed Individual Sewage 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 Certificate of Compliance has been issued by the board of health._.
Signed '
Application Approved By
Date
Application Disapproved for the following reasons
Permit No -'-%
Date
Issued..._).__...::._Date 7. .<..< .
by
at
has been installed in accordance with the provisions'of Article X1 of The State Sanitary Code as described inithe
application for.Disposal Works Construction Permit No 43 dated ` - :. `.l THE ISSUANCE OF T}IIS CERTIFICATE SHALL NOT.BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM.WILL FUNCTION SATISFACTORY. _
DATE` t 1 l Inspector
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
•:h OF /J ..
ftrrrifirnfe of (go i plianrr
THIS-IS TO CERTIFY, That the individual Sewage Disposal System constructed (� ) or Repaired ( )
- Installer
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
%ispo nt i,r arks (aunsirurtiau truth
Permission is hereby granted " =- `-....ter.:,.:..__. '
to Construct ( ) or Repair ( ) an Individual'Sewage Disposal System
at No A.-ei'.tio.Ga+.:' . .....c'.:.. . •
Fee
street
as shown on the application for Disposal Works Construction Permit•No - Dated L.. 'L.....�
DATE._\,,t.___:4_._!..(.....L i
FORM 15 HOBBS & WARREN. INC.. PUBLISHERS
%H✓.i��-{ Board of Etealth
250 Jackson Street,
Northampton,Mass.
May 31.1963.
City of Northampton
Board of Health
City Hall
Main Street,Northampton,Mass,
Attention Plumbing Inspector.
Gentlemen:
Enclosed are the results of the perculation tests performed by at
on the property of Mr,Donald Wade on Chesterfield Hoad,leeds. These holes
were dug according to the State regulations. The three holes were dug in a
triangular fora two 2V-6• deep and one 71-0• deep,
Hole 11
Hole #2
12" water level maintaned for 30 minutes,
9" to 6" level took 30 minutes
6° to 3" ° • 60 " or 20 minutes per inch
12 • water level maintained for 30 minutes,
9" to 6" level took 26 minutes
6• to 3" " " 51 " or 17 minutes per inch,
Hole 0 indicated heavy soil of stone,loaa, sand and some granular
material around the three foot level.
ALMER HUNTLEY, JR. & ASSOCIATES INC.
Successsars to Davis Engineering Co. Established 1870
Registered Land Surveyors & Civil Engineers
I3or oo, ,
Otiohy
T
30 CRAFTS AVE., NORTHAMPTON, MASS.
TEL. (413) 589-7444
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