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Misc. Septic Application 13
CHECK OR FILL IN WHERE APPLICABLE FRS THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CITY' of e. T4AP MPT J_..._.__.. Application for i3inpnsal U arks Tonntrurtinn lJermit WEbn is hereby made for a Permit to Construct ( ) or Repair (✓) an Individual Sewage Disposal Cl4a5TEe_FIEL> P-°AD Location.Addms _ or LM No. ?..?E+T_....C.k. 11.+._..��1_�'"�c�� .PfL Owner Address Installer Type of Building Size Lot 1•IS Z' sk'Sq=sat Dwelling—No. of Bedrooms 3 Expansion Attic ( ) Garbage Grinder (■ J Other—Type of Building No of persons Showers ( ) — Cafeteria ( ) Other fixtures Design now SO gallons per person per day, Total daily flow 3Q.A gallons. Septic Tanks,Liquid capacity.l.© Qgallons _ L_ength.$(61CIQ Width 5 a u Diameter Depth b 4" Disposal T'seu�r—No. I Width %-I Total Length .D.0 Total leaching area weo sq. ft. Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft. Other Distribution box ( ) Dosing. tank ( Percolation Test Results Performed by jf.'.A!CA 'd ikatIY.eacii€E£'.. Data 3-1.-.1¢ Test Pit No. 1...LQ:5_..minutes per inch Depth of Test Pit 3L a'�. Depth to ground water t- r Cie- Test Pit No. 2 minutes per inch Depth of Test Pit 7 I-O o Depth to ground water b'-0f.'_ Description of Soil 3 " PTS.-.....1.�:.dv" 5 L t S'- 3" S 'LT 4 .$..A.NI.p °...13C. �l'6-2 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 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 Application Disapproved for the following reasons' Permit No Date Date Data Issued Date REQUESTED 8y: O1SJE.2VAT/ON PITS Ro7.7!'_-r C DATE : =, - 1 - 74 c=Ftc LS? n.-)rao 08^ERVER: RPB N p i2-T 1-1-F-.m•P-!t t• MA/L ADDRESS 7-0•. DEEP /doze A/ on ,/LT 3" /!6u 6P7UND WATER 51 O"' PERC RATE : 6.5 "T/tX,, i GROUND WATEk Pt2C RATE L 620UND WATER PEkr RATE : GROUND WATER PER< ,g4TE ALMER HUNTLEY, JR. a ASSOCIATES, INC. REGISTERED LAND SURVEYORS & CIVIL ENGINEERS 238 BRIDGE STREET NORTHAMPTON, MASS.