Lot 11 Septic Application CHECK OR FILL IN WHERE APPLICABLE
No FEE
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
City OF Northampton.
.gpplirntinn far Disposal Works Cnnnstrurtinn lrrmit
Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal
System at:
r,Qt_,3_3._. aa.3.Xg___Svenu Extension
'"°""°"-1 40 Bridge Roagc{;`t"City
_Harold K, Pitzgeral 3 .. .
Owner
Address
Installer 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 gallons Length Width Diameter Depth
Disposal Trench—No. Width Total Length Total leaching area sq. ft
Seepage Pit No Diameter Depth below inlet Total teaching area sq. ft
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by Lamer..Huntley.....d.r Date 10-14-65
Test Pit No. 1 5 minutes per inch Depth of Test Pit_36° Depth to ground water None
Test Pit No. 9 minutes per inch Depth of Test Pit Depth to ground water
Description of Soil L'lsdiim_sand., 10.111°_u.1.1.t.r.._p ebbles
Nature of Repairs or Alterations—Answer when applicable
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System
the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to
operation until a Certificate of Compliance has been issued by the board of health.
Signed
Application Approved By
Application Disapproved for the (allot reasons'
in accordanc
place the system in
10-29-65
Date
Date
Permit No Issued
Date