Misc. Lot 14 Septic Application & Plans No
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
C/7Y of /Y�/icrH!2,77/' ;MA/
Fat_.....
Application for Binomial rr;arks (tnnstruction rrmit
Application is hereby made for a Permit to Construct ( • for Repair ( ) an Individual Sewage Disposal
System at:
ACt
L«ntion.Addreae a Lot No.
.5�.e.<"-3...—.2.r2,t/O.v/ *Y...✓/./..a.tS?Z..__.�I/i97ric-Gf?..
Address
Installer Address
Type of Building Size Lot Sq. feet
Dwelling—No. of Bedrooms J 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 300
Septic T�--Liquid capacityS.Cgallons Length..=c2L: Width S '-4" Diameter
Disposal No / Width Total Length 3 C'' Total leaching area '0 G
Seepage Pit No
Other Distribution box
Percolation Test Results
Test Pit No. 1 .9.-3
Test Pit No. 2
gallons.
sq. ft.
sq. ft.
Description of Soil CU t 3
Diameter Depth below inlet Total leaching area
) Dosing tank ( ) ,/ _
Performed by✓.:lideeZ..ia'NTc.c2 4;crate• Date C.A....3
minutes per inch Depth of Test Pit 3-0 " Depth to ground water..b!glr
minutes per inch Depth of Test Pit Depth to ground water
!7e'Z- 2C- ,..]2122 lrip BY 07w .}
` C.e4rin//C- 740•'sn,5 :Y'_i., -C/C7'!-6 " 66/ t?f/.le 774 4.-
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.
Date
Date
Date
Application Approved By
Application Disapproved for the following reasons
Permit No Issued.
Daze
1
'SSV69 'N01dC4VH1M0N
•
.REQUESTED 8Y:
L).: T/.2V
O53ERVATION PITS
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No,!>NA/1YP7On/ 4.1.4-14.•
MA/L ADDR(33 : ye 'Pa.t r r»2M A) 4Th '7 •41:0-17:C etc)n
DATE: S/'P//_?
OBSEQVCQ L/It',e r,
3 -4, "
3/4 T
(>GAC/Ac
4A A/O
D =3"
D 6. '1
6POUND WATER /o AiE
DEQC RATE : 3,3 /tlit//�•!V
- GROUND WATER
PCRC RATE
orb a
To,0SO/c
L erar
620UNb WATER
DEX RATE :
T
AA *ye
GROUND (WATER
PERC RATE •
■
ALMER HUNTLEY, JR. H ASSOCIATES, INC.
REGISTERED LAND SURVEYORS B CIVIL ENGINEERS
238 BRIDGE. STREET
•
REQUESTED 6
Y:
AWL ADDRESS
3 _G "
OBJERVATION PITJ
C ', Inv/o /
A'1e71i,neAJ dentrn
A/a 7NA/BPYON/ .4%//SS,
'71#064e7r itt4.d ..on-rap H..jflte S
7l.ote/L
S/L T
c+ AC/AL
SAA/D
6POUND WATER £/a t
PteC RATE : _7. 3.
0 =3 °
/ %3"
•
D —(eh
GROUND WATER
Peke LATE
DATE:
OBSERVER:./#t .
To,05 ,
L eC
GROUND WATER
DEX LATE :
r
GROUND WATER
PERG g4TF
ALMER HUNTLEY, JR. a ASSOCIATES, INC.
REGISTERED LAND SURVEYORS B CIVIL ENGINEERS
238 BRIDGE. STREET
NORTHAMPTON, MASS.