287 Septic Application Permit & Perc Test 1963 CHECK OR FILL IN WHERE APPLICABLE
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No �
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
(ti , OFrnt t°'/
Application for 3Jthponal e'orkn !uuntrwtiuri Permit
Application is hereby made for a Permit to Construct ( ✓) or Repair ( ) an Individual Sewage Disposal
System
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i ver
V
h Iler
Type of Building
Dwelling— No. of Bedrooms
Other—Type of Building
Other fixtures
or Lot No.
Address
Address
Size Lot Sq. feet
Expansion Attic ( ) Garbage Grinder ( )
No. of persons Showers ( ) — Cafeteria ( )
Design Flow TT,�T��t gallons per person per day. Total daily flow
Septic Tank—Liquid capacivty.L(!CWgallons Length Width Diameter
Disposal Trench—No. `......_.. \Vidth... .(i r Total Length__,3? Total leaching area
Seepage Pit No Diameter Depth below inlet Total leaching are
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by Date
Test Pit No. 1 minutes per inch Depth to ground water
Test Pit No. 2 minutes per inch Depth to ground water
gallons
Depth
sq ft.
sq. ft.
Depth of Test Pit
Depth of Test Pit
Description of Soil
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 i nr .'1 'r<t- n.
Application Approved By _.,. +— ... ._,.: .4-tu1.Liff 1 : ,L -•/Gk.: /.2/3
Application Disapproved for the following reasons
Permit No 3
Date
Issued E{ . Li,. -S
Date
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARDS�O_.F�HEALTT�H
1N OF. /.w' :4t >I
rrttfwatr of tIIn plttt
nrr
THIS IS T CERTIFFY That the Individual Sewage Disposal System constructed (Y) or Repaired ( )
at Ci1 InHaller
0 1h A0CPN`�'..%1 �.
has been installed in accordance with the provisions of Article RI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No ..5.6 q� ---
dated__ ..F,c. ..� --L-9A.r
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. / �/
DATE a.SL'4. 1 X. _____ Inspector_' T :( LH' %j.tt.r'LCG:
r
No
Permissio rr -hereby to Construct f' )� nf�ep ( a mid P
at No L�"C ^"n.Y' tJf street rr
as shown on the application for Disposal Works Construction Permit No -� � Dated "`�L` �< 7 V_2
/Roan'�i h
Hvilth
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
!+" �y. OF 17,4af'=4..lz—erni
iginpns i nrcLi-totruction lrrtnit
granted
it an I 4'd 1 llis osal System
FEE
DATE
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
ALMER HUNTLEY, JR. & ASSOCIATES, INC.
Successsors to Davis Engineering Co. Established 1870
Registered Land Surveyors & Civil Engineers
10. 10. 5x
Board of Heslth
City Hall
Northampton, Mass.
Gentlemen:
30 CRAFTS AVE., NORTHAMPTON, MASS.
TEL (413) 584-7444
November 18, 1963
I have examined the soil at land on Coles Meadow Road belonging to Mr. Bruce
Walton, and find the following:
Soil:
0 to 8" Organic matter and loam
8" to 22" silt, send, stones an pebbles
22" to 40" glacial Lill, stones, sand, silt, some caly .
Percolation rate: one inch in 15 minutes.
_Very truly you. ,
Almer Huntley, Jr. Reg S
/n
iiKarian