Lot 19 Title 5 Applications/Permits CHECK OR FILL IN WHERE APPLICABLE
taly
No ^7{.
�c THE COMMONWEALTH OF MASSACHUSETTS
oK BOARD OF HEALTH
CITY OF NOR THAMPTCN
oil-se for 3ainpunnl Marko C1tunntrurtiun j rrmit
Application is hereby made for a Permit to Construct ( Repair ( ) an Individual Sewage Disposal
p Jr Q t
System at:
4 /_d Itit
erE°0Oag'i:IA'N ....orb Sn.u.
Owner
Installer
Type of Building
Dwelling—No. of Bedrooms
Other—Type of Building
Other fixtures
Design Flow gallons per person p
Septic Tank—Liquid capacity gallons Length
Disposal Trench— No. Width Total Length
Addre
Address
Size Lot Sq. feet
...Ex i Att ) Garbage Grinder ( )
L-'No. so . ._.. _. wers ( ) — Cafeteria ( )
G I n
day T t y flow gallons.
Kith Diameter Depth
Total leaching area sq. ft.
inl et Total leaching area sq. ft.
Seepage Pit No
Other Distribution box
Percolation Test Results
Test Pit No. I
Test Pit No. 2
Description of Soil
Diameter Depth below
Dosing tank ( )
Performed by Date
minutes per inch Depth of Test Pit Depth to ground water
minutes per inch Depth of Test Pit Depth to ground water
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 TITLE 5 of the State Sanitary Code —The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been i d e b o%'heal'
Signed
Application Approved By
Y74/42
Application Disapproved for the following reasons
Permit No
Date
Date
Issued.
CHECK OR FILL IN WHERE APPLICABLE
No FEZ
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
Application for l inponai
arks alonsfrurfion Wrath
Application is hereby made for a Permit to Construct (xx) or Repair ( ) an Individual Sewage Disposal
System at:
MAPLE..RLDGE..ROAD
Location•Address
RIIHEB.T...GODDlAN
Owner
Installer
Type of Building
Dwelling— No. of Bedrooms 3
Other—Type of Building
Other fixtures
Design Flow 55 gallons
Septic Tank—Liquid capacity 1500
Disposal Trench—No R
Seepage Pit No 1 Diamete
Other Distribution box (x Dosing tank ( )
Percolation Test Results Performed by PHARMER ENG. CORP
Test Pit No. 1 2 minutes per inch Depth of Test Pit
Test Pit No. 2 minutes per inch Depth of Test Pit
Description of Soil IT
LOT..#.L9
or Lot No.
01.1? SOUTH, STZEZTaNQB TRAMP TON.,MA.
Address
Address
Size Lot 137, 562 Sq. feet
Expansion Attic ( ) Garbage Grinder (x )
No. of persons Showers ( ) Cafeteria ( )
per person per day. Total tail flow 330 gallons.
gallons Length 10 ' 6" Width 5 6n Diameter Depth 514
'idth Total Length Total leaching arm sq. ft.
Depth below inlet 1• 921 Total leaching area 474 sq. ft
Date 5/1/86
TEST P #18
9 ' Depth to
Depth to
0-10" TOPSOIL
10-39" SANDY SUBSOIL
39-108" MIXED FINE—MED.SAND W/SILT
Nature of Repairs or Alterations—Answer when applicable
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal ystem m 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
Issued
Date
Application Approved By
Application Disapproved for the following reasons
Permit No
CHECK OR FILL IN WHERE APPLICABLE
No
FEE
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
Applirntian for Disposal Monts &Lonstrnrtinn hermit
Application is hereby made for a Permit to Construct (xx) or Repair ( ) an Individual Sewage Disposal
System at:
MAELE...RSRGE..R.OAQ
Location•Address
RQBE.R.T...GQQDk1AN
Owner
Installer
Type of Building
Dwelling—No. of Bedrooms 3
Other—Type of Building No.
Other fixtures
Design Flow 55 gallons per person per day. Total daily flow 330 gallons.
Septic Tank—Liquid capacity 1500 gallons Length 10 ' 6" Width 5 ' 8" Diameter Depth 5 ' 4n
Disposal Trench—No Width Total Length Total leaching am sq. ft.
Seepage Pit No 1 Diameter Depth below inlet 1• 92 Total leaching area 974 sq. ft.
Other Distribution box (x)) Dosing,tank ( )
Percolation Test Results Performed by PHARMER ENG. CORP Date 5/1/86
Test Pit No. 1 2 minutes per inch Depth of Test Pit 9 ' Depth to gr 1
Test Pit No. 2 minutes per inch cT Depth of Test Pit Depth to
I,QT...#.14
or Lot No.
O.LD...S QVTB...S.TREET...N'.QRTHAMPTON2 MA.
Address
Address
Size Lot 137, 562 Sq. feet
Expansion Attic ( ) Garbage Grinder (X )
of persons Showers ( ) — Cafeteria (
Description of Soil
0-10" TOPSOIL
10-34" SANDY SUBSOIL
34-108" MIXED FINE—MED.SAND W/SILT
Nature of Repairs or Alterations—Answer when applicable
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal ystem m 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
Permit No Issued
Application Approved By
Application Disapproved for the following reasons
Date
CHECK OR FILL IN WHERE APPLICABLE
No.
FEE
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
city orNQRTIAMA PTTt1N
Application for Bioponal
ci
nrka (gonotrurtion Permit
Application is hereby made for a Permit to Construct ( 4) or Repair ( ) an Individual Sewage Disposal
System at -i
Owner Address
Installer
Type of Building
Dwelling—No. of Bedrooms �.....
Other—Type of Building / — E No. df pe
Other fixtures
Design Flow
Septic Tank—Liquid capacity
Disposal Trench—No.
Seepage Pit No
Other Distribution box
Percolation Test Results
Test Pit No. I
Test Pit No. 2
Address
Size Lot Sq. feet
op�ttie ( - ) Garbage Grinder ( )
1. Showers ( ) — Cafeteria ( )
� 'r
gallons per person pet.da ']4'Qtal daily flow gallons
gallons Length Width Diameter Depth
Width Total Length
Diameter Depth below ink
Dosing tank ( )
Performed by Date
minutes per inch Depth of Test Pit Depth to ground water
minutes per inch Depth of Test Pit Depth to ground water
Total leaching area sq. ft.
Total leaching area- sq. ft.
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 TITLE 5 of the State Sanitary Code— The undersigned further agrces not to place the system in
operation until a Certificate of Compliance has been ' u l t to bgaret o7healtpf o/
Signed.
Application Approved By
/ 7
Date
Date
Application Disapproved for the following reasons•
Date
Permit No Issued
THIS I
by
at (ma<dly
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
I1YOF_NQ.R.'1.HAMPPIN
frrtifiratr of QCnmplianu
TIFY, - : the In< .al Sewage Disposal System constructed (At) or Repaired
has been installed in accordance with ( e provisions of ITIF of h,—Ctate Sanitary C,-,,7° esc in the
application for Disposal Works Construction Permit No [ dated 1 �s..�
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARAIUEE TWAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE Inspector
G'7
No
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
FNOR11 AMPT,)1\ - cc
En
Oiopooal_ iii prim, Qtwml ;utian Ilrrmit_
y� . }o ,_,, Ad 6^. ...,--. f5(�Ac >i S�-A
Permission is hereby granted • T" -
to Construct (4.<o r ( In Ind'v du�$ewage Dispenl System
i (
at No ...._L_._....._
as shown on the application for Disposal Works Construction Permit No Dated..._.x:,77 i
1"/L< L
DATE
FORM 1255 A. M. SULNIN, INC., BOSTON
Board of Health