Lot 4, Title 5 Application/Permits 1988 CHECK OR FILL IN WHERE APPLICABLE
f17
No FEE
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
FNelP4f-{AMPTi
Appliratinn fur Oispti al Works (gunsiruritun jrrmit
Application is hereby made for a Permit to Construct
Sr at
ler
or Repair ( ) an Individual Sewage Disposal
40Z N
Address
Address
Type of Building Size Lot Sq. feet
Dwelling—No. of Bedrooms Expansion Attic ) Garbage Grinder ( )
Other—Type of Building No. of persons s ( ) — Cafeteria ( )
Other fixtures ,%�.'aj�{�,'^�
Design Flow g( pe son peT talad flow gallons.
Septic Tank—Liquid capacity s ngth � ' dth Diameter Depth
Disposal Trends—No. "p al Length Total leaching area sq. ft.
Seepage Pit No Di et Depth below inlet Total leaching area sq. ft.
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by Date
Test Pit No. 1 minutes per inch Depth of Test Pit Depth to ground water
Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water
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:ITl 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been '..ued by -- +oard of health.
X
Sign
Application Approved B
Application Disapproved for the following reasons-
-2a ry
Date
Permit No
Date
Issued
CHECIC OR PILL IN WHERE APPLICABLE
No
THE COMMONWEALTH OF MASSACHUSETTS
hOARD OF HEALTH
CITY OF NORTHAMPTON
FEE
Appliration fur ilizprwal 11ffnrhn aftmritrurtinu 7,1rrinit
Application is hereby made for a Permit to Construct (XX) or Repair ( ) an Individual Sewage Disposal
System at:
.M21PLE. RIDGE ROAD LOT fi 4
Location-Address
or Lot No.
.ums2EAD. & 111ORTIR.EARB.S...ED,FLORENCE,PIALOI 0 6 0
Owner
Address
Installer
Address
Type of Building
Size Lot..3.1.,.6.Q.Q Sq. feet
Dwelling—No. of Bedrooms a Expansion Attic ( ) Garbage Grinder (10)
Other—Type of Building No. of persons Showers ( ) --- Cafeteria ( )
Other fixtures
Design Flow 5.5 gallons per person per day. Total daily flow 3.3.0 gallons.
Septic Tank—Liquid capacity15.0.0.gollons Length1.0 ' 6" Width5 1.8" Diameter Depth..5 ' 4"
Disposal Trench—No. 2 Width 2. Total Length...80 ' Total leaching area 40 "q. P
Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft.
Other Distribution box (xx) Dosing tank ( )
Percolation Test Results Performed by...2HARMER...E.N.G.IN.. CORP Date .4./4./86
Test Pit No. I 2 minutes per inch Depth of Test Pit 8.6" Depth to ground water. .7..6"
Test Pit No. 2 minutes per inch Depth of Test Pit Depth to groun
Description of Soil • 0.6.8" 102.S0IL
8-24" SA.NDY .suascaL
2.4.H.8.6. MED.HCOARSE SAND
Nature of Repairs or Alterations—Answer when applicable
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal Sys C with
the provisions of Article XI of the State Sanitary Code -- The uiu]t-nitetl further agrees not tOS tie S.). 11.111 ii
operation until a Certificate of Compliance has been issued by the board of health.
, Y( 1/ M , � ,
by
at
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
UT' OF.iN.O.&.T.HA.M.P.i.C'.N
Qlrrtifirair of (dnmplixarr
THIS IS,s C f2T1$Y,aThat e Individual Sewage Disposal System constructed
Nally
or Repaired ( )
has been installed in accordance wink the provisions of TI 591
$g(
application for Disposal Works Con truction Permit No �+—r
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU A A GUA NTE THE
SYSTEM WILL CTION SATISFACCT(O .
DATE .. .._6 e(! 4(RY Inspector •
State Sanitary Code as de* b the
dated /a-r 1 r'Q�
No 1,.-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
CITY orNORTHAMPTON
Disposal r:;nrks Cionstrartipas rrm
Permission is hereby granted ).
to Construct ( t) or Repair ( ,) an Individual Sewage`Disposal Systemic-) _e _t
at No ,.,:.. /:1..s.k.S..S..<r
stte'et
as shown on the application for Disposal Works Construction Permit No ..: Dated
FEE
se-CIA i/yc1,-
Board of Health
DATE --
FORM 1255 A. M. SULKIN. INC., BOSTON
'AC