Lot 5, Title 5 Application/Permits 1988 No.._../ 'G_.R.._
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OFNDP' HANIVir.r.
Fag
SS
.Appliration for fli5poan1 3Ilorlu Lonntrurtion 1rrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
IN WHERE APPLICABLE
or Lot No.
Address
Installer Address
Type of Building Size Lot 31. It)--s q. feet
Dwelling— No. of Bedrooms 3 Expansion Attic ( ) Garbage Grinder pQ
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../5allons Length Width Diameter Depth
Disposal Trench--- .r.. ..._ Width 3 Total Length Total leaching area sq. ft.
Seepage P N — Diameter Depth below inlet Total leaching area sq. ft.
Other D', i. • box ( ) Dosing tank ( )
P ( Test Results Performed by Date
st 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
CHECK OR F
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 TITim 5 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.
Application Approved By P
Application Disapproved for the following reasons.
Permit No
Date
Issued.
Data
._I It OF NORTHAMPTON
Carrtifirtttr of fanm}Tlittnrr
THIS IS TO RTIFY, Thy/Lie In iividual Sewage Disposal System constructed (t,\) or Repaired ( )
by ..
Install
has been installed in accordance with the prove ions of TITLE 5 The State Sanitary Code desgr�,y'pd,yin the
application for Disposal Works Construction Permit No .—it dated..._ I /j//.O
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR_ED AS A GU NTEE T THE
SYSTEM WILL F CTION SATISFACTQRY.
DATE :..e., /f Inspector
No
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
(LIT f OFNORTHAMPTON:
13inwnnttl
I.I:
nrkn (annstrurtinn Prrmit
FEE
Permission is hereby granted
to Construct ( ) or Repair ( ) an Individual Sewage Disposal System
at No
Street
as shown on the application for Disposal Works Construction Permit No Dated
Board of Health
DATE
FORM 1255 A. M. SULKIN. INC. BOSTON
CHECK OR FILL IN WHERE APPLICABLE
No
Fax
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
CITY OF OF. NORTHAMPTON
Applirntion for lJioponnl Mirka QIonotrurtion tirrinit
Application is hereby made for a Permit to Construct (xyJ or Repair ( ) an Individual Sewage Disposal
System at:
MAPLE RIDGE ROAD LOT #5
Location•Address tut No
HOMSTEAD & CO. INC. 408 NORTH FARMS RD. tFLORENCE, NA. 01060
Owner
Address
mauler Address
Type of Building Size Lot 31• 292 Sq. feet
Dwelling—No. of Bedrooms 3 Expansion Attic ( ) Garbage Grinder (Nd
Other—Type of Building No. of persons Showers ( ) -- Cafeteria ( )
Other fixtures
Design Flow 55 gallons per person per day. Total daily flow 330 hllons
Septic Tank-Liquid capacity 1500 gallons Length 1" ' 61 Width 5 i �i� Diameter De)pth �1 4 "
Disposal Trench— No. 2 Width 31 Total Length 80 Total leaching area 400 sq. ft.
Seepage Pit No Diameter_..._____ _ Depth below inlet Total leaching area sq. ft.
Other Distribution box (X ) Dosing tank
Percolation Test Results Performed by PHARMEI ENGINEERING CORP. Date 4/4/86
Test Pit No. 1 2 minutes per inch Depth of Test Pit 8°11 Depth to ground water 72
Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water
TEST PIT #5
Description of Soil 0-12" TOPSOIL 1 '�h. rF , I'S
22-24" SANDY ARSEOIA ' + —"
24 8't MED—COARSE SANE < ;t RM ye-
m
Nature of Repairs or Alterations Answer when applicable ac ""Ep T�
txr tyrn6
Agreement: - r„¢i .
The undersigned agrees to install the aforedescribed Individual Sewage pispasat S accordance with
the provisions of Article XI of the State Sanitary Code— The undersigned fu rtlie#vi e place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Signed
Application Approved By
Application Disapproved for the following reasons•
Date
Date
Date
Permit No Issued
Date