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46 Title 5 Report Application/Permits 1990, 1997, Report 1997 Y1�M+ M M1:Yom..,. ._....^-5��.� tint U "MY'". biixfk 1.i„ Losa6nn' exrwtosNe ,' -� �RCOIATIpH�t1T- _. . . _EOMM©NWEAL7fra F74YASSACHISETTS.. G .MersecM.x�la tailaginanillall L � SI adimat ®- - -- ®® • �Ia;Cd m ,tlonVit myt M pManed II bmn the Mmw are AND - - Mt'Passed p _...._..._. Mmessed By: Comments: W V .i.. 4. S LecatiorA ress or Lot Dee'H�`cumber — ocation 'den• on site an Land Use V talon landfonn Position on Water Bod Possible Wet Area Dee Hole 0: DePD�o Saran ion Pad{Matal On-Site Review ' EW. (JUJU Dall 311— etch on the back sal RAMO V r) feet feet Distances from: Weather Surface Stones Other DEEP OBSERVATION HOLE LOG` IIDIIMUM OF TWO HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA SW Golx Sol Tease SA . Sol qo Slane% Derr Breed SeasaW Dee Hotel Dent tom Solace Wake In Ile Hob Gourd Water =' DEEP-OBSERVATION HOLE LOG* *MWOAUM OF TWO HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA a, Sol Haimn SW Tease LG:. PawtMaMS b ramdratec Winged Seasonal Waerkthe Hob Grand Water %G feet feet he CHECK OR FILL IN WHERE APPLICABLE THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH City OF Northampton 1pplirtttion for 3jinponttl Works Tnnntrurtian 1rrmit Application is hereby made for a Permit to Construct (X) or Repair System at: Maple Ridge Road Location Address Scott Hamilton Owner Clifford Clark Installer Address Type of Building Size Lot _7...a 630 Sq. feet Dwelling—No. of Bedrooms 4 Expansion Attic ( ) Garbage Grinder (X ) Other—Type of Building No of persons Showers ( ) — Cafeteria ( ) Other fixtures Design Flow 55 gallons per person per day. Total daily flow.4.40.!.22.0E6.64 gallons. Septic Tank—Liquid capacity 150 gallons Length 10 ' 6" Width.5 ' 8" Diameter Depths 4" Disposal Trench—No. 2 Width 3 ' Total Length 90 ' Total leaching area 45.0 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__Pharme.r...Eng Go.r.p Date 4L41.5.6 Test Pit No. 1 2 minutes per inch Depth of Test Pit 82" Depth to ground water 7 2" Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water - 0" OTS Description of Soil 0"-36" sand fill ( L" be ...neuv a 36"-82" med/coarse sand w/ fine sand layers an India idual Sewage Disposal or Lot No. 79 King St ree 5.......N.RS.thd.mF-k.Q.tl.«-..N.fl. Address Nature of Repairs or Alterations—Answer when applicable Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not system in operation until a Certificate of Compliance has been issued by the board of health. Application Approved By Application Disapproved for she following re610 Permit No. Issued THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA TH (1OF !� gortificate of @lompiin THIS IS • FR TPY, That 'e Indio. ual Sewage Disposal System constructed ( or Repaired - P , 0 ,r by has been installed in accordance w the provisions:if TITLE 5 of he tat Environmental Code as described in the application for Disposal Works Construction Permit No THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED S A GUARANT THAT THE SYSTEM Will FJe T,IQ1N�SATISFACTORY. //7�`l''"'//�� DATE l 1�� �/47f/ Inspector No THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAL , 7 A/ ai_ `0- r'J�" OF ( . Elispnstt • x @i¢ns i9innfiermtt Permission,is� hereby granted to Constructs' To epair ( )xt Inds at No l T �� S w ge isp sal System as shown on the 7plication for Disposal Vorks Construction Permit DATE FORM 1255 V/BBS 8 INC.INC.. PUBLISHERS t§ (( ter FEE J THE COMMONWEALTH OF MASSACHUSETTS BOARD OF 'HEALTH N or th amP.F..on............................_........ es Y'jj f id mp fittttt Tp ER IFY }mot the THIS S l , ._. 1} t�.£Q._. o{ he State Sanitary C .. described.. th dated.. e as d�rib . t�U _ - e provisions of TI- �____-,._ E AT THE 'r L t A GUARAN ..._in rt No.......... i ON57R Works Construction ATE SHALL NOT BE G has been installed m accordance with application for Disposal OF THIS CERTIFICATE ,• ,. SATISFACTORY. .. THE VA ISSUANCE CT1 EI SATISFA nsPKtor........._......._ ....... .. SYSTEM WIL �O^/�, U /�///// ^A-rc ........!aka... ...- /O /// ^P��/✓`may n e D sposal System constructed ( ndfvidual Sevrag THE COMMONWEALTH OF MASSACHUSETTS BOARD 'OF MEAD- ... OF -/v _ wn omit o..l� ' E�s-.^ -'-- stem granted n Indi�r'�r�9 ge tpoa Permission is hereby S - 'l �( / or,$epair ( ) Sue= a - _�/ to Construct'(.. .3_.............. - - � at No..--- ks Construction Penmt�' application for Disposal if as shown on the�pP INC.. PUBLISHERS t No I 7 THE GOMM1IONWEALT/i OF MASSACHUSETTS MASSACHUSETTS a FEE 'Poo Ppplictttion for pisposal (*gstem Construction Permit Application is hereby made for a Permit to Construct ( ) or Repair( n-Site Sewage Disposal System at: pun s Name Ad,ress and Tel.No l ocatio Addrree'S or l of Nb- (J6 n f/� Y�li NOr r Installers Name.Add a-s,and Type of Building: Dwelling Other If Den neh Na .4ddr'ss and Tel No. • ��• /A Garbage Grinder No. of Bedrooms No. per Persons Showers( I Cafeteria Type of Building =ther Fixtures gallons. gallons per day. Calculated daily flow Design Flow ---t ( - Number of sheets Revision Date e'f 6A. y Yffr /jj Plan Date Title Description of Soil Nature of Repairs or A Date last inspected: The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Date Signed —i/'� A..�� s.--•-� Date Application Approved by Application Disapproved for the following reasons I -a rations(Answe - SA n applicable) Date Issued Permit No. TH rOMMONW ALTH OF MASSACHUSETTS Abie , `k^^^?C ,MASSACHUSETTS Ierttifirate of Compliance Dis osal System installe replac CERT{ Y.-ritat�tlle On- �P ' p� P Y � rt�� ..�- -O � :J . �// ♦� .. for ,� ( ,. �. IIr¢cgt ructed in at dated accordance with the provisi.ns of Title 5 and thiie for Disposal System Construction Permit No . Use of this system is conditioned on compliance with the provisions set forth below: The issuance of this certificate,allotabe emstji9edias% A anlee that the sy em will function as es lied.This Certificate expires efl / 1� V1✓ .ems �;' �i� '�c¢— DATE �, Inspector cP5_2 7 THE CO a rALTH OF MASSACHUSETTS crz� nor /_�! MASSACHUSETTS FEE No. Plopnmai i*gstem @lgnstruciTnn Permit y&5 M4/94' �� 4L Permission tr is or hereby pai grant o to construct ( )or repair( an On-site Sewage System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his.her duty to comply with Title 5 and the following local provisions or special conditions, r� All constructiopiiwst b spm feted within two years of the date below. / 2/ J DATE � Approved by FORM 1255 Rev 315 AM SULKIN CO.-BOSTON.MA