Lot 20 Title 5 Application/Permits 1988 WHERE APPLICABLE
CHECK OR FILL
ac4
THE COMMONWEALTH OF MASSACHUSETTS
Fanef..5 °"
BOARD OF HEALTH
CITY OF NORTHAMPTON
Appliratinn far titspnua1 illarks (nnnstrnrtinn Permit
Application is hereby made for a Permit to Construct (x) or Repair ( ) an Individual Sewage Disposal
System at:
litre
r
r<ds�
e4-- ( Address
tos
or Lot No.
Type of Building ��[[
Dwelling— No. of Bedrooms 7 Expansion Attic
Other—Type cyf Building No. of persons
Other fixture,CO./�
Design Flow fa .O
Septic Tank—Liquid capacity
Disposal Trench—No.
Address
Size Lot_/429•LI IT Li Sq. feet
Garbage Grinder (X)
Showers ( ) — Cafeteria ( )
gallons per person per day. Total daily flow
gallons Length Width Diameter Depth
Width 'rota! Length Total leaching area
Seepage Pit No Diameter Depth below inlet Total leaching area
Other Distribution box ( ) Dosing tank (, ) p
Percolation Test Results Performed by ('U .. /�
Test Pit No. 1 (a minutes per inch Depth of Test Pit y 7 Depth to ground water_'4Zie-
Test Pit No. 2 minutes per inch Depth of Test Pit / Depth to ground water
6& a
gallons.
sq. ft.
sq. ft.
_ . Date SP/76
M t
h.
Description of Soil s. ....�-..C-:U !•' O""�"�,
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 S of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issue4\hy the ho rd of I1-alth.
Application Approved By
Application Disapproved for the following reasons'
Permit No
Date
Issued.
CHECK OR FILL IN WHERE APPLICABLE
f
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
III Y_.OFNah .HAl2 GTO N
Application for ilis{Insttl
larks CEnnstrurtinn lJrrmit
Application is hereby made for a Permit to Construct (el' ) or Repair ( ) an Individual Sewage Disposal
System at: : f �
a k 4 � c
Sr I Location-Address /1 / . or Lot No.
Installer_)
Type of Building
Dwelling— No. of Bedrooms
Other—Type of Building
Other fixtwes
Design Flow
Septic Tank—Liquid capacity
Disposal Trench— No.
Seepage Pit No Diameter Depth below inlet
Other Distribution box ( ) Dosing tank
Percolation Test Results Performed by
4
Address
Size Lot._.& �t f OSq. feet
Expansion Attic ( ) Garbage Grinder (.\')
No. of persons Showers ( ) — Cafeteria ( )
gallons per person per day. Total daily flow L- C} gallons.
gallons Length Width Diameter Depth
Width Total Length Total leaching area. sq. ft.
Total leaching area sq. ft.
/ (^
Date SP/
Test Pit No. I f
Test Pit No. 2
Description of Soil
(id h�l", 4
of �est Pit �
Depth minutes per inch Depth o epth to ground water
minutes per inch Depth of Test Pit Depth to ground water
k
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 n issuedrby the bold of hyalth.
!
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
CITY OFNORTHAMRTsN
Qlrrtifirstr of ainmplianrr
T S OCR Y, That th n ' id Sew, e DispaSysvi con
by
at E..D_i._..c2:D
has been installed in accordance v>Ith the provision. TITLE. 5 Doff The State Sanitary
application for Disposal Works Construction Permit No c 9 £ dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CON RU AS A
SYSTEM WILL FU/N TIIOI/yrySATISFACTORY.
DATE (A .ewJ.L.h... Inspector
er
4 or Rewired ( )
No •2q—cl:
Code as "Issrbed in the
ViitY
UARANTEE THAT THE
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
CITY OF NORTHAMPTON
Disposal ris4 atnnstrurtin x Permit
Permission is hereby granted
F
(Xi) :- I1 5^...%k
to Construe; /i or Repair ( ) an Individual Sewage Disposal System
__
Street - '
as shown on the application for Disposal Works Construction Permit'No..Y.-L:-. DatedF Th '
FEE
f
DATE
FORM 1255
INC BOSTON
c �-
43na d f Health