Lots 2&3 Title 5 Application/Permits 1987 al-30
Applicado
fielin
CO 1 1ON 4i'L\LT1I OF NASSACIIUSFTTS
Board of Health, Northam pfon
FEE . 5a
APPLICATION POP DISPOSAL. SYSTDI CONSTRUCTION PPPMII -rl-`
Wji NorfhFarma Road (Northerm woods)
owners Name 5weei- Meoc10W Proper heS,ILC''.
Map/Parcel# 2/ i
,
Address 48 Saks 51-ree+-, Northampfan
hone C4i3) 581! -8287 Meq
no 2
r ( ;ie
Installer's Nam ►�-.
_
De ner'/s Nan e /I�( q3e Curvol/fir C.
Add
u.
Address Co�le l
I ... r . .
■ • if s f
l.,
e. Np iiwa, Clank 5h PO.ix I
Telephone# �. -.af -
Telephone#
- - X1, 5outham fon!
Type of Building Nouse
Dwelling-No.of Bedrooms 4 Searop
5
Other-Type of Building No of persons
Other Fixtures // p
Design Flow (min. required) 11�0 gpd Calculated design Bow 8
(OCD
Plan: Date Ootl)her 24.
Tide No
Description of Soil(s)
Soil Evaluate]Fotm No.
Int Size 474884 sq.ft.
Garbage grinder X
Showers ( ),Cafeteria ( )
Design flow pros ided Co(O 5 gpd
Number of sheets Z Revision Date No ve.mberr 253 aool
s I' Cr • • • = • I •s ty • r a,rc - 1 243
5re_ 5heet Zof 2 fer Sot Lois P.Name of Soil Evaluator Mark Reed Dare of Evlu
on 5/3(/Ol
(p72//oI
DESCRIPTION OF REPAIRS OR ALTERATIONS
The undersigned agrees to install the above describe
further agrees to not to plac .terin....,
ra oq
/d7
Signen�,H I -
•
ndividual Sewage Disposal System in accordance with the provisions of TITLE 5 and
ril /Certificate of C pp lian has been issued by the Board of Health.
Date /I 0'/
M?�
Inspections
COMMONWEALTH OF MASSACHUSETTS 02
Board of Health, Ae A/ M,
DISPOSAL SYSTEM CONS UCTION PERMIT
FEE
Permission is hereby granted to;�Construct Repair( ) _Upgradeyj )melon( ) an individual sewage disposal system
at L e / /1/42 £4414 RI Cii7 11 as described in the application for•
Disposal System Construction Permit No. dated C./Provided: Construction shall be completed within three Years of the date of er it. 1 local co o must be met.
Fonn 1255 Phu.5/96 AM.SLAPS Co.Boston MA Dal e701/j -B/ Board of Health
CHECK OR FILL IN WHERE APPLICABLE
No. ..o--,
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF AMP TOW.
Appliratinn far iiinpnsal
rr:
arks (tlanstrnrtinn der
Application is hereby made for a Permit to Construct (V) or Repair
System at:
No 4:i..th .FARMS.....B.12dP
L t n—Address
C,.QID .ML.i ..1 M.D&a1 SWIFT
-7 1..b ner
ILstaller
Type of Building
Dwelling A/No. of Bedrooms
Other—Type of Building
Other fixtures C,
Design Flow._'5.5....e..SQ .�&4/_g C. allons per person per day. Total daily flow U.......&Fr..Q...._gallons.
Septic Tank—Liquid capacity-./.SfQ.gallons Length../.0 ' Width 5 Diameter Depth Se
Disposal Trench-d No. 3..._..... Width Z' Total Length..2..1.R' Total leaching area /Z<aO sq. ft(50144Y1,3)
Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft.
Other Distribution box (X) Dosing tank ( )
Percolation Test Results Performed by
Test Pit No. 1..Z0.4_minutes per inch Depth of Test Pit 11 I.IQ" Depth to ground water....tie.IV£
Test Pit No. 2 minutes per inch Depth of Test Pit ICI' Depth to ground water_ NO
aL
Faa.... . ..
4.4 r,rr1+I
or Lot No
Qu WARM Sr QRz.c.±9!!t2.101
Address
F� Fill
Address
3 Size Lot S 4 315 Sq. feet
Expansion Attic ( ) Garbage Grinder ( )
No of persons Showers ( ) — Cafeteria ( )
311
F.A..FILIo$ Date
Y 7 %lo
Description of Soil E.i%iLLS�5 .IJ.
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 s been s ed by thee oar�of health.
Siam d.. fe�.4e1
Application Approved By
Application Disapproved for the follow
g reasons
Permit No 41 —fr�
Date
Issued.
Due
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD HE TH
OF �cJ
rriifirafr of Otnmplianrr
THIS 73'FQ CERTIFY, fiat e Individual Sewage Disposal System constructed (Yl or Repaired ( )
,/af
mn�l
at a- 3 lU .�a...N.rt^�-. .... .
has been installed in accordance with the provisions of TITLE 5, e State Sanitary Code s scribed in the
application for Disposal Works Construction Permit No i -or- J/1/ 7
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTE THAT THE
SYSTEM WILL FU Tt(Ct ION SA�SF 9 .
DATE .... _....... Inspector
THE COMMONWEALTH OF MASSACHUSETTS
�J rr BOARD OF HEAL
No J
Ms}Tnstt orin Tar frnrtion rr. tit
Permission is h refry granted '�e n I' v' r" —��yr
to Construct or epair ( an j>jdivid Sewed Disposal Srpriy
at No A1“et _3 .4 f'Ir- t-t Tf7 ,`.VW.a rt.
t Street
as shown on the application for Disposal Works Constr�,uction Permit Np�','...;_.::. Dated
/Iri
Hof Health
DATE 3 /7����
FORM 1255 HoBBS & WARREN. INC.. PUBLISHERS
its
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