8 Application & Permit 1987 CIVIL
FEE
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF NORTHAMPTON
Applirattnit far 13i0pxSal Elarka Tnnstruction tinntit
Application is hereby made for a Permit to Construct ( X) or Repair ( ) an Individual Sewage Disposal
System at:
....a...S.haptl er ds..._H.a.1.7.nat,...Nnr..thamp.tnn
t, a:on—Address or Lot No.
Greg Zakrzewstk1 37 Damon Pppd Raad......C.heste.r.f.i.e1A
Address
Owner
Installer s Address
ns
Type of Building Size Lot 4 . 687 Acres
Dwelling—No. of Bedrooms 3 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 330 gallons.
Septic Tank—Liquid capacity 1500gallons Length Width Diameter Depth
Disposal Trench—No Width Total Length Total leaching area sq. ft.
Seepage Pit No 1 Diameter Depth below inlet? ' -0° Total leachingc a pa city 699 GAL/Day
Other Distribution box ( ) Dosing tank ( )
617/$Q
Percolation Test Results Performed by R P B , Huntley & Assoc Date
Test Pit No. 1 2 minutes per inch Depth of Test Pit 8 ' -8° Depth to ground water.._NIA
Test Pit No. 2 minutes per inch Depth of Test Pit..8 ' -BB Depth to ground water N/A
Description of Soil SEE._AL ACHEB---P.LAN
Nature of Repairs or Alterations—Answer when applicable
Agreement:
The undersigned agrees to install the aforedeseribed 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 been issued by the board of health.
Signed
Application Approved By
Application Disapproved for the following reasons
Permit No
Issued 93187
Dare
Date
Date
Date
by yy /� �)
at se?'t{�€.Pr�-dPieE,qlarifc07vlTfrftt6 Fis'XnX 'O
has bee m pro tons o of The State Sanitary Code as escribed in the
application for Disposal Works Construction Permit No ui-81 dated 7/34,
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST RED AS A GUARANTEE THAT THE
SYSTEM WILL FUN ION SATISFACT Y.
DATE L \c. ... .... `
THE COMMONWEALTH OF MASSACHUSETTS
al�/"��� BOARD /4F/ EA TH
,' OF !;{
orriifirttit of atumplitt t
THIS IS T C RTTFY, hat the I i id al Ills sal System constructed sic ) or Repaired ( )
Inspector
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
ID rt of. NGRTN rn ,V
Negq—$7 FEE zs=
3lhnponttl hinrkn Cnnnoiruriinn lrrmii
Permission is hereby granted .0((Ea 2t#lfif Z cNa.%Y1. N✓hFizdi
to Construct D( ) or RFpair ( ) an Individual Sewage Disposal System "'
at No t SNEEPrD.5 yoIIar✓1, ,yorrrNninflgM
as shown on the application for Disposal Works Construction 4!%2%
eir
Street
DATE thin
'
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
of Health