9 Applications & Permits 7
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
City OF Northampton
Application fur lispnnuI n arks Q unstrnrtian
Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individ .° Sewage Disposal
tern at:
Sylvan Lane Lot No. 18
James F. and tff51.'Y°i lek. Boyle 4 Tiffany Lane, gbillampton
Owner
Address
Installer Address 32,721
pe of Building Size Lot Sq. feet
Dwelling- No. of Bedrooms Four Expansion Attic ( ) Garbage Grinder (XX)
Other—Type of Building No. of persons Showers ( ) — Cafeteria ( )
Other fixtures
sign Flow 55 gallons per person per day. Total daily flow..44Q..X..1-5 = 660 gallons.
ptic Tank—Liquid capacity.154Q.gallons Length 10 Width 5 Diameter - Depth 4
posal Trench—No. 3 Width 2 Total Length..15.Q Total leaching area 900 sq. ft.
epage Pit No Diameter Depth below inlet Total leaching area sq. ft.
her Distribution box ( X) Dosing tank ( )
rcolation Test Results Performed by Killam Associates Date March 4, 1996
Test Pit No. I...-._fa.minutes per inch Depth of Test Pit..132" Depth to ground waterN011e
Test Pit No. 2 minutes per inch Depth of Test Pit..120" Depth to ground water
ascription of SoilA and B layers previously stripped off.
Cl sand
ature of Repairs or Alterations—Answer when applicable
;reement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
e provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
ieration until a Certificate of Compliance has been issued by the board of health.
pplication Approved By
pplication Disapproved for the following reasons
DV
Permit No
Date
Issued
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Trrtifirott of Qlamplianrr
THIS IS TO CERTIFY, That the Individual Swage Disposal System co
y - r
Lf i .
wen installed in accordance with the provisions of TITlE 5 fy he State
cation for Disposal Works Construction Permit No
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED
TRM WILL FUNCTION SATISFACTORY.
nstructed ( /I or Repaired (
Sanitary Code as described in the
dated ' -/`r-
Ay GUARANTEE THAT THE
CE
Inspector.=.L.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
r 6r / /
Eisposttl I./ orks hionntrurtii?n Pamir
1 POrmission is hereby granted ,1llir. S e t /
Foinstruct.( ) or.,Repair ( ) an Individual Sewage Disposal System
V „ f __ “._..._
5 `
ro�_._..,. : Dated tiavn on the application for Disposal \Yorks Construction Permit No
.....__:— - Baatd of Health
F
RM X1255 A. M. SULKIN, BOSTON
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
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fgek..
_ ........._OF...../1..gE18. .9.1 .......................................
c(rY
Qintitiratt of Tompliattre
\35-01
THIS IS TO CE1TrIPY, That the Individual rage Disposal System constructed (/or epaired ( )
been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
. ....... .
cowsrieurnAL 3-pon ,0,02r/6/19 eyth- --OW/W-3
ilic.ation for Disposal Works Construction Permit No
THE ISSUANCE Of THIS/CERTIFICATE SHALL NOT BE CONSTRUE' GUARANTEE/THAT THE
rSTEtA WILL FUNCTION SATISFACTORY.
171 Al 27.A./ff........................
SYL YEN 44/1/5 (La L;vig 5,17nitaAni_wooD
Inspect° ...
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