12 Applications & Permits 96
No
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
City of Northampton
Appliratian fur Bispusal rcurks hlnnsfrutfio
Application is hereby made for a Permit to Construct ( X) or Repair ( ) an Individual Sewage Disposal
System at:
12 Sylvan Lane Lot No. 12
Location:Address
James F. and Patricia A. Boyle
Owner
Installer
Type of Building
Dwelling—No. of Bedrooms
Other—Type of Building
Other fixtures
Design Flow 55 gallons per person per day. Total daily
Septic Tank-Liquid capacity1SO.Qgallons Length 10 Width 05
Disposal Trench- No. 3 Width 2' Total Length
Seepage Pit No Diameter Depth below inlet
Other Distribution box ( X) Dosing tank ( )
Percolation Test Results Performed by....Lawrettee..Smith
Test Pit No. 1 2. minutes per inch Depth of Test Pit
Test Pit No. 2 minutes per inch Depth of Test Pit
or Lot No.
4 Tiffany Lane
Address
Address 40,180
Size Lot Sq. feet
4 Expansion Attic ( ) Garbage Grinder (X )
No. of persons Showers ( ) — Cafeteria ( )
now 440x1.5 = 660 gallons.
Diameter N/A Depth 4
Total leaching area. 900 sq. ft.
Total leaching area sq. ft,
Date 4/09/96
Depth to ground water>10'
Depth to ground water
Description of Soil
0" - 1.0" Sandy..lnam; 10" - 18" Loamy sand; 18" - 120" sand
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 ssued by the • rd e health.
Signed f
Application Approved By - eat) i
Application Disapproved for the foliowin?measons'
Permit No
Date
Issued.
Date
by
at
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No ,_ dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE r .,i - / -, Inspector
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HF.�ALTH
t .1 1 �/
fllrrtifientr Qlumplianrr
TIiZ$ IS TO CERTIFY, That the Individual Sewage Disposal System constructed (:-Yor Repaired ( )
/ t
Installer
O
CU GVI BOARD OF HEALTH
Ti 43 T L -I , t OF . , r�
WA fA,
70411?
g � >
m "' 'ermission is hereby
THE COMMONWEALTH OF MASSACHUSETTS
Disposal fl arks faunstrurtiun Permit
:O'ptCiinstruct (1-1or Repo.
$!QQ
shown on the application
I?A'TE
FORM 1255 A. M. SULK IN, BOSTON
it ( ) an Individual. Disposal System
Street
for Disposal Works Construction Permit No Dated
.._<:._.`.._ of Hf_:<
Board o
-f aeaIee
Pas...:.:. .
THE COMMONWEALTH OF MASSACHUSETTS
BOA
OFRDIVO HE
flrrtifirttfe of fbnm{►littttrr
DE 1 61996
T ,I,S Tp CEt 7FY, Thaj the I0� u!dual Sew. Disposal System constructed (1/j-.ot Repaired ( ) '
by 0.e.!_tL�-- t.CD'u-^�-G�-Fern ��--,�pp ■
at � /a — Ic!'- A ��_''.'.'�..:.�_...%.._..... ._.
has been installed in accordance with the provision of TITLE 5 o The State Sanitary LteMe descr Gdi he/
application for Disposal Works Construction Permit No ci'y -7 P dated 8%0
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM W.�D,t. FUNCTION SATISFACTORY.
DATE ...„„-.........../..47 1 !.� Inspector i Kj(' ,