20 Applications & Permits r
A,
No ark 90 ir,-.
._, THE COMMONWEALTH OF MASSACHUSETTS t .
BOARD OF HEALTH
33426
City OF . Northampton y*
Application for l)isposnl works Qlonstrurtion pp ti b
Application is hereby made for a Permit to Construct (x ) or Repair ( ) an Individual ewage Disposal
System at:
20...Sylraa.Lane Int..No_-13.
Location.Address or Lot No.
Jamet;.E 3ndat ..A_..aoyle ......4..T.iffany Lane, Northampton
32 532
Sq. feet
pat toaau. Address
Size Lot x
C Type of Building
U Dwelling—No. of Bedrooms 4 Expansion Attic ( ) Garbage Grinder (X )
p� Other—Type of Building No. of persons Showers ( ) — Cafeteria ( )
G
Other fixtures
W Design Flow 55 gallons per person per day. Total daily flow 440x1.5= 660 gallons
W'Septic Tank-Liquid capacity 1500 gallons Length Width Diameter Deepth 4
xDisposal Trench-No 3 Width 2 Total Length 150 Total leaching area u sq. ft.
Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft.
z Other Distribution box (X ) Dosing tank ( )
Percolation Test Results Performed by Killam.ASSAC - L....Smith Date 9 April 1996
■-1 Test Pit No. I 2.._minutes per inch Depth of Test Pit 1Q' Depth to ground water yt
V. Test Pit No. 2 minutes per inch Depth of Test Pit 10' Depth to ground water 91
P4
0 Description of Soil 11-12" lAOSS..£illi 12je 1.120" CI. sand
61
W
UNature 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 h issued by the boar heal
7-2"74 C k
Signed 1'` ‘/ � fe,, - afa77I
Application Approved By � ® Dam t
Application Disapproved for the follows re ons•
Date
Permit No Issued.
Date
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
f rrtifirtttt of fknmolianrr
THIS IS-TO.6. RTFY, That the Individual Sewage Disposal System constructed (j.-') or Repaired ( )
Installer,
ht cs.
has been installed in accordance with the provisions of TITIL 5 ot..Tihe State Sanitary Code as descyit7Rd in the
application for Disposal Works Construction Permit No = dated f -7.) / /--
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CON$TRUED,AS A GUARANTEE THAT THE
SYSTEM WILL F)INCTION SATISFACTORY.
DATE ''Y ' 1 % Inspector
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Disposal SIC arks f2tonuirurtion 1, rrmtt
Permission is hereby granted rT ib+ rI 71 NC /t 2-Y
to Construct (ki<or Repair ( ) an Individual Sewage DisposaL/$ystem
at No ,5.2 Street
as shown on the application for Disposal Works Construction Permit No..7 ' - '° Dated
v Board of Health
DATE
FORM 255 A. M. 41LKIN, BOSTON
FEE
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HE-p�LTH
OF 61-4E
Olrrtifirtttr of Otvmpllitt 4(rr
NOY 2 s Etas
THIS IS T�qq C��,,��zzTtZ Y, That the Individual Sewage Disposal System constructed'( : ). or Repaired ( )
by H"' l'_. Ue.I. CvvL t
at d'00.5. .. .... _CNLt�I �.s .._ sL.tllQaalS.kY.ITPd 1/K-C.45a+^c4
has been installed accordance with the provisions of TITLn•.! 5 of The State Sanitary Code as descI tbed in the
application for Disposal Works Construction Permit No .} % dated a/ati!-10
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE �ll' �? 16, Inspector