28 Applications & Permits CO!IMONWL
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'II I IC '44SSACIII ISLI!S
P�SAI SYSaWICO)S hUUION PERMIT
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DISPOSAI SYS }1 CONSTRUCTION Pc.PM1T a r,: = w
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COMMONWEALTH OF MASSACHUSETTS
MA.
FEE
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
uiun tor a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( - ❑Complete System O Individual Components
if Building Lot Size sq.It.
Garbage grinder( )
mgy Type f Bedrooms
-'I)pe oBuilding No. of person Showers O,Cafeteria ( )
•Fixtures
n Flow (mi n.required) gpd Calculated design flow Design flow provided gpd
Date Number of sheets Revision Date
iption of Soil(s)
:valuator Form No.
Name of Soil Evaluator Date of Evaluation
:RIM ION OF REPAIRS ORATERATIONS ACe to( t'iNr\ Ck7
r`; C r A ) —1-11 k-• v hi)02
undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
ter agrees to not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health.
cd Date
ections FcT G1 —
S
J Q/\ 5 k
(
Cc-
Owner's Name
i( y ✓t - t\l X✓IS�
icon Ci
/Parcel#
I
Address )CY'
/�
5Q l;ftwcA( k OH
t -
Telephone# hi 1%
Q9
1
- a� ,n o
aller's Name
Designer's Name
ress
Address
phone#
Telephone#
if Building Lot Size sq.It.
Garbage grinder( )
mgy Type f Bedrooms
-'I)pe oBuilding No. of person Showers O,Cafeteria ( )
•Fixtures
n Flow (mi n.required) gpd Calculated design flow Design flow provided gpd
Date Number of sheets Revision Date
iption of Soil(s)
:valuator Form No.
Name of Soil Evaluator Date of Evaluation
:RIM ION OF REPAIRS ORATERATIONS ACe to( t'iNr\ Ck7
r`; C r A ) —1-11 k-• v hi)02
undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
ter agrees to not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health.
cd Date
ections FcT G1 —
COMMONWEALTH OF MASSACHUSETTS
Board of Health, tsl nl{Nq rrp IJ 11 MA.
CERTIFICATE OF COMPLIANCE
niption of Work: )Hndividual Component(s) ❑Complete System
undersigned hereby certify that the Sewage Disposal System; Constructed ( ,Repaired (;),Upgraded ( ),Abandoned ( )
\( U
FEE
q st a(r peA
all ^
xen installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating m
Cation No. Zoi0 t j dated jest V- a.miD . Approved Design Flow (gpd)
tiler tit j
i
gnen Inspector 7_��,f„QiA% � Date:
L.," / caf
issuance of this permit shall not be construed as a guarantee that the system will function as designed.
Zj
COMMONWEALTH OF MASSACHUSETTS
FEE
DISPOSAL SYSTEM CONSTRUCTION PERMIT
mission is hereby granted to; Construct( ) Repair ') Upgrade( ) Abandon( ) an individual sewage disposal system
L% S ; . n
posal System Construction Permit No. 7 as 1 3 dated
sided: Construction shall be completed within three years of the date ojvthfr permit.
as described in the application for
iota] conditions must be met.
i
1255 Rev 5/96 au.sullenCo Pmmo MA Date -i Board of Health( ii/',eZ2
rod :7
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
City- OF Northampton
Applitatiun fur 333ispusttl Mirky Qtunsirur#inn
Application is hereby made for a Permit to Construct (K ) or Repair
lystem at:
2B..sxlxaa..Lane
Location.Address
James..F�.and.P.atrici.a..A_..HOy1e
Owner
Installer
'ype of Building
Dwelling—No. of Bedrooms 4
Other—Type of Building
Other fixtures
an Individual Sewage Disposal
1nt...No—..14
or Lot No.
4 Tiffany..lane......Northampton
Address
Address
Size Let....32..2E.7 Sq. feet
Expansion Attic ( ) Garbage Grinder (K )
No. of persons Showers ( ) — Cafeteria ( )
)esign Flow 55 gallons
Septic Tank—Liquid capacity 1500 gallons
)isposal Trench—No. 3 Width
Seepage Pit No Diamete
per person per day. Total daily flow
Length 10 Width 5 Diameter Depth 4
Total leaching area 900
440x1.5=
660
gallons.
2 Total Length 150
Depth below inlet Total leaching area
Dther Distribution box (x ) Dosing tank ( )
Percolation Test Results Performed by Killam Assoc. - L. Smith Date 9 April 1996
Test Pit No. 1 2 minutes per inch Depth of Test Pit 10' Depth to ground water>> 1 t
Test Pit No. 2 minutes per inch Depth of Test Pit De th to round water
sq. ft.
sq. ft.
Description of Soil A and B horizons previously stripped pff, 0-120" Cl 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 been issued by the board of health.
ed... C// e��p
Application Approved By !/"'--� L l '5L `
nae
Application Disapproved for the following reasons
Permit No
Date
Issued
nee
THE COMMONWEALTH OF MASSACHUSETTS
, BOARD OF HBALTH
4' -t(1. (1
trrtifirat; of Tamp hate
THIS,IS TO CERTIFY c Thatthe Inili*dua Sewage Disposal System constructed (4-or Repaired ( )
by • • 4 • C.
at
has been installed in accordance with the provisions of TITLL ?.,of The State Sanitary Codeias 9lesaribed in the
application for Disposal Works Construction Permit No iea! "-9,ti: dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. ,
I DATE "---P12- . .): ' 15 Cr- Inspector - .
. ., k
t''. 7,------- .
..) a.) THE COMMONWEALTH OF MASSACHUSETTS
0. CO 0 q OD /
V.) .1.. E 0 .
BOARD OF HEJJ-TH /
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t ri C4.4 OF /
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0 ..-1 p.100-.3
LOCO Disposal 1'i:in-Ito auticrurtuitt Permit,
z i-> co ni ei
E c .,_,0 .0pitmission is hereby granted ---7-1/ kail e / , : g 7. 1-- „., zo.
.9 --1 El gofibtruct ( \4 or Repair ( ) an Individual Sewage Disposal System\ /
ge; Te, t_ “.-- L-1. ri,... i1/4.3-.1- i i i"l '
i-1 tloRn on the application for Disposal Works Construction Permit No- . ' Dated
:
ri .4.) cu street .i.../
—.-
.Ni > 0)rel
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%) cit 54V Board of Health
C."
t. /I•
FORM 1255 BOSTON
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEAAcTH
OF Q.r.
DEC Oa Trrtifiratr at Qlampli___..
ThaLthe Ind: 11 - Sewage Disposal System constructed (141r Repaired
THI IS
ar
has been installed in accordance with the pr S isions of TITL: p jof The State Sanitary Co ,sit; bed in the
application for Disposal Works Construction Permit No cla dated .7 (�
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTE THAT THE
SYSTEM W'�,�L\�nerTION SATISFACTORY. /!
DATE 5. � L 15 7'1'
Inspector