29 Application & Permit 1997 i -97
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
City OF Northampton
1 ppliratinn for Disposal lurks htnnstrurtinn
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
an at:
) Sylvan Lane Building Lot No 16
uses F. and Partraiciad ."e Boyle 4 Tiffany Lane, ittoitthampton, MA
Owner Address
Installer Address
of Building Size Lot 66,122 Sq. feet
Dwelling—No. of Bedrooms Four Expansion Attic ( ) Garbage Grinder PI)
Other—Type of Building No. of persons Showers ( ) — Cafeteria ( )
Other fixtures
gn Flow 55 gallons per person per day. Total daily flow 440 x 1.5 = 660 gallons
is Tank—Liquid capacity...IS.QOgallons Length..10 Width..a DiameterN/A DepthA
osal Trench—No. 1._._.. Width....2£t Total Length_.l OE.ft. Total leaching area. 901) sq. ft.
Cage Pit No Diameter Depth below inlet Total leaching area sq. ft.
s Distribution box ( fl Dosing tank ( )
olation Test Results Performed by__Lillam..ASSoCiates..Nem..England Date .4/906
Test Pit No. 1 2 minutes per inch Depth of Test Pit....1Q_ft.... Depth to ground water_?Aft..ft
Test Pit No. 2 minutes per inch Depth of Test Pit 11..ft. Depth to ground waters 11_ft
siphon of Soil Rfl.16 - 1.* 0" - 9" Ap.sandy...1oam...9" - 15"..Bw._loaay...saad...16" - 120" C
3nde 01116....- 2' Q" - 9" Ala..sandy..loam...9" - 16..2w..lQamy..samd...16" - 132._C..Auld.
are of Repairs or Alterations—Answer when applicable
cement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
anon until a Certificate of Compliance has been issued by the board of health.
dication Approved By a -lr - /' j4-- 7
Date
dication Disapproved for the following reasons•
Date
Permit No Issued.
Dam
THE COMMONWEALTH OF MASSACHUSETTS
- BOARD OF HEAL/EH
OF ^
trrtifiratr at Gautplittnre/
THIS-IS TO-CERTIFY, That the Individual Sewage Disposal System constructed (4.1- or Repaired ( )
Installer .
m been installed in accordance with the provisions of TITLE ,5 of The State Sanitary Code as described in the
• , ,
)plication for Disposal Works Construction Permit No .1 — / ' dated . -
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
YSTEM WILL FUNCTION SATISFACTORY.
ATE Inspector
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Elispusal arks Olonstrurtion J1rrmit
FEE
Permission is hereby granted
Construct ( o2 Repair ( ) an Individual Sewage Disposal System
ry ...... g.
Street
shown on the application for Disposal Works Construction Permit No • Dated
Board of Health
ATE
RM 1255 A. M. SULKIN, BOSTON