336 Applications & Permits THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
Pas tOt.0 .`
1ppliration for Dinpn,ittl iflurks Cnnnstrurtinn 1rrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
Lri1' Cy/Ye-54X :RA—
S.144..., /
Losat -pdd ss L eP s moo'
wa<! N ' I-urMs^dd
Installer Size L i 4C
Type of Building Size Lot....arb y.......nder . feet
Dwelling-No. of Bedrooms Expansion Attic ( ) Garbage Grinder V )
Other—Type of Building No. of persons Showers ( ) — Cafeteria ( )
Other fixtures
Design Flow Sr gallons per person per day. Total daily flow gallons.
Septic Tank—Liquid capacity/SCQgallons Length Width Diameter Depth
Disposal Trench—No. I Width ? r Total Length 39 r Total leaching area_3_.V/ sq. ft.
Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft.
Other Distribution box ( ) Dosing tank pp� /+ �,/
Percolation Test Results Performed by Itimejt. �_- 5,.. Date....z.... .-D...i
Test Pit No. I 7 minutes per inch Depth of Test Pit._.6 D th to ground water....
Test Pit No. 2 minutes per inch DD7eepthofof Test Pit Depth to ground water
Description of Soil (°N 5o Soz 7 Q
,ai —f y%.r2C2
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 bee ssu d by the board of health.
igaed /, q/'- —t 7A Vir
Application Approved By - a� `
to
Application Disapproved for the following reasons'
Permit No (7—
Date
Issued �+YI°
Date
by
at I
has been install in accordance with the provisions of TITLE 5�ttof TTyy}}1//�� State Sanitary Code a desc ' in the
application for Disposal Works Construction Permit No .!'�a� dated i,-el%.S
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU AS A GUA
SYSTEM WILL FUN IQN SATISFACTORY.
6a
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
hlrrtifirate of TomoHance
THIS IS ILA TIF}Y,rTha the Individual Sewage Disposal System constructed ( or Repaired ( )
Installer
DATE
No 'Ai
Inspector
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
Pas -
fliapaattl rhnrkn Olnnstrurtiun rrmit
Permission is hereby granted
to Construct ( ) or Repair ( _ ) an Individual Sewage Disposal System
at No
Street
as shown on the application for Disposal Works Construction Permit No Dated
I CA
DATE
FORM 1255 A. M. SULNIN, INC., BOSTON
Board f H alth
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
City OF Northampton
FEE
A.pplirntinn fur ilis}iusttt 3flnrks Oiunstrurtiun hermit
Application is hereby made for a Permit to Construct ( X) or Repair ( ) an Individual Sewage Disposal
System at:
Sylvester Road
Location-Address
Stephen F. Vanasse
Bob Wade
Owner
374 Slyvester'ttbaia
North Farms Rd'& P'
Installer Address
Type of Building 3 Size Lot 8. 64 Acrd_ i.
M
Dwelling—No. of Bedrooms Expansion Attic ( ) Garbage Grinder (X )
Other—Type of Building No. of persons Showers ( ) -- Cafeteria ( )
Other fixtures
Design Flow 55 gallons per person per day. Total daily fjow 330 tigaalIons
Soptic Tank—Liquid capacity 1500 gallons Length 10 . 5'Width 5' 6 Diameter Depth .53 �
Disposal Trench—No. 1 Width 8 ' Total Length.....39'..__- Total leaching area 349 sq. ft.
Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft.
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by_2haimer...Ensineering Corp. Date. 6, 1985
Test Pit No. I 4 minutes per inch Depth of Test Pit 61 Depth to
'rest Pit No. 2 minute s per inch Depth of Test Pit Depth to
3" Top..Soil
Description of Soil 6" Sub. Soil
42" Medium._S.and and Gravel
2.1" Silt Till
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 Article XI 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.
Signed
Application Approved By
Application Disapproved for the following seasons:
Date
Date
Date
Permit No Issued
Date
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
Tertifirate IIf fltampiianre
TLIIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
Installer
at
has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the
applico.i"n 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 Inspector
No
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
Uispnattl rr; arks hlnnstrurtinn hermit
FEE
Permission is hereby granted
to Construct ( ) or Repair ( ) an Individual Sewage Disposal System
at No
Street
as shown on the application for Disposal Works Construction Permit No Dated
Board of Health
DATE