205 Applications & Permits THE COMMONWEALTH OF MASSACHUSETTS
r-1 11 arnisrie l BOARD OF HEALTH
DISPOSAL SYSTEM CONSTRUCTION PERMIT
FEE /j°
Permission is hereby gr nted to Con
sposal system at e ft
ct ) )
R ) Upgrade (� ) Abandon ( ) an individual sewage
05, " trot * as as described
the application for Di posal System Construction Permit No. a5—O3 dated 7--lc---0? .
rovided: C-o7nstruction shall he completed within three years of the date of this permit II cal c di ons m b et.
'ate L37/03 Board of Health
ORM 2 - DSCP DEP APPROVED FORM 5/96
(
DRM 1255 (REV 5/961
!HMI( ) Hos sn WARREN."
PUBLISHERS-BOSTON
7-gs
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
CITY0F NORTHAMPTON
Faa...0-
Application tar 13ispnsal 3hsrks &nstrnrtinn 3rrntit
(pplication is hereby made for a Permit to Construct ( ) or Repair (✓) an Individual Sewage Disposal
acas
m at:
of Building
Dwelling—No. of Bedrooms
Other—Type of Building
Other fixtures
gn Flow allons per person per day. Total daily flow
Width Diamete
:osal Trench nc Liquid capacity../.5 -.Width Length Total Length
Total iosal Pit No—No. Width
Pit No � Diameter Depth below inlet
Expansion Attic
No of persons
Address
Size Lot Sq. feet
Garbage Grinder ( )
Showers ( ) — Cafeteria ( )
gallons.
Depth
l leaching area sq. ft.
Total leaching area sq. ft.
sage
er Distribution box ( ) Dosing tank ( )
solation Test Results Performed by
Test Pit No. 1 minutes per inch Depth of Test Pit
Test Pit No. 2 minutes per inch Depth of Test Pit
Date
Depth to ground water
Depth to ground water
cription of Soil
ture 7 ReparS or Alt ratio :Fss er w en appli *La—
The The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
zeement:
provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
eration until a Certificate of Compliant as been issued by board of health.
pplication Approved By
pplication Disapproved for the following reasons
_ __. Issued. vis> �l..li
Permit No
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
CITY orNSRT.HAMPT.QN..
Oltrtifirate of (omplinnrt
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
Installer
s been installed in accordance with the provisions of TITLE 5 of The State Sadn`itarry Code as described in the
Iplication for Disposal Works Construction Permit No
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
YSTEM WILL FUNCTION SATISFACTORY.
IATE....... . Inspecto
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
CITY OF.N.Q.BTHAM PION
Disposal p_orlinIttwialffiott hermit
Permission is hereby granted.. �j��,�
n Construct ( ) or R5patr ri =�lE'� E'(Dispo ILystem
It No sl
as shown on the application for Disposal Works Construction Per
0 / ) C J/i C
DATE F FORM Ia5S A. M. S BLKIN. INC.. BOSTON
4I
it
FEE
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
CITY OF NORTHAM°TON
flinpanagl�Uli kn Tnauirurtinn irrmit
1 to nsinn is hereby granted �fX t _tig
Construct ( ) o R pair ( an �di� 11 Si�}}1(e D osal System
FEE
ss-
St
shown on the application for Di spusa I Works Construction Fermi
kTF /D- 6/%5
aIA 1E55 AM. SuLKiN, IMc.. eoSTON
9-6 Datoli_A ‘ite
sant or treat~
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
CITY OF _. .NORTHAMPTON__ _. . . . ..
FEE..dt
l3inpnstti orkB Oi n�u ige"
Permission is hereby granted
;onstruct ( r R/pjr ([ ) an Indio u Sewage Disposal Sys
Jo - .. street �-
Ihown on the appl anon for Disposal Works Construction Permit N afl%Pr s
it 'd of Health
M 1255
ORBS &
ARREN. INC.. PUBLISHERS
atc K`
-2-90
Permission
Tonstruct ( .
hown on the
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
City OF Northampton
3@ispnsttl Plinth Olun tnxrtinn 1rrntit
is hereby granted Ll...
ohR ( ) an ICivtAuJdt Sewage Disposal System
Street
application for Disposal Works Construction Permit o.. '.l�% _ ated. .. ..`' /900
.4//1y/9a
F _eta-- .
Gard of Health
TE
M 1255 A. M. SULKIN, INC. BOSTON
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HE LTH
OF Yrt
hirriifirtt r of ainmpli nrr
by
THISet C TIF➢ the Individual Sewage Disposal System construct
XZ �
has been installed in accorda ce with the provision
application for Disposal Works Construction Perm
SYSTEM WILL A FUNCTION SATISFACTORY. S
of he State Sanitary Code S d.... eed� the
Permit
nstaller
) or Repaired ( )
of dated. 3`cri
HALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
Inspector