207 Applications & Permits THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
L!l. _OF.NOR THAMP!i)N
Application for 3)ispunal m l urku Qlon trnrfiun ermii
Application is hereby made for a Permit to Construct (k) or Repair ( ) an Individual Sewage Disposal
:em at:
l0
e of Building
Dwelling—No. of Bedrooms
Other—Type of Building
Other fixtures
ign Flow
itic Tank—Liquid capacity-
posal Trench--No. Wi
page Pit No
ter Distribution box
colation Test Results
Test Pit No. I G...;
Test Pit No. 2.S_
or Lot No.
Address
Expansion Attic
No. of persons
Address
Size Lot Sq. feet
Garbage Grinder (X)
Showers ( ) — Cafeteria ( )
allons per person per day. Total daily flow gallons.
lions Length Width Diameter Depth
dth Total Length Total leaching area
Depth below inlet Total leaching area_�j..a
cription of Soil
Diameter
Dosing tank ( )
Performed by
minutes per inch Depth of Te
minute e 'nch th T
Date
Pit /2 Depth to ground water.-�4424/6--/0. Depth to ground water ..pa/Vt
.rte
titre of Repairs or Alterations—Answer when applicable
reement:
The undersigned agrees to install the aforedescrihed Individual Sewage Disposal System in accordance with
provisions of TITTLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
:ration until a Certificate of Compliance has been issued by the board of health. //
✓✓ iiiii��
tplication Approved By
)placation Disapproved for the following reasons
Permit No
Date
Issued
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
17r
or NORTHAMPT^.h
tlrrtifiratr of (Compliance
THIS IS T9�RX,/ / �✓✓//l/ idual Sewage Disposal System constructed
1
) or Repaired ( )
been installed in cordance wit!I e provisions of TITLE,- 5 of The State Sanitary
ication for Disposal Works Construction Permit No LS—C " dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUA
ITEM WILL FUNCTION SATISFACTORY.
as described in the,
6 -) 2car
NTEE THAT THE
FE /0
is-Fi
Inspector
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
:17roF NOPTHNMPT!0P,
%pos
Permission is hereby granted
;onstruct Retatir ( A an Sewage Dispo System
To t
Street
hewn on the application for Disposal Wo ks Construction Permit No ��.
kr At '`' y
TE
.1 1255 A.
SULKIN. INC.. BOSTON
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
CITY OF NORTHAMPTON.
&rtifiratr vi Tompliann
TEAS TnR5IF hat th Hidual Sewage Disposal System constructed (X) or Repaired
Installer
bet install in accordance with the provisions of TITLE 5 of he State Sanitary Code Mescribed in the
(Fe•JP-
ilication for Disposal Works dated
orks Construction Permit No /5 .ST-
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
STEM WILr41914CTION SATISFACTORY.
LTE e.) 6 nce2 Inspector