425 Applications & Permits ' .Cf tH OF g°_/ J7/// _72077 ,
$o MARK B. � '
N•
�i4 rj i��?t,,E COMMONWEALTH OF MASSACHUSETTS
�4)7; fEAE; ��% �" BOARD OF HEALTH
\ ,yS10r Vv E\.‘G r CITY OF _ NORTHAMPTON _
_. .. ..
Application for Disposal Morita elonsbrurtion 'Iltrmit
Application is hereby made for a Permit to Construct Qfx) or Repair ( ) an Individual Sewage Disposal
System at:
U2•�SPR INC STREET _ ----- ---- --
ff�u �.,—...._.____-
Iootiuu.Addreav SPRING STREERF,t°Si HAMPTON
RICHARD TACY ---
$AME
__ ____ ___ ......... Address
J Type.. Building Installer
Type of Building Size Lot Sq. feet
4 Ex ion Attic ( ) Garbage Grinder ( )
Dwelli No. of Bedrooms Expansion Showers — Cafeteria ( )
a. Other—Type of Building No. of persons ( )
Other fixtures 660 gallons
Design Flow 82.5 gallons per person per day. Total daily flow
W 1500 gallons Length Width Diameter Depth
a. Disposal nench— id capa1 gal 80 Total leaching caPac i,ty: 720 G
W Disposal Trench—No. 1 Width 4 Total Length
x Seepage Pit No Diameter .Depth below inlet. Total leaching area................sq. ft.
z Other Distribution box ( ) Dosing tank ( ) April 29, 1 92
Percolation Test Results Performed by R.P. BRAZEAU1 HUNTLEY ASSOC. Date. P g
4 Test Pit No. 1 2'0 minutes per inch Depth of Test Pit Depth to ground water.. . ..
{y Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water
O 0"-4" TOPSOIL, 4"-16" GRAVELLY SILT, 16"-78" COARSE to MEDIUM SAND
Description of Soil
Z p and MEDIUM to COARSE GRAVEL, GROUNDWATER at 7s.
-.-----------
x• 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 health.
board of healt
Application Approved By
Application Disapproved for the following reasons'
Date
Permit No _ _--_.--- di .Dm
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
)
OF
sicrtifirafr uf latoutpliancr
THIS IS'TQ CERTIFY, That the Individual Sewage Disposal System constructed ( , ) or Repaired ( )
Installer
has been installed in accordance with the provisions of TITIE 5th The State Sanitary Code as described in the
at
application for Disposal Works Construction Permit No • s - ' - dated.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE Inspector
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
ilioposal fitful (Construction Permit
Permission is hereby granted_ 7■ ' rt.'
to Construct (>, ) or Repair( ) an Individual Sewage Disposal Syatem
at No :-.,, -;)._ ..,,,fri.. • l _..
Street
as shown on the application for Disposal Works Construction Pernik Nor..;-......a... Dated,-.:.i
No
DATE
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
Board of Health'
by
5
THIS
at L r✓ltia �c _-
THE COMMONWEALTH OF MASSACHUSLI IS
BOARD OF HEALTH
OF
Olrrtifirtttr of Qlnm}Tlianr
the jnaividual Sewage Disposal System constructed ( y or Repaired ( )
has been installed in acco ance wit j e provisions of TITLEE 5 or The State Sanitary Code s des iibbed in the
application for Disposal Works Con action Permit \o..a.S-- 9 a.— dated ri1r./t3 F 2—
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
DYSTEM WILL FU T ON SATISFACTORY.
DATE /J �`/ /9,3 p ector