474 Application & Permit 1984 HUN[L
eo e:
4
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
City OF Northampton
Fns
n for flinpostti iiinrIu Tonntrurtion Irrmit
plfcatidn is hereby made for a Permit to Construct ( X) or Repair ( ) an Individual Sewage Disposal
ystem at:
Sp.ring..Sttee.0
Te d Towne D°�"°""nda"'r or Lot No.
Owner
Installer
Address
Address
Type of Building Size Lot_-1Q..2QQ Sq. feet
Dwelling—No. of Bedrooms 3. Expansion Attic ( ) Garbage Grinder ( J
Other—Type of Building No. of persons Showers ( ) — Cafeteria ( )
Other fixtures
Design Flow 55 gallons per person per day. Total daily flow 330 gallons
Septic Tank—Liquid capacity 1500gallons Length Width Diameter Depth
Disposal Trench--No. Width Total Length Total leachinneaae Y.ry_6,99.stripf.
Seepage Pit No 1 Diameter Depth below inlet 3' Total leaching area—.—.sq. fi.
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by DT..Euntlay..Assoc r Date 5-10-79,/
Test Pit No. 1 2•0 minutes per inch Depth of Test Pit LO Depth to ground water...6lD.F/ -
Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water
Description of Soil 10 deep hole, 6" OTS 1.'A" sandy...ti t; s.i1t...3.:A"
medium sand, 5'6" coarse s.an.d..amd_gravel__No...grnund._etater..st..1f1.'.-A" _.
Nature of Repairs or Alterations—Answer when applicable
1
Agreement:
The undersigned agrees to install the aforedescribed individual Sewage Disposal System in accordance with
the provisions of T_ '. 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 board of health.
1
Application Approved By
Vel
Application Disapproved for the following reasons
Permit No
3 � - 71
Date
Issued. {p/�'y t
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF H LTH
OF
Qtrrtifirntr of (lnm#Iliana
THIS IS TO C$I$1 fl, Tha the Ipd'. -.1 Sewage Disposal System constructed ( 4-rn repaired ( )
by -
at
has been installed in ac ordanc jitit the provisions of TiTi_4:1 5 of The State Sanitary Code desc ibed in the
application for Disposal Work onstruction Permit No dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED GU ANTEE TH HE
SYSTEM WILL FU�TIOF� SATISFACTORY.
DATE' . /� { Inspector
N
THE COMMONWEALTH OF MASSACHUSETTS
OARD OF HJALTH ,.{ / 1
% w FEE
Oi penal ligurkg nnstrurtinn graft
Permission is hereby granted t—est ! ft n
to Construct (\) or Repair ( ) an Individual Sewage Disposal System
at No tti_� f N t .S )))
Svaa
as shown on the application for Disposal Works Construction Permit No Y Date* .'..'1/d
Board of Health
DATE
FORM 1255 HOBBS & WARR EN, INC., PUBLISHERS