Misc. Lots Applications & Permits a
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF Ht LTH
WN OF
Application for Manumit
arks Clonstrurtion remit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
ystem at
1 SrvcE• L/v LoT#14 /1iA2/4B .Q!a610
. .... ....-.._....._re
tioa-A dress or Lot .12.–
?.ri4_ ._a vissI /�: OC. _ .... P No /`/A�?� .._.._..._...._ —...
....... Installer // Address
'ype of Building Size Lot Sq. feet
Dwelling—No. of Bedrooms +3 Expansion Attic (2 ) Garbage Grinder (in
Other—Type of Building nab No. of persons le Showers ('A) — Cafeteria ( )
Other fixtures ....le S__- -...nt.0
)esign Flow gallons per person per day. Total daily flow gallons.
leptic Tank—Liquid capacity gallons Length Width Diameter Depth
)isposal Trench—No. Width Total Length Total leaching area sq. ft.
ieepage Pit No Diameter Depth below inlet Total leaching area sq. ft.
)ther Distribution box ( ) Dosing tank ( )
'ercolation Test Results Performed by Date
Test Pit No. 1 minutes per inch Depth of Test Pit Depth to ground water
Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water
)escription of Soil
■ature of Repairs or Alterations—Answer when applicable
Sgreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
he provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
iperation until a Certificate of Compliance has been is t e board o
r
%Sign / ,, _ alb �i
Application Approved By / ' f- i,4--"--11z – _ ° �-Fl .i
Application Disapproved for the following reasons'
Permit No
Date
Issued.
Dam
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF N
rrtifiratt of faom}�lianr red
he Individual Sewage Disposal System constructed (k) or Repaired (
THIS �0 4E TIT',G hfi�
been installed in accordance r ith the provisions of TI/TILE 5 o The State Sanitar dated 02/1101 d rbed in the
?lication for Disposal Works Construction Permit No
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR D - . a A
_
rSTEM WILL F CTION SATIS/FA.CT,_0 T.
STE 7a- 4 jj Inspector
L.1
b
THE COMMONWEALTH OF MASSACHUSETTS
BOARD QF HEA):TH
OF
(&A ( , .4n., ,: ... . .-�—.
flispnsat. 1nrks fan
Permission fs hereby granted '` 6.1) 6
C ct 9.0 or Rwatr4 ) an I,rpy dui,/Sewa
onstru r
s shown on the application for Disposal Works Construction
F.
,.( Board �alth
emit
UARANT T T THE
D
Fes
sal.d-'B System
s„� _r
Permit
)ATE
ORM 1255 . BOSTON
34- 77
THE COMMONWEALTH OF MASSACHUSETTS
F.> a-
BOARD OF HEALTH
CITY OF NORTHAMPTON
Application for fliupooal Moritz 1ouutrurtiuu 1, rrutit
Application is hereby made for a Permit to Construct (g) or Repair ( ) an Individual Sewage Disposal
stem at:
SPRUCE LANE LOT
Locate's'-Address 21 KIMBALL ST. ,FLORENCE,MASS.
e oft G°OR TOBIN ,rd,l,,.,,
Installer Size Lot 35, 642 Sq. feet
ype of Bing- 3 Expansion Attic ( ) Garbage Grinder ( %)
Dwelling of Bedrooms No. of persons Showers ( ) — Cafeteria ( )
Other—Type of Building
Other fixtures -
esign Flow 5.5 gallons per person per day. Total daily flow 3-3.0 gallons.
a
peptic Tank—Liquid capacity1.561.0gallons Length l.0-L6".. Width 5 '.8"__ Diameter -- Depth 5 ' 4"
:isposal Trench— No. 2 Width 3 ' Total Length..90 ' Total leaching are• 450 sq. ft.
itepage Pit No Diameter Depth below inlet Total leaching area sq. tt.
)ther Percolation Test box (X ) Dosing tank ( ) 4/8/86
' colation T Tesst Results ts Performed by PHARMER ENGINEERING CORP. Date
Test Pit No. 1.. ---- minutes per inch Depth of Test Pit 86" Depth to ground
minutes i per inch Depth of Test Pit Depth to grow -,
Test Pit No. 2 m I TEST PIT 428
Description of Soil
0-18" SANDY LOAD
18-36" SILTY SAND
36-54" FINE SAND
Nature of Repairs or Alterations—Answer when applicable 54-86" LAYERS OF F
Agreement:
The undersigned agrees to install the aforedescribed Individual Sevnge Disposal . yste•.n
the provisions of Article XI of the State Sanitary Code-- The undersigned further agrees not to
operation until a Certificate of Compliance has be issued by the board of heals
SAa.j
Application Approved By row
Application Disapproved for the fallowing reasons'
in accordance
place the system in
//-c- F7
L.i �D
�%
it—d
Permit No 3(1' 17
Issued
-f7
Date
-r7
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
- ply or'NQP.TNAMP1r:
Application for 3iuponal Works C>zunstrurtion hermit
pplication is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
n at:
Owner
Owner
Installer
of Building
Dwelling—No. of Bedroon
Other—Type of Building
Other fixtures
gn Flow..__._._._._._.._ _._.__gallons per person .er
is Tank—Liquid capacity ns Length4�.
cal
oral Pit No--No. Depth belo
>age Pit No __.___.. lliame
er Distribution box ( )
Dosing tank ( )
:olation Test Results Performed by
Test Pit No. I................minutes per inch Depth of Test Pit
Test Pit No. 2_._._-.._.minutes per inch Depth of Test Pit
C.J/
or Lot No.
Address
Address
Size Lot Sq. feet
Expansion Attic ( ) Garbage Grinder ( )
is
No. of persons Showers ( ) — Cafeteria ( )
Ions.
Total .;' Y fl: —A - t%. i.J 1w i.—.
ar
mg area sq. ft.
inlet of 1 thing area sq. ft.
;cription of Soil
Date
Depth to ground water
Depth to ground water
ture of Repairs or Alterations—Answer when applicable
;reement:
previsions e
of agrees
5 of the State Sanitary (Code be ThIndividual ndersgned furtkher agrees not o to accordance
systemiin
eration until a Certificate of Compliance has been issued by the board of health
Signed
pplication Approved By
Date
Date
pplication Disapproved for the following reasons'
Date
Permit No
Issued
Data
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
11Y OF NUFi nq:VI Pi !' q
QCtrtifiratt of Cantina= or Repaired c
THINS T,i1,oge , That the Individual Sewage Disposal System constructed
d ( /O
3 �- rU_
been installed in accordance with the provisions of TITLE 5 of The State an ry Code as described in the
lication for Disposal Works Construction Permit No dated a THAT THE
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR D,S'j � ✓
STEM WILL FU. v.+t TI I�j(S�ATISFACTORY.
TE l Inspector
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
Disposal r:i'arlto (tojtstrurtintt jtrmit
Permission is hereby granted
Construct ($3.or Repat„( _) an Individual Sewage Dispdallt System
No TT strKt
shown on the application for Disposal Works Construction Permit No Dated
ATE
RM 1255 A. M. SULKIN. INC.. BOSTON
Board of Health
L