Septic Permit�L\ Commonwealth of Massachusetts
City/Town of Northampton 2023-11
Number
Disposal System Construction Permit
ug
Form 2A
l
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with
the local Board of Health to determine the form they use_
Permission is hereby granted to:
Important: When Waller Thayer
filling out forms Name
on the computer, $4 King Street
use only the tab _
key to move your Address
cursor - do not Hatfield
use the return
key.
Citynown
Thayer Excavating
Name of Company
MA
State
to perform the following work on an on -site sewage disposal system:
❑t1 Construction
❑ Repair or replacement
F] Repair or replacement of system components
95 Chesterfield Rd
Facility Address
Northampton
Cityrrown
JD Ross Builders/Becca Constantine
Owner
MA
State
413-374-7983
Telephone Number
01038
Zip Code
WON
Zip Code
The work to be performed is further described in the Application for Disposal System Construction
Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions
or special conditions:
Complete septic system for new home per 310 CM 15.0
Final installation inspection prior to back -fill.
A nstruct must be completed within three years f the date below.
L
Approved b Date
Commissioner
Title
t5fonn2a.doc• 06/03 Disposal System Construction Permit - Page 1 of 1