35-018 (5) _ FRs..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD Off' HEALTH
/02 ALMER
o HUNTLEY, JR City- .. ...............OF............NOrthATm do ...................
Hu.9419 r_ i
A�o�Fcl
AVp tration for Di5 oBal Works TouBtrurtuan Vrrufit
. pplication is hereby made for a Permit to Construct ( or Repair ( } an Individual Sewage Disposal
ystem at:
West Farms Road
....•.........................•--••---------•--.....-.......------------•-----...._.._...-•••-•-•• ------'...--••-'-•--••--...•-------•-'--- -----•••--------------..._.._..---•-•--••-•-----....---
Location-Address or Lot No.
James Omasta 55 Wilson Rd. _ Northampton
....-------••----............................--- ------------------•-----------•-•--•-•--- -••--••--•-•------•----••••---•-- --r . -
Owner Address
Installer
Address 4 0 4 2 6
Type of Building 2 Size Lot__ _ ___ ____ ____•.._..Sq. feet
a Dwelling—No. of Bedrooms--------------------------------- Attic ( ) Garbage Grinder (X)
Other—Type of Building ---------------------------- No. of persons_-._-________._- -------- Showers ( ) — Cafeteria ( )
Q Other fixtures
W Design Flow-_____..__-_5.5_____________..........15..0_gallons per person per day. Total daily flow_------------------------------------------220
gallons.
W Septic Tank—Liquid capritv-__._-_--_gallons20 Length________________ Wid30_---_-_--.-.- Diameter.-__--__-----_-_ Depth....
•_____-.___.
x Dispasal Trench--No. .................... Width___._.._.__.____._._ Total Length.__ --------------- Total leaching area___--__0---_____-_-.._sq. ft.
Seepage Pit No-------___------- Diameter_----------.------ Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosin tan ( )
H� ey & Assoc. , Inc. 6-18-80
Percolation Test Results Performed by.--•__.nt---........---------------------•-"..... '-----------•--- Date--- ...................---------•----
aTest Pit No. Pest th-minutes per inch Depth of Test Pit--..-1�- Depth to ground water_nOrie
ri Test Pit No. 2................minutes per inch Depth of Test Pit_.----.___.__.----- Depth to ground water------------__--------
_.
9 --- ---------------------'..........................................'---......-.....................................--.....................................
D Description of Soil----------Medium---san- .-r--'.som&_q- -a ve-1------------------------'-------------------------------------------.....................
W
U ........................ ................................-----------.......................................................................... ............ .........••-.......-'-•-•-----
W
U Mature 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 2 :t.`: 5 of the State Sanitary Code — The undersigned further agrees not to place the system in
operation until a Certificate of Com fiance has bee issued by the and of h ____ �ate
�igned-'-- . .......
ApplicationApproved By......................................•.. .......----------'----------'--••---•--'---'-•••-
Date
Application Disapproved for the following reasons:_-------------------------------------------------------------------------------------------------------------
....................•-•----------------•--•--•'-•••---•---••-•-•----••--•'-••--•------_•----••---•--••-•-'--•-------- ---------•----- ------------------
Date
PermitNo.................................-'----------'------••-- Issued--•-----'-----•----•----'--••-........................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.................................OF..................................................................................
Trrtifiratr of (lomplinnrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Installer
at------'...........................................-•--•----_...._..._...._...--
has been installed in accordance with the provisions of TIT!!, 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No----------------------------------------- da.ted--------.-----.---------------------------------
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
......I—......................OF.-----.................................................--.........................
No......................... FEE_......................
Bisposal Workn Tomitrnrtinn famit
Permission is hereby granted-------------•------------- ............................................................ ....................................................
to Construct ( ) or Repair ( ) an Individual Sewage Disposal System
atNo-----------------•-................................................. ----•--•--
Street
as shown on the application for Disposal Works Construction Permit No--------------------- Dated--------------------------_------
_.__._._.
----•------------------------------------------------------ .........................................
Board of Health
DATE.................. -------•---------- ----------•----------'---•---•. ..........
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS