35-219 (7) ..........._....... Fics..............................
1NQFM4S�q�ti THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
GARY R. CITY NORTHAMPTON
cSWANS N y - __ .. _ .OF..................................... ..................................................
No.27 3
.o F�IS7 ° �`� pliration for Klhipooal ork,6 Towitrurtion "rrmit
��
FSS�ONAL tion is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal
t:
LADYSLIPPER LANE LOT NO. 20
. --•-••--•...........................................•---••-•-.........-•----•....-••------- .........-••--•--••--•---------••----•••--•.....•--------...._..........._.....------......--•-
LAWRENCtOeA`UD` tT`E 65 WHITELOAF R0A&,t NSOUTHAMPTON, MA
.................._........._............................................................... •-•-•-•-•••••---••------•-•-•-•-----.._....••-------•--....•--------•-------....._................
Owner Address
W
Installer Address
dType of Building Size Lot............................Sq. feet
V Dwelling—No. of Bedrooms.--.....---_------4......................Expansion Attic ( ) Garbage Grinder (X )
aOther—Type of Building �_�.0 GAL/EIR No. of persons-_-------------_-____-__. Showers ( ) — Cafeteria ( )
PA Other fixtures ............................... . .
Design Flow.J.1_0.. tAL/BDRM...•..gallons per person er day. Total daily flow.............444......................gallons.
Septic Tank—Liquid capacity.-500.galIons Length_1. 6::._._ Width.E2B."------- Diameter................ Depth....4.8.11....
x Disposal Trench— No. .................... Width........_. --------- Total Length.................... Total leaching area...... .............sq. ft.
Seepage Pit No......._............. Depth below inlet-5_J........... Total leaching area-3.3.6........ ft.
z Other Distribution box ( ) Dosin tank ( )
Percolation Test Results Performed byCRY-.R......SWAN$QN• P E .1J-I-1W•• Dat�?.-_�.-845.-2_Q- 4.
,.._.._.�_ .,
1 Test Pit No. I.......2......minutes per inch Depth of Test Pit.....2.1.......... Depth to ground water......NQ E•_....
Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
--------------------------------- ------------••-----._.........-- .... ........................._ ............ i...................--•_...
D Description of Soil.......1.' TOPSOILr____2.r'_._SUBSOILI. 5z' M-ED......SANDI...62.'___.FINE GREY
U SA-ND•'--- 1.0'.._COARSE--GREY_SAND-----------•-•-- •. . . . •--
W .......... ----------------------------------------------------- ..............................--•-....................................................................... ...............
UNature of Repairs or Alterations—Answer when applicabl e---------................................_......................................................
-•------•-•.---•-------•----....-•..............•-•-••--••-•-----......._.._._......----•--•-•-•••--............-•---------------------•----••••-- .....................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLL 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.
Signed.................................. ................................................... ................................
Date
ApplicationApproved By.................................................................................................. ........................................
Date
Application Disapproved for the following reasons:........... ............................................__...................................................
....................................................................................................................................... ------------------•-----•-•••--•------•-•-•----.........._._._..
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........CIT.Y...................OF... NO.RT.HAMP.TON.............................................
Trrtifirate of Tantphattre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (X ) or Repaired ( )
by...............•....•------••••-••-•............--•-----•-•-....--•------•-.........._...... ----------•-•-•---.._......-•-•------•-----••-•-----•.............--•-------------•--•----.......••---•
Installer
at..........LOT.--LOT.-M—...20+---LADYSLI.PP_ER...LANE...-----•••-----•-------•-•-------•---••-•-•-------•••-•••-•-•-••----•••---•-•-•-----•-•-••••......----•-.
has been installed in accordance with the provisions of TITI-E, 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No---------------------------------------_ 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
CITY............ .. OF.......NO.RTHAMPTON...._.......... ----•---
No......•••.............•. FEE...................--...
Uiapooal Workii Tonitrudion ILermit
Permission is hereby granted......LAWRENCE---AUDETTI E.........................................................................................
to Construct (X ) or Repair ( ) an Individual Sewage Disposal System
atNo......LOI--•.NOQ ...20 ...LADYSLI.PP.ER...LANE------------------------------------ --------•------•-----------------..........-•••-•-•-•-....---------
Street
as shown on the application for Disposal 'Forks Construction Permit No.-_----------------- Dated--------_................................
..............•-••-------•-••---•-•--•--. .. •--------..................................................
Board of health
DATE-------------------------•----- ------------------------------------------------
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
7
January 29, ,-185
--sJ1 notit (-)n C
permission to install a driveway at lot 120 "Tinkham Woods" off of
Westhampton Road. Twenty-four (24) Maximum width at the street line.
Gutter drainage not to be disturbed. Driveway surface to he paved if the
grade of the proposed driveway exceeds 3 or more.
-B7.
Mr. , udette
Southampton, Mass.
527-7-766-
-
Inspected bill:
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