378 Septic Permit & Plans :. Non
wMON
We
HERE APPLIC
CHECK OR FILL IN
IyltDwelling—No. of Bedrooms 4 Expansion Attic ( ) Garbage Grinder(X )
Other—Type of Building No. of persons Showers ( ) — Cafeteria ( )
Other fixtures
Design Flow 55 gallons per person per day. Total daily flow 440
Septic Tank—Liquid capacityl1D0_gallons Lengthl.01-6"Widths '-6" Diameter
Disposal Trench—No. 4 Width 3 ' Total Length 340 Total leaching area
Seepage Pit No Diameter Depth below inlet Total leaching area
Other Distribution box (X) Dosing tank ( )
Pere __ E
Percolation Test Results Performed byS.... ...VANASSE
gallons.
Depth5 r—4'
1360 sq. ft.
sq. ft.
Date MARCH 27, 1981
Test Pit No. 1 10 minutes per inch Depth of Test Pit 10 Depth to ground water No
Test Pit No. 2 15 minutes per inch Depth of Test Pit 1.0 Depth to ground water No
Description of Soil__.....__6" Loam, 21' - Gravel and sand, 7 ' tight soil
s.ame._gxavel....mi.xecjwith sand and clay.,
stones .
Nature of Repairs or Alterations—Answer when applicable
Agreement:
The undersigned agrees to install the aforedescrihed Individual Sewage Dispo
the provisions of Article XI of the State Sanitary Code-- The undersigned further agr
operation until a Certificate of Compliance has been issued by the board of health.
Signed
Application Approved By
Application Disapproved for the following reasons
nce with
system in
by
Date
Date
Date
Permit No Issued
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF .
Tertifirnte of Q nmplinnre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
Installer
at
has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the
applic:o.inn 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
No
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
... . . . .. . . OF
Binomial
nrks Qtnnstrurtinn ljermit
FEE
Permission is hereby granted
to Construct ( ) or Repair ( ) an Individual Sewage Disposal System
at No
Street
as shown on the application for Disposal Works Construction Permit No Dated
DATF
amrzl of Health
CHECK OR FILL IN WHERE APPLICABLE
THE COMMONWEALTH OF MASSACHUSETTS
BOARDnLOF EALTH
OF /b
Applirntinn for Pinpnnnl i nrks Tunntrurtinn Damn
Application is hereby made for a Permit to Construct (✓) or Repair ( ) an Individual Sewage Disposal
FEE a • eJ Iq /
System at:
Location.-Addrress
Owner
Installer
Type of Building
Dwelling—No. of Bedrooms
Other—Type of Building
Other fixttwes
Design Flow ,�� �. gallons
Septic Tank—Liquid capacity /S y allons
Disposal Trench—No.____41..._.. Width__
Seepage Pit No Diameter
Other Distribution box ( ) Dosin
Perc T R ult Performed b
/ ` `2a` sqs.. Gds
Address
Expansion Attic
No. of persons
Address p� (Y
Size Lot R• r . feet
Garbage Grinder ( )
Showers ( ) — Cafeteria ( )
per person per day. Total daily flow 440 gallons a,
Length/0 ti .. Width.S. (.X r` Diameter Depth_n _y
.$r Total Length ,340 Total leaching area._L.3.60 sq. ft.
Depth below inlet Total leaching area sq. ft.
g to ( V f} 414.1
$C Date j)/1 7/r/
olatton Lest es s >
Test Pit No. I (0 minutes per inch Depth of Test Pit 10 Depth to ground water_.120
Test Pit No. 2 15__minutes per inch De of Test Pit f� Depth to %end wat r
Description of Soil
Nature of Repairs or Alterations—Answer when applicable
Agreement:
The undersigned agrees to install the aforedescrihed
the provisions of TITLE 5 of the State Sanitary Code
operation until a Certificate of CompliancMas h
Application Approved B
Application Disapproved for the following reasons
dividual Sewage Disposal System in accordance with
nders';ngd�t�titer agreey4not to place the system in
he h
Oer fr3
%ojgtl
Permit No
/D—Y3
Issued_
61 3e/K3nate
ate
. BOARD OF NEALTH
JOHN T. JOYCE,ChNtmao
PETER C. KENNY, M.D.
armaramozationnaus,
PETER J. McIRLAIN, Health Agent
CITY OF NORTHAMPTON
MASSACHUSETTS
OFFICE OP THE
BOARD OF HEALTH
OOp1'
TO: Mr. Fred Ostrowski , P.O. Box 123, Leeds, MA 01053
FROM: Peter J. McErlain, Agent Board of Health ,B1/IX--
DATE: May 25, 1983
SUBJECT: Sewage Plan for Lot 3, 378 Audubon Road
210 MAIN STREET
01060
0113)566-6950 Eat ILI
At the request of Building Inspector Cecil Clark, I have reviewed a sewage
disposal system plan for a lot owned by you at 378 Audubon Road, Leeds (#3,
Plan Book 112, Page 45) .
The plan does not comply with the requirements of Section 15.02 (5) of Title
5 of the State Environmental Code, a copy of which is attached.
In addition, the following items must be included:
- The engineer preparing the plan must stamp and sign it.
- The sites of the percolation and deep hole tests must be
located on the plan.
- Any water supplies (wells) within 200' of the leaching
facility must be located on the plan.
- If the leaching system is to be located under any portion
of a driveway, it must be constructed of material capable
of withstanding H-20 wheel loads (Regulation 15.14:(14)) .
- Existing and proposed contours, soil log and design calcu-
lations must also be shown on the plan.
- All other aspects of 15.02 (5) must be complied with.
If you have any questions regarding this matter, please contact the Board of
Health Office.
her
cc: Building Inspector Cecil Clark
EAU
MAY 2 5 1983
EPT.OF BOILOB'J tNSPEC10N5
NORTHJVPTCN IIA CCSO
NORTHAMPTON BOARD OF HEALTH
PERCOLATION TEST DATA
Address
Lot N
Owner Engineer/Sanitarian
Date
Perc Rate min/in
Depth to water
min/in
min/in
min/in
Sketch of Lot w/ Location of Test Holes 7'
Witness Fee
Witnessed by