487 Application & Permit THE COMMONWEALTH OF MASSACHUSETTS
Ur 4/I/ BOARD OFtr HEALTH
OF A
'Qirriifirair of Tom liana
THIS IS I QQ CE TWA, That thee Individual Sewage Disposal Sys t constructed (j/j or Repaired ( )
by JET. ..acti111.1 -y7-......._[�� .... I
at .7 YI? JGZL:Rso f.-..r7.k5d IVfr U1 $/O' i AutipM...:! .� .. .raizT'h
has been installed in accordance with the provisions of TITLE /5/ofa a State Sanitary Code; esert
application for Disposal Works Construction Permit No fi µ4n dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT RE CONSTRMED AS A GUA RA YNAT THE
SYSTEM WILL FUNCTI N SALT ORY.
DATE Inspector
No ii—ZO
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OFaAITlryl
OF
ThopoS / Qioie f rnntit
Permission is hereby granted I
to Construct ({/forte 1 j ) an tdivi. al Se age Dispo7
at No ..9... .... .. .. ._ sv
as shown on the application for Disposal Works Construction Perm
DATE )
FORM 1255 HO BS S WARREN. INC.. PUBLISHERS
0V70/5-
1/s
Fmt&.6
Board of Health
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
City OF Northampton
ppliratiun far ffispnaal Marks Cltanstrurtian Patna
Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal
System at:
Jackson Subdivision Northampton Lot #2
Location-Address
ai.ana..Kraaath
W7 Yu Q Audubon Road Owner
.
Installer
G Type of Building
O Dwelling—No. of Bedrooms 3 Expansion Attic
'"l
pe Other—Type of Building No. of persons
im Other fixtures
or Lot No.
186 Cresent Street Northampton
Address
Address
Size Lo
Showers
5.112 Ac. sgoKua
Garbage Grinder (X)
( ) — Cafeteria ( )
Design Flow 55 gallons per person per day. Total daily
Septic Tank—Liquid capacity15f10gallons Length Width
Disposal Trench—No. 1.0 Width._....3..._..... Total Length 544'
Seepage Pit No Diameter Depth below inlet
Dosing tank ( )
Performed by MI Huntley.
....minutes per inch Depth of Test Pit
minutes per inch Depth of Test Pit
flow.........33.0 gallons.
Diameter Depth
Total leaching area sq. ft.
Total leaching area sq. ft.
Other Distribution box
Percolation Test Results
Test Pit No. l..ZC
Test Pit No. 2
Date 3-10-81
71 6" Depth to ground water ' °
Depth to ground water
Description of Soil....3._...0T.S.* 18" SLIt_4 5'9" say till
at 7 0"
th boulders. Groundwater
Nature 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 TITLE 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
Application Approved By
Application Disapproved for the following reasons
by
Date
Date
Date
Permit No Issued
Data
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
Qlrrtifiratr of Qlontpliattrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
Instant,
at
has been installed in accordance with the provisions of TITLE 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
CHECK OR FILL IN WHERE APPLICABLE
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
City or= Northampton
ppiiratinn for f inposttl i G=kg Cnonwtrurtion hermit
Application is.hereb mad fora ermtt to Construct (X ) or Repair
System at: 9f7 , to
Jackson Subdivision Northampton
D.ana_Krauth
Audubon Road
Location.Address
an Individual Sewage Disposal
Lot 1(2
or Lot No.
186 Cresent Street Northampton
Address
ize Addresa 5.112 Ac
Type of Building rV` " ` Size Lot 9grtfmt
Dwelling—No. of Bedrooms 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 35.9 gallons.
Septic Tank—Liquid capacity.L5_QO_gallons Length Width Diameter Depth
Disposal Trench—No. 1.0..._.... Width 3 Total Length___5.0Q' Total leaching area sq. ft.
Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft.
Other Distribution box ( ) Dosing tank ( )
Percolation Test R Performed by Dill' klun.tley....6.6ESOC. Date 3-1water 0-81
°
Test Pit No. 1...2.5. .minutes per inch Depth of Test Pit 7' 6" Depth to ground ' °
Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water
Description of Soil....3.��...Q.I.S...+ j,8" silt 4 5'9" sandy till with boulders. Groundwater
at 7' 0"
Nature 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 TITLE 5 of the State Sa itary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliant as been issued by the board of health.
Application Approved By
ype
Application Disapproved for the following reasons'
Permit No 1.,- 010
Issued- gil.e{..7L 2
Date