Lot 7 Septic Application & Permit CHECK OR FILL IN WHERE APPLICABLE
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
CITY OF NORTHAMPTON
°"L A#I}Iliratinn for DSpnsal Works (IInnstrurtian ¥emit
Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal
System at:
TINKHAM ROAD LOT #7
Im(i®-Adds=
KEVIN NETTO
SOUTHAMPTON ROAD, W!• THAMPTON
Owner Address
Lamar Address
Type of Building Site Lot 1.124 ACRES S4&CS
Dwelling—No. of Bedrooms 3 Expansion Attic ( ) Garbage Grinder (K )
Other—Type of Building _________ No. of per Showers ( ) — Cafeteria ( )
Other fixtures
Design Flow 82.5 gallons per person per day. Total daily flow 495 gallons
Septic Tank—Liquid capacity_1500_.galons Length Width.. Diameter...__ Depth
Disposal Trench—No..__--Width—.-- Total Length._ Total leaching are, N. ft
Seepage Pit No._-2......._... Diameter_.— .Depth below inlet-10" Total Ladling an mot,,&
Other Distribution box ( ) Dosing tank ( ) CAPACITY = a54 cP0
Percolation Test Results Performed by GARY SWANSON - PE Turn 6/1/84
10'30 ._.......__...
Test Pit No. I...?••�.minutes per inch Depth of Test Pit_.._— Depth to ground water...
Test Pit No. 2 minutes per inch Depth of Test Pit_.—.- Depth to ground water_ NONE
Description of Soil_0"-6" TOPSOIL, 6"-1'-0" SUBSOIL, 1'-0" TO 10'-0" COARSE TO MEDIUM SAND. NO 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.
Application Approved By
Signed
Application Disapproved for the following reaasons•
Due
this
by
Permit No
Den
two
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
fertifiratr of f!tumpliana
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
Dweller
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 —
TNE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE_
Inspector