Lot Application Permit & Plans 1963 CHECK OR FILL IN WHERE APPLICABLE
THE COMMONWEALTH OF MASSACHUSETTS
FEE
BOARD OF HEALTH
/ OF y,/, .- i
Appliratiuu for Binpnnttl tr;nrkn Clnuntrurtiun Brrutit
Applicatiop is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: Stet ated.e. 543
1d
Lot Na.
Addtess
Installer Address
Type of Building Size Lot Sq. feet
Dwelling—No. of Bedrooms Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building No. of persons Showers ( ) — Cafeteria ( )
Other fixtures
Design Flow yyjj ..gallons per person per day. Total daily flow gallons.
Septic Tank—Liquid capacity.(.''U gallons Length Width Diameter Depth
Disposal Trench—No. Width Total Length Total leaching area - p5'p-"ft.
Seepage Pit No Diameter Depth below inlet Total leaching area /%t",j-asTp.Er!'`f
Other Distribution bon ( ) Dosing tank ( ) V V
Percolation Test Results Performed by Date
Test Pit No. I minutes per inch Depth of Test Pit Depth to ground water
Test Pit No. 9 minutes per inch Depth of Test Pit Depth to ground water
Description of Soil
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 Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been,jssued by the board of health. %—,Si ued t'
Application Approved By 1 CZ1a.-,et o t
,lyy
Application Disapproved for the following reasons'
,/ry ( e
Permit No Issued _J ' Dat
Date
by
P 16at /'��
.I I 524,
has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the
%i
application for Disposal Works Construction Permit No dated '-y!¢6d
4
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARkNTEE THAT THE
SYSTEM WL� L FUNCTION SATISFACTORY. I
DATE `�"y o2 QI--�yk.� Inspector
THE COMMONWEALTH OF MASSACHUSETTS
ff BOARD OF HEALTH
C, OF 71,014'M'Al61
rag-irate of Tnutplianrt
THIS IS T CL IPY, 'CI 1_ h t the Tndividual Sewage Di posal System constructed (<or Repaired
Installer
No 6
THE COMMONWEALTH OF MASSACHUSETTS
�( yLL BOARD OF HEALTH
L(i OF
Dis}tnsal,Wu l;s Qlnnutrurtinn ihrutit
Permissio ereby granted
to Construct ) r I:eiaay'�
at No - .. i�'� sheet 6
as shown on the application for Disposal Works Constructio r sheet
loy�
FEE
Individual Sewage Disposal System
DATE
FORM 1255 HOBBS & WARREN. PUBLISHERS
ALMER HUNTLEY, JR. & ASSOCIATES, INC.
Successsors to Davis Engineering Co. Established 1870
Registered Land Surveyors & Civil Engineers
Cae-e-tak Ab
30 CRAFTS AVE., NORTHAMPTON, MASS.
TEL. (413) 584-7444
G 4-, /* /943
4L ip o A
G // _L,.
, pp3
efit
, Aci, . _ Y ,i . - i -
i I
j
dad, Fp -aaF R
o -Tian
rNJ1; 6L /yf 1,1)5-711747�
xa
ay IT
1
7V-o :/-1;15, -
I
1
j
trz ar>„ 1a FR 7ra,,,, s3-: ..4 11 et—:;y� i# ar24 6aap -a
of C. cmi ,T,
%:
.‘ ,
-Ye-raiigtr)3
F
a
--tvx itt
__---
'C
? ----
_
-
We s
_ _,
,
, r---
J ! ,
, 51
,i ___vf,___,_0•-
,
I 1
I t
_.
4)5, -aiiird,Op ) V ili1/41,1 6-.4-rki-
Ft 'eft 14 -Soc.) i# aiat,{ On4r,
n 4 .
t, , - /
r ,,,rc: I' 1,1 r firl/T