836 Septic Applications & Permits THE COMMONWEALTH OF MASSACHUSETTS
fro✓*I"orni tJ 67
MASSACHUSETTS
FEE
cAppliratiun for pizpo82tt gstrm Construction Permit
Application is hereby made for a Permit to Construct ( ) or Repair(/1)an On-site Sewage Dispo al System at:
Owner's Namg.Address and Tel.No.
r4
i a
A.4„.- a, fa;/.rha
Lo�@@tip AddryEs orl of Na.
A/ a., ish
4- 7?V
In9Iter'S Name.Address and 1 el No
3 t
(p L
it / Asa of
Ato
Designers Name.Address and Tel.No.
te- 5356
Type of Building:
Dwelling No. of Bedrooms
Other Type of Building No per Persons Showers( ) Cafeteria
Other Fixtures `
Design Flow gallons per day. Calculated daily flow
Plan Date Number of sheets Revision Date
Title
Description of Soil _.
3
Garbage )
gallons.
Nature 9f Repairs or Alterations(Answer when applicable)
Z.IC t� // ,?ew / T00 ya/'n� S»h
Date last inspected'
Agreement:
The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-site sewage disposal
system in accordance with the provisions of Title 5 of the Environmental Code and not to placethe system:in operation until a
Certificate of Compliance has been is ued by ih is Board of Health.
Signed
tt f%rw. (» /5 , Le.,b) Date /d�r5/03
',`-_--. ( ; I-- -i7—.__ Date /` /tf L//mil-
Application Approved by
Application Disapproved for the following reasons
Permit No
Date Issued
THE OMMONWEALTH OF MASSACHUSETTS
,MASSACHUSETTS
THIS IS TO CERTIFY, t
by jT ' Jf has been constructed in
a0 s, , }'�' '03 dated
accordance with the provisions of Title 5 and this for system col System
one Construction c Permit No.
-/(o-0 3 Use of this system is conditioned on compliance with the provisions set forth below:
@l�xtificttle of Compliance
On-s'te Sewage Disposal System installed
for
The issuance of this certificate h shall not be onstrued as a guarantee that the system will function as designed. This
Certificate expires on
DATE 5 c)-0-mcn) Inspector
/THE 'MONWE LTH OF MASSACHUSETTS
'. /� a':u' 'v , MASSACHUSETTS
FEE
No "
Pis il tsttl getout (llnnsfrixcfion lyter,tit,
/ 7 / ! �
Permiss• is hereby grants. to hLf L- -� - ' f'r
F3� ,
to constr. ( )or repair(ijan On-site Sewage System located at
pal as as described in the above Application for Disposal'System Construction Permit. The applicant recognizes his•her
duty to comply with Title 5 and the following local provisions or special conditions:
All constructiop'm t be completed within two years of the date below.
A
DATE i t t t° - . Approved by
FORM 1255 Fed.3/95 AM.S LKN cD-BOSTON.MA
CHECK OR FILL IN WHERE APPLICABLE
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
11 OFNORTHAMPTfN
Apptiralton far Disposal
rC
arks Cllnnstrurtinn lrrmit
Application is hereby made for a Permit t Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at J -1
R.4.ter.a.ckei
.
° H�
- ...�1 i�',ek«.
Installer Address
Type of Building Size Lot Sq. feet
Dwelling—No. of Bedrooms I Expansion Attic ( ) Garbage Grinder ( A)
Other—Type of Building No. of persons Showers ( ) — Cafeteria ( )
Other fixtures
Design Flow gallons per person per day. Total daily flow gallons.
Septic Tank—Liquid capacity gallons Length Width Diameter Depth
Disposal Trench—No. Width Total Length Total leaching area. sq. ft.
Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft.
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by Date
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
Address
Description of Soil
Nature f Repairs py41,teraWons—!*ns wwheen.eatiLlicpble
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 bgq,,issued by the board-pf,J ajth./
Dat
Application Approved By to
Application Disapproved for the following reasons'
Permit No
Issued.
Dale
THIS
by
SG
at ,
has been installed in accordance with the provisions of TITLE 11` of 'C�te State Sanitary Corgi 0�tgs�tbed in the
application for Disposal Works Construction Permit No ! dated (e.. -
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED A AfGUARANT
SYSTEM WILL NCTION SATISFACTORY.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
y OF NOR?eAMFtT:'^. .. .. ...
(Qnntifttatr of atmnpfistttr
TO CER1j{FY, 71/it th Indivicll Sewage Disposal System constructed (�"Or Repaired ( )
DATE
No 11-- a4
Inspector
AT THE
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
r OF NQRTHAMOT(;h
Disposal.
tufisn lirnnif
Permission is hereby granted
r JG t
ruct ( � f Rep ( 7�)-- In d—
O �
as shown on the application for Disposal Works Construction Permit No.
4-
/
Disposal Systeyy Pit {6 l C..
Street A: L - , , —.....
Date {
1 DtyT
BORN 1255 A. MjfULKIN, INC.. BOSTON
•
No
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF .. . ..: .
FEE
Appliratimi far Uispaual Mirka Tnntrttrtiatt 1rrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
Location.Address
Owner
or Lot No.
Address
L.a. Address
Wj Installer Size Lot Sq. feet
Type of Building Expansion Attic ( ) Garbage Grinder ( )
V DwellingType of Bedrooms Showers ( ) — Cafeteria ( )
.a No. of persons
�y Other of Building
4
Other fixtures gallons
Design Flow gallons per person per day. Total daily flow Depth
{{z�]] gallons Length Width Diameter P
rG Septic nk—Liquid capaci ,._ Width Total Length Total leaching area sq. ft.
``l Disposal Trendt—No
7 Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft.
z
Other Distribution box ( ) Dosing tank ( ) Date l
Percolation Test Results Performed by Depth to ground water
"'1 Test Pit No. 1 minutes per inch Depth of Test Pit Depth to ground water
`"1 minutes per inch Depth of Test Pit Depth g
Test Pit No. 2 P
0.i
0 Description of Soil
v
xU Nature of Repairs or Alterations—Answer when applicable
The undersigned agrees to install the aforedescrihed Individual Sewage Disposal System in accordance with
Agreement:
the provisions of 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., _ I (HA
Signed Date
Date ..�`-•-
Application Approved By
Application Disapproved for the following reasons
Date
Permit No
Issued.., , -...r....
Date
by
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
Ttrtifirttte of kinmplittnre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
installer
at
has been instilled in accordance with the provisions of T1711 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.
DATF Inspector
No
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
Eliopnuut lNorkz htonoirurtion Jrrmit
FEE
Permission is hereby granted
to Construct ( ) or Repair ( ) an Individual Sewage Disposal System
at No
as shown on the application for Disposal Works Construction Permit No Dated
Board of Health
DATE
FOAM 1255 HOBBS & WARREN. INC.. PUBLISHERS
CHECK OR FILL IN WHERE APPLICABLE
No
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
Fes
? ppliratiun fur UiuprI al lurks CEunutriutiun lirrmit
Application is hereby made for a Permit to Construct (-- ) or Repair ( ) an Individual Sewage Disposal
System at:
Location-Address
Owner
Jnstaner
Type of Building
Dwelling—No. of Bedrooms
Other—Type of Building No
Other fixtures
Design Flow gallons per person per day. Total daily
Septic Tank—Liquid capacitf I. ` gallons Length Width
Disposal Trends—No W idth4:t C e Total Length... G/
Seepage Pit No Diameter Depth below inlet
Other Distribution box 04 Dosing tank ( )
Percolation Test Results Performed by
Test Pit No. 1 i minutes per inch
Test Pit No. 2 minutes per inch
or Isar \o.
Address
Address
Size Lot Sq. feet
Expansion Attic ( ) Garbage Grinder ( )
of persons Showers ( ) — Cafeteria ( )
flow gallons.
Diameter Depth
Total leaching area-.J.OS.J.sq. ft
Total leaching area sq. ft.
Description of Soil
Date
Depth of 'Pest Pit f Depth to ground water.
Depth of Test Pit Depth to ground water
Nature of Repairs or Alterations—Answer when applicable
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of -IT 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 hoard of health
Signed
Application Approved By
Application Disapproved for the following reasons'
r
Permit No
Issued_
Date
Date
Date
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF ..__._..__...
Tertifirtttt of (Qnniplittnrr
THIS IS TO CERTIFY, That the Ino.vrdual Sewage Disposal System constructed or Repaired ( )
by . ..... . _.._........ .............. ._ _
.. . ............... .....
alter Inbt _ _-
at.__ _ __-
— - of The State Sanitary Code as described in the
has been installed in accordance with the provisions of 1 ': 5
appli H S Disposal Works Permit Nn
. ... . . .. ....
dated
THE ISSUANCE OF TH IS CERTIFI CATE S HALL
NOT BE CONSTRUED AS A GUARANTEE THAT
SYSTEM WILL FUNCTION SATISFACTORY.
DATE......_.__._.__.__._.__.._._.._....._._..__.._.._..._ Inspector__._...._._...._._.._._._.___..____..___.......__..
No......._..........._.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF_......._._____.__._.._.__._._.____.._...
flispnnttl r!nrks Onnntruttinnrrmit
F
Permission n i ereRyair ( ) an Individual Sewage Disposal System
to Constrict (� ) or Repair ( )
street.
at No ...........................................................
"""'""" Dated
as shown on the application for Disposal Works Construction Permit o.-- .---._ --
Board of Health
DATE.—........ ............... .. ...._._.._.__..._._ .. ._._....
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
No
A
Hunts
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
City OF Northampton
Oration for 13itpnstti Works Tonztrurtinn '1rrmit
lication is hereby made for a Permit to Construct ( X or Repair ( ) an Individual Sewage Disposal
FEE
System at:
Lot-.42,.BUxts.P.it.eROad
............Peter_&...Eliza.htfh...Bretnzi
owner
Installer
or Lot No.
41..Evergreen...Drive.-_HOIYOXe
Address
Type of Building 3 Expansion Attic
Dwelling-No. of Bedrooms No. of persons
Other—Type of Building -
Other fixtures
Design Flow 55 gallons per person per day. Total daily fi
Width
Septic Disposal ena -Liquid capaci1 ..l.... Width lthns 2 Length' 35'
`� _No. j,.___.- Width 25' Total Length
Seepage Pit Depth below inlet
Seepage Pit No Diameter p
Other Distribution box ( X) Dosing tank ( )
Percolation Test Results Performed by RPB-Huntley ASSOC
7•tl minutes per inch
Test Pit No. 1-�.-- minutes per inch
Test Pit No. 2 p
Address
Size Lot 314 250 Sq. feet
Garbage Grinder ( X)
Showers t ) — Cafeteria ( )
Description of Soil
ow
Diameter Depth
Total leaching area 875 sq. ft.
Total leaching area sq. [[
Date 4-14-78
None
330
gallons
4' Depth to ground water
Depth of Test Pit 91-9. Depth to ground water
n Depth of Test Pit Depth
OTS-9" Silty Sand- 2' 0" Med./Fine Sand - Layers -of_
M-F Sand & Silty Clay - Varved Clay/sand
None
Nature of Repairs or Alterations—Answer when applicable
Agreement:
The ions undersigned agrees ft' install te Sanitary eCode — Individual
further System in
to to place the system in
operation provisions of Certificate operation umil a Certificate of Compliance has been issued by the board of health
Signed
Application Approved By
Date
Date
Application Disapproved for the following reasons'
Date
Permit No
Issued-
Address
ssued
Date
No
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
FE
Applirutinu far Uis}Insul Tuttotrurtinu Permit
Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
7
System at:
Location-Address
or Lm No.
Address
''-Ono*
W Address
,�,
Installer U Size Lot Sq. feet
2 Type of Building Expansion Attic ( ) Garbage Grinder ( )
,U, Dwelling Type of Building Showers ( ) — Cafeteria ( )
� Other Type of Building
No. of persons
PA
Other fixtures
Flow gallons per person per day. Total daily flow Depth
g: .11ons Length N i ltheld' Diameter I
re Septic l Trench—Liq� td capaotg i / Total Length__ ' — Total leaching r _/ —. l / sq ft.
`til• Disposal Trench—No. er Width .. Total leaching area a9 it
Diameter Depth below inlet
2• Seepage Pit No Dosing tank
Percolation Test Results Performed by Depth to ground water
.-I Test Pit No. 1 minutes per inch Depth of Test Pit V
De th to ground water
w Test Pit 50. 2 minutes per inch Depth of Test Pit P
¥
G Description of Soil -
x
U
wU Nature of Repairs or Alterations—Answer when applicable
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
Agreement:
the provisions of Article NI of the State Sanitary Code—The ndearg ofd further agrees not to place the system ill
until a Certificate of Compliance has been t{p7o1 by// • /
Signed
Application Approved By
Application Disapproved for the following reasons'
Date
D
Permit No 1
Issued
Date
by
at
has been installed in accordance with the provisions of Article NI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No
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
OF
«trrtitintt of (linmplinnrr Repaired>a
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Re I (
Installer
No
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
Di spnsu[ Marks Cnunstrurtiun Prrmit
FEE
Permission is hfreby granted
to Construct ( )'or Repair ( ) an Individual Sewage Disposal/System
at No strut
as shown on the application for Disposal Works Construction Permit No
Dated
Hoard of Health
DATE
FORM 1255 HOBBS & WAPREN, INC_ PUBLISHERS
CHECK OR FILL IN WHERE APPLICABLE
No.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
ix L. , . OF /Yr. p ,�
Application for fliopooal re orko alonstrnrtintt rrmit
Application is hereby made for a Permit to Construct ('" ) or Repair ( ) an Individual Sewage Disposal
System at:
Location-Aeeat b
F..�.:.....
..t
Installer
I
or Lot Na.
Address
Type of Building Expansion Attic
Dwelling—No. of Bedrooms
Other—Type of Building No. of persons
Other fixtures
Address
Size Lot Sq. feet
Garbage Grinder ( )
Showers ( ) — Cafeteria ( )
Design Flow
Septic Tank—Liquid capacit
Disposal Trench—No.
Seepage Pit No
Other Distribution box
Percolation Test Results
Test Pit No. 1
Test Pit No. 2
Description of Soil
-:.gallons
Width
Diameter
Dosing
gallons p
er person per day. Total daily flow gallons.
Length Width Diameter Depth
rn�
Total Length Total leaching area sq. ft.
Depth below inlet Total leaching area sq. ft.
tardy ( )
Performed by Date
minutes per inch Depth of Test Pit Depth to ground water
minutes per inch Depth of Test Pit Depth to ground water
Nature of Repairs or Alterations—Answer when applicable
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 undersign further agrees not to place the system in
operation until a Certificate of Compliance has beenAssued by the bqa.
Signed....:4(..:y....i:.t..ie«e..:1-'�:.
r y
Application Approved By
Application Disapproved for the following reasons
Permit No
Date
Daate
by
has been installed in accordance with the provisions of Article XI of The State Sanitary
y 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
OF
Q rrtifirate of @Cnutpttatttt or Repaired THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) P
Installer
No
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF -._:._ ...,
Disposal rr;nrks aiptustrurtistt lrrmit
Permission tyl(ereby granted .t- -+- _"""'"'
to Construct 4+'') or Repair ( ) an Isividual,Sewage Disposai5yst een
at No ,. r :.a.s.. 'l ..,;3
as shown on the application for Disposal Works Construction Permit No
Dated •3 _::::.....
.V
.r.,:J..J..' Bodra of He th
FEE/.s::'
DATE
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
No..
THE COMMONWEALTH OF MASSACHUSETTS
FEB
BOARD OF J-IEALTH
OF /./
Application for flinpunttl nrkn @luuntrurtiun Vermit
Application is hereby made for a Permit to Construct (1 7) or Repair y( ) an -Inndividual Sewage Disposal
System at: a; f ?if',2,14, D�'J! /
- -- or Lot ti+.
Address
Address
a Installer S feet
Size Lot q
M• Type of Building Expansion tic ( ) Garbage Grinder ( )
O Dwelling—pe of Bedrooms Showers ( ) — Cafeteria ( )
j No. of persons
Other—Type of Building
-4
a. Other fixtu. s C l gallon=.
d Design Flow u gallons per person per day. Total daily flow Depth
/2`d gallons Length Width Diameter tch Q
a Septic l Tr nc Liquid capacity i Total Length Total leaching area sq. ft.
W• Disposal Trench— No. Width Total leaching area sq. 9t
No Diameter Depth below inlet
Other Distribution Ao Dosing tank
.Z, Other Distribution box ( ) g ( ) Date Oil.
i-I Percolation Test Results 0 Performed by Depth to ground waterM°w
-) Test Pit No. 1 / minutes per inch Depth of Test Pit P
Test Pit No
t . 2 minutes per inch Depth of Test Pit Depth to ground water
CS
O Description of Soil
U
tr7
U Nature of Repairs or Alter atiars—Answer when applicable
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
Agreement:
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 issued by the board of health.
Sighed
Application Approved By
Application Disapproved for the following reasons
OtIP
Date
Permit No
Cl
Issued
THIS TO"
by
at �{° p
has been installed in accordance with the provisions of Artie N� The State Sanitary ode s e�rilie in the
application for Disposal Works Construction Permit No
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. �' / "� q..-r , .C✓1
° x 1 ' 2; Inspector l'-"ii ^ I ' L "fr
DATE -'�' I�
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF �f
din of tdont littnre Repaired IFY,"Tha to Indipi,dnal or Re Sewage Disposal System constructed ( ) p (
No
I/-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
`j4.- +AtLr..r;^., ''t/
I3isposttl
Permission isitereby p granted ,
to Construct ( pF ( ) ap 3ndidualJSeaFS�ispgsal System
at No =f f .. street �: 0
Dat
as shown on the application for Disposal Works Construction Pet R it- o f
It
Qiipnttrortiuu,?rr ntit
FEE
DATE
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
Board of Health