Lot 1 Septic Application & Plans See Attached Sheet for Design
FEB
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
City_. . of Northampton.
viatica inn fur flinpuuttl !!lurks Lunmtruriiltu Brrntii
Application is hereby made for a Permit to Construct ( X ) or Repair ( ) an lndiridual Sewage Disposal
System at:
Bunts Pit RQ.ad Lot #1
Leattnn-Aaatcs. or Lot No.
Robert Skrocki
owner Address
Installer
Address 1 .071 Ac
.
Type of Building Size Lot .opxteex
Dwelling—No. of Bedrooms Expansion Attic ( ) Garbage Grinder ( )
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 :ire-i sq. it
Other Distribution box ( ) Dosina tank ( )
Percolation Test Results Performed by H. Brazeau - Huntley Assoc. Date 5/13/7(
Test Pit No. L.]._3.3 minutes per inch Depth of Test Pit 4'-Q" Depth to ground water None
Test Pit No. 2_.0...33_niinutes per inch Depth of Test l'it 4' -Q" Depth to ground water None
Description of Soil........._.l.Q_-.Q"..Deep - na.groundwater = On OTS, 1 '-Q" Silty Sand
.8.1.=6" .11-G Saactand...Gr..auel
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 issued by the board of health.
Signed
Date
Date
Date
Application Approved By
Application Disapproved for the following reasons•
Permit No
Issued
Date
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PREPARED FOR.
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ALMER HUNTLEY,JR. ex P..SSOCIATES,: C.
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