Lot 24 Septic Appication CHECK OR FILL IN WHERE APPLICABLE
No Jr f
THE COMMONWEALTH OF MASSACHUSETTS
PEE
BOARD {OF HEALTH
rt) OF ,f M(atA'r lf
Appliratiun fur i liapuunl Marko Eiunstrurtiun lrrmit
Application is hereby made for a Permit to Construct (V or Repair ( ) an Individual Sewage Disposal
System at:
cirri
ii/44„ dress a1
W rxG
✓ ++ owners"
,6GLe+t� /4.".� ,}._K-.
Type of Building
Dwelling— No. of Bedrooms
Other—Type of Building No. of persons Showers ( ) — Cafeteria ( )
Other fixtures
or Lot No.
Address
Address
Size Lot Sq. feet
Fxpansion Attic ( ) Garbage Grinder ( )
Design Flow gallons
Septic Tank—Liquid capacity.24 gallons
Disposal Trench— N4. Width
Seepage Pit No i Diameter
Other Distribution box
Percolation Test Results
Test Pit No. 1
Test Pit No. 2
per person per day. Total daily flow gallons.
Length Width Diameter Depth
Total Length Total leaching area s ft.
Depth below inlet Total leaching area.I-l.. ft.
Dosing tank ( )
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
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 ttee t�iiissued by he board of health. ////((''--gy�pp
Si ed✓ f'O"^ /.(�Nc. 1'r X11 aMi
•
Dam
Application Approved By pot t !� ; _ td F:_3t.., ,aY/QE_}!.
Date
Application Disapproved for the following reasons
Permit No I
Issued.
fa . - '7 /It
Date
0
by
at
has been installed in accordance with the provisions of Artic,G
application for Disposal Works Construction Permit No
THE yIy/SSS�UANCE OF THIS CERTIFICATE SHALL NOT
DATE " 421 FUNCTION( I yloY SATISFACTORY. �1.
1 J1rl. 'Y
Inspector
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF ))C4-ttet+tan
rrtifiratr of Qlnutplianrr
THIS IS TO CiIrTI-F�
cc cc,
ThaYrthe Indipidnal Sewage Disposal System constructed t ) or Repaired ( )
A NP Yom'
ofd qty %1 +t fJ Olt`
of The State Sanitary Code described the
.
dated `W L y y
BE CONSTRUED AS A GUXRANTEE THAT THE
No
Rt
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF " ly-'v �'1hl
ri Via=°'A
Motional Witrka Oinitaintren Irrntit
Permission}" hereby granted
to Construct{' or Repgir ( ) an Indjcidtp Sewage Disposal System
at No 'jilt- r' °1 7 Px) an n iect tniL
street 9
as shown on the application for Disposal Works Construction Permit No
Lf
DATE - " a. .._�. ._c.7r..p
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
Bo
FEE
Dated
ALMER HUNTLEY, JR. & ASSOCIATES, INC.
Successsors to Davis Engineering Co. Established 1870
Registered Land Surveyors & Civil Engineers
Board of Health
City Hall
Northampton, Mass .
30 CRAFTS AVE., NORTHAMPTON, MASS.
TEL. (413) 584-7444
July 7 , 1964
Gentlemen :
i have made a percolation test at Lot 24, Mayorsville,
located on °arts Pit 30=:_l, or '_.and belonging to Wm. Ormond , Jr.
Soil : Coarse sand, stones. A good clean gravel.
Percolation Rate : One inch in three minutes.
No ground water.
0 if
Almer Huntley, J
Registered San', o;