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Lot 27 Septic Appication ALMER HUNTLEY, JR. & ASSOCIATES, INC. Successsors to Davis Engineering Co. Established 1870 Registered Land Surveyors & Civil Engineers 30 CRAFTS AVE., NORTHAMPTON, MASS. TEL. (413) 584-7444 T{{.21LZ�C/<L by at ,ie *4 a 7 2ti2 THE COMMONWEALTH OF MASSACHUSETTS BOARD. 1HEALTH fr Gat" OF_ 1,FCt #1 Pt;tcl Trrfifiratr of Tnmplianrr THIS IS TO SERTIFY, Tha the Indi dual Sewage Disposal System constructed (ror Repaired Jti r«z �C <.> t< has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No J// dated p l,IV i 3U I 7 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. (( �� yc DATE 1 !iv. 34, f f4 P Inspector -4c* 4 No ' !/ Permission to Const at No as shown on the THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Dizp nal llinrka (!t muttit fine 'Profit erehy granted 140r. Repan ( ),att4 divideuall Sewage Disposal System - 4,1." FEE street application for Disposal Works Construction Permit No DATE FORM 1255 HOBBS & WARREN C.. PUBLISHERS Dated y Board of.rasamn ECK OR FILL IN WHERE APPLICABLE No r1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH i i OF / ,y Appl ration fur Qinpnsul nrks Qlutwtrurtinn tirrmit Application is hereby made for a Permit to Construct ( ) or Repair System at: Fee ` 7 I(? d an Individual Sewage Disposal or Lot Na. Address Address Type of Building Size Lot Sq. feet Dwelling—No. of Bedrooms Fxpansion 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— N . Width Total Length Total leaching area sq. ft. Seepage Pit No 1 Diameter Depth below inlet Total leaching area 'O 0 sq. ft. Other Distribution box Percolation Test Results Test Pit No. I Test Pit No. 2 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 been 'ssurd by the board of health. Signed )." , ^ . .:. . Application Approved By v.) .�rn J or'..T Date ' Pate Application Disapproved for the following reasons Permit No ( / i Date J ' Issued...!J. '- Date