219 Septic Application Permit & Compliance 2007 r tei
•
4/' to Construct j Repairk Upgrade e Abandon() -/Complete System ❑Individual Components
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COMMONWEALTH OF MASSACHUSETTS %l<
Board of Heu[(h,A/Ck )/i/%/1�% LIl�MA. ��/��
TION EDP DISPOSAL SYSTEM CONSTRUCTION P ERMIT i8V-6itc
I.ocmlorpr e44,'rs'la %')T fl(l/7
Owner's Name ,S7AytT atenglL J't/%
Map/Parcel# 3/9 I / , 5 /Y/y�//�-AJ)C&'fl
Address T-/7 eWf 4'%e/1.ca' 4
I or* 4/En 7/7/l/y9,%,C/� VAJ MASS
Telephone# FIJO '//%P/%%/7) fCl /1%455
Installer's Narne
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{{{{�������'���"'^^^^"/''����
Designer's Name IC) J ,S/_f/ZU%fl Mr
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Address5 Si
ale� �
ddress 95-3 5t
, 9c- re2/
Tel
Telephone# In�����//_Z G� l A V /
Type of Building /2451,0,I AJr, L• /76x-COC
Lot Size /P'1/5/C sq.�ft.�
Dwelling-No.of Bedrooms 3 . 4 &KcOS�S 4 V %J/S//e'i/ c._ Garbage grinder yy�iey'
Other-Type of Building 5'r vo C t- A-4h%/t C/ No.of persons Showers(a Cafeteria (44)
Other Fixtures 6'e sio Coi isy/2tfc newt)
Design Flow(min.required) pi) x 3 gpd Calculated design flow 310 Design flow prmided 379 gpd
Plan: Date t Z'L% e1 dte 7Number of sheets a Recast n Date
Title J,Egn4 4/77:4-11-7 ,94 s *42 < e_
.fie/ ,r>r7C/Acrl
Description of Soil(s)
Soil Evaluator Form No. J/ Name of Soil Evaluator 41-1.7"
DESCRIPTION OF REPAIRS OR AI TERATIONS
e fun cc//( try dl? ec>c.rf
/YifJ?/Jvul
ht)D
Date of Evaluation
Stlfine SW 4,09 P/
TC) -3l0C/214 /s•n
5 /52c till AF_
C"/YJ It li
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed
Insper tic
Date
No. (ft0 'l
COMMONWEALTH OE ASSACAUSETTS
Board of Healt
MA
CEI2TJELCATE Of COMPLIANCE
FEE Vi°b.Pal
Description of Work: ❑Individual Component(s) 4mplete System // (k(Abandoned The undersigned hereby ' rtify that the Sewage Disposal Syste .; Constru ed ( ),Repaired (Q pg aded Abandoned ( )
b,.: ,l LL..� .t/ ua >' t t'
has been Installed in accordance with th pisions of 310 CMR 15.00 (Tide 5) anddt/heeja(f prod design plan s/a built plans relating to
application 0 pro
. pproved Design How 37 (gpd)
Designee i3O SIM Jf/i/ vyr ltInspector: £ Z4 CV iia Date:
The issuance of this permit shall not be construed as a guarantee that the.system�ion as designed.
COMMONWEALTH OE MASSACIUSEITS
Board of Health, ALA,
DISPOSAL SYSTEM CONSTRUCTION PERMIT
epair( (1 Upgrade(/Abandon( )an individual sewage disposal system
Permission is hereby granted to; C nstruct(
r. .u� A
Disposal System Construction Permit No.
Provided: Construction shall be completed
FEE JVC"
,
`93,dated _ aea-7
as described in the application for
w/t]{h(i5 three years of the date of thi, ermit. All local cond ti q; ust be met.
�$ —�_
Form 1255 Rev 5,96 AM.Suldr.co.Boston.MA Date Board of Health
DIRECTOR Of
William J. Sieruta, P.E.
453 Federal Street
Montague, MA. 01351
Board of Health
Town Hall
Main Street
Northampton, MA. 01060
September 11, 2007
Subject: "As built Inspection"
Blanchette Residence
219 Coles Meadow Road
Northampton, MA. 01060
An "as built" inspection was completed for the subject septic system. This
system is in compliance with 310 CMR 15.0 and local board of health
regulations.
If you have any questions or need any additional information, please do
not hesitate to contact me.
Very truly yours,
William J. Sie ta, P.E.
�m2>>
End: Plan
2Cc : J.W. Cotton
5 West Street
Hatfield, MA. 01038
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