Lot 25 Septic Application & Plans CHECK OR FILL IN WHERE APPLICABLE
No
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Fax
OF
P4lptuattonitor fltspnsat 3nnm woustrnttiran lJrnnit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: x
Florence RoadL0mt`m
d
Brad Collins
Owner
Installer
#25
or Lot No.
Address
Type of Building
Dwelling—No. of Bedrooms Expansion Attic
Other—Type of Building 3
Other fixtures
Design Flow
Septic Tank—fi$uid capacity
Disposal T —No.
Address
Size Lot Sq. feet
t 6py4Grinder ( )
No. of persons Showers ( ) — Cafeteria (x )
gallons per person per day. Total daily flow gallons.
gallons Length Width Diamsco. Depth
120Width To Lent th 5.1p.:'..Total leaching area
Seepage )>yTt7 L. Diameter 241 Depth below inlet.. 38.s Total leaching area.B.B.
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by Date.
Test Pit No. 1 minutes per rock.fAoatiteliS tleg-.-6-ES&to ground,'
Test Pit No. 2.1....0 minutes per inch Depth of Test Pit 4.t.p1L. Depth to ground
7).4"
Si.At1 ft.
sq. ft.
Description of Soil
9" GTE,. 2' 0" ailtg...sa tad,..-4-!3--"..-.usrg.-f-ine..g.
clay (oxide Y ( ak...3...Q"..)
Nature of Repairs or Alterations—Answer when applicable
Agreement: //,n.. r
The undersigned agrees to install the aforedescribed Individual Sewage Disposal Sys m attor nce 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
WILLWM SF,
B[A"" G.
ttelld---N
tersTF%ii
Application Approved By
Application Disapproved for the following reasons:
Date
Permit No
Date
Date
Issued.
Date
LOT z4
VorE % 9770 „) OF /Ellcf//4Ep
TO RE 4o " ✓E
,U/bF/ 6R0c/4/D Gu4TCR
F/LL /F A/ECESS4,ey
LOT Z3
LOT '.Z4
L SFPnc
O'5TC BOX
WO ZFACH
Dew
4T/OA/
/D'MiA/
78.76'
FLORE/VCE Ro4,o
PLAN OP i 2 OSED WAGE DISPOSAL SYSTEM
fir LOT 25 ) NORTYAMPTOA/, MISS.
PREP4RED POP
5RE4D COLLINS
ALMER HUNTLEY,JR. a ASSOCIATES, INC.
REGISTERED LAND SURVEYORS • CIVIL ENGINEERS
125 PLEASANT STREET
NORTHAMPTON , MASS.
DRAWN: R/313 SCALE
DATE : 6/Z7/75
/A 401
NOTE:
ALL WORK
TO OE DONE IN
ACCORDANCE WITH
STATE SANITARY
CODE ART YI