395 Title 5 Application/Permits 1983 -8..3 FEP2 s:Cv
A`MI 1 1/111 BOARD OF HEALTH
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THE COMMONWEALTH OF MASSACHUSETTS
VHERE APPLICABLE
CHECK OR FILL IN
ty OF Northampton_
ppliratinn fur lithium' Murky Cnnstrurtiun lirrmit
Application is hereby made for a Permit to Construct (x ) or Repair ( ) an Individual Sewage Disposal
System at:q [A
yC.._ North Farms Road s LOL.A..._.f vu°° ��i /
FredL?ack laress rt 37 7gqg22ty
or bit No
Installer
Type of Building
Dwelling—No. of Bedrooms 4 Expansion Attic
Other—Type of Building No of persons
Othe xtures
Design Flow bh St gallons per person per day. Total daily flow 440 gallons.
Septic Tank—Liquid capacity 1500 gallons Length Width Diameter Depth
Disposal Trench—Np. Width Total Length Total leaching area sq. ft.
Seepage Pit No L Diameter Depth below inlet 2.25 Total leaching Nita- sq. ft.
Other Distribution box ( ) Dosing_tank ( ) Capacity-721 GPD
RPB Huntley Assoc. 5-18-83
Percolation Test Results Performed by y� Date
"
Test Pit No. I '8 minutes per inch Depth of Test Pit 9 6 Depth to ground water
Test Pit No. 2 Z' minutes per inch Depth of Test Pit 4 6 Depth to ground water
Descri tono Soil .,...1 '-0"-OTS 9" silt, 2`-9" fine sand, 5 '-0" varied V.F. sand
and silt, 9 -6" deep No groundwater
Ad ess
Address
Size Lot Sq. feet
Garbage Grinder (X )
Showers ( ) — Cafeteria ( )
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 TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance s bee
Application Approved By
ue0/73
40 a r3
Application Disapproved for the following reasons•
Permit No
.2O —S3
Issued
finjitite
THE COMMONWEALTH OF MASSACHUSETTS
qBOARD OF H LTH
/Y.�
OF rtifitttte of Qlamplitt re
THIS IS Terri 2JTIjY, T thq IWiVid al Sex:nge Disposal System constructed (paired ( )
at �fL(1• tit ,taller i / _
has been installed in accordance with the provisions of TJTJn 5 of The State Sanitary Code as des r�? in the
application for Disposal Works Construction Permit No .2.0-�'3 dated Lo� �'1 r
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR D AS UA ANTE A THE
SYSTEM WILL FUN�CyT�OyN T SFACTORY. �e
DATE y:7(77 Inspector
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF H
OF ran Permit
flispnnttl i_Dritn,
Permission is hereby
�ogranted
to Construct ( ) or ?eogir.f ) arylpidB tytid�taY S
at No
�{/ �N
as shown on the application for Disposal Works Construction Pe
164 � r
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f - VA/min 1?rsFw+Al
DATE ivyr3
FORM 1255 HOBBS a WARREN. INC.. PUBLISHERS
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Board of Heath