181 Disposal System Permit & Application No._"it
FORM 1A - APPLICATION FOR DSCP
COMMONWEALTH OF MASSACHUSETTS
Board of Health, Northampton ,MA
Fee 1,z
deeA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to: Construct 2 Repair ❑ Upgrade❑Abandon ❑
2 Complete System ❑Individual Components -
Location 1?gWesthampton Road
r
Map/Parceik 36-087,43-005,43-006,43-075
Address 25 Main Street,Suite 445,Northampton
Lot e 3
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' ,1 RdifIILe/IL�YMIJ
Installers Name Sovereign Builders.Inc.
ail!IMF
,-M
Address 135 Southampton Road,Westh.
(Stoll
^'d Urea s 57 Munn Road.Monson,MA 01057
Telephonek 4}j=5t -8 44
Telephone* 413-267-3696
Type of Building:single family dwelling
Dwelling-No. of Bedrooms -3-
Other-Type of Building
No. of persons Showers 0, Cateteria()
Other Fixtures
Lot Size 30,195 sq.ft.
Garbage grinder yes
Design Flow (min. required) 495 gpd Calculated design flow 495 gpd
Design flow provided 525 gpd
Plan: Date Jan. 3, 2003 Number of sheets 3 Revision Date
Title On-Site Sewage Disposal System, Lot#2, #169 Westhampton Road
no ❑
Description of Soil(s)0-4"=A=SL, 4+-24"=B=SL, 24"-76"=C=SL,
Soil Evaluator Form No. Name of Soil Evaluator Timothy E. Maginnis
Date of Soil Evaluation October 24, 2001
DESCRIPTION OF REPAIRS OR
ALTERATIONS
The undersigne
with the prov
of Complianc p.
Signed
Inspections
Individual Sewage Disposal System in accordance
agrees not to place the system in operation until a Certificate
Board of Health.
Date /21111-0- JZ, zoo
DEP APPROVED FORM 5/96
in copy
No. V 65/
FORM 2A - DSCP
Fee 12'd0
COMMONWEALTH OF MASSACHUSETTS ' e(`7
Board of Health,Northampton MA. 609
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to: Construct El Repair❑ Upgrade❑ Abandon Dan individual
sewage disposal system at Westhampton Road 6%3144/
as described m the application for Disposal System Construction Permit No. 2106 V-D5
dated
Provided: Construction shall be completed within three years of the date of this permit.All local
conditions must be met.
Date/VMd/4 Board of Health
DEP APPROVED FORM 5(96
ERNEST 1. MATHIEU. R.S., M.S., C.H.O.
DIRECTOR OF HEALTH