517 Applcations & Permits COMMONWEALTH EALT11 OF MASSACHUSETTS
Board of Health.lot-hoM?7 iU . MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRU
rplication for a Permit o Construct( Repair O O
) Upgrade( - Com p lete S
Owner's Name Lou,C 7 CY
Fneaenn.S?9 tu?.fri-/Amp7oA) S?oA)
Map/Pan el#
Lot#
Installer's Namegde e_ A cA✓ATio6
Addrrs /y6 Mae ley c hithLty /y✓fl
Telephone# Sy lf{fY
ype of Building D:=liM/.U,1)6
(welling-No of Bedrooms
)they-Type of Building
*tiler Fixtures
)-sign Flow (min.required)
'Ian: Date MhhZ I D 3p
fide'll(,. t
)escription of Soils)
;;oil EvaluaU)r Form No.
FE1. 1-57
frtv Com- 136,00‘
es
()N P111T1IT
em O Individual Components
AddressS39 fbs rn.4Nf»2AJ R' , NoErMMP7ofJl
Telephone# SAg6 /Rlo
Designers Name L SHUH A, ) ASSOC die-
Address/Y6 740-0e sr apwar ✓YEA
Telephone# % (7- V28
Lot Size 3Y 992 rq.ft
Garbage grinder
No.of persons Showers( I.Cafelcda ( )
/ID
gpd calculated design flow 340
Number of sheets 2
Design foss pros ided a-sa,c9 gpd
Recision Dale
Name of Soil Evahmtor/CFCNffHAA)L Dat
DESCRIPTION OF REPAIRS OR ALTERATIONS COIi
tina
MNIWati
TL E 5 and
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisto
further a -es to not to place the system in operation until a Certificate of Compliance has been issued by the Board of Heal
a
Signed
. e Date A122/0J
,� . �-
Inspect ns
3� a2
COMMONWEALTH/F AL'LTT OT MASSACHUSETTS
Board of Health, AhtTHrma Thr3 MA.
CFTlTl1ICATE OF COYTPL1ANCF
escription of Work: 7 Individual Component(s) Complete System
he Jundersigned hereby certify that the Sewage Disposal System: C ynimu red ( ), Repaired IjQ.Upgraded ( Abandoned (
c: RRud(E. %XCAUAT,FIG
9 IA,[ < tlFltae■ r F'p
as been installed in accordance with the i s rf 310 CMR 15.00 (Ill 5) an the a roved design plan /a.huih plans rt anug to
opl ion No. .3�"0 , dated wen 0-3. Approved Design Flow a 3 (gpd)
1staller
FFF /f//�
he issuance of this permit shall not be construed as a guarantee that the system
unction
Date:
designed.
/0 - 5 —O
FL!]
S
C O 1\lON1\[L\LTTI or MASSACIIUSLfTS
Board of Health. Apr lAt 1,/74 A MA
DISPOSAL SYSTF?1 CDNSI/PU 'I1OIN P1IP 11T
'ermission is hereby granted to; Construct(r Repair(,l!/) Upgrade( ) Abandon( ) an indi vidu al sewage disposal system
t SS? co( Jr IAni. Ind) GCDAi% as described in the application for
)isposal System Con strnction Permit No. . ( 3 .dated C%��)l
'rovided: Construction shall he completed within three years of the daft of this pgrntje All It con di tionrur
s) st be met
/ .
41 I (ual
r.r 1255 Rev 5'96 AM.Sulk n Ca.Boman.MA Date ! /G Z Board of Health
SIIIIIIMININSIIINOSSIMISMOIMPIISSIIr-
No THE COMMONWEALTH OF MASSACHUSETTS FE.
may-- BOARD OF HEALTH
V OWE OF Oc-- 0,,u t •
Application for +Disposal #'gstem (gonstrurtion V gr p ltosal System at:Application is hereby made for a Permit to Install ( ) or Repair/Replace (X)
t I r irirv .�
t...a A hlroNs C^/G 4lesr
AA - ys Adda.s
—s oemg��e[.,r i,1.wuer UO 7 '..8_=1--Sq.feet Address
Size Lot
Type of Building -r� Garbage Grinder (�
No.of Bedrooms 3 Expansion Attic ( ) Cafeteria ( )
Dwelling— , No.of persons�-- Showers ( )-
Othar—Type Mixtures
Other fixtures ?3� gallons.
S-�-� gallons per person per day.Calculated daily Flow —Depth t
Design Pnwer t' Width Diameter p --
Dispo Disposal r n Liquid capacity ___ gallons Length—_Total Length— Total leaching area sq.ft.
Disposal Trench—No. Width t S'" Total leaching area !9__—`q.ft.
Diameter �a_X_a�_Depth below inlet / )
Seepage sabot Dosing tank ( ) ?/a$'�9'j
Other Distribution box ( ) vi , y�efrlwl�- Date --
Percolation Test Results performed by Ih y ,r - -/a? z
Test Pit No. I _minutes per inch Depth of est Pit �y�, ��tr Depth to ground water
Depth of Test Pit .J i.• 2O
Test Pit No.2�—^Ti^°�� _
Description of Soil_ - 4 • --�
.0**-, v
n ,_. < • .
Nature of Repairs or Alterations—Answer when applicable C
Date Last Inspected f at
Agreement—The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the
provisions of TITLE 5 of the State Environmental Code.The undersigned further agrees not to place the system in in op
until a Certificate of Compliance has en issued by the Board of Health.
Sign- /�— -ti g��
n- - .. __i �
Application Approved By
air
Application Disapproved for the following;aasons:
oa(.
Issued
'T_____ ow
Permit No.
THE CO ONWE'LTH OF MASSACHUSETTS
I'I • 4/4W —tirOARD OF HEALTH
02,ertifiate of(inmptinnre or R�Paired/Replaced
THIS IS TO C T {FY, at the On-Site Sewage Disposal System ( ))%%
@ by. Trl�a a
on IsN�y�oY at .
for I1N1�°1�� The
has been constructed in accordance with the provisions of TITLE of S�tT e Environmental Poderas described in the
application for Disposal System Construction Permit No.
Use of this system is conditioned on compliance with the provisions set forth below:
I
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT RE CONSTRUEQ . S A GUARANTEE THAT THE
��
SYSTEM WILL FUNCTION AS DESIGNED. This Certificate expires on
1� D
,--/� tiwt Inspector .%_.,.. "" v {� L� -
1§ /
PE r
1 . _ ��� TH ( BOF MASSACHUSETTS
/ // ARD
OF HEALTH
f isyn,, ,1 '.otem (fatotru Linn Permit
Permission is hereby granted to % 4 (T'
L. •
l to Construct ( ) or Repaid' 'place ( ) anon-Sity ewage Disposal System located at
): 0 - t / �C sv..1 .
-
as described on the application[or DLSposal System Construction Permit.The Applicant recognizes his/her duty to comply
I with Title 5 and the following 1. II (C----ons(AA r special condition../ t cr t a
All construction must be completed within three years of the date below.
.ynud of HuaIIM1
DATE A
FORM1255 (REV 4/95) HSW HOBBBSWWRENTR PUBLISHERS BOSTON
\ THIS FORM APPROVED BY THE MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION -- —
No. 6- 03
THE COMMONWEALTH OF MASSACHUSETTS.
NORTHAMPTON ,MASSACHUSETTS
Application for Disposal System Construction Permit
FES S75
lication is hereby made for a Permit to Constmd(R)or Repair( )an On-site Sewage Disposal System at:
Location p ss m fat.No.
�f
LOT a
W ESTHAMPTON ROAD
NORTHAMPTON,MA 01060
Owner's Name,Address and Tel.No.
JOHN COOPER
47 STONERIDOE DRIVE
FLORENCE,MA 01062
HOME:(413)585-0545
4 1)
te - p5� 111
4
Designer's Namg Address and
HUNTLE ASALDRIVE SEASTI.No.(413)584-7444
30 NORTHAMPTON,MA 01061
Type of D(Slding:Dwelling
Dwelling No.of Bedrooms 3
Other Type of Building
Other Fixtures p
inar
Design Flow d y%5� gallons per day. Calculated daily flow 330 gallons.
Plan Date 3/18/03 Number of sheets 2 Revision Date
Garbage Grinder( )NO
No.of Persons
Showers( ) Cafeteria( )
Title Sewage Disposal System-526 Westhampton Road,Northampton MA-Prepared for John Cooper
Descdpdon of Soli Sandy Loam
Nature of Repairs or Alterations(Answer when applicable) New 1500 Gal.Septic Tank D-Box and 825 S.F.of Leaching Bed.
Date last inspected.
Agreement:
The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-site sewage disposal system in accordance
with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by
this Board of Health.
Signed Date
Application Approved by Date
Application Disapproved for the following reasons
Permit No.
Date Issued
THE COQ MONWEALTH OF MASSACHUSETTS
pp /
is ten nfl
Certific to of Compliance
,MASSACHUSETTS
THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed(or repaired/replaced( )on
by for
at has been constructed
in accordance with the provisions of Title 5 and for the Disposal System Construction Permit No. dated
Use of system is conditioned on compliance with the provisions set forth below.
The issuance of this certificate shall not be construed as a guarantee that the system will function designed. This Certificate
expires on
DATE Jesfiifilh&KJ ZI -3
Inspector
Jo/3
No. 6-425
licati
FEE S75
THE COMMONWEALTH OF MASSACHUSETTS
NORTHAMPTON ,MASSACHUSETTS
Application for Disposal System Construction Permit
hereby made for a Permit to Construct(X)or Repair( )an On-site Sewage Disposal System at:
Location Address or lac No.
LOT 526
LOT 526 MPTON ROAD
MA01060
Owner's Name,Address and Tel.No.
JOHN COOPER
47 STONERIDGE DRIVE
FLORENCE,MA
HOME.(413)585-0545
Designer's Name,Address and Tel.No.(413)584-7444
HUNTLEY ASSOCIATES,P.C.
30 INDUSTRIAL DRIVE EAST
NORTHAMPTON,MA 01061
Type of Banding:Dwelling
Dwelling No.of Bedrooms 3
Other Type of Building
Garb ge Grinder( )NO
No.of Persons
Showers( ) Cafeteria( )
Other Fixtures
Design Flow d36- 4f 5 gallons per day. Calculated daily flow 330 gallons.
Plan Date 3118103 Number of sheen 2 Revision Date
Title Sewage Disposal System-526 Westhampton Road,Northampton,MA-Prepared for John Cooper
Description of Soil Sandy Loam
Nature of Repairs or Alterations(Answer when applicable) New 1500 Gal.Septic Tank,D-Box and 825 S.F.of Leaching Bed.
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-site sewage disposal system in accordance
with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by
this Board of Health
Date
Application Approved by
Application Disapproved for the following reasons
Date
Permit No.
Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replaced( )on
by for
at has been constructed
in accordance with the provisions of Title 5 and for the Disposal System Construction Permit No. dated
Use of system is conditioned on compliance with the provisions set forth below:
The issuance of this certificate shall not be construed as a guarantee that the syete
expires on
DATE. Inspector
ed. This Cenificale °9)
THE COMMONWEALTH OF MASSACHUSETTS
No. 6-03 NORTHAMPTON ,MASSACHUSETTS
�icnnc,I Cucfs m
rnnctr,rflnn i vs 1..1
Permission is hereby granted to John Cooper
to construct(x)or repair( )an Onsite Sewage Syy '.Swesthammon Road
FEE 575
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes that his/her duty to comply with Title 5
and the following local provisions or special conditions.
All construction must be completed within three years of the date below.
DATE ---)114A-t--4 / / 3
Approved by
\ThNTLEY1 t AMrN\PROJ l N FO\PROJECTS\ea\ml\SewagePernii t-COOPER.Mc
�a ,
FORM 1255