Misc. Lots Applications & Permits FEE
COMMONWEALTH OF MASSACHUSETTS
Board of He bh, /__Ha4441A.
CATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
inn
p/Parcel
#
tore
roller's Name ce/( ( --
dress
lephone#
of Building
[ling-No.of Bedroom
_r-Type of Building
i
•
.ac/tes
t re-e .-r✓
AO 11GVm 7
JLr - i'd ) 7 �/tJ
Onnrer's Name/77, .eotO re/20
Gite997Ynr[`/ �ipii .
Address
Telephone
Designer's Name
Address
Ezmissi
No.of
/09
er Rxtures
060
d) 5L,('//d ,Y/'�pd Calculated design flow
gn Flow (min.required)
2 H4%i
t: Date S6 8 /99% Number of sheets
to e / / N pot , - o1O77
cripdon of Soil(s) �QP �J",�/lG/Y.// Dare of Evaluation
Evaluator Form No. � Name of Soil Evaluator dose G
/(o
//Ql4 d
Lot Si
•
L
d
tS /Q /7/'J
pp Garbage grinder(yCg
persons CJ Showers&,Cafeteria (yt)6
re A ' y0 A/5 OS.dL-
_ Design flow provided gpd
Rlsisiou Dar
. .' avr O e esiedat1/n J
SCALP PION OF REPAIRS OR ALTERATIONS
Veld 5-0 Ire
to undersigned age
rther agrees to no
gncd
described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
o err anon until a Certificate of Co Lance been issued by the Board of Health.
�•✓ Date Z"S
uspeCtiOns
f c77
COMMONWEALTH OF 1ASSAIIIIUSETTS
Board of Health, /n(46
CERTIFICATE OE COIN, PLli\NCE
ription of Work: ❑Individual Component(s) Rennplete System O,Upgraded O•Abandoned ( )
undersigned hereby certify that the Sewage Disposal System; Constructed (L Kepat'red
FEE
Cat 17 Se,r',}y
ee
e
d with the provisions of 31 O CMR 15.00 (Title 5) and the approved design plans/as-built plans rel
been installed}t acuu anca. wr k Approved Design Flow y�>—(gpd)
ll erion No. ✓ dated
igner:
�* • SIP YOTef Inspector: J . /c r 1 Date:
•
issuance of this permit shall not be conseued as a guarantee that the system will function as designed.
34,-12
tn
p' d Board of Health, �CY'f(I(i,W,l] MA.
ea 8 } 'DISPOSAL SYSTEM CONSTRUCTION PERMIT
En O a
�i ' isherebv gra e o' Cu struct( epair( ) U radel ) Abandon( ) an individual ewdgedisposa(system
- eft? /�/{ I ,r-.}N C /I). PA)l e 11/j/p as described in the application for
'Sn77 G j("- / -7 dated s/a7 ..7 ,.
COMMONWEALTII OF MASSACHUSETTS
ing to
FEE sir ra
w
sits$1f'stem Construction Permit No.
pli Construction shall be completed within three years of the date of-this perq)it. Ail oc�.11cconr, must be met.
..a qq / I//�
a He 3 5.421 7Board of Health
1255 Hey 5/96 AM1LSuIkIn Co Boston MA Date
y- ,a-TY
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
City OF
Northampton
14ppliratinu for Uispnnat iflnrks Cnnnntrurtinn j rrutit
Application is hereby made for a Permit to Construct ( X) or Repair ( ) an Individual Sewage Disposal
ystem at: Lot 11 L
Audubon Road wt
Bug Hill Road, Ashf reld
Location-Address
Robert-.itilson
�.addre. 1.09 AC
rozmn� Size t -Sq,=feet
Cype of Buil g Expansion Attic ( ) Garbage Grinder (x )
Dwelling—No. of Bedrooms a Showers ( ) — Cafeteria ( )
Other—'Type of Building
No. of persons
Other fixtures 330 gallons
Design Flow 55 gallons per person per day. Total daily flow Depth
Width Diameter
Disposal Tank—Liyvid capacity_150D_gallons Length Total leaching area s . ft.
Width Tons Length..3.B.,
Disposal Trench-No. Total leaching swamity=69s RED
Diameter_ Depth below inlet
Other Distribution No 1 Dosing tank ( )
Other Distribution box ( ) g Date
Percolation Test Results Performed by_—G_epth of Pit .ASSOn Depth to ground water
Test Pit No. l..__1..6Zminutes per inch Depth of Test Pit Depth to ground water
Test Pit No. 2._.._1..QQminutes per inch Depth of Test Pit Depth g
Description of Soil 10" OIL.-1.14°...silty..saint,..31" sand..andgnavel...with...cabbie
No ground water
5-27-76
Nature of Repairs or Alterations—Answer when applicable
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System
the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to
operation until a Certificate of Compliance has bee issued the%board health.
Application Approved By
Application Disapproved for the following reasons'
S
in accordance with
place the system in
Permit No
a
Issued.
Date
by
Lot o t At# ¢vN R4AO
at d A�t7��
has been installed in accordance with the provisions of TIT UT State Sanitary Code as de� ribed in the
application for Disposal Works Construction Permit No
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU 5 A GUARANTE THAT THE
SYSTEM WILL FUNCTION. SATISFACTORY. �i° ,/y
DATE jr�Z/ t9 Inspecto .. /
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
crri or__NOtryninproi✓
h ntifiratr of Tontolianrr
h Individual Sewage Disposal System constructed (`{or Repaired THIS IS 1Q CERT
AytnaNDYGRR�' e /1SyH>=a0
THE COMMONWEALTH OF MASSACHUSETTS
BOARD��//OF EALTH/
OF 1t4i. .fF^�r. D'�t._ . ... ._.. .
��ton rrmit
Bis}�nsttl 3rk:i o�os--�,a--I �
Permission is hereby granted
to Construct ( " raepy i) an
ivi age Dis ystem
at
at No slay
as shown on the application for Disposal Works Construction Permit No
DATE
FORM 1255 HOBS g WARREN. INC.. PUBLISHERS
Bo LCoi Health
HJNIL
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
City
Y ..,
anon fur flispailat i' arkn Tnnntrnrtinn j rrmit
Application is hereby made for a Permit to Construct ( X) or Repair '(( (,/)) an Individual Sewageef Disposal
system at: Lot #1 " 1,( k dl /
Jackson Subdivision or Wt No.
Location-Address 41 Park Roadt Sunderland
Jim Williams , y )
OF Northampton
Type of Build ng
Dwelling—No. of Bedrooms
Other—Type of Building
Others fixtures
Design Flow gallons per person per day. Total daily
1500 gallons Length Width 60
Septic Tank—Liquid capicity Width 3 Length
Length
Disposal age Pit No No. Diameter Depth below inlet
Other Distribution No Dosing tank ( )
Other ation Test box ( ) DT Huntley Assoc.
Percolation Test Result�y 6 mnutesmedr inch Depth of Test Pit
Test Pit No. 1 p
Test Pit No. 2 minutes per inch Depth of Test Pit
A r
- DSize Ls 8.354 Ac gnat
Size Lot g
3 Expansion Attic ( ) Garbage Grinder (X )
p
No. of persons Showers ( ) — Cafeteria ( )
Description of Soil
_.._at._4.:.Q"
flow
Diameter -
Depth
eht
Total leaching 2i p----Y
Total leaching area
330
gallons
Date
Depth to ground wate
Depth to ground wate
3-10-81
Qt
GPI)
6"YiTS 1'D" silt, 8r6° sandy till with boulders, groundwater
Nature of Repairs or Alterations—Answer when applicable
Agreement:
The undersigned agrees to install
the provisions of TITLE 5
of the State
operation until a Certificate of Complia
Application Approved By
the aforedescribed Individual Sewage Disposal System in accordance with
Sanitary Code—The undersigned further agrees not to place the system in
has been issued by the board of Ith
C // '^"�
Li-
4Pthfic
Application Disapproved for the following reasons'
Permit No / — S
Issued_ J . rr
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
CITYor..N.ORTHAM.PTON .
hTertiftrate of Otumptntnte or Re aired ( )
THIS IS T9 CER I T he Individual Sewage Disposal System constructed / ,r P
by Se'
at 4"r ' il""" ' i y� / f e to Sa ry Code as described the
has been installed Disposal in accords ce Construction the provisions Permit No TITLE f `yp - dated y. '-�-t:-.3.of
appli THonSSDiNCE Works sCoCERTIFI ATE S SHALL L�
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS��J�TEE-THAT HE
SYSTEM WILL FUNCTI N SATISFA?CTTYy
DATE e..1j.! { Inspector
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
CITY NORTHAMPTON FEE a s �
No.._14F�I�
°ispnnnt ranks Qlnnsfrnttinn Permit
Permission is hereby granted....TOAN4.l---.04.“4"0=' c.c '
to Constructs r RRepair ( ) an Indivi ual Sewage Disposal System - /��,,.., /.�. �L
at No / / 4!.:3-4.4-/e..-4 .„%-"'--'v it, rest :'`..°'� _..F. ..(r..y.J..t.�.^f.
p ._. Incr. Dated.._..e� .-dr. _.QS
as shown on the application for Disposal Works Construction Permit -
' � of Health /�
DATE._' 0.�,�.� C. ` �� cy<
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS �'" O
FORM 1 - APPLICATION FOR USCP_-
Fce 75
COMMONWEALTH OF MASSACHUSETTS
Board of Health, Northampton , MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Applkation for a Pemtit to Construct C Repai!()Ronde()Abandon()- Complete System DIndlvMNt Component
Type of Building: Residence
Dwelling-No.of Bedrooms three
Other•Type of Building
Other Fixtures
Dedln Plow(min. required) 330 god Calculated design flow 330gpd none
Design flow provided 360gpd
Pte:Dare 11!77/06 Number of sheet one Amnion Date
To •_ - - • t. s-o�. . e e v: • e.h and Kathlee Maiewski
Deleription of SoiAs)_ Fine sand and gravel. Please see plan for detailed descriptions.
Soil Evaluator Form No. Name of Soil Evalmtor nouglas MaCLeay Dm of
Lot sue 7.487 'es
Garbage grinder( Not! !
No. of persons Showers( ), Cafeteria( )
DESCRIPTION OF REPAIRS OR ALTERATIONS
5 and further agrees to puree the �Iyste ON operation until•Certificate of Compliance a in mesoderm Ms been issued tby the provisions of Health.TITLE the above
Signed Q Pr bail-4"A. Date 3)I Z
bwp.dbae
0 DEP APPROVED FORM
'I
Locrion Audubon 1 ad
Owner's Name Joseph & Kathleen Ma ski
Mep(PsIC{l
Addrel 10Z V el-00A S4. 10a:i}vtwveitbq
Lou 9
Telephone/ 535-1065 or 584-5555 '
Imulle?I Name ryq��LL lsu f
Designer's Now Mac1eay Associates, Inc.
Adam' ?p,1\x g06- 4'V k,tns Sti (.14LC
Address 102 Bridge St, Shelburne Falls
Telephoned 7--{'1-55!04
Telephoned 913-625-9774
Type of Building: Residence
Dwelling-No.of Bedrooms three
Other•Type of Building
Other Fixtures
Dedln Plow(min. required) 330 god Calculated design flow 330gpd none
Design flow provided 360gpd
Pte:Dare 11!77/06 Number of sheet one Amnion Date
To •_ - - • t. s-o�. . e e v: • e.h and Kathlee Maiewski
Deleription of SoiAs)_ Fine sand and gravel. Please see plan for detailed descriptions.
Soil Evaluator Form No. Name of Soil Evalmtor nouglas MaCLeay Dm of
Lot sue 7.487 'es
Garbage grinder( Not! !
No. of persons Showers( ), Cafeteria( )
DESCRIPTION OF REPAIRS OR ALTERATIONS
5 and further agrees to puree the �Iyste ON operation until•Certificate of Compliance a in mesoderm Ms been issued tby the provisions of Health.TITLE the above
Signed Q Pr bail-4"A. Date 3)I Z
bwp.dbae
0 DEP APPROVED FORM
'I
No
FORM I - APPLICATION FOR DSCP
•
COMMONWEALTH OF MASSACHUSETTS
Board of Hcalt, Northampton , MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application fat a Pcmtil m Constmct(N Regal'()Upgrade()Abandon()- Complete System OlndlviduSl Components
Addmsa 8 Hemlock Drive Sunderland
Addma102 Bride St, Shelburne Falls
Type of Building; Residence
Dwelling•No.of Bdsuoms_-. —
Othct•Type of Building,`_—.
Other Fixtures
Design Fbwtmin. required) 330 gpd Calculated
Plant ote i i InJo6 Number Number of cbeeta_pne_
Title
Description of SO(s)
. Soil Evaluator Form No
!rat sae 7.487 gjes
Garbage grinder O NCH I I
No. of persons Showers( ). C•feleria( )
design now 330gd Design now provided 360gpd
Revision Pete none .• e•h and
1 s• •.m• •e u: w
d • avel. Please see plan for detail
Kathle@ Maiewski
ed descriptions.
d De of Evelun 10/02/96
Name of Sell Plaintiff Douglas Maf'T,eay u um
DESCRIPTION OF REPAIRS OR ALTERATIONS
the liw
5 and fusyhe spin not e0 Install
st the above tens N operation •i Certificate oofCu nplle System(
in has accordance
been issued tby the Board of Health.
Date _� 12.1a�
p DEP APPROVED FORM S
No.
I '1
$ B • . n.\•
Fee
COMMONWEALTH OF MASSACHUSETTS
Board of Health, Northampton
CERTIFICATE OF COMPLIANCE . • •
- • Description of Work: ❑Individual Component(s) ID Complete System
The undenigned hereby certify that the Sewage Disposal System,Constmcted W Repaired().Upgraded(1.Abandoned O.•hY: ✓
at
Nu been installed in accordance with the g• i c of 310 CMR 15.00(Tide si sod
Fl we 2D igpd)kn 9linslanWih pbm relating no approved
'application No. - �. dated 3 e
•
'Installer / ' 1 �_. WS./ 'tom
DeaiEnea:Ma Ld5nClatES. ndnspecma_ r '
The Sane.of this pennh shall not be construed as a guarantee that the system will function c dni put'
`. DEPAPPROVELI FOAM 5/96 '^/ _ 1
• (�V` 5/.54,7,•• d •k Fee •
COMMONWEALTH OF MASSACHUSETTS •
Board of Health,_. Northampton . MA. •
' DISPOSAL SYSTEM CONSTRUCTION PERMIT
Comma()o Repaid 1 Upgrade( ) Abandon( ) an individual sewage disposM system
Perminbn is hereby grained or, C Isdescdbed in the spoliation for Disposal
at T t 0 AtadnMn
System Cannrvction Remit No._/ —,� Dated
/24/5
provided:Construction shall be completed within three years of the date of this permit. All local conditions must b t
j/ /cykoAulniHealdt
B LF')AMAOR'y FORM 3I96 fate a� 1