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THE COMMONWEALTH OF MASSACHUSETTS ,'I'\'~\\\ OF 'I.""~" BOARD OF HEALTH ,,"~<..~ . . ~~.)j>~;'"

Town ...... oFAmAerscf ............ /!;- . F.;,iW \\

('/~-{3 No .... Q.: ...... _ .......

. ~~ / ~~~~~'. , ~~ Appliratinn fnr mi.spn.sal lllifnrk.s OInu.s1rudinnJ ~ ' . 6889" R.S. . ~}

Application is hereby made for a Permit to Construct ( ...,....-or Repa!r ( ) an Ind1V1d~ S age Dispo ,~ S tern t ""... ,," ys a : ,,~ * ., .. <l.3 .... Ela.LlidL$. ... ..l?£JI2.d.............................. .. .................... _ ........... L ............................. >~!."..! ...... J ••• ~~"" .... .i3.1a..I:L_ .. t)/h.dlt;,,~;;,,~~:.~':................................... .Z~.z ... t!(4/J. .n:s./;;:;?~.I.7A ... AP.1.iz.e.r..n_ ... U .. ........ W.~*'-..... (.\~,:;.l~.................................... ...r.~... : ..... d~:t ... ~~~ ...... .

bstaller Address 2' y~ l Type of Building Size LOLL .... , ................ Sq. feet

Dwelling - No. of Bedrooms ............ ~ ............................. Expansion Attic ( ) Garbage Grinder (--T k., Other - Type of Building ............................ No. of persons ............................ Showers ( ) - Cafeteria ( )

Other fixtures ....................................................................................... ............................................................. . Design Flow ................. S£ ................. .. gallons per person per day. Total daily flow ....... ....... ~.;';l.C! .................... gallons. Septic Tank - Liquid capacity/Qt?O .. gallons ~ength ................ \Vidth········ r ······ Diameter. ........... ... Depth ................ ~ do Disposal ~ - ~o ........ 2. ........ Width ..... e ............ Total Length ...... ,.a ........ Total leaching area ...... ;;~ .... sq. ft. 1;1,,11"';;.. Seepage Pit :-.10 .......•............. Diameter .................... Depth below inlet .................... Total leaching area. .... ............. sq. ft. Other Distribution box ( vf Dosing tank ( ) . / Percolation Test Results Performed by ...... JTu/t!.Uc.f ...... 5.:IL'o..$.r ................ Date . .l!.e.c. .... ?" . ..1.1..~:~ .... .

Test Pit No. 1.?,.3.3 ... minutes per inch Depth of Test Pit ........ .? ........ Depth to ground water ..... itJ1.Y.1.~ ... . Test Pit No. 2 ................ minutes per inch Depth of Test Pi!.. ..... ............. Depth to ground water ....................... .

Description of SOil ...... 01d.i?:;i,:~::::::::::4:ori::::ir;T::~::ii::::~~:'fiii~::::: ................................................ : .. ::: -........................ - ........ ................................................................................. .............................. ..... ... .. ....................................... ---.-..

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 :'ITLE 5 of the State SJ.ni tary Code - The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be . ue by the board of hea tho

1;;:hf.(".~<= ...... R\. . .... : .... ::: .. ::::::::::::::::::::::::: ............... ":::: ... ij/4!1:c..~:::: Application Disapproved for the following reasons: ................................................. .. ................................................. .......... ..

................ ~:=;: .. ~~:::::.:??.~::;.::j"'5..::.::::.:: .... ::::::::: ................................... ~=:= ......... :.·.·.·.·1..Ii1ii..·.~·.~· .. ~.~:~::.·.·:: ... ·· .. .. Date

THE COMMONWEALTH OF MASSACHUSETTS

BOARD OF HEALTH

.................... ............ .... ... .. OF

OIrrtifiratr nf OInmplianrr THIS [5 TO CERTIFY, That the Ind;vidual Sewage Disposal System constructed ( ) or Repaired ( )

by ..................................................................................................... .. ............................................................................................ . in staller

at ...................................................................................... .............................................................................................................. . has been installed in accordance with the provisions of Tl '7 IE 5 of The State Sanitary Code as uescriued in the appl ication for Di~posal Vv70rks Construction Permit No.. ... .... .. ..... ........ ................. dated ..... ...... ........ ... ....... ................. .

THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY.

DA TE............................................ .................................... Inspector ................................................................................... .

- - - -- ._ -- ----THE COMMONWEALTH OF MASSACHUSETTS

~.s--/3 No.2}_~ __ ............ _ .. _

BOARD ..f>F HEALTH

...... ~,,c/A) ..... ... OF ... .... jf1!J.I."-~s...C. ..... ... ... . ~ FEE .. ~ ........... .

iJinpnnal Imfnrkn ~Ptt~~inn Jrrmit Permission is hereby granted .. . ~~W.Ll1i<f1r'-. .. :::: ....... W . .w..: ....... ~I:t!!..<. .................................................................. .

~~ ~~~s.tr·l1J.::::J~:·~/~~ .. ~~ .. F~·;~·~·i~~;;t~: .. g~.s.~steII1 ......... ..... u ................... 'l .... ~. "'d" ............... . St,,~t ~rf....3.. .. D,!:t (l)-!

as shown on the aRPlicayon~r Disposal Works constru~ti.~.n ... ~.e~=~~.Ql~~:.: .• :h: ..... ~: ..... ~.:::::::: ....... ~. DA TE. ......... Jit.I.lI!.~................... .... . . .. .... .. . ..... . .... llwd of H .. h

FORM 1255 HOBBS 8c WARREN . INC .. ~UBLISHERS

•

-_ .. - -- ""-_. _- _ .. _--

.~ .-. BOARD OF HEALTH

10WN OF AMHERST ,11AssAcimSETTS

. kiJf'/tu.s A,?otrD .. : Important Information Regarding Your ' Pri~ate Sewage Disposal System,

DISPLAY THfs DoCUMENT IN A PROMINENT. PLACE

Owner- BL..41~ . tv l~ ,

Instal l~r W. W' QLA12-K

Address ,J; 7 l/arf7l(RJn;va- KD Ad.dress ' PeA-7T 0~6~.l<{) Stw~~

Date Installation Inspected and Approved __ · ~7t...L/..:::3'-'()-'/'c..>fL& ___ _

Description of sy~'tem: tankcap~city: ,ISo(] / So (jJ S'tD~ , ' . ' lJ

Leach Field OC) Bed ( ) Seepage Pit ( ). Square Feet: ' ,2;,.(" 807JO"1

Garbage ~rintjerYes ,( > - 'HO(j(> . No. Bedrooms: ,~N~,~ People --£ , 3 ~" , .

~ As ,- BUILl: PLAN: ; , , , , u. , ,oq "

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PROP NCE OF YOUR PRIYATE SEWAGE DISPOSAL SYSTEM

1. This system must be ,inspected periodically and the tank pumped out at an Interval not to exceed years. ,

2. ,For your protection sanitary pumpers ·are ·licensed by the Amherst Board of Health.

, . ,

3 • . Regular pumping is crucial to avoid early failure and costly repairs 'of , the system.

4. DO NOT dispose into the system sucli Hems as rags, string, sonitary napk~ns, coffee grounds as they can cause it to clog' and fait •

. , 5. Further information can be obtained by 'contacting your Health Department at 253·7077. '

•

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,''''~ \-\.\\: O\._l,f4.r':'" -r-:. BOARD AO~ H~AL TH . l;/"/ A //i0f;-=::.

THE COMMONWEALTH OF MASSACHUSETTS

ApPliraful:, ~:~~;~~~'"~:;~~ Or~~;;~~;';~-pM~) ~) Application is hereby made for a Permit to Construct ( ~or Repair ( ) an Individu.'t!, S<!\i(age Disp~ /

SysteDl at: '''''1 ~-- -.1. .... , ..

_ .......... Ela.L..If.dfs. ... ..!"'?nf2.d ................... _._.. .. ................................. L ...... _ ................... ::~~~" ... :f.~,~~~~ .•. ... ..I3Ja..lL .... l!lh.Jb:';.~;;t:.~:: .............................. _.. ..Z.:?.z . ..ftca/£~.t:s.I;:;::,~.I.7£CAbJ.h.u.~z.. .. U«

Owner Address

Ins:.allcr AddrC'ss 2C 'i~ Z Type of B~i1ding . '3 . . . . . Size Lot .. .'.. .... , ................ Sq. feet

Dwelhng - No. of Bedrooms ............................................ ExpanSlOn AttIc ( ) Garbage Grinder (--t-k • Other - Type of Building ............................ No. of persons.......................... .. Showers ( ) - Cafeteria ( )

Other fixtures ..................................................................................................................................................... . Design Flow ................. S5.: ................... gallons per person per day. Total daily flow .............. ~.~." .................... gaIlons. Septic Tank ----:- Liquid · capacity/ltOo. .. gallons ~ength ................ Width ........ , ... ... Diameter ................ Depth................ Ii. Disposal ~ - No ........ 2.. ........ Width ..... e. ............ Total Length ...... '.O ........ Total leaching area. ..... /i:f-.... sq. ft. ?c-;: Seepage Pit No ..................... Diameter.. .................. Depth below inlet .................... Total leaching area .................. sq.·it. Other Distribution box ( v) Dosing tank ( ) • Percolation Test Results Performed by ...... £r:uit!.Uc.!;. ...... G.:£.'a.$.r ................ Date . .:D..f:.!:. .... ?"...lf.-!1..~ .. .

Test Pit No. 1.?'.,.3.?.minutes per inch Depth of Test Pit ........ 7. ........ Depth to ground water ..... ;.'1:<':Y.l.~ ... . Test Pit No. 2 ................ minutes per inch Depth of Test Pi!... ................. Depth to ground water .. ..................... .

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 ':'ITLE 5 of the State Sanitary Code - The undersigned further agrees not to place the system in

operation until a Certificate of Complia::~~:.::~_ ...... _.......... . .................... _ ....... ..

Da.te

Application Approved By ................................................................................................ .. Date

Application Disapproved for the following reasons: ........................................................................................................ _ .... ..

D,te

Permit No ................................. _ ... _ ..... __ Issued. ....... _ ......................... __ .. _ .. _ D.te

THE COMMONWEALTH OF MASSACHUSETTS

BOARD OF HEALTH

......................... ....... .. ........ OF ...

C!rrrtifirut2 uf <!!untpliun.rr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )

by ............................................................................... _ ................................. _ ......................... _ ...... __ .............. _ .. _ .... _ ...... .. lnsu.ller.

aL ................................................................. _ ............................................................................................................... _ .............. . has been inst:llled in accordance with the provisions of T':T r..::: 5 of The State Saninry Code as described in the application for Di5po5.1.1 \Vorks Constr~C'tion Permit ~o .................................... _.... dated ... ............................................. .

THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY.

DA TE ............................................................................... . Inspector ................................................................................... .

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DEEP SOIL LOGS

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SPECIFICATloNS~

ALL MATERIPo.LS AND C.ONSTR\JC.I\ON WILL

BE IN ,b.,c:.c..OP-DANC.£ WITH THE. COMM . of

MA.s.s. D.E. Q.E.. STAI£. E.NVIRoNME.NTAL

CODE. TITLE 5.

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DET~I L SHOWING PL1\N OF SEWAGE DISPOS~L

FOR: BLA.IR • W~ ITHAtv\

22. 7 HE.t>.T\-\'C.?.SiOt-iE

A.M\-\E.RST, MASS.

LOT I FLA. T HI LL5. RD.

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MARCH I C\ g 5

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