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No. 73-58

BOARD OF HEALTH, AMHERST, MASSACHusms APPLICATION FOR DISPOSAL WORKS CONSTRUCTION

Date May 22, 7973 Fee S3.00 By DGP

Application is hereby made for a permit to Construct System at: Location-A?dress /?!~:/;!;,~ ~/, Owner $"".man ltd kJln

Date Rec'd. 5/22/73

(x.) or Repair ( ) an Individual Sewage Disposal

or Lot No. I 7(,/ I?.E. /)"fI.1 A", her6t-Address

Contractor .. Address Type of BuildingJ;.ci'A I. p,.,.,f / .. ellltj Dimensions .;"1 X.7 C' ' Size Lot 3.3.1 000 ;i:

Dwelling-No. of Bedrooms 2.. Expansion Attic ( ) Garbage Grinder ) 1)0 Other ___________ ~ No. of persons Sho","rs ( ) Other fixtures _______________________________ _ Town Water? tf e S Type of Well ________________ _

Design Flow --SJ2. gallons per person per day. Total daily flow :1.00 gallons Septic Tank-Liquid capacity 1000 gallons Dimensions: IL._-.~_ W ____ D ___ _ Disposal Trench-No. ~ Width 3.0' Total Length ~ 8 Total leaching area I yt/ sq. ft . Disposal Bed-No. Diameter Depth below inlet Total leaching area sq. ft. Dry Well-No. Diameter Depth below inlet Dimensions: x ___ x __ _ Other: Distribution box ) No. Dosing tank ( )

Percolation Test Results Performed by m~ _. H ,~ • .t-aM fEo Date £-/7-1? (Depth of Soil Line Below finished grade at founda.tj,on a )

Test Pit No. 1 L/= minutes per in Depth of Test Pit g.O' Test Pit No. 2 minutes per inch Depth of Test Pit _____ _

Description of Soil 5 aO d Depth to Ground Water _~·~.c,-,.-<O:l--'· _______ _ Will disposal area be filled? £,-1 L " ()V~,.. are.q Cut down? (On reverse side or separate shee ow plot plan with building. Include dimensions, distances from aU boundaries. Show location of wells, streams, e ge, large trees, etc.)

AGREEMENT: The undersi ed agrees to construct the aforedescribed individual sewage disposal system in accord· ance with the provisions 0 Article XI of the Sanitary Code and regulations of the Amherst Board of Health. The un· dersigned further agre not to place the system in operal2"on ntH a Certifi£:lcat -£ Compliance has been issued by this

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board of health. ~Af...~~a..£ . t / 4' -! L -..- C~ Owner or builder 1_ date Application Approved by , _.j - ~ :v 7]

date Application Disapproved lor the JoUowing reason.s: '3't..ln"?l'\...~"z- ~/?d"4

BOARD OF HEALTH, AMHERST, MASSACHUSETTS CERTIFICATE OF COMPLIANCE

THIS IS TO CERTIFY, That the iudividual Sewage Disposal System installed ) or repaired ( ) by __________ at has been constructed in accordance with the provisions of

INSTALLER

Article XI of the State Sanitary Code as described in the application for Disposal Works Construction Permit No.

--:=:--: dated ---,:-:-:----:-:--0-::-The issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily.

DATE _______ _ Inspector _________ _

BOARD OF HEALTH, AMHERST, MASSACHUSETTS 58 DISPOSAL WORKS CONSTRUCTION PERMIT

No. -z.~iss~on is hereby granted it 1l10N f\c:oe'-lkfc/~ to construct (}() or repair

Individual Sewage Disposal System at 17'/ fA 1fT'S rS~ . as shown on the application for Disposal Works Construction Permit No. tti -" y

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This permit is issued with the understanding that future alterations or additions will be made if necessary" This permit shall not be construed as permission to create or maintain any sewage nuisance and in the issuance of this permit the Board of Health assumes no responsibility for the future operation or maintena~omA\

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