No. 73-71

BOARD OF HEALTH, AMHERST, MASSACHUSmS APPUCATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT

Date 6/18/73 Fee $3.00 Date Rec'd. 6/fJJ8/73 By DGF

Application is hereby made for a permit to Construcl (vf or Repair ( an Individual Sewage Disposal System at: n Location-Address ~-=!L~di"-"+<~FL'o/---"=':!-'=--=:-------",,=-- or Lot No. --'0"""-___ _ Owner Address j" R l-v L

Contractor j{J11l:4 's Exc ... Ie "T, ~? Address lie DI 10'1 , Type of Building _______ -= ___ Dimensions __ _ Size Lot ________ _

Dwelling-No. of Bedrooms _-->.3"-__ Expansion Attic Garbage Grinder (.---J Other ____________ No. of persons Showers ( )

Other fixtures Town Water? Type of Well ________________ _

Design Flow ~ gallons per person per day. Total daily flow _'3"". c:::t:;'!X>""'--___ gallons Septic Ta~-~~uid capacity Loo 0 gallons Dimensions: r. .p!.--{" W 5:-"" D ¢ ~-£o'" Disposal TlClfa, No. / Width ~o Total Length a" Total leaching area ~O",,-,(J,,-_ sq. ft.

~~fIns:~~1 Bed-No. Diameter Depth below inlet Total leaching area sq. ft, --'Dl~~U----N,>. ____ Diameter Depth below inlet Dimensions: x ___ x __ _

'''_, .... ,.,,,:-w,wtriibulion box ( .' ) No. Dosing tank ( ) Line Be]ow finished grade at foundation -)

~N",e~\f!I~ii Test Results Performed by ,.e::SJC'AZe?1U .... ,!/uAlT<-c-,YL/Y'6'R. Date :/,l"r: 7 3 0/<"",0", Pit ~o. 1 O. '3 minutes per inch • Depth of Test Pit 3 !.-. (1 "

•~~~~~~~~' Pit ~o. 2 - _ !Dinutes per inch Depth of Test Pit /I' <' ,. of Soil ~5t1¥L> I GeAvC:. L Depth to Ground Water ---<8J-_'-'Q"'---', _______ _

disposal area be filled? Cut down? (On reverse side or separate sheet, shOW' plot plan with building. Include dimensions, distances from all boundaries. Show location of weBs, streams, ledge, large trees, etc.)

AGREEMENT: The undersigned agrees to construct the aforedescribed individual sewage disposal system in accord· ance with the provisions of Article XI of the Sanitary Code and regula lions of the Amherst Board of Health. The un' dersigned further agrees not to place the system in opera ~'on unlil Certificate of Compliance has been issued by this board of bealth. r.. ...-.-V~ H ............ , ~ I ) 2- '2--) 7.3

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~ Owner or builder I , date

Application Approved by If .a \, date

Applicalion Disapproved for the following reasons:

BOARD OF HEAlTH, AMHERST, MASSACHUSETTS

CERTIFICATE OF COMPUANCE THIS IS TO CERTIFY, That the individual 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 -:-:--:----:--::-----=---:c-The issuance of this certificate shall not be construed 3S a guarantee that the system will function satisfactorily.

DATE _ ______ _ Inspector _________ _

BOARD OF HEAlTH, AMHERST, MASSACHusms

DISPOSAL WORKS CONSTRUCTION PERMIT No . .]i-71 (')' J} /I~

. Pennission is h~reby granted Vf..JI11,~g V~' k lftr1ff;:" to construct (X) or repair IndIVIdual Sewage DIsposal System at 6 0 r- ~ ~, 6i-~- .~' ~ _ ..

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as shown on the application for Disposal Works Construction PeYmit No. 73 - 7t This permit is issued with the understanding that Iu ture alterations or additions will be made if necessary. This

permit shan 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 Iuture opewtion or mainten@::li

DATE ~!!IC JJ( (57..3 Board of Health

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ALMER HUNTLEY, JR 11 ASSOCIATES, INC. flEGiSTERED LAN.D SURVEYORS 6 C!;'tl. ENGINEERS

, 238 BRIDGE STREET ... ,.

~··· NORTHAMPTON, MASS.

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BOARD OF HEALTH TOWN OF AMHERST, r1ASSACHUS ETTS

t. O( 8 s;:. ('::e:.-re n, ~(''J7I) ,F

Important Informati on Regardi ng Your Pri vate Se\~age Di sposa 1 Sys tem

DISPLAY THIS DOCUMENT

Owner P fvtN77l T7~') V 1}t..L", t )( rmGJ

Installer ~. LA V1-u .. ..,y i

IN A PROMINENT . PLA~E

Address 47 8 ~EC'~h1..,w ~(:= Address Ilb/l.-~TO.-J, l2yf'rN R.!J

Date Installation Inspected and Approved _-"fl<...-_:...../ __ 7---'~ ___ _ Description of System: Tank Capacity: ) G OO

Leach Field ( ) Bed ( X ) Seepage Pit ( ) Square Feet: qoo Garbage Grinder Yes ()( ) No ( ) No. Bedrooms: ~ No. People '~

As - BUILT PLAN:

- - - - -it'

PROPER t1AINTENANCE OF YOUR PRIVATE ~o

SEWAGE DISPOSAL SYSTEM

1. This system must be , inspected periodically and the tank pumped out at an i nterva 1 not to exceed ..s 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 such items as rags. string. sanitary napkins. coffee grounds as they can cause it to clog and fail .

5. Further information can be obtained by contacting your Health Department at 253-7077.

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