IOAID OP HEALTH, AMHDST, MASSACHUsms

No.

.I] / APPUCATION FOR DIS~ WORD CONSTRUCTION PEBMIT 1c Date -:?, -fa - 77 Fee /5" Date Rec'd. March 30 .1.977 By -=DG"'F'---__

Application is hereby made for a permit to Construct O() or Repair ( ) an Individual Sewage Disposal

System at: t · ~ . /') /-;, \ :.h Location-AP.iIr... _ ~t.C.(;-~!CL 'C'trJW b-ou '0 or Lot No~- v n' Owner £.VCL/37vcr ~ __ - ' Address ~~1d(~1'!. .".u Contractor 13' 4 L.. ' Address ~C1!?.4JM",=~,,= (~="7""'---:--'~"-'!f'ljj"llr~7 Type of Building Dimensions ______ , Size Lot ~O, cxz::,:t"

Dwelling-No. of Bedrooms A Expansion Attic Garbage Grinder (iI.RJ Other No. of pe",ons Shower, ( ) Other fixtures Town Water? Type of Well

Design Flow .i1Vgallons per person per W .;Jotai daily Bow aOO gallons Septic Tank-Liquid capacity /(JOO g~lorui Dimensions: 1. W D ___ _ Disposal Trench-No. Width Total Length Total leaching area aq. h. ~ . , .1 Disposal B'ld .. No. I Diameter ()OIJ{, Depth below inlet Totalleachin~ area~_~: f~' Dry Well-l'ro. I Diameter Gl

Depth below inlet Dimensions: , x ~ ~ 'fl.O,g Other: Distribution box (I) No. Dosing tank ( ) ~ (Depth of Soil Line Below finished grade at foundation ) « _ -z$- 7'1' Percolation Test Results Performed by ~ 6'4,"0.£ f's., ~Il.~e M.&. - r ,.;-

Test Pit No. I ~ minutes per inch Depth of Test Pii":::: __ --'c?"-__ Test Pit No.2 minutes per inch Depth of Test Pit _ -, _ __ _

Description of Soil ~ RklI l':C{.e.. Depth to Ground Water iJc,,'tftb- ler '

Will disposal area be filled? tV 0 Cut down? ,---,-__ -'" ===-=-________ _ (On reverse side or separate sheet, show plot plan with building. Include dimensions, distances from all boundarie8. Show location of wells, streams, ledge, large trees, etc.)

AGREEMENT: The under.igned agrees to construct the aforedescribed individual sewage disposal system in accord· ance with the provisions of Article XI of the Sanitary Code a regulations of the Amherst Board of Health. The un-dersigned further agrees not to place the system in opera t' ntil a Certificate 0 ia has been issued by this board of health. 1-, (} -71

Application Approved by Cf-~...t\( ( (3 ~at;o -'77 it date Applic.tion Dis.pproved lor the lollowing reworu:

IOAlD OF HEAlTH, AMHERST, MASSACHUSEnS CERIIfICATE OF COMPLIANCE

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 aa described in the application for Disposal Works Construction Permit No. _ -=:::---: dated _-:--:-__ -:-_-:--::-

The issuance of this certificate ohall nol be construed as a guarantee that the system will function satisfactorily.

DATE _ _ ____ _ Inspector ________________ __

IOAIO OP HEALTH, AMHDST, MASSACHUSITTS DEPOSAL WORD CONSTRUCTION PERMIT

No. 11-J ;) ' C Permi .. ion i. hereby granted l5! Ll..- ~IC to ~tru ... t (><[ or repair ( ) an

Individual Sewage Disposal System at It 4 r= A,j> .J*_ mtH«<-rrt".:& (!L-l':.J .. shown on the application for Diapooal Works Construction Permit No. 77- (

This permit is issued with the undentanding that fu ture alterations or additions will be made if nec .... ry. This permit shall not be conltrued .. permiaoion to create or maintain any sewage nuisance and in the i .. uance of this permit the Board of Health assumes no respoDlibility for the future operation or maintenan~

DATE 3-/ ~ - 71 Board of Health'

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• BOARD OF HEALTH

TOWN OF AMHERST, MASSACHUSETTS

Important Information Regarding Your Private Sewage Disposal System.

DISPLAY THIS DOCUMENT IN A PROMINENT PLACE . ft11Gr-}-I1 (,.:. 12.0

Own e.r £ C. Ovb' ~ r;ni N I Ad d re s s _ --,-/-,-,--,-hk...:::Lt -'-.H-'-I!.!:L<-==''--....!.~~!)'-Ins ta 11 e r a / ~ c: '-It.e./C Ad. d re s s ~S""4=U.!..Tf"--&"...,f,""u .::>R-.;y'---__ _

Date Installation Inspected and Approved _--47_--,()~q-,--_7_7 __ _ Description of System: Tank Capacity: 1000

(jJ . Leach Field ( ) Bed ( ) Seepage Pit (X ) Square Feet: 7',:>,"0 .

Garbage Gri nder Yes ( ) No (X ) No. Bedrooms: ,g No. People b

As- BUILT PLAN:

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PROPER r1AINTENANCE OF YOUR PRIVATE SEWAGE DISPOSAL SYSTEM

1. This system must be .inspected periodically and the tank pumped out at an i nterva 1 not to exceed ..3 years .

2. For your protection sanitary pumpers are licensed by the Amherst Board of Hea lth.

3. Regular pumping is crucial to avoid early failure and costly repairs ·of . the sys tem.

4. DO NOT di spose 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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