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No. THE COMMONWEALTH OF MASSACHUSETTS

Amhoe:S:f . MASSACHUSETTS

J\ppli.catiou for ~isposal ~lZstem (!loustrudiou Jermit Application is hereby made for a Permit to Construct VIO or Repair ( ) an On-site Sewage Disposal System at:

l ocatio n Address or Lot No. ~:;s R={"J,·tfi~~e;:o ;).53 -3"~

tY - 4vrkr hut--y Lv...e.- 1212~ ~~.~ /J.,7(,e( ',4..., t,~ _ M ,,<j Installer's Name, Address. and Tel.No. Designer's Name,' Address a nd Tel. No. '328- 7/,;}-V

~;::4-Cc-oI-r ~~~ ,(1b ,~ -s, • , E . ?-i~l /." '" ...,'" MA

Type of Building: No. of Bedrooms _ __ L/-'-__ _ Dwe~

Other Type of Building Garbage Grinder ( ~ ::S

_______ No. per Persons Showers ( Cafeteria ( ) Other Fixtures ____ ____ ______________________ _

Design Flow __ ~-",-",~,-,5",,-_____ gallons per day. Calculated daily flow -=CZl.>"" =..5,",-"-,~,,,-_ ____ gallons.

Plan Date -'D'""'q"'£=-''l,.".,-'-lq~q'__q''_ ___ Number of sheets ____ ___ Revision Date ___ ____ _ Title

Description of Soil

Nature of Repairs or Alterations (Answer when applicable) ·· ________ ___ .J.-.>

Date last inspected: _____ _ _ _

Agreement: ~"'--$p . Dd-JJ-€. ~ 8 t .... :Sic " The undersigned agrees to ensure the construction and m . enance of the aforedescribed on-site sewage disposal

system in accordance with the lSIons of tie 5 ofthe Elan ental Code and not to place the system in peration until a Certificate~ompliance as be . (I b~ hi of Ith. ~ /2

/'I- Signed Ofte ----<L--,-<'-__ - ----

-~.&~4~{?<""""~---- Date ~/.,"'~""_L/~;:"__!./__L9.>.l>.r_-_ _ _ Application Approved by

Application Disapproved for the followin

Date Issued . ./ :;J.../ihL~'1 ~ ~/'\ 1~@) THE COMMONWEALTH OF MASSACHUSETTS V ~

/I""L " r-------~~~~~~--------

Permit No.

<!Ierlifictti2 of <!Iumplittnce THIS IS TO CERTIFY, that tl)~ On-site S age Disposal System installed ( ""-;;J repaire:l / replaced ( ) on ~

_ Cf, 19q c;. __ by W, P, ,. · for ,&> ..J h/f"~& "';" at' c;.., N "-'---:: , ... ~ has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. :10=- 7/ dated ______ _ ______ _ Use of this system is conditioned on compliance with the provisions set forth below:

The issuance of this certificate shall not be construed as a guarantee that th stem will function as designed. This

Certificate expires on ;;--,,----------------'7rr--:-=~

DATE 9/<£ / 9 ( Inspector --.J~;::£;i~~#~~~~~~..b.~;r.......c.~-

No.

THE COMMONWEALTH OF MASSACHUSETTS

________ ~/1~· _4~~~J,~;-_.MASSACHUSETTS ~i5pU5ttl ~\l5tem <!Iutt5truciiutt Jermit

,

FEE

Permission is hereby granted to --.J.'-'~"-.!:,.,!:::...!"L!I.~JL-.lJc~~~~S""'-=::_-=:--7i---___c,_---­to consJruct ( %or repair ( ) an On-site Sewage System located at _ _ -='-"...L.._-"''---' ...... =.....,''''' ...... '-''"~'--__

t./I~

and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his / her duty to comply with Title 5 and the following local provisions or special conditions .

.,,-.-.~~~- ..... ,~-"' ........ -. eVh . ,,{ C:;::Z;7i" DATE /Ol- Approved by '£..../A z.-..c _~ FOAM 1255 Rev 3195 A.M. SULKIN CO. ' BOSTON. MA I

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'--r.:-;::'7::C=Jl (f~ L-. U:.LI\ 1 V ...

lr-t ~ TOWN OF AMHERST Health Department

~ Bakery • - Bed &: Breakfast - Burial Permit - Car Seat Rental

Treasurer/CoIleclOr

White: Applicant

0I-O-501-4433.(J()

0I-O-501-4474-{)1

--k.. --01-0-501 ____ -.::::....;,.,. --

Date

OffaVGarbage Perc Teat 0I-O-501-4472.(J()

0I-O-501-4344.(J() Retail Permit 01-0-501-4473-00

Sanitary Coc!e Booklet 01-0-501-4380-00

Septic Installe", Permit 0I-O-501-447().{)1

Septic Private Applications OI-O-fOI-44~~ Septic - ReinspeCtion -9f-fJ-...w ~ Sub-Division Rev. ~' 61 . .o..JOI~ T.B. Qinic IfJl50{..frt9~ Twenty-<lDe D 1iclteta I dl-O-501-4879-OO

Jil"-

/ I II Date M!JSt ave Co"~r's "PAID STAMP' OD ~Ipt to be val/d.

Health Department

Gold: Health Dept. /'

I

~ PERC TEST DATA SHEET ~

TOWN OF AMHERST

DATE IJI'!l I /I~/8'1 LOCATION VOl 70"7 d LOT SIZE L d-;-flj

OWNER 72 01'1' L4 tie", 0 I~«e ADDRESS L C/8wl /J'-::;?'M cV>!.-v-cJTELE # ~. f..2-Y';;-

p . E./RS ~, /J -;y/~ '!.. FIRM h l CJ" ClvI OBSERVED Byj), Z/}!'rVn/{f/ i BACK HOE OPERATOR S 7V/1/f)'" 'r BENCH MARK __________________________ __

" PERC DEPTH '7,,< PRE SOAK TIME /:;;; /0 (

TEST (34 "( --T" 1-11'------­

ptt) :3 q I/t/ ,?.J/v J¥1 ,4

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,. PERC DEP TH «3 PRE SOAK TIME /2: / (J

RATE ____ ('-~=;;;L=__'):=:.....------~ RAT E ______ ""'c3=2,...;)L-----------------------

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TOP TOP

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