APPLICATION FOR PERMIT TO CONSTRUCT OR REPAffi

A PRIVATE SEWAGE DISPOSAL SYSTEM

TO: THE BOARD OF HEALTH, AMHERST, MASS. /./ No ............................ .

........ A1:1...5 ·<?·~6wd;~~~)············ · ··············· of ··(~~~i··~~····················iiih~f(6 r hereby applies for a permit to construct or repair a private disposal system for a ....... ~~

(residence, store, etc.)

which will be located at ...... .. ...... .. c.:. .... ~~ ........................................... to be installed by

i~~'Jf.'~tUu.:I;~i";~; BUilder IS ...... ~ .. , ......................•.••............ Plumber IS ....•.......•.••.........•.................................•..........

Description of lot, building and fixtures as follows: ~

Lot: Dimensions ... /~x.J.6?~ype Of.Soil~}j({l.:...vell or Town Water? .... .!~ ...... . Distance to Town Sewer fo:1i.:k..~th to Ground Water .. Z ........... Kind of Well ......... ................ .

Will Lot be Graded? ..... :~ ....... By Filling or Removing Soil? ... ~~ .......... ' ...... .

Building: Dimensions .RZk.)r ... S.'l ...... No. Bedrooms ..... -.3. ....... ............... No. Occupants ......... ......... ....... .

Fixtures: No. Toilets ... ./ ......... Urinals""::::::::": ....... Wash Basins ... / .................... Bathtubs ... ~/7 ........... . Shower~ .......... 1··········~··7 Kitchen Sinks ........ / ..................... Garbage Grinders ...... &~ .... ... ~. . -4' Auto Dishwasher ..... /Va ..... Auto. Clotheswasher ..... .. 1. .. ......... .... .. Other (basement) .. ~ .. ~

I (On reverse side show plot plan with building. Include dimensions, distances from all boundaries. Show location of wells, streams, ledge, large trees, etc.)

I certify that the above information is correct and that I will notify the Board of Health if any cgvdi­~ns are gh!1'\'?,d. I also declare that I have read and understand all the rules and regulations applying

ereto aFomPIY with all requirements and stipulations as included in a permit if issued to me.

\ Date ...... ..... .......... t)~.I-Li .. ~ 0 ...... &.~ ...... 1t~::LL .. . (Signature of Applicant)

PERMIT TO CONSTRUCT OR REPAIR A PRIVATE SEWAGE DISPOSAL SYSTEM

a "yJ~ No ............................ .

......... ul'. .. , ..... /..« .... ~ ................... is hereby granted permission to proceed with the construction or repair of private sewage disposal system with the following minimum requirements:

Septic Tank: Must be of Cement and of ..... 75]2 ..... Gals. Liquid Capacity.

Le h · S t T h f t I th ' ;,I2,Hz Jail.. Ft b~ ac mg ys em: renc es 0 no ess an .................... \Sq.. m ;:;ea.

Dry well . L ....... ± .. ( ft. bottom area and ....... ..7.~ ft. below the inlet.

Other ...... ........ ......... ................................................................................................................... .

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 r~nsib:l'lity f r the future operation or maintenance of the system. i... 1(/ _ . /

# ....!!i.: .... ..t.~ ...... ~ ....................... o/..O/~

k )- t) / J (d for the Board of Health da:e

Inspected . ' ............ 7 ................................................ Approved ............................................................ ~ .... .

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, BOARD OF HEALTH, AMHERST, MASSACHUSmS

APPJJCATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT No.7S xl Date 7/17/75 Fee NO>j~Date Rec'd. ________ _

Application is hereby made for a permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: Univ. of Mass., E. Pleasant St., 400' + Location-Address n01;'th of Amherst "liiter supply t01A'ers (over)>r Lot ~o. -=---;---Owner Univ. of Mass. Address C.E & F.A.E. Depts. Contractor NEWF Project -Hatch Proj. 324 Address Univ. of Mass., Amherst Type of Building Dwelling (over) Dimensions 32' X 48' Size Lot 300 'x300' (arbitrary)

Dwelling-No. of M#ooms 7 Expansion Attic No) Garbage Grinder ( Nb Other Full basement No. of persons ~t. _ Showers (1 ) Other fixtures 2 Lav.. 1 stool, s~nk, elec. -dishwasher, washing machine, drier

Town Water? Yes Type of Well.--;c-----------------Design Flow ~ gallons per person per day. Total daily How 600 gallons Septic Tank-Liquid capacitj1.000-120~allons Dimensions: TL • ____ W ____ D ___ _ Disposal Trench-No. Width :b-' " tI Total Length Total leaching area -,..,--:-:c- sq. ft. Disposal Bed-No. 1 Diameter (sguarebepth below inlet 12" Total leaching area 1400 sq. ft. Dry Well-No. Diameter Depth below inlet Dimensions: x ___ x __ _ Other: Distribution box ¥e$ No. 1 Dosing tank (N~ (Depth of Soil Line Below finished grade at foun tion 1 3' ) Percolation Test Results Performed by Date ,1M ~ q, /47:J-

Test Pit No. 1 I 4' minutes per inch ... No, , s,:; 7. Depth of Test Pit $" + . Test Pit "0. 2 pt;, 7 minutes per inch ,N.<Depth of Test Pit 24 "±

Description of Soil See pl an sheet Depth to Ground Water None found at 7~' Will disposal arca be filled? Yes Cut down? c-.."..N=o'-,-----,;:----:---::-:----,c-c-(On reverse side or separate sheet, shOW' plot plan with building. Include dimensions, distances from aU boundaries-. Show location of wells, 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 reaulations of th Amherst Board of Health. The un· dersigned further agrees not to place the system in opera tion nnti ert' c te 0 Compliance has been issued by this

board of health. /V~. /' ~...J J~d";ite7~?.!:--'-J Owner or builder .. Application Approved by ____ 2...-""=-~p.....'---

Application Disapproved for the following reasons:

----------------------------------------------------------------------~

BOARD OF HEALTH, AMHERST, MASSACHUSEns

CERTIFICATE 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 as described in the application for Disposal Works Construction Permit No. _-::,-_ dated _-;-;-:-_---:-:-_-,--::-

The issuance of this certificate shall not be construi!d as a guarantee that the system will function satisfactorily.

DATE ___ _____ _ Inspector _________ _

--------------------~

BOARD OF HEALTH, AMHERST, MASSACHUSEns

DISPOSAL WORKS CONSTRUCTION PERMIT No. t S i ) (I ' NJ

;rmission is hereby granted Jll),i' 0 ':::- ,.' IJt..sS to construct ( Vor repair ( ) all Individual Sewage Disposal System at:A ti4fIJ.,r sr 'too ' No .,.,W1 12"< rz,.~(..,. ') " as shown on the application for Disposal Works Construction Permit No. 7 r--x:

~his permit is issued with the u~d~rstanding that fut~re ~Iterations or additions will be made if necessary. This perm~t shall not be construed as perrmSSlOn to create or mamtam any sewage nuisance and in th 'ssuance of this permIt the Board of Health assumes no responsibility for the future opel3tion or mainten

DATE 7-/7- Is

Location - Address (cont.)

South of Orchard Hill Drive, East of parking area 23, WE ,st of East pleasant Street.

Type of Building (cont.)

Dwelling - with research facility in basement

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CKD. DRAWING NUM8ER

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