23 Construction Permit 2010 James A. Gracia, PE
99 Glendale Street
Easthampton, MA 01027
(413)527-8318
jrracia@charter.net
June 17, 2010
Heather,
I had the"As Built" and Certificate ready to mail out to you right after the system went in, but
we realized that we had the wrong street number. I have waited for Ted to confirm the correct
house number. It should he #23 Cardinal Way, and not #7 as we had originally thought. I don't
know where that error occurred, but it goes back to May 2008 when we did some additional soil
evaluations. I knew the number did not make sense, but that is what I was given at the time.
Please adjust your records to reflect this correction.
Important:When
filling out forms
on the computer,
use only the tab
key to move your
cursor-do not
use the return
key.
a.
Commonwealth of Massachusetts
City/Town of NORTHAMPTON
Certificate of Compliance
Form 3
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with
the local Board of Health to determine the form they use.
This is to Certify that the following work on an On-Site Sewage Disposal System
® Construction of a new system
❑ Repair or replacement of an existing system
❑ Repair or replacement of an existing system component
Has been done in accordance with Title 5 and the Disposal System Construction Permit(DSCP):
DSCP Number DSCP Date
Theodore Towne
Facility Owner
Z3 VCardinal Way
Street Address or Lot A
Northampton MA 01060
City/Town State Zip Code
Designer Information:
James A. Gracia James A. Gracia, PE
lure
Installer Information:
Mark Lavalley
Name
Name o Company
paany Zola
/�
Name - 2-aM
Date
Lavalley&Sons Trucking
Iftjesk Name ofCgn an is
�V/ 55 �0
Signature Date
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 the system will function as
designed.
Approving Authority
Signature Date
t5form3.doc•08/03 Certificate of Compliance•Page 1 of 1
Title V Checklist
Date Received: j' -
Owner: 'T htodo't
Engineer:
Address: it La.dc 11v i2mD
Installer: tV)c4- L-_.v-kkv�y
✓Make sure 4 copies of the plan are submitted (do not accept permit
application until we have 4 copies of the plan)
\ Give the permit a number (use computer based log)
Make copies of all documentation including checklist
Send Copies to Dave with two of the original design plans and put
originals in Aimee's Box
Dave Approve Plan. Send letter to BOH noting approval or corrections
that need to be made. Also send a copy of the checklist.
Once letter from Dave is received AP or BW will sign permit and stamp
plans.
Before we issue construction permit staff must make sure installers
name is on the application AND that that installer has a permit with us. DO NOT
ACCEPT MONEY OR PERMIT IF INSTALLER DOES NOT HAVE PERMIT.
Contact home owner or installer that plans have been approved.
Either mail them or have them come pick plans and permit up.
AP will schedule Final Inspection and contact Dave
Final inspection is passed and "as built" received.
Cert of compliance Issued.
CLOSED
Commonwealth of Massachusetts
ca City/Town of NORTHAMPTON
Disposal System Construction Permit
Form 2A
Important:When
filling out forms
on the computer,
use only the tab
key to move your
cursor-do not
use the return
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UrS
Number
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with
the local Board of Health to determine the form they use.
Permission is hereby granted to:
Mark LaValley
Name
Sylvester Road
Address
Northampton
City/Town
LaValley & Sons Trucking
Name of Company
MA
State
to perform the following work on an on-site sewage disposal system:
® Construction
❑ Repair or replacement
❑ Repair or replacement of system components
7 Cardinal Way
Facility Address
Northampton
City/Town
Theodore Towne Jr.
Owner
MA.
State
413-527-9645
Telephone Number
01061
Zip Code
01061
Zip Code
The work to be performed is further described in the 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.
All construction must be completed within three years of the date below.
Approved by Date
Title
t5form2a.doc•06/03 Disposal System Construction Permit•Page 1 of 1
Jeep Hole Number_ k 3 / T Date'
Location(identify on site plan):
Land P'=. Vegetation:
Landform: Position of Landscape:
Distance from
TP C
Depth from
Surface
(Inches)
Open Water Body
Possible Wet Area
Drinking Water Well
Feet
Feet
Feet
Time
Weather
Slope(%)
Surface Stones:
Property Line
Other
Feet
Feet
Feet
Soil
Horizon
DEEP OBSERVATION HOLE LOG
Soil Texture Soil Color Soil
(USDA) (Mmrsx6) Mottling
Other(Structure, Stones,Boulders,
Consistency-,%Gramf)
b -
i
I)
R e '` ,
Cep : U ". zi-4- 4__,
6-t-A5-1
i"
Parent Material(geologic)
De•th to Groundwater: Standing Water in the Hole: J 2
ted Seasonal High Ground Water. 30 `.
LP
Depth from
Surface
(Inches)
Soil
Horizon
DEEP OBS
Soil Texture
(USDA)
RVATI
Soil Color
(Munsen)
A
C
Depth to Bedrock: % /
Weeping front Pit Face: �5
ON HOLE LOG
Soil Other(Structure,Stones,Boulders,
Mottling Consistency,% Gravel)
I
Parent Material(geologic) _
Depth to Groundwater: Standing Water in the Hole: 5 1
Depth to Bedrock: C _S
Estimated Seasonal High Ground Water: --M-f/ Weeping from Pit Face: 7/
Certification. I certify that in November 1994. I passed the soil evaluator examination approved by the Department ofEmironmental
Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in
310 CM X 15.017. Mass.Soil EvaL Approval No.SE1543
Signature: Date: J
Peter J. McErlain
Project Number
Performed by:
Health Insperacr:
NORTHAMPTON BOARD OF HEALTH
212 MAIN ST. , NORTHAMPTON, MA 01060
TEL; 413-587-1213
Site Suitability for On-Site Sewage Disposal
Date 9 7/Q
Equipment Operator: - 7
Site Address
(New CoManteirse>r<
d-4- /\/' 4^ °—f-
Published Soil Survey Avala-blle�: rNooit Yes rz
Year Published Publication Scale Soil Map Unit Drainage Class Soil Limitations
Surficial Geologic Report Available: No g Yes it
Year Published Publication Scale r-nlr gr Material(Map Unit) Lardtirm
Flood Insurance Rate Map:
Above 500 year flood boundary it Within 500 year flood boundary IT Within 100 year flood boundary Jr
Wetland Area:
National Wetland Invetory Map(Map Unit) Wetlands Conservacy Program Map(Map Unit)
.4
Client Name& Address
Repair r
Cunene Water Resource Conditions(USGS): Month
Range: Above Normal x Normal it
Other References Reviewed:
Below Normal x
Percolation Test Results
Percolation Rate
Bottom of Percolation Test Hole:
Percolation Rate:
Bottom of Percolation Test Hole:
Determination for Seasonal High Water Table
Method Used
❑ Depth observed standing on observation hole inches ❑ Depth weeping from side of observation hole inches
❑ Depth to soil mottles inches
❑ Ground water adjustment inches.
Index Well Number Reading Date Index well level
Adjustment factor Adjusted around water level
Depth of Naturally Occurin Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil
absorption system?
If yes, what is the depth of naturally occurring pervious material? TP# TP# .
If not,what is the depth of naturally occurring pervious material? TP# TPd
On-Site Review
T.P. #
Time
Measurement
Time
Measurement
Begin Saturation
Besmm Sanitation
End Saturation
ad Satiation
9„depth
Measurement
9"depth
Measurement
6"depth
Measurement
6"depth
Measurement _
Elapsed Time
9"to6"
Elapsed Time
9"to 6"
Percolation Rate
Bottom of Percolation Test Hole:
Percolation Rate:
Bottom of Percolation Test Hole:
Determination for Seasonal High Water Table
Method Used
❑ Depth observed standing on observation hole inches ❑ Depth weeping from side of observation hole inches
❑ Depth to soil mottles inches
❑ Ground water adjustment inches.
Index Well Number Reading Date Index well level
Adjustment factor Adjusted around water level
Depth of Naturally Occurin Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil
absorption system?
If yes, what is the depth of naturally occurring pervious material? TP# TP# .
If not,what is the depth of naturally occurring pervious material? TP# TPd
On-Site Review
T.P. #
Commonwealth of Massachusetts
City/Town of NORTHAMPTON
Application for Disposal System $
Construction Permit Fee
Form 1A
Important:When
filling out forms
on the computer,
use only the tab
key to move your
cursor-do not
use the return
key.
Number
DEP has provided this form for use by local Boards of Health if they choose to do so. Before using
the form, check with your local Board of Health to make sure that they will accept it.
A. Facility Information
Application is hereby made for a permit to: ® Construct a new on-site sewage disposal system
❑ Repair or replace an existing on-site sewage disposal system
❑ Repair or replace an existing system component
1. Location of Facility:
7 Cardinal Way
Address or Lot#
Northampton
City/Town
2. Owner Information
Theodore Towne Jr.
Name
21 Loudville Road
Address(if different from above)
Easthampton
City/Town
3. Installer Information
Mark LaValley
Name
Sylvester Road
Address
Northampton
City/Town
t5forml a.doe.06/03
MA
State
01060
Zip Code
MA
State
413-527-9645
Telephone Number
01027
Zip Code
LaValley & Sons Trucking
Name of Company
MA
State
413-586-3779
Telephone Number
01061
Zip Code
Designer Information
James A. Gracia James A. Gracia, PE
Name Name of Company
99 Glendale Street
Address
Easthampton
City/Town
MA
State
413-527-8318
Telephone Number
01027
Zip Code
Application for Disposal System Construction Permit•Page 1 of 3
JAMES A. GRACIA, PE
99 Glendale Street, Easthampton, MA 01027
GARAGE
NOTE: TIES MEASURED FROM
PORCH FOUNDATION CORNERS
NOT FROM SLAB
NEW
LEACH TRENCH
SYSTEM
NEW
4 BEDROOM
DWELLING
PORCH
1500 GALLON
SEPTIC TANK-
56.5'
I.P.
29' 40.5'
36.5'
39' 62.5'
MUNICIPAL WATER
SERVICE
INSPECTION PORT
1-
50'
GRANITE
BOUND
-
CARDINAL WAY
LP
THEODORE TOWNE, JR.
23 ? CARDINAL WAY
NORTHAMPTON, MA
SEPTIC SYSTEM "AS BUILT"
SCALE: 1 " = 20' 6/5/2010
Commonwealth of Massachusetts
City/Town of NORTHAMPTON
Application for Disposal System
Construction Permit
Form 1A
Number
$
Fee
A. Facility Information (continued)
5. Type of Building:
® Dwelling
Other: Type of Building
❑ Showers Number of showers
Specify other fixtures:
6. Design Flow:
Calculated Daily Flow'.
7. Plan:
1
Number of Sheets
Septic System Design Dwg#2010-01
Title of Plan
8. Description of Soil:
Loamy Sand - See Soil Logs on Drawing
Z Garbage Grinder (check if present)
9. Nature of Repairs or Alterations Of applicable):
N/A
10. Date last inspected.
Number of Persons Served
❑ Cafeteria ❑ Other fixtures
680 Gals/Day
Gallons per Day
660 Gals/Day_
Gallons
3-02-2010
Date of Original
Revision Date
Date
15forml a.doc•06/03 Application for Disposal System Construction Permit•Page 2 of 3
Commonwealth of Massachusetts
City/Town of NORTHAMPTON
Application for Disposal System
Construction Permit
Form 1A
Number
$
Fee
B. Agreement
The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-site
sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and
not to place the system in operation until a Certificate of Compliance has been issued by this Board of
Health.
j/l 3- y - 'a
Signature Date
Application Approved By.
Name Date
Application Disapproved for the following reasons.
t5forml e doc•06/03
Application for Disposal System Construction Permit•Page 3 of 3