101 Septic Appication & Inspection 2007 CHECK OR FILL IN WHERE APPLICABLE
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
C ly OF NORPI k )
tttinn fur flispnstti Marks Cnuustrurtinn Permit
Application is hereby made for a Permit to Construct (✓) or Repair ( ) an Individual Sewage Disposal
System at: U l C &LD
-
-lol ( HC`Jf ttl.Q l L er Lot Noll pip
.3..htidaLSID ...Pt' f+APLa x.r.tN.LA
Address
Location..4ddress
(3.cQj;t:E,..NQs!t
wittA -it ffst-.4. ... .s'r ?'Rapt rhpr Ding
I
n i t Address �5 t
Type of Building �� 3'a j-1 ..gi6 Size Lot.7v, OSU Sq. feet
Dwelling—No of Bedrooms 5 Expansion Attic ( ) Garbage Grinder (✓j
Other—Type of Building No. of persons f <) Showers (✓) — Cafeteria ( )
Other fixtures S
Design Flow t t 0 gallons per person per day. Total daily flow gallons.
4 p" .�e)6g •
Septic Tavk—Li hid ca acity.lJi allons Length JI ' Width._ Diameter Depth�...�
Disposal Trench—No _a-1 Width S Total Length hy Z Total leaching area sq. ft.
Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft.
Other Distribution box (4- Dosing t nk ( )
Percolation Test Results Performed by_.1_iks fi eaR6-1✓JNtS Date SV1,v 9, ZOOS- t
Test Pit No. I < d"' minutes per inch Depth oir Test Pit.1 2d —�4
�� Depth to ground water4sie R6 t
Test Pit No. 2 4 0-- minutes per inch Depth of Test Pit..(26 Depth to ground water—.t42:Q_1Oe 9L
(20.8f/1' (A)"=L)ka<,e.t.. SAntO f a se.a_,.(e. c-roNtS
Description of Soil $b&9y
StAlrz.: __C14)C4-eN
Nature of Repairs or Alterations—Answer when applicable._ .fx
Agreement:
The undersigned agrees to install the aforedescrihed Individual Sewage Disposal System in accordance with
the provisions of TITLa 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Signed
Application Approved By
Application Disapproved for the following reasons
Permit No....aTh4U6 -06
Dam
Date
Date
Issued-
Commonwealth of Massachusetts
City/Town of Northampton
Application for Disposal System
Construction Permit
Form IA
Number
$
Fee
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
Important:
When filling out Application is hereby made for a permit to:X❑ Construct a new on-site sewage disposal system
forms on the ❑ Repair or replace an existing on-site sewage disposal system
computer,use
only the tab key ❑ Repair or replace an existing system component
to move your
cursor-do not 1. Location of Facility:
use the return
key
YI Im
a
Vacant lot between#87& # 107-Chesterfield Road -#101 0-1/2% .
Address or Lot#
Northampton
City/Town
2. Owner Information
George Houck
Name
3 Hillside Drive
MA.
State
01060
Zip Code
Address(if different from above)
Hadley
City/Town
3. Installer Information
UigtJ"CPu— 1-ii+pc�fra-
/ Name
MA. 01035
State Zip Code
f413) 896-4906
Telephone Number
Name of ompany
/Address
ress
lu D ti_ty\Pc 01638
City/Town State Zip Code
`713- LA1 - s'SCo I
Telephone Number
4. Designer Information
Timothy E. Magininis RS.
Name
70 Montague Road
Timothy E. Maginnis&Associates
Name of Company
Address
Westhampton
City/Town
MA.
State
5413) 527- 5291
Telephone Number
01027
Zip Code
t5form1a.doc•06/03 Application for Disposal System Construction Permit•Page 1 of 1
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:
X❑ Dwelling 5 Bedrooms
Other:Type of Building
X❑ Showers
Specify other fixtures:
6. Design Flow:
Calculated Daily Flow:
2
❑ Garbage Grinder(check if present)
10
Number of showers
Number of Persons Served
❑ Cafeteria ❑ Other fixtures
550 qpd
Gallons per Day
550 qpd
Gallons
7. Plan:
February 8, 2005
Date of Original
2 N/A
Number of Sheets Revision Date
Subsurface sewage disposal system design
Title of Plan
8. Description of Soil:
Sandy loam—sand & gravel
9. Nature of Repairs or Alterations (if applicable):
N /A—This is for new construction
10. Date last inspected: N /A
t5formla.doc•06/03
Date
Application for Disposal System Construction Permit• Page 2 of 2
Commonwealth of Massachusetts
City/Town of Northampton
Application for Disposal System
Construction Permit
Form IA
Number
Fee
B. Agreement
The undersigned agrees to ensure the construction and maintenance of the afore described on-site
sewage dispo - stern in accordance with the provisions of Title 5 of the Environmental Code and
not to - e e s ste in • - an u - Certificate of Compliance has been issued by this Board
pf Hea th. -� ✓ r/ /
Signature Date
Application Approved By:
Name
Application Disapproved for the following reasons:
Date
t5formia.doc•06/03 Application for Disposal System Construction Permit•Page 3 of 3
Septic System Permit Payment Receipt
q t>+ I ,
it au
Permit#;� Gl1f4Date: lj4 4/, Const'Repair
Amount:
Address:
SACKREY CONSTRUCTION CO.
83 S.Main St.
Sunderland,MA 01375
/374 4 Cash Check#ti�
NORTHAMPTON CO-OPERATIVE BANK
NORTHAMPTON,MA 01060
53.7233/2118
5665
5/4/2006
PAY TO
ORDER THE City of Northampton I $ *950.00
One Hundred Filty and 00/100********s*****************************t*****s**as*********************************su*sss**DOLLARS a,
City of Northampton
212 Main Street
Northampton MA 01060-3191
Houck D
gn
00056650 42LL872330: OL 25 0002270
/1/ifilt
Name: EASTHAMPTON
Date:2/7/106
Scale: 1 inch equals 2000 feet
Location: 042°20'00.9" N 072°41'58.7" W
Caption: George Houck
Chesterfield Road Oeptic system
Northampton, Ma.
NO.
FORM 11 - SOIL EVALUATION FORM
Page 1 of 4
Commonwealth of Massachusetts
Northampton, Massachusetts
Soil Suitability Assessment for Un-Site Sewage Disposal
Performed by: Timothy E. Maginnis R.S.
Witnessed by: Ernie Mathieu, Health Agent
Date: June 7, 2004
Location Address; Chesterfield Rd. - Leeds, MA,
Lot #: Vacant ( between # 87 6 107)
New construction'
Repair:
Owner's none: Janes Parsons
Address' 87 Chesterfield Rd.
Leeds, MA.
Telephone: ( 413 ) 584 - 9236
Office Review
Published Soil Survey Available.
Year Published 12/81
Drainage Class: Excessive
Soil Limitations' Peres fast, poor filter
Surficial Geologic Report Available
Year Published: Not referred to
Geologic material: sand, gravel
Landform: Glacial terrace
Flood Insurance Rate Map:
Above 500 Year Flood boundary
Within 500 year flood boundary
Within 100 year flood boundary
Wetland Area;
National Wetland Inventory Map ( nap unit ), Not referred to
Wetlands Conservancy Program Map ( map unit )
Current Water Resource Conditions (USGS): Month - March
Range: *Above Normal■ Normal
Other References Reviewed: Soil Survey, Hampshire Co.
No
Publication Scale: 1/15 840 Soil Map Unit: Hgb
( Hinkley series )
No
NO
Publication Scale
Below Normal
DEP approved form - 12/07/95
Surface
FORM 11 - SOIL EVALUATION FORM
Page 2 of 4
Location Address or Lot No. Chesterfield Road - Leeds, MA.
( Between # 87 & # 107 )
Deep Hole Number # 1 Date: 7/7/04 Time: 2.15 PM Weather: Clear
Location: ( identify on site plan) - east side of lot
Land Use: Vacant Slope: 57. + S.jrface Stones: none
Vegetation: upland hard wood, and white pine, grass
Landform: Glacial terrace
Position on Landscape ( sketch of the back )
Distances from:
Open Water Body: > 100' Drainage Way> 100'
Possible Wet Area: > 200' Property Line: 20"
Drinking Water Welh.> 200' Ether.
DEEP OBSERVATION HOLE LOG
Other
Depth from
( inches) Soil Horizon Soil Texture Sor Color Soil ( Structure,7. Gravel )
( USDA ) (MunseU) Mottling Stones, Boulders,
Consistency,
0 - 12"
A
S / L
10YR 3/2
N/A
Friable, fine roots
Few stones
dk. brown
B
S / L
2.5 Y 5 / 4
N/A
Friable, med. roots
yellowish brown
24" - 120"
C - 1
None
0
compact
medium sand
gravel, Ig stone=_
10YR 6 / 5
N/A
loose, single grain
cobbles, coarse sand
wavy boundary
Parent Material ( geologic ): Sand, gravel, cobbles
Weeping from face: 96" Depth to Bedrock: > 10' Indicates
ESTIMATED
Depth to Groundwater: 120" SEASONAL
HIGH WATER
Estimated Seasonal High Groundwater: None V
DEP approved Form - 12/07/95
Surface
FORM 11 — SOIL EVALUATION FORM
Page 3 of 4
Location Address or Lot No. - Chesterfield Road - Leeds, MA.
( between Lot # 87 & Lot # 107 )
Deep Hole Number # 2 Date: 7/7/04 Time: 2:45 PM Weather: Clear
Location: ( identify on site plan) - front ana east side of lot
Land Use: Vacant Slope: nearly level Surface Stones: none
Vegetation: upland hard wood, and white pine, grass
Landforrv: Glacial terrace
Position on Landscape ( sketch of the back )
Distances from:
Open Water Body: > 100' Drainage Way:> 100'
Possible Wet Area: > 200' Property Line. 20"
Drinking Water Well:> 200' Other:
DEEP OBSERVATION HOLE LOG
Other'.
Depth from
Sod Horizon Sol Texture Sod Color Sok ( Structure, 7. Gravel )
( inches)
( USDA ) (MunseR) Mottting Stones, Bo.dders,
Consistency,
0 - 12"
A
S / L
10YR 3/2
N/A
Friable, fine roots
Few stones
dk. brown
12•' - 24°
B
5 / L
2.5 Y 5 / 4
N/A
Friable, med. roots
yellowish brown
24" - 120"
C - 1
None
0
compact
medium sand
gravel, Ig stones
10YR 6 / 5
N/A
loose, single grain
cobbles, coarse sand
wavy boundary
Parent Material ( geologic ): Sand, gravel, cobbles
Weeping From face: 96" Depth to Bedrock:
Depth to Groundwater: 120"
Estimated Seasonal High Groundwater: None
DEP approved
> 1W Indicates
ESTIMATED
SEASONAL
HIGH WATER
V
form - 12/07/95
FORM 11 - SOIL EVALUATION FORM
Page 4 of 4
Location Address or Lot No, Chesterfield Road Leeds, MA.
( between Lot # 87 S Lo l # 107 )
Determination for Seasonal High Water -fatale
Method used:
Depth observed standino in observation hole: 96"
Depth weeping from side of observation hole- TP # I @ 8' TP # 2 @ 8'
Depth to soil mottle. N / A
Ground water adjustment: 8 feet @ TP. # 1 8 feet @ T.P. # 2
Index Well Number. Reading Date: Index weR ,eve,
Adjustment factor Adjusted groundwater level: 96"
Depth of Naturally Occurring Pervious Material:
Does at least four feet of naturally occurring pervious material
exist in all areas observed throughout the area proposed
For the soli absorption system 7 YES
If not, what Is the depth of naturally occurring pervious material ?
Certification
I certify that in November 1994 I have passed the so4 evaluator examination
approved by the Department of Environmental Protection and that the above
analysis was performed by me consistent with the required training,
experience and expertise performed by me consistent with the required
training described in 310 CMR 15.017
Signature:
Timothy E. Maginnis RS LJ Date: July 10, 2004
DEP approved form - 12/07/95
Location Address or Lot
C ❑VM❑NWEALTH
FORM 12 - PERCOLATION TEST
No. - Chesterfield Road - Leeds, MA.
( between Lot # 87 R. Lot # 107 )
❑H VASSACHUSETTS
PERCOLATION TEST
Date: July 7, 2004 Time: 2 :45 PM & 2 : 55 PM
Observation Hole #
1
2
Depth of Pero
48'
50"
Start Pre-soak
2 : 43 PM
2 55PM
End Pre-soak
25
25
Time at 12'
GALLONS
GALLONS
Time at 9'
IN < 15 MINUTES
IN < 15 MINUTES
Time at 6'
Time ( 9' - 6' )
Rate Min. / Inch
< 2 MR
< 2 MR
Design 0 < 5 MPI - Effluent loading rate = 0.74 gol
Site Passed Site Failed
Performed by Timothy E. Maginnis R.S.
Witnessed by: Ernie Mathieu - Health Agent
Comments: effluent loading rate = 0.74 gal / sq. ft,
DEP APPROVED FORM
/ sq. ft.
—
N
,Q'" ov IMSS94
TIMOTHY
E.
° MAGINNIS
X982
4, #982
N
0,
No 0W6-06
Jin}Tns I g3hnrkz �Qiun;irnctint rrmit is-6L
Permission is h rebv granted._ l,7.! J.'J.E_.t..t.u.UeV"' 3..i L4 Stprte, L in._.
to Construct ( �tor,Rquit ( ) an Individual Sewage Disposal System a<
at No {01 C-i>! T'ea2E.I. -.r) 2.0EE3)
S.reet rrpp,,tt --
as shown on the application for Disposal Works Construction Permit No2.00t+ %6. Da ed_Ky.IM1L-
BOARD OF HEALTH
OF_ v ?-:nr) v,- PION FEE �sb e c�
DATE
zoo a,
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
CAV Bard of Health
rpm L her.!.al, RS, MS C.H.O.
DIRECTOR OE HEALTH
�j 24.9 a
Commonwealth of Massachusetts
z, City/Town of Morci' ■aM(aN
Certificate of Compliance
Form 3
Important:
When filling out
forms on the
computer.use
only the tab key
to move your
cursor-do not
use the return
key
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
I I 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
George Houck
Facility Owner
101 Chesterfield Road
Street Address or Lot#
Northampton
CityRown
Designer Information.
Timothy E_Maginnis R.S.
Name
Installer Informati n
(,n/u •'r Cu tr
Nm
Signature
DSCP Date
Ma.
State
01062
Zip Code
Timothy E. Maginnis&Associates
Name of Company
March 24, 2007
Date
Walter Thayer
Name of Company
J - ro -C?
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. , 0L3 /Th itat>z -_
Approving Authority
Signature
Date
�� Sir s26-07
t5form3.doc•06/03 Certificate of Compliance•Page 1 of 1
_ _ —W_ - �� —EA— �� , 3 Infiltrator trenches
C.) -W_ \ 3 with 7 Infiltrators per trench
QI ,''H ,
CO
Wi iii ii+\
r+ p Water line /�������i�'���
O 'F (Ref. only .lili,AiIi,i— \
--1 FE "11111111 Dyer ■
N Existing
Q 5 bedroom
house
i -,-..
•ump—out manhole ("C")
O
xisting distribution box ("D")
Q \ Existing
garage
. •
° - e'
/
er
, / i
f5 L
J / �. i t
.-r < L L /
O 1 ‘ I Driveway
/l< �- . / i 4" pvc solid pipe -
Existing septic tank
0 —11T-1
56° of 4" pvc solid pipe 4" pvc solid pipe
Q Distribution box top view As—built dimensions
n
3 A to C = 24' — 6" As—built plan
uD i B to C = 1T — 7" Subsurface sewage disposal system
0 00578, A to 0 = 31' —6" George Houck
' B to 0 = 27' — 0" 101 Chesterfield Road I
Septic tank top view
Northampton, MA. 01062