414 Septic Applications & Plans 2012 Important:
When filling out
forms on the
computer,use
only the tab key
to move your
cursor-do not
use the return
key.
vfr
mm
Commonwealth of Massachusetts
City/Town of Leeds
Application for Disposal System
Construction Permit
Form 1A
a07, - -7
Number
$150
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
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:
414 Chesterfield Road
Address or Lot#
Leeds
City/Town
2. Owner Information
Frank& Nancy McNulty
MA
e
01063
Zip Code
Name
414 Chesterfield Road
Address Of different from above)
Leeds
City/Town
3. Installer Information
James Dimos
Name
Fair Street Ext.
Address
Northampton
City/Town
MA
State
(413) 584- 1876
01063
Zip Code
Telephone Number
J.C. & Company
Name of Company
4. Designer Information
Timothy E. Maginnis RS
Name
70 Montague Road
MA.
State
(413) 575-2069
01060
Zip Code
Telephone Number
Name of Company
Address
Westhampton
City/Town
MA 01027
State Zip Code
kill 3)527 -5291 -cell: (413)575-8523
Telephone Number
t5formla.doc•06/03 Application for Disposal System Construction Permit•Page 1 of 3
Commonwealth of Massachusetts
City/Town of Leeds
Application for Disposal System
Construction Permit
Form 1A
Number
$150
Fee
A. Facility Information (continued)
5. Type of Building:
® Dwelling
Other: Type of Building
❑ Showers
Specify other fixtures:
6. Design Flow:
Calculated Daily Flow:
4 bedroom dwelling
❑ Garbage Grinder(check if present)
8
Number of showers
Number of Persons Served
❑ Cafeteria ❑ Other fixtures
440
Gallons per Day
440 gpd
Gallons
7. Plan: July 12, 2012
Date of Original
2
Number of Sheets Revision Date
REPAIR-SUBSURFACE SEWAGE DISPOSAL SYSTEM DESIGN
Title of Plan
8. Description of Soil:
FSL- LS-MED/FINE SAND
9. Nature of Repairs or Alterations Of applicable):
Replace the existing failing subsurface sewage disposal system. Install a new 1,500 gallon
2 compartment septic tank and a new distribution box. Install an Infiltrator leaching trench system,
two trenches @ 56' long each. 14 Infiltrators per trench=28 Infiltrators provided.
10. Date last inspected:
t5forml a doc•06/03
N/A
Date
Application for Disposal System Construction Permit•Page 2 of 3
Commonwealth of Massachusetts
City/Town of Leeds
Application for Disposal System
Construction Permit
Form IA
Number
$150
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
nqt to place the system in ope til a Certificate of Compliance has been issued by this Board
f Health. (' �1� �/
'FoR -j✓� °oui- ��ll�t�l ' �n�t b�.t .U'■`L
Signature
Application Approved By:
Name = Date
NrC/ ate ✓
Ca prov �.✓Se
Application Disapproved for the fo wipng reasons:
t5formla.doc•06/03 Application for Disposal System Construction Permit•Page 3 of 3
Important:
When filling out
forms on the
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only the tab key Address
to move your
cursor-do not
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Commonwealth of Massachusetts
City/Town of Northampton
Disposal System Construction Permit
Form 2A
,fora - 7
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:
James Dimas
Name
Northampton
City/Town
J.C. & Company
Name of Company
MA.
State
01060
to perform the following work on an on-site sewage disposal system:
® Construction
® Repair or replacement
® Repair or replacement of system components
414 Chesterfield Road
Zip Code
Facility Address
Leeds MA.
City/Town State
Frank 8 Nancy McNulty (413) 584-1876
Owner Telephone Number
01053
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 ate elow.
Approved by Date
�w/lA .T ,« r
Title
tsform2a.doc•06/03 Disposal System Construction Permit•Page 1 of 1
NO.
FORM 11 - SOIL EVALUATION FORM
Page 1 of 3
Commonwealth of Massachusetts
Leeds, Massachusetts
Soil Suitability Assessment for On-Site Sewage Disposal
Performed by: Timothy E. Maginnis R.S. Date: July 9, 2012
Witnessed by: Edward Smith, Board of Health Agent
Site: 414 Chesterfield Road
Leeds, Massachusetts
Owner: Frank & Nancy McNulty
Address: 414 Chesterfield Road
Leeds, Massachusetts
Tel #: (413) 584 - 1876
Office Review
Published Soil Survey Available:
No
Yes
Year Published: 12/81 Publication Scale: 1/15 840 Soil Map Unit: WxB
(Woodbridge - series)
Drainage Class: Moderately Well drained
Soil Limitations: perched water table, slope
Surfidal Geologic Report Available NO Yes
Year Published: Not referred to
Geologic material: sand
Landform: Glacial outwash plain
Flood Insurance Rate Map:
Above 500 Year Hood boundary No
Within 500 year flood boundary
Within 100 year flood boundary
Wetland Area:
National Wetland Inventory Map ( map unit ): Not referred to
Wetlands Conservancy Program Map ( map unit
Current Water Resource Conditions (USGS): Month -December
Range: Above Normal Normal Below Normal
DEP approved form - 12/07/95
Publication Scale
Yes
Yes
Other References Reviewed: Soil Survey, Hampshire Co
Location Address or
Deep Hole Number q
Location: ( identify
Land Use; lawn
Vegetation: lawn
Landform: Glaciated
Position on Landscape
Distances from
Open Water Body! >
Possible Wet Area: >
Drinking Water Well:>
Depth from
Surface ( inches Soil Horizon
FORM
Lot No. # 414 Chesterfield Road
1 Date: 07/09/2012
on site plan) front of
Slope: Moderate Surface
grass, upland trees
upland, (till)
( sketch of the back
100' Drainage
100' Property
100' Other:
Test pit data
11 - SOIL EVALUATION FORM
Page 2 of 3
- Leeds, MA.
Time: 9:00 am Weather: clear/Mild
house - see plan
Stones: Few
)
Way: > 100'±
line: 50' ±
Other:
( Structure,
Soil Stones, Boulders,
Mottling Consistency, ( % gravel)
Son Texture Soil Color
( USDA ) (MunseR>
0 - q'•
A
FSL
10YR 3/3
N/A
Friable, dk. brown
med/fine roots,
4" - 24"
8
L/S
7.5YR 4/4
N/A
Friable, yellowish brn.
wavy boundry
16" - 108"
42
2
Medium/Fine
sand
10YR 3/4
N/A
Firm in place, crumples
in hand. wavy boundry,
massive, coarse frag.
stones, rocks, boulders
Parent Material ( geologic ): Medium/fine sand - Sandy loam
Weeping from face: None
Depth to Groundwater: None
Indicates
Estimated Seasonal High Groundwater: 42" ESTIMATED
SEASONAL
Depth to Bedrock: N/A HIGH WATER
7
DER approved form - 12/07/95
FORM 11 — SOIL EVALUATION FORM
Page 3 of
Determination for Seasonal High Water Table
3
MA,
above
m
Location Address or Lot No. # 414 Chesterfield Road
Method used:
- Leeds,
well level
Depth observed standing in observation hole: None
Depth weeping from side of observation hole: None
Depth to soil mottle, 42"
Ground water adjustment: 42"
Index Well Number: Reading Date: Index
Adjustment factor Adjusted groundwater level: 42"
Depth of Naturally Occurring Pervious Material:
?
examination
that the
required
tN OF kiss
47 TIMOTHY 9o�oy
MAGINNIS
o #982E
ga/SAS N
Does at least four feet of naturally occurring pervious material
exist in all areas observed throughout the area proposed
for the soil absorption system ? YES
If not, what is the depth of naturally occurring pervious material
Certification
I certify that in November 1994 I have passed the soil evaluator
approved by the Department of Environmental Protection and
analysis was performed by me consistent with the required training,
experience and expertise performed by me consistent with the
training described in 310 CMR 15.017
Signature: Uwe a
Timothy E. Maginnis.EBate: 07 / 13 /
B
DEP approved form - 12/07/95
IN/TA RIp
FORM 12 - PERCOLATION TEST
Location Address or Lot No, # 414 Chesterfield Road - Leeds, MA.
Leeds, Massachusetts
COMMONWEALTH OF MASSACHUSETTS
REPAIR
PERCILATIIN TEST
Date; June 9, 2012 Time 9:00 AM
Observation Hole #
it 1
Depth of Pert:
42`
Start Pre-soak
9:45 AM
End Pre-soak
10:00 AM
Time at 12'
10:00 AM
Time at 9'
10:16 AM
Time at 6'
10:38 AM
Time ( 9' - 6' )
22 MINS.
Rate Min. / Inch
7,33 r'tpi
Site Passed
Performed by: Timothy
Witnessed by: Edward
x
Site Failed
E. Maginnis R.S.
Smith - Agent, Board
—
of Health
DEP APPROVED FORM j(L.. (C (
°
�SN OF 4ASggs_
TIMOTHY
E.
MAGINNIS
//982
4) #982
�..• �
cN
En
�
Jfl %nn
Name: EASTHAMPTON
Date:7/11/112
Scale' 1 inch equals 2002 feet
Location: 042°20'24.7" N 072°42'39.1" W
Caption:Septic system repair
414 Chesterfield Road
leeds, MA.
Copyright(C)1998,Ear0visions,Inc.