940 Septic Application & Plans No “9-1/
COMMONWEALTH OF MASSACHUSETTS
Board of Health, An a-7/4-41101 PON MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION P
Applica Rnfoo a Permit to Construct Repaid ) Upgrade( ) Abandon( ) - XeComplete System In
FEE ? --s
Location �I TE-P— EL-1) (to A-0
Owner's Name 12144.).)CI_0.pp SIONAlEtm
Map/Parcel# p(prE. 3 C- Z
Address f(9 L St. )SIKiBLIRNE
tM
Telephone# ( Z- 8117
Lot#
Designer's Nam f�/
Installer's Name -��±/.!rC»! . _
�3L fa_'
Address V P A i l t i a.
Address 2 3//E SLR CreaNR(.LD, Mk
Telephone# •
Telephone# 112--( o is
Type of Building f'
Dwelling-No.of Bedrooms T
Other-Type of Building / No.of persons
Other Fixtures
Design Flow (mm.required) it/0 gpd Calculated des gn flow if
CO Design flow provided if Ca gpd
Revision Date
Lot Size
sq.ft.
Garbage grinder (AVO
Showers( ),Cafeteria ( )
Plan: Date 617-1478 Number of sheets
Title SFPne cyS7n4 Trps/G-A) CL-/APP
Description of Soil(s) SAND /�
Soil Evaluator Form No. 97 -0'11 Name of Soil Evduator t 7A-e Lc-A-7
DESCRIPTION OF REPAIRS OR ALTERATIONS
Date of Evaluation Co b i / r
The undersi
further agree
Signed
Inspections
s above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
e tem in operation until a Certificate of om II e has been issued by the Board of Health.
Date 7
Clow
41. 0- 412 C
FORM 11 — SOIL EVALUATOR FORM
OWNER ' S NAME:
LOCATION ADDRESS: LOT #
JOB NUMBER: 97-0 DATE: 44111_
COMMONWEALTH OF MASSACHUSETTS
rlcatIam'fTO1-1 Massachusetts
) il Suitability Assessment for On-Site Sewage Disposal
Performed By:___ cat.hs llc- Leery
Witnessed By: .41..sie MG F -(c RdC
Location Aaeresa or C11'L$T EQ Fl EL.D POO
Lot a/
Owner's Nato. ea 4.! CLA PP
•aaresa, ana )OW EC-NAU1C 0-rrzerr
Teleenone s CW6C t)p-AJ'L rKIL4S
67 S- 7(-7 1
New Construction Repair ❑ Number of Bedrooms
. Office Review
Published Soil Survey Available: No ❑ Yes ® '//
Year Published MD Publication Scale: /1• 137.0 Soil Map Unit al,
Drainage Class Soil Limitations
Surficial Geologic Report Available: No ❑ Yes ❑
Year Published Publication Scale
Geologic Material (Map Unit)
Landfarm
Flood Insurance Rate Map:
Above 500 year Flood boundary NO ❑ YES
Within 500 year Flood boundary NO YES ❑
Within 100 year Flood boundary NO r^y YES ❑
Wetland Area:
National Wetland Inventory Map (map unit)
Wetlands Conservancy Program Map (map unit)
Current Water Resource Conditions (USGS) : Month
Range: Above Normal ❑ Normal
Below Normal
FORM 12 - PERCOLATION TEST
OWNER ' S NAME:
LOCATION ADDRESS LOT #
JOB NUMBER: 97-G44
COMMONWEALTH OF MASSACHUSETTS
No2Tb4 P7Prorl, Massachusetts
Percolation Test
Date: 6b1/91 Time
Observation Hole f
3
Depth of Pero .
S4"
Start Pre-scak
End Pre -soak
Time at 12"
Time at 9"
II -S? AM
4
Sd "
Wool-
JOT
IJoLLD
Time at 6"
Time (9"-6 1
Rate Min/Inch
Site Passed T(
Site Failed
Performed By_Th) k r.s Mar L.c as
Witnessed By: -.e/ (}' L lathe
FORM 11 - SOIL EVALUATOR FORM
Page 2
OWNER ' S NAME:
LOCATION ADDRESS: LOT N
JOB NUMBER: 97. o44
On -Site Review
Deep Hole Number 4 Date: cf i-i 91 Time: I CS. PO' Weather: Pia" CL'el(mob'
Location (identify on site plan)
Land Use: Ng' G 7,a) Slope (%) I Surface Stones Fe& SraLIet"
Vegetation:
Landform:
Position on Landscape (sketch on
Distances from:
Open Water Body
Possible Wet Area
Drinking Water Well
the back)
feet
feet
feet
Drainage way
Property Line
Other:
feet
feet
DEEP OBSERVATION HOLE . LOG
Osdth f oo 5urfece
fin heal
Sell horizon
Soil Texture
(USDA)
Soil C for
(MUnselll
Soil Mottling
0 - -7e
- 7•- /co
42e- sot
SU- SS's
Tit 94 '
A
Gz
C;
C.4
6AUOv
Lc P621
Loo q MY
S*..•
Co A fLcSLr
lo''R44
oYR 5%;
IoYR 4/6
ZisY4/4.
2.5Y413
57' 4/3
Ss"
-bra yP
Other
(St uc ture. Stones. Boulders.
Consistency. s Grand
�Ri 4 c
Pew ern<
PM'Als r, 12< S, c_
'rent Material (geologic) 73 ASA L TI LL--- Depth to Bedrock: >SC'
pth to Groundwater; Standing Water in the Hole: Mc e- weeotnn ernet 04 e e.... . .o)
OWNER ' S NAME:
LOCATION ADDRESS:
JOB NUMBER:
Deep Hole Number :3
FORM ii — SOIL EVALUATOR FORM
Page 2
97-044
On -Site Review
Location (identify on
_and Use:
Date: Cif-1191 Time:
LOT #
2
i Weather: e&Dy Coe
site plan)
Slope (X) I Surface Stones Pi Ek)
Vegetation:
_andform•
>osition on Landscape (sketch
listances from:
Open Water Body
Possible Wet Area
Drinking Water Well
on the back)
feet
feet
feet
Drainage way
Property Line
Other:
feet
feet
DEE
P OBSERVATION HOLE LOG
leoth from Sur ece
(mehe I .
Soil marl on
S it emture
(USDA)
Soil C for
(Munson)
Sail Mottling
G'- 7 "
2'- 24`
141"- 41+"
ctqA
�rM
- b4
A
eI
CL
Cs
6a NAY
SAM
CSANer
Lo Arin
CO A PS LC
LSA nrs-
MeawM
SAf.m
P.(1/41E
'Sc wa
ZsY
'7S R
Other
(St ucture. Stones. Oculars.
Con elttencr. S Grovel)
Fes
FGuJ STO•.13'
Pam sLe-
FEW STOLAtF
F4(gbLLr
2.G S , m-
FC.(g8LC
FEW strbtQ
'ent Material (geologic) C4 Are L 7? -L
Depth to Bedrock: S4
■th to Groundwater' Standing Meter in the Hole; I• ONLC Weeping from wt Parr
At on t • .e"
•
FORM ii — SOIL EVALUATOR FORM
OWNER ' S NAME:
LOCATION ADDRESS: LOT #
JOB NUMBER: 9-7-044 DATE: 6
Determination for Seasonal High Water Table
Method Used:
❑ Depth observed standing in observation hole inches .
❑ Depth weeping from side of observation hole inches .
❑ Depth to soil mottles-1=406 inches . Z° S iyc '
❑ Ground water adjustment feet .
Index Well Number Reading Date index well level
Adjustment factor Adjusted ground water level
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 soil absorbtion system? yst
If not, whet is,the depth of naturally occurring pervious material?
Certification
I certify that on /0 (date) I have passed the examination approved by the
Department of Enviro ental Protection end that the above analysis was
performed by me cosistent wit TC(wired training, expertise end experience
described in 310 CMP 15.017
Signature
Date
a7/97
Amherst Water Laboratory
180 Pine Street, Amherst, MA 01002
(413) 549-0009 MA#139
09/03/98
loan Northampton
Source 940 Chesterfield RD
Collector : Clapp
Parameters)
arc(mg/1)
Sanple Date
Date received
Date analyzed
11?port# 4916-4037
09/03/98
09/03/98
Counts/100 ml Limit
Coliform bacteria
Color nd
Or nd
P*
0/100 ml
0-15
0-3
`SM'rtent neg
Turbidity 2. 49
PH 6. 28
Alkalinity(Ca0D3) 30
Chloride(C1) 14
Hardness(CaCO3) 20
Sulfate(504) 5
Conductivity(unhos/cm) 44
Dissolved solids 29
Calcium(Ca) 3.0
Magnesium(Mg) 1. 0
Sodium(Na) 3. 2
Potansium(K) 0 . 6
Iron(Fe)
nd
Nl3nganese(1't) nd
Copper(Cu) nd
Nitrate-N(NO3-N) 1. 0
Nitrite(N07-N) nd
Am onia-N(NH3-N) 0. 6
Lead nt
neg or pos
0-5 NIU
6.5-8.5
none
250
none
250
none
0-500
none
none
20.0
none
0.3
0.05
1.0
10.0
1.0
none
0.05
*P=Present. Disinfect Well
nd = Not detected
nt = Not tested
Analyst
Amherst Water Laboratory
180 Pine Street, Amherst, MA 01002
(413) 549-0009
MA 4139
Sample No. AA860
Time 2: 00
Bottle No.
Collector J. Clapp
Location 910 Chosterf; or a Rd
Northampton
Parameter(s)
Environmental Consulting
Report 4926-AA860
Date Received 09/14/98
Sample Date 09/14/98
Date Analyzed 09/14/98
Con (mg/1) Counts/100ml
Total coliform bacteria
*Potable
0*
Analyst .--