Misc. Lot 17 Septic Application Permit & Perc Test CHECK OR FILL IN WHERE APPLICABLE
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
CITY . OF NORTHAMPTON
Applirttfinn for flisponttl loorks Tonstruriinn 1rrmit
Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal
System at:
COLES MEADOW ROAD
GEORGE ESAOR"-Address
COLES MEADOW RD.7 INbRTHAMPTON• MA
ule.AslAMILf n — gar
Installer
Type of Building
Dwelling—No. of Bedrooms /l/2:2NiL°
Other—Type of BuildinkRIVATE GARAGEN0.
Other fixtures
Design Flow 2Q gallons per person per day. Total daily flow 20 gallons.
Septic Tank—Liquid capacityL,500gallons Length 101 Width....5' Diameter Depth._CI 95_f_
Disposal Trench--No. 1 Width..2•0'_.__. Total Length 35' Total leaching area 280 sq. ft.
Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by ERNEST..J,...NAflIESU..RS # 851 Date OCT• 29, 1993
Test Pit No. 1_..30 minutes per inch Depth of Test Pit__..Q' Depth to ground water 96" OH –1
Test Pit No 2 minutes per inch Depth of Test Pit Depth to ground water
A
Size Lot v Sq. feet
Expansion Attic ( ) Garbage Grinder ( )
of persons 1 Showers ( ) — Cafeteria ( )
Description of Soil
ENCLOSED ON PLAN
Nature of Repairs or Alterations—Answer when applicable
SZE_A'fTACHED..PLAN
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System i accordance with
the provisions of TITLE 5 of the State Environmental Code The undersigned further agrees not to place the
system in operation until a Certificate of Comp lance has been issued by the board of health.
YAAC
Application Approved By
Application Disapproved for the following reasons:
Permit No. Issued
e l.li;___._.._.
774 7147V 41 ■. - .112:211011 }n .hc, J /Let a c oaeCL:mtwu be7.17144 ql0- 14,71e44
74 710
4n co44e4ncr ( 4 gasr. t_ .4 (Inn(_ ma} 2aa,a6 D>7bo2i 21,4-em
J., 12 } i. &LS4Ilcc
ISZ±telztit[ ;nr.Cs4 r3URUtrtz41n11 hitting
LEE
tiCVBD OE HEVriH
IHE COWPvo1A1FV77r1 Ot Vitae VC Fill2E112
1z I-4.444P
'41.7r 2.i.Etit , Irr kilieiC.'.!(Ml 2VIiaEVCIOKA'
THE 122FWVACE OE 1H12 CELc11EIC'VLE 2HVrr 4901 BE CON21SRER 112 V C11VTV491EE 1HV11HE
It L •_Mon [ OrzLn.•i}/r4>y z L.r;rz.Ln4. oa fia'_mlt 1/1r�
I t 4 Tr c I∎an C 0!114 1}IC bL ).rz el L o4 yV Fu ir(" l r cc.ipeq w
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BOVSSD OE HEVr'IH
riH Ot WV22VCFllA[ Le
THE COMMONWEALTH OF MASSACHUSETTS
cc-f
BOARD 1 HEAL
OF 1'n)
certificate of Compliance
TELLS That the In ividual Sewage Disposal System constructed ( ) or Repaired ( d<)
S IS TO CERTIFY,
by jJ� /}
CO-12-&S iA1L2 a7 IC-JL InvaT ,y"
has been installed in accordance with the provisions of TITLE 5 of e State nvironmental Code as described in
the application for Disposal Works Construction Permit No. 9' 9 3 dated r.)' 77'93
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
at
SYSTEM WIL UNCTION SATISFACTORY.
a g
DATE a- /9 / 3
No.. .-/..-./ .
Inspector
THE COMMONWEALTH OF MASSACHUSETTS
el, BOARD OF HEALTH /
t,)
Disposal i!I ark 4,Tanntrurtia t 1erutit
Permission is hereby granted A4.11-01,4.... _yt.(a.t...
to Construct ( ) or epair 'R ) an Indiviehtal Sewa Disposal Syst
at No....r�.-1-&t..i.0.dt l C,./F'.5,..._ i.Eariew._t 1
` u
street GG
as shown on the application for Disposal Works Construct on Permit AOJ.2 5ii ± Dated.... .Z -/ 7- /`3
FEE. °1
DATE /a3 1.7'
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
_N
tX�ir a, Gtrtnlf+.K Ii
12.11(i. ,1 y� a.
PERCOLATION TEST(S)
I Time: I Time:
Observation Hole #1 Observation Hole #2
Depth of Perc ii63"l Depth of Perc
Start Presoak Start Pre-soak
G1 '.0 :
End Pre-soak q End Pre-soak
Time at 12" Time at 12"
. Time at 9' l 3 c; Time at 9'
Time at 6' Time at 6"
l0 I1LI
Time(9'—6') Time(9"-6")
Rate Min./Inch Rate Min.Mch
() lM.L__
*minimum of 1 percolation test must be perromred in both the primary area AND reserve area. (
, . 2 . "i ■ s'J, ■
Performed by I !DAL, fAV2 Performed by I
Wit I
Witnessed by Y, Witnessed by
Comments:
On-Site Review
�Lobanor}ddrejs or tot#
Date
Engineering Firm
Identity on Site Plan
Land Use
Vegetation
Landtorm
FPosition on Landscape
Soil
Owner
1 - Time
Open Water Body
Possible Wet Area
feet
feet
-1`7 i Address
V� Weather
Engineer or Sanitarian
Slope°o I Surface Stones
Distances from:
Drinking Water Well
Drainage Way
1h 7
feet
feet
Property Line
Other
Deep Hole #:
DrpN Irom
DEEP OBSERVATION HOLE LOG*
'MINIMUM OF TWO HOLES REOUIREOAT EVERY PROPOSED DISPOSAL AREA
Sol Ilonzon
Texture
(USDA)
l_ s
L5
SI-
Soil Motllm
Other
(ure Stones Lloulc r5 C[onsi eii
Parent Material(geologic)
Depth to groundwater. Stadig
Estimated Seasonal High G{ountWaler•
Depth to BOrn
Weeping from Pd Face
1 Deep Hole#:
Dent 'horn :oil
rye micros!
DEEP OBSERVATION HOLE LOG*
MINIMUM OF TWO HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA
anzon Soil Texture
oil Color
(USDA) (Mouses)
Soil Mottling
Other
(Structure Stones Boulders.Consistency ' we
Parent Material(geologic)
Depth to groundwater Standing Water in the Hole
5 Seasonal High Ground Water
Depth to Bedro
Weeping from Pit Face