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82 Septic & Well Application & Plans ' • No Si—GU FORM I-APPLICATION FOR DSCP Fee Commonwealth of Massachusetts NORTHAMPTON, Massachusetts Application for Disposal System Construction Permit Application is hereby made for a Permit to Construct(X) 'stem at: Location Address or Lot No.2 COLES MEADOW ROAD or Repair() an On-site Sewage Disposal Owner's Name. Address and Tel. # ROY GIANGREGORIO 31 RUSTLE WOOD RIDGE NORTHAMPTON, MA 01062 413/586/7623 Installer's Name.Address.and Tel.IS Designer's Name, Address and Tel. # D n4.2A MacLeay Associates, Inc. 102 Bridge Street Shelburne Falls.MA 01370 (413) 625-9774 Type of Building: Dwelling No. of Bedrooms Garbage Grinder Other Type of Building_No. of Persons Showers Cafeteria Other Fixtures Design Flow 440 gallons per day. Calculated daily flow 689 gallons Plan Date 6/22/99 Number of Sheets Revision Date 5/8/00 Title SUBSURFACE SEWAGE DISPOSAL PLAN IN NORTHAMPTON.MASS FOR ROY GIANGREGORIO.LOT 2 COLES MEADOW ROAD. Description of Soil MEDIUM SAND SEE PLAN FOR DETAILED TEST PIT DESCRIPTIONS. SEASONAL HIGH GROUNDWATER AT 80 PERC RATE 16 MIN./INCH. . WITNESSED BY PETER McERLAIN Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure thee' .truction and maintenance of the aforedescribed on-site sewage disposal system in accordance with ro Title 5 of the Environmental Code and not to place the system in operation until a Cert; diance has been issued by this Board of Health. XSigned 6/7t� - Date v S" Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued FORM 3-CERTIFICATE OF COMPLIANCE Commonwealth of Massachusetts NORTHAMPTON, Massachusetts Certificate of Compliance This is to Certify, that the On-site S wage Disposal System install d (X) or�reppa--ired/'. plac O on (,�].7 D by �� Q•wt tt y I-�M ` for R GIANGREGORIO at I 7,J LOT 2 COLES MEADOW ROAD has been constructed in accordance with the provisions of Title 5 and the for Disposal Syste Construction Permit No. 3/— CO dated 9/3VCI Use of this system is conditioned on compliance with the provisions set forth below: The iss[lance of this certificate shall not be construed as a guarantee that the system will function as designed. The Certificate expires on 7/macfrov3 Dateicii' Inspector fC1 2 acrt_ FORM 2-DISPOSAL SYSTEM CONSTRUCTION PERMIT Commonwealth of Massachusetts NORTHAMPTON, Massachusetts Disposal System Construction Permit No (—� Permission is hereby granted to ROY GIANGREGORIO to construct(X) or repair () an On-site Sewage System located at LOT 2 COLES MEADOW ROAD and as described in the above 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 two years of the date below. Date Approved by Analyzed For: Address : L., CO 1uu HOWARD LABORATORIES of NEW ENGLAND, INC 750 North Pleasant Street Amherst , MA 01002 Phone: (413) 549-8260 Fax: (413) 549-1850 MA Lab Lich M-00851 WATER ANALYSIS REPORT Contemporary Country Builders 31 Russelwood Ridge Northampton, MA 01060 Sample87506 Lo F "-- Sample Location: 02 Coles Meadow Rd Roy' s House Sampled By HWU Date Sampled: 8/17/00 Date Received: 8/22/0D r Parameter Results Limits Comment.,: Total Califon Bacteria PH 0 =mo.lo.no..l 7.28 pH N.,I OK 0 coIo:r:eeh ox Manganese Hardness OK 0.074 ...q/ Conductivity chloride Iron 64 .qn 0. 14 s/ 5.2 .qn 0. 01 No ..,.I,dref u, a....d.m OK OK Sodium Nitrate Nitrite 10 .s/I 28og/3 ox 0 .1 0.001 mm/-. OK ,...,n OK Color 8 P.m Co.or w.. I_ Pt cn :'PIOr Jose OK Turbidity OK Recommendations: This sample meets acceptable standards of potability for the parameters tested. Date : 8/23/00 Analyst : 3K checked By:Jona han S. Begq Laboratory Super'7.EOr MacLeay Associates, Inc. CIVIL ENGINEERS 102 BRIDGE STREET SHELBURNE FALLS,MA 01370 PHONE (413)625-9774 FAX (413)625-9704 SYSTEM INSTALLATION OBSERVATION REPORT SITE INFORMATION LOT# 2 DATE: 07/10/01 STREET COLES MEADOW ROAD TOWN NORTHAMPTON JOB# 99-015-2 OWNER INFORMATION PROPERTY OWNER ROY GIANGREGORIO STREET ADDRESS 31 RUSSELLWOOD RIDGE TOWN NORTHAMPTON MA 01062 INSTALLER INFORMATION NAME OF INSTALLER ROY GIANGREGORIO STREET ADDRESS 31 RUSSELLWOOD RIGDE TOWN NORTHAMPTON.MA OBSERVATION RESULTS DATE OF OBSERVATION: 10/3/00 &6/27/01 O ( ) THE SYSTEM APPEARED TO BE INSTALLED SUBSTANTIALLY IN ACCORDANCE WITH THE APPROVED PLAN. AND 1S IN COMPLIANCE WITH TITLE 5 THE SYSTEM DOES NOT APPEAR TO HAVE BEEN INSTALLED ACCORDING TO THE APPROVED PLAN.AND IS NOT IN COMPLIANCE WITH TITLE 5 DEFICIENCIES: (X) THE SYSTEM DOES NOT APPEAR TO HAVE BEEN INSTALLED ACCORDING TO THE APPROVED PLAN,BUT IS IN COMPLIANCE WITH TITLE 5. ENCLOSED IS A COPY OF THE PLAN SHOWING"AS BUILT-LOCATIONS AND ELEVATIONS. COMMENTS: House.well sc rtic tank and leach told 1. `ions are as t'fl ime 0 .,_./ ... AS J.M. LEAY E. shown. These locations are as ound DENT SEND COPIES TO: BOARD 0 HEAL Giangregorio MacLeay Associates, Inc. CIVIL ENGINEERS 102 BRIDGE STREET SHELBURNE FALLS.MA 01370 PHONE (413)625-9774 FAX (413)625-9704 SYSTEM INSTALLATION OBSERVATION REPORT SITE INFORMATION LOT# 2 DATE: 07/10/01 STREET COLES MEADOW ROAD TOWN NORTHAMPTON JOB # 99-015-2 OWNER INFORMATION PROPERTY OWNER ROY GIANGREGORIO STREET ADDRESS 31 RUSSELLWOOD RIDGE TOWN NORTHAMPTON.MA 01062 INSTALLER INFORMATION NAME OF INSTALLER ROY GIANGREGORIO STREET ADDRESS 31 RUSSELLWOOD RIGDE TOWN NORTHAMPTON.MA OBSERVATION RESULTS DATE OF OBSERVATION: /03/00 &6727/01 () () THE SYSTEM APPEARED TO BE INSTALLED SUBSTANTIALLY 1N ACCORDANCE WITH THE APPROVED PLAN. AND IS IN COMPLIANCE WITH TITLE 5. THE SYSTEM DOES NOT APPEAR TO HAVE BEEN INSTALLED ACCORDING TO THE APPROVED PLAN.AND IS NOT IN COMPLIANCE WITH TITLE 5. DEFICIENCIES: (X ) THE SYSTEM DOES NOT APPEAR TO HAVE BEEN INSTALLED ACCORDING TO THE APPROVED PLAN.BUT IS IN COMPLIANCE WITH TITLE 5. ENCLOSED IS A COPY OF THE PLAN SHOWING"AS BUILT'LOCATIONS AND ELEVATIONS. COMMENTS: House.well. septic tank and leac midi ;lions are as shown. These locations are as found a ime of nspec SEND COPIES TO: FORM 2-DISPOSAL SYSTEM CONSTRUCTION PERMIT _.17. '7 n ? -� '""�tU4Yhmonwealth of Massachusetts ) / _ /'197 / % 1119 E G 4191 F S2'l'HAMPTON, Massachusetts -14kisllaial System Construction Permit No. —� Permission is hereby granted to ROY GIANGREGORIO to construct(X) or repair() an On-site Sewage System located at LOT 2 COLES MEADOW ROAD and as described in the above 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 two years of the date below. Date Approved by 9, Analyzed For Address: p Samp1e(17506 HOWARD LABORATORIES of NEW ENGLAND, INC 750 North Pleasant Street Amherst, MA 01002 Phone; (413) 549-8260 Fax: (413) 549-1850 MA Lab Lic8 M-00851 WATER ANALYSIS REPORT Contemporary Country Builders 31 Russelwood Ridge Northampton, MA 01060 Lc T Sample Location: 82 Coles Meadow Rd Roy's House Sampled By: HWD Date Sampled: 8/17/00 Date Received: 8/22/00 parameter Results Limits Comment,; J Total Coliform Bacteria 0 : ..ao-do pH 7.28 pH Units Manganese 0.014 Hardness 64 .qn Conductivity Chloride 0.14 .slti 5.2 sn Iron 0.01 .gn Sodium 10 .qn Nitrate 0.1 Nitrite 0.001 mgn Color 8 MC° Co,tr Turbidity Recommendations: This sample meets acceptable standard:: of potability for the parameters tested. Date: 8/23/00 Analyst : 3K checked Bv:7onathan S. Begq Laboratory Supervisor