108 Septic Application FORM 1-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) or Repair O an On-site Sewage Disposal
system at:
Location Address or Lm No.5
/pr-COLES MEADOW ROAD
Owner's Name, Address and Tel. #
ROY GIANGREGORIO
31 RUSTLEWOOD RIDGE
NORTHAMPTON,MA 01062
413/586/7623
Installer's Name,Address,and Tel. #
Designer's Name, Address and Tel. #
MacLeay Associates, Inc.
102 Bridge Street
Shelburne Falls,MA 01370
(413) 625-9774
Type of Buildinp:
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 666 gallons
Plan Date 6/22/99 Number of Sheets Revision Date 11/11/99
Title SUBSURFACE SEWAGE DISPOSAL PLAN IN NORTHAMPTON.MASS FOR ROY
GIANGREGORIO.LOT 5 COLES MEADOW ROAD.
Description of Soil SAND SEE PLAN FOR DETAILED TEST PIT DESCRIPTIONS,
SEASONAL HIGH GROUNDWATER AT 44"PERC RATE 4 MIN./INCH, . WITNESSED BY PETER
McERLAIN
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
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 not to
place the system in operation until a Certificate of Compliance has been issued by this Board of Health.
Application Approved by
Signed
Date
Date ((/i%//
Application Disapproved for the following reasons
Permit No.
Date Issued
FORM 2-DISPOSAL SYSTEM CONSTRUCTION PERMIT
/25`
i1/n /s 5
Commonwealth of Massachusetts (r�/ --
NORTHAMPTON, Massachusetts
Disposal System Construction Permit
No. t0-7
Permission is hereby granted to ROY GIANGREGORIO to construct (X) or rep
an On-site Sewage System located at
LOT 5 COLES MEADOW ROAD
O
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 // s /�/�7
Approved by f—`"�' , 2$ °� ��"-�`��-•'�
FORM 3-CERTIFICATE OF COMPLIANCE
Commonwealth of Massachusetts
NORTHAMPTON, Massachusetts
Certificate of Compliance
This is to Certify,that the On-site Sewage Disposal System installed (X)
or repaired/r€placed() on /��"f�y by
repaired/replaced
rSw �-c-�, for ROY GIANGREGORIO at
/OK Co is unae ) LOT 5 COLES MEADOW ROAD
has been constructed in accordance with the provisions of Title 5 and the for
Disposal System Construction Permit No. 417— 9, dated
//7/77999 Use of this system is conditioned on compliance
with the provisions Bet forth below:
The issuance of this certificate shall not be construed as a guarantee that
the system will function as designed. The Certificate expires on
y c200
Date y"uX.(/3r,c;obr7 Inspector Y- -�h l��•-U G��
MacLean 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# 5
STREET COLES MEADOW ROAD
TOWN NORTHAMPTON,MA
JOB# 99-015-5
OWNER INFORMATION
PROPERTY OWNER ROY GIANGREGORIO
STREET ADDRESS 31 RUSSELLWOOD RIDGE
TOWN NORTHAMPTON.MA
DATE: 11/30/99
INSTALLER INFORMATION
NAME OF INSTALLER ROY GIANGREGORIO
STREET ADDRESS 31 RUSELLWOOD RIDGE
TOWN NORTHAMPTON.MA 01060
OBSERVATION RESULTS
DATE OF OBSERVATION: 11/29/99
( )
()
THE SYSTEM APPEARED TO BE INSTALLED SUBSTANTIALLY IN
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 I5 IN COMPLIANCE WITH TITLE 5.ENCLOSED IS A
COPY OF THE PLAN SHOWING"AS BUILT'LOCATIONS AND ELEVATIONS.
COMMENTS: STONE&TITLE 5 SAND ! 'PE• TO BE EXCELLENT
UAL
SEND COPIES TO:
DOUGL : J. Mac "AY.P.E.
PRESI'. NT
BOARD OF HEALTH
ROY GIANGREGORIO