176 Septic Application Permit Soil & Perc Test 2003 THFr COMMONWEALTH OF MASSACHUSETTS
MASSACHUSETTS
A;r , -tfui
FEE
cAppliratinn for !ispasul !gstem frinnstrnrtinn Permit
Application is hereby made for a Permit to Construct( )or Repair( )an On site Sewage Dispo al System at:
Location Address or 1 of No
Owlet's Named-Address and r 1.No
In. Ile Name.Ad dreyy and Tel.No.
Designers Name.Address and Tel.No.
Type of Building:
Dwelling No. of Bedrooms
Other Type of Building No per Persons
Other Fixtures
Garbage Grinder(i
Showers( ) Cafeteria( )
Design Flow gallons per day. Calculated daily flow gallons
Plan Date Number of sheets (1 _ Revision Date
Title _. . .
Description of SoiF
Nature of Repairs or-AAltewgons(An swer when applicably)
/ 2
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.
/'signed Date
Application Approved by Date
Application Disapproved for the following reasons
Permit No Date Issued
THE CpMM NWEALTH OF MASSACHUSETTS
✓f�'�� '' i7)/74 MASSACHUSErrs
Certificate of (tinmplianre
yyy
THIS IS TO CERTIFa that tl)eOn-rCiip Sewage Disposal System
formlled(1 i f ripppaIre4tigpllaced ) o I
at yr �'e C�"_� r a .. � h3y.bge�co ,ructed in
accordance wiih.1hg pfpv lions of Title 5 and the for Disposal System Construction Permit No `f dated
Use of this system is conditioned on compliance with the provisions set forth below:
The issuance of this certificate shall not qe cQpstrtas a guarantee that the ystem will function as designed. This
Certificate expires on r.
/
1--;" !rj
DATE - % _ Inspector J <' ' (�
THE COMMONWEALTH OF MASSACHUSETTS
No. ^"" 1--(4-,.. )_J:n/ MASSACHUSETTS
!ispusttl $gstem (Construction Permit
"--,1 : [5.-/,,,, : r
Permission is hereby granted to -
to construct( ) or repair( )an On-site Sewage System located at
1 1/4,"/!
FEE
J
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.
.a
DATE - Approved by
FORM 1255 Be v 3/95 A M.SOLKIN CO-BOSTON,MA
-
No.
FORM II - SOIL EVALUATOR FORM
Page I of 3
"446/61
Date:/ /6
Commonwealth of Massachusetts
. Massachusetts
Soil Suitabili y Amassment for On-site Sewage Disposal
Dis posal
Performed By: (Ott( //9/77 v/ Date: %L/� /
z h I / 7? .49(€
Witnessed By: n 1C /7 %Z 6 ///c/ ge/�
Net (-.4/f/ Jlitccin/a J - /1/4_, o.( / sie ctil or-el
/7/ /&/FS titNUl"c} r'O . /74, _
Cv6 5 %1-%re...1,0 /.t;
AA)/477/N-f¢'/P /Oti /2-/4,55 �/ �>_
new construction lit Repair iKl /OOIJI/jy7,le., Ai fl
Office Review
'ulrlished Soil Survey Available: No U yes .07
/iav Published Publication Scale Soil Map Unit
Utainage Class Soil Limitations
58(0 - b0 /3
Suriicial Geologic Report Available. No ❑ Yes 0
Year Published Publication Scale /...)4/0/4/17
Geologic Material (Map Unit)
Landferm ...
Flood Insurance Rate Map:
Above 500 year flood boundary No ❑Yes
Within 500 year flood boundary No 0 Yes 0
Within 100 year flood boundary No ®Yes ❑
Wetland Arra.
14ttional Wetland Inventory Map (map unit) ..... .. __.
Vieslands Conservancy Program Map (map unit) __..
Curren( Water Resource Conditions (USGS): Month
Range :Above Normal 12Nonnal El Below Normal ❑
Other References Reviewed:
ov Arraova,roan,. um.n
•SI 4.0111 141401 ilLS.411410.41JV ISO
_r S' Z'Ai a
,z_____ .Y•Y/IN matte _.'---1,•°M Sow. ON news nterswa. _
-_._ _
-_ __'__.. 7/ 'M•U nNWuwM•`MP•q 'yn/ C' •44u0WY000.4
I..L____ •_.._ _
) > /3' Ory
sv 790, Orr
„ z
3/7ri4// z%✓
75- i5 Gd-y/
2r, _)-767
1147/ 7 � °
a/h OMeiS t'/ -�
.
1' o /v
� �n� 098 9/- O/
a'no/ "A"' (/y
A •NA.s
f1 IYIw•] '.Jpwy -•«r1Y xn.n.wl s,YU...
1441 Y"Y v I•'I .•AI.4I Ml 1•W.ylYayr
IM•Y 1••u sou "Atli yYYp •
.001 37011 NOII.VAU398O d330
OSnii20/YaRe/ 7<<i 21 7S-0rvilorY
}'n/r7 1rv,7z/' ,52 7"- . •aI 970° o
J 'J .yu. .. u.. . .Y PM eI•. e
(�~l// ? I �/S� .o.. , �L . A:......." . u (7(J/ u...V uM q4P J
1 " -14 O0/ n.... v u."." ,..y , CV/
AVn4 w YJ
•M • O
. m.. Y•m01010
n.••4 .y. . 440.1..01l Y tau•Imry uY u°MM•d
J/72/2/4/, Al 50.nv1nQ '4Io/Mrl
p.y167rY ti Ub/ 0'094/7 uep•1M•A
+ i lY.lni7( /1/YJ(!/43Z an pal
limo ails sit. Alll4•PII II•II•• l 1S//7 24/bra
�'/7 OJ IYIIIYY.I.I (/06 . .uU 2 0/01/V :YIY11 awl N •W/ lama ..
/-///1
Pry dl am a;% /11/f.f-tan/ /'/ /��
SS N/ - 0/ (lid/-(/t /G1 (/ C2/ 1 nN Ili In NNI11.N YNINaY I
C/tint/ R7 00V-7A/ .3-9/122 62/ /
CO r at■d
IWMOI UOJ.VII•IVnu 'lllls I I IVlll Id
■
.1.l au -Iwua U4l$.IV BU
c
Mw1...65 '104.0• N'sae q3/4110.•1100.8
/.I.wa_
1.11.11..Y q Y .M eWM.el
fil wei tiry 0 e4Yrww.w.11 GrL% h S 1
cY $0 p 7)(/07e
, ./f5.4g4, /
J
57_5 a44;7/ah Q/ l/ rGci o - 8/
orvire A o/ 7iho/ % u
v7 y 8/--0/
/ 7/s p CC/4,/
0/
eu
• v•14•1y.I1e D ' a .n4+'b161 eya I . wrvl 1.14 4 nut: •44I y° uw ° B 1.11
- a
ypO �
31011 NOLIV/U.09BO J330
O rroan16i i-p cai
O—n- ) -i/r?'22/=/ ph °nail) 1...1 110M ••10nn 801,11.110
7!14/7I me ° s2 .....I..`1 7 nW/••_•v leak *Min..'
.....1 F ...I gr.,. . AMaY uI.M 1..Np
/ . IX,"/n.. .1 y, OW .1.u., Yw...HW
—'r i..,.•y 1.111 1116 simmig ammunitions 1.0 1.000•04
h'5F4rnjoQ waelprl
.,/Y n74'7 uap'IWA
C7 or>, a ?t/Q$ •14.IU1e YID 11.y. / c tut o.1.yy 76,itfy 9 a/$fl/ °Opal
j.SII JyS,LY �r YI IYY O or/C 700! 1 M ...1.y1 :.11411 1.1.11.141/4 non aN
6 7 17/n/z/ 7-,(//
41ai.laN' a,es-1.n
Sstonvi /va{dGV(7,v_e orY
O'l1 rnani 1,141/ 5,-1/02 9( / ..N ,.,, M I..1,p1y ae,leoe'1
CATalma
'woe 1OJ.V/l'IV csI lit IS 11 11111114
Pe, cola ion 'fes t
Test No . 1F'r: / Z9 64e
Reading _ -_. Tillie .Snp/ci
Sa turat Ion ( 15 mlu ) 930- 9V
/2 9 VS
c lye
?..5".3
7 (ss
io 00
pert Rate c.) M/ ni i .e�n�i'
1f, 0 Mlu/ inch Poi I' . lime J •o Min/inch
Ground EIev . C, wind P: I rv . __-
Dept h of hole VV Urplh of Inn I -34j4-------
Test I'll 7/), - / nett I' 'real PI I. is J f/19 �Lp rp. i.`.
Depth Soil Vesta Jilt nun 'I'rvf Pll �/ /' L_
--------- - - -L -- Dept ll Soil Description
(l -/o _ ars- eu ,lip ) - - P
_1.C1 -/_8__- LFi.r $ y 5-44-40 c Q -/U o�S_coir/,-
S v,5- /0 --/(13 ,_57c._ ry _a_.4.0c,o Svc
/r5 -/Z c i T.9s% s/J/u o ir.��e..?
Groundwater UepU� J kitty P Ste__-?-6�tD S rt
Bedrock Z' Ceoundwa ler Depth ZI Elev.
Ground Elev . Depth / c E, lev . Iled rock Depth s« >'�lev .
__ 7. Ih-uand hlev .__ A-yL�r 6 L
S . C . S . Soil Descriptiou _S Seasonal Iligh Wa Ier 'fable? /%f Air 6
Bench Mark : Elev . 5-2 ( L.;,)06., _ description --- —
/Pir. A "Ye fRL14u
Ilrn'I IUr 'I' I me q
S a off at lon ( 15 mlll ) 937 - 75--a
pra
/D
C o19MGMrs•
1(4 Dia XI
eye cc)A,
0 La accdes c-e'l
1
)
6
9
Rug l nee r
WI l ue sn :
Lora( Ion OF ere
FORM 12 - PERCOLATION TEST
Location Address or Lot No. /76, Gat 5 / ,5/De, 2C)/9O
COMMONWEALTH OF MASSACHUSETTS
A.1/21/21771/9/11/74,, Massachusetts
Percolation Test'
Date: /2//i0/0 2- Time:
Observation Hole p
j
//, '97(3- /
r/O
Z
Depth of Pere
V y /,
Start Pre-soak
zyyec_A 2,y,4
End Pre-soak
9�s= 9sa
930 9V-
iuf/�'f4 8
Time at 12" %57J
7 VS--
$o ii A4el
Time at 9" 47(3
9 98
P /lc FaL
Time at 6" /000
q t.575-
- p P2V UK4/
- /e?/O.v//Z P,f i
Time (9"-6")
7/3 r 2, 33
G0Li5/5 TT/t/T
Rate Min./Inch
,04-.3764' ' A''- 7LE
,%U /�.,//_'
.pPS/c,•C/ £ATj
f C
/ /0o//
• Minimum of 1 percolation test must be per ormed in both he primary area AND
4if1""0 p,00ra /7oPv ,eirc;)D
Site Failed ❑ A2e/' 3/61 C n-e/e /3-, 2/Z
reserve area.
Site Passed
Performed By: c_e- r etixi9 E
Witnessed By: /1)427-,CA:. tic /k,Ct,ry /.(J go/.,/
Comments: -)
c
?cc' 7o
ov APPROVED FORM.vmn,
587 it .y
I.orallon A,Idren, or lot No.
FORM 11 S011. EVALUATOR FORM
Page Sof3
/76 (-0c-05 n ,¢z7,p0 w 244¢,0
/00,te/-NAviy,o /z ii svA75-5
Determination for Seasonal Hits Table
Milhod_Utted;
Latepth obser vad shoaling In
IsJ�- l`)np11. wnapinp from olds of
1. J-a,epih to soil r nottlon
Ground wwtm wdlrrwlmnnt
Indere Well Number nenrllrr
Adluetmenl factor Arllnsre
nliaarvalloo bolo Inc
allaervnoon holy. hi
I.u•hen
Inn, blo/////I!/
Unrn
./e-r, r-e /V
J tndnn w
rl pr moot welnr level
hes
cline 72
7z
�rei6z"
11 level
7/?--/ 7%%-z
DeD.lh offla urolly_Qocuning Pervious Material
Does et least four observed throughout the area proposed for the
If not what le the depth of naturally orrpning
Q_ertllicaikon
I osrtlly that on
pervious materiel exist In all areas •
soil absorption system? r./P47_
IlerulOpe material? •
Jets) 1 have passed the soil evaluator ex 1 r
approved by the Department of Environmental Protection and that the above
wee performed by me oone)etent with the requirer)training, expertise end elato�ir la�
described In 310 CMR 15.017.
Signature
DO arr11O VIII ro•M. 11nrn1
thole
PERCOLATION TEST(S)
I Time:
I Time:
Observation Hole
#1
Observation Hole
#2
Depth of Pero
Depth of Perc
Start Pre-soak
r !
Start Pre-soak
End Pre-soak
!' -,
End Pre-soak
Time at 12"
-
Time at 12"
Time at 9"
Time at 9"
Time at 6"
-
Time at 6"
Time(9"-6°)
Time(9"-6")
Rate Min./Inch
Rate Min./Inch
primary area AND reserve area
s
NORTHAMPTON BOARD of HEALTH- Title 5- Site Review
Locaiion Address or Owner
Lot# , - y < ; /. _ :
Date
p— ' / in,—
Time
Soil Texture
(USDA)
Owner's
Address
Sol
Mottling
Engineer j
Weather Phone
Land Use
%Slope
I Surface Stones
Landfomt
Parent Matal(geobgic) I I Depth to Bedrock I
Vetetation Start Time
Distances Stop Time
Position on Landscape(tietdi on the back)
Open Water Body
feet
feet
Drinking Water Well
Drainage Way
feet Property Line
feet Other
feet
feet
Possible Wet Area
DEEP OBSERVATION HOLE LOG*
Deep Hole#: 'MINIMUM OF TWO HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA
Depth from
Surface Inches)
Soil Horizon
Soil Texture
(USDA)
Soil Color
(Munson)
Sol
Mottling
Other
(Shucture,Stones,Boulders,Consistency,%Gravel)
it
Parent Matal(geobgic) I I Depth to Bedrock I
Depth to groundwater Standing Water in the Hole
I Weeping from Pit Face
Estimated Seasonal High Ground Water
I Weeping from Pit Face I
DEEP OBSERVATION HOLE LOG`
Deep Hole#: *MINIMUM OF TWO HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA
Depth from
Surface(Inches)
Soil Horizon
Sal Texture
(USDA)
Sod Color
(Munsell)
Soil
Mottling
Other
(Shucture,Stones,Boulders,Consistency,%Gravel)
Parent Matrial(geologic)
Depth to Bedrock I
Depth to groundwater Standing Water in the Hole
I Weeping from Pit Face I
Estimated Seasonal High Ground Water
•
J.W. Cotton
Excavating, Trucking& Snow Removal
5 West Street
West Hatfield,Massachusetts 01088
Telephone: 413 •247•9608 Fax: 413 •247•0276
April 01, 2003
Board of Health
City Hall
Main Street
Northampton, MA 01060
Subject: Helen Steward
176 Coles Meadow Rd.
Northampton, MA 01060
The subject septic system has been installed in accordance with the approved plans, 310
CMR 15 and local board of health regulations.
Sincerely,
.9iohn W. Cotton, Installer
JWC/kr
Internet: www.jwcotton.com
Mailing Address: P. 0. Box 921,Northampton,MA 01061-0921