235 Septic Application Permit & Compliance 2004 No.
FORM 1A - APPLICATION FOR DSCP
Fee
COM∎401■4'WEALItiOE 7■491SSACAISETITS
(inard of Health. Northamnton MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to: Repair
( X ) Complete System ( ) Individual Components
Location 235 Coles Meadow Road
Owner's Name Steve Mongeon
Map/Parcel
Address 235 Coles Meadow Rd.
I Lot#
Northampton, MA 01060
Installer's name
Telephone# 413 586-0254
Address
Designer's Name Thomas Leue, Homestead Inc.
Address 1669 Cape St. ,
Williamsburg MA
Telephone #
Telephone 413 628-4533
Building Type. Dwelling
Lot Size (sq. ft.) 134 .900
Bedrooms: 3
Other - Type of Building
No. of persons
Other Fixtures
Design Flow (min. required):
Calculated design flow:
Design flow provided:
Garbage grinder (no)
Showers ( ), Cafeteria ( )
330 gpd
330 gpd
330 gpd
Description of Soil(s)
Soil Evaluator Form No.
Name of Soil Evaluator
Date of Soil Evaluation
lo y sand
315
Thomas Leue
8/25/04
DESCRIPTION OF REPAIRS OR ALTERATIONS new septic tank and leachfield.
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with
the provisions of TITLES and further agrees not to place the system in operation until a Certificate of Compliance
has been Issued by the Board of Health.
Signed
Inspections
Date
DEP APPROVED FORM 596
FORM 3A- CERTIFICATE OF COMPLIANCE
No. Fee
COM241oa(wnAr t(oF Wtss.CIIIISEYYs
Board of Health, Northampton, MA
CERTIFICATE OF COMPLIANCE
Description of Work: ( X ) Complete System ( ) Individual Components
The undersigned hereby certify that the Sewage Disposal System: Repair
by: J.W.Cotton Excavating
at: 235 Coles Meadow Road, Northampton
Homestead Inc. Project#: 15
has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved
design plans/as built plans relating to application No.
dated 9/5/04
Installer
Designer:
Inspector:
. Approved Design Flow 330 (gpd).
pv� - (-kid 47 » )Date: a-24°`/
Date: 11/22/04
Date: i///2%/ a%
The issuance of this permit shall not be construed as a guarantee that the system will function
as designed.
cc: Steve Mongeon, 235 Coles Meadow Rd., Northampton, MA 01060
DEP APPROVED FORM 596
North a
.a vi
Outline o =
3
tn
PL f 3 bedroom house Infiltrator leachfield: use Standard H-10 na Ft
infiltrators or equivalent. Four rows d
with four chambers per row. it
1
Use 6" Title 5 sand between rows. Use
select native sand for backfill.
0
Town water
...
3 .Zx14
/
/ o !R •
\ s� Orig. Surf. Elev.:
New, 1500 gallon, 100.9
I Title 5 septic tank. -2
I
I 25'
A'
TBM: Nail at base of pole. so Mil IIERLI ItIUl
tt Elev.: 100.00' :74,1,■ - I�IPII[ITIIIIII
Driveway i • sa' �1 IIIIIIIEBILI E
I
I
I
1 MECo #25 Orig. Surf. Elev.: r
99.3
COLES MEADOW ROAD
Date: Owner: ' M '
As-Built Drawing HOMESTEAD INC.
Existing Septic System 9/5/04 Steve Mongeon Ieo TMptAf6. Thomas S.Leue R.S.
Revision 235 Coles Meadow Ro. e f ° /1 6eaCape s
Scale: 1 : 20'
Northampton, MA 01060/ Williamsburg,MA 01096
Except as Noted
11 /22/04
se [4131628-0533