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301 Septic Application & Plans 2007 Important: When filling out forms on the computer, use only the tab key to move your cursor-do not use the return key. Commonwealth of Massachusetts City/Town of rJer-K Application for Disposal System Construction Permit Form 1A c 7— /Z Number $ SO . o-o fcf Fee q ZZ 7 DEP has provided this form for use by local Boards of Health if they choose to do so. Before using the form, check with your local Board of Health to make sure that they will accept it. A. Facility Information Application is hereby made for a permit to:❑ Construct a new on-site sewage disposal system Repair or replace an existing on-site sewage disposal system ❑Repair or replace an existing system component. fmgos€4 sy&-k 'r t s nb-t so 4Able 1. Location of Facility: .�o r c "au,as a,spcse.4 . 30, I Coles 01.eakm.r P-4). Address or Lot# 11Jor+Intria"FCh cA 0 GO City/Town State Zip Code 2. Owner Information j / p ,�7 C7reyaYy J. Lctfor �, P4 oi3 /t �(i�17%A pAt 0(oaf r.,,r ks .•r Name JJ fr3/4%:$77,. 361 Coles liAsiet cats-i r— erp- ! '-"Address Of different from above) fihac�"Cr- (J- _ . o €t r- _wide', n/l4 of oGO F. City/Town State Zip Code g'w.n4s� CH 13-) 335- 7 z42- %an / Telephone Number 12703 3. Installer information frtAi Ct — Name �/ ��� Name of Company Address / G (/ {� 9. 0/083 City/Town / State Zip Code SSG rTelephone Number 4. Designer Information esc.ke/t,cl E .c.os4zt re/Coped- S-lov er A 34 G,o-r•s+ C,ui I EnsivieeH Name Name of Company jC2, O. .SaX 33/2 Address A v ■ hers+ 614 DI cog -32 City/Town State Zip Code Telephone Number t5forml a.doc•06/03 Application for Disposal System Construction Permit•Page 1 of 3 Commonwealth of Massachusetts 2o.,,7 -(Z City/Town of 1\1 e r 0-AA"124-trV1 Number Application for Disposal System $ Sv ad el Construction Permit Fee Form IA 4. 22-7 A. Facility Information (continued) 5. Type of Building: Dwelling Other:Type of Building ❑ Showers Specify other fixtures: 6. Design Flow: Calculated Daily Flow: 7. Plan: (5-}yC. Number of showers D ❑ Garbage Grinder(check if present) OMy caadbu2DisposA- I sInR re.w'bJf ❑ Cafeteria Number of Persons Served ❑ Other fixtures ?b r Oa Gallons per Day 332 409 Gallons it / 2307 Date of 0 ginal Number of Sh Is I' PTcn a Title of Plan 8. Description of Soil: 444CkaP Revision Date 9. Nature of�Reppairs or Alterations(if applicable): Xti(rinRti 5+r�wh,' tat m.4) Pt ' p -ufmO Cc amn L — ?tine -ek(uet f" -Ex'LS-Fr S 600 Go 1 J '1-b vr -4.4.1' hec( (18' x 325 ; , back Jana( 10. Date last inspected: Date t5fonnta.6oc•06/03 Application for Disposal System Construction Permit•Page 2 of 3 Commonwealth of Massachusetts City rUof Nor-V &v .p+'- Application for Disposal System Construction Permit Form 1A •� 7 ( Numbed ." 2 r s .5-J. c) B. 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. ��.]J �'''}� r.J/)rry it, 2/ • 07 Signature / (/ ��// Date Application Approved By: Name Date ENNEST I. MATHIER RS, MS, CEO. DIRECTOR OF HEALTH Application Disapproved for the following reasons: t5for ita.doc•06/03 Application for Disposal System Construction Permit•Page 3 of 3 • Important: When filling out forms on the computer, use only the tab key to move your cursor-do not use the return key_ Commonwealth of Massachusetts City/Tspyriof Adr-Hi OAAt2Jo>7 Disposal System Construction Permit Form 2A %ao7 —1 2— Number DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with( the local Board of Health to determine the form they use. Permission is hereby granted to: Ci rtt o r / J %e Name of Company 30, Coles i&acfow _,,c/ Address inr /%w 010 aty,?own State 06 Zip Code to perform the following work on an on-site sewage disposal system: ❑ Construction ��Fepair or replacement ❑ Repair or replacement of system components Facility Address City/Town State Zip Code Cr • lAPar-{ (413) 335- 729a Owner Telephone Number The work to be performed is further described in the 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 constr Approved b Title ust be completed within three years of the date below. air 461,- 7 —MST h MAME% RS M.S. CH O. DIRECTOR OF HEALTH Date i1/62407 t5form2a.doc•06/03 Disposal System Construction Permit•Page 1 of 1 No. FORM 11 - SOIL EVALUATOR FORM Page 1 of 3 Date: Iotz)o7 Commonwealth of Massachusetts . No r--41,vyriplon , Massachusetts Soil Suitability Assessment for On-site Sewage Disposal Performed By: Rthef-4-- .Thver Witnessed By: E r 11eS-4- M Date: 14121°7 lama°."Inn rnie niactioW 40. • Yew construction D Repair* Office Review Published Soil Survey Available: No 0 Yes Year Published • / $I Publication Scale I Drainage Class Soil Limitations Surficial Geologic Report Available: No 0 Yes Year Published Publication Scale Geologic Material (Map Unit) Landform • Ci re-5 4 Inn( Leper-4C, al Coles »q.0.4, 4 0-et Noraex,,,to+on, MA D104,0 (41.),336- 7L 3 Soil Map Unit r C rn 0 ibbto.a- ..s toP-e- ktith et-ten 1-•4,-/0 = >G2.0' beA.A.,ock = > 401/ Flood Insurance Rate Map: Above 500 year flood boundary No 0Yes Within $00 year flood boundary No acres 0 Within 100 year flood boundary No j141es 0 Wetland Area: National Wetland Inventory Map(map unit) Wetlands Conservancy Program Map(map unit) Current Water Resource Conditions(USGS): Month Range :Above Normal ONormal OBelow Normal Other References Reviewed: S 017 AMOY=PAM•11/117/95 FORM 11 - SOIL EVALUATOR FORM Page.2of3 Location Address or Lot No. 301 &D1.9.-6 rr t-Capolai 2D . ae )%4A. sl On-site Review Deep Hole Number __.I Date: 1,12/IZ f�D7 Time: .q_�,30 Location (identify on she plant ---_ .-si?.Qs-.f .._. Land Use fP5lc1RN\Ata.QUprISO Slope (96) 2% Surface Stones Vegetation -tc,Jocicf rca ock... Position on landscape (sketch on the back) Distances from: Open Water Body 2,0t, feet')' Possible Wet Area / D..t feert Drinking Water Well ZpD feet-Y Weather OVCrCaS4 Coo° Y?Zu tYt.l icary%y Drainage way rlZr`L feet Property Line r"I0. feet Other DEEP OBSERVATION HOLE LOG Depth horn Surface(Inches) Soil Horizon Soil Texture (USDA) Soil Color (Monseli) Soil Monling Other (Structure,Stones.Boulders. Consistency, % O _ —i tq Sd — G rfL r.s4- FsL, IDYe3/3 IoYRgI4 t �2iE nPPe h Lc F nab(-c M1tau-1 rrt 11le : �s 1 5I1y � 4Py� ` Li – IS — 18- 5z vu =c • MINIMUM 0 1 1 HOLDS AA UU1NlU A Fast Material tgaoloPet Oe"" VERY rH4 tUSLD DISPOSAL RASA YOB Depaq+Babarl: Death w Groundwater: Standing Wow in the Hole: &Waled Seasonal Mph Ground Water: t. S D ARROVm FORM-11107/95 Il(hQ. Weeping from Pit Fan:\ nfl Location Address or Lot No. FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 30 t Go ln-d YVLi.a4644- Nor- 4«-flour On-site Review Deep Hole Number _2.a_ Date:..I Uj/2/07 Time: j,1 .3C Weather $_hn g-624J 6C Location (identify on site plc ) See roan _. _._.. Land Use erSiLu1%LVaiq Slope (%) Z- Surface Stones . ..LY).. . _ltO.a-4i�-h_. 4Ae�SCepe, Vegetation Qa E 1 /. /-„id._04 k- !� • Landform _..�arca can-;ript Position on landscape (sketch on the back) Distances from: Open Water Body 2.00 feet-t— Drainage way n Im2 feet Possible Wet Area 10o feet t Property Line r4 0. feet Drinking Water Well 2oD. - feet 4 Other DEEP OBSERVATION HOLE LOG Depth from Surface Inches) Soil Horizon VAT ertur e (USDA) Soil Color (Munsell) Soil Mottling Other (Structure,Stones,Boulders.Consistency. % Grave O -11 y - 18 I B -5 2 A B`i G -Fs c• F5L FS L, ID*3(3 (oYr4JH fsyU/b nalL• n aput. frialPL rnc1ab(, , >nLa/47 stb",a° 5 i;2 4 1'I 404 • MINIMUM OF 2 H U 1 LS 1 O E N ED A I LVEHY PHUF'USfU DISPOSAL AREA Berne Materiel loeobgicl -4-; It nu haidn.se DepCmBeJOrk: .S a " 9.ohto Groundwater: Standing Water in the Hole: banned Seasons ugh Grottos! Water: S n Weeping from Pit Face: nr,a S2" DE7 APPROVED IOWM-LLCM/PS Location Address or Lot No. FORM 12 - PERCOLATION TEST 301 Co (oa haerd- £J COMMONWEALTH OF MASSACHUSETTS t%or-f ctar*7, Massachusetts Percolation Test Date: ....,/.AI/Z1.P7 lime. ,.:.JD;Fl3_._._,. . Observation Hole # I Z Depth of Perc ,, 11 1 ,l Start Pre-soak fu;u3 1 : aC End Pre-soak T) 59 /1 2.0 Time at12" fp , yG 11 ; 2-- Time at 9" 11: 13 1144 Timeat6" 11 " y -7 Time (9"-6"I 3 4 Rate Min./Inch • Minimum of 1 percolation test must be performed in both the primary area AN reserve area. Site Passed g Site Failed ❑ Performed By: teo%er-f- S-/¢ye/- Witnessed By: 5l77('5$- ;09x Comments. # Z Fe.)).�°Q $ ALY1-12 s21 Da Aen*OV®Four.1W44 FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No. 3o I &les Witazior 44 No leS.Andirfern Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole _ inches ❑ Depth weeping from side of observation hole . inches Depth to soil mottles >51 inches ❑ Ground water adjustment feet Index Well Number .. Reading Date Index well level Adjustment factor Adjusted ground water level . . . .... ._ Peoth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in a II areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious material? - (/ Certification I certify that on Co 1993 (date) I have passed the soil.evaluator examination approved by the Deo rtment of Environmental Protection and that the above analysis was performed by me consistent with the required veining, expertise and experience described in 310 CMR 15.017.5. / • - Signature I W 6t4 //` ,b/,I ate (o(/2/02 Important: Vvhen filling out forms on the computer,use only the tab key to move your cursor-do not use the return key t5form3 doc•06/03 Commonwealth of Massachusetts City of (Vor',-I&Ina Ie Certificate of Compliance Form 3 DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with the local Board of Health to determine the form they use. This is to Certify that the following work on an On-Site Sewage Disposal System ❑ Construction of a new system Repair or replacement of an existing system ❑ Repair or replacement of an existing system component Has been done in accordance with Title 5 and the Disposal System Construction Permit(DSCP): DSCP Number Circa or y r. Lag'or-te Facility Owner 301 (cLes htectakikr DSCP Date Street Ad ress o Lot# 6C-6 MAI Id' i VYj bk b lo&o City/Town State Zip Code Des gner Info motion: auth _ Name, 44,r.-5-71 C.l JLL�✓✓G� �/eEr/lry Name of Company O' v/ /s/oe Signature Date Date Installer Information: Name Name of Company Signature Date Use of this system is conditioned on compliance with the provisions set forth below: The issuance of this certificate shall not be construed as a guarantee that the system will function as designed 110 Approving Authority Signature Date ERNEST J. MATHIEU, R.S., M.S., C.H.O. DIRECTOR OF HEALTH Certificate of Compliance•Page 1 of 1 AMHERST CIVIL ENGINEERING PO Box 3312, Amherst, MA 01004-3312 (413) 256-3400 November 25, 2007 Ernest J. Mathieu Director of Public Health Board of Health City of Northampton 212 Main Street Northampton, MA 01060 Re: Repair of Septic System serving 301 Coles Meadow Rd., Northampton Gregory J. Laporte, owner I hereby request that the Northampton Board of Health grant a variance to its regulation that the area requirements of all proposed soil absorption systems be increased by 50% in order to accommodate any future installation of a garbage grinder. Granting this variance will allow the installation of a replacement soil absorption system at the address specified above that is sized to meet the Title 5 requirements for a three-bedroom house without a garbage grinder. This is a three-bedroom house and the owner will remove the garbage grinder now installed in this house. It is not possible to provide a soil absorption system at this site that provides a 50% increase in area over and above the area required for a three bedroom house because there is not sufficient available space that meets the Title 5 requirement that sewage disposal systems be located in areas where there is at least a four foot depth of naturally occurring pervious soil below the entire area of the soil absorption area [310 CMR 15.240(1)]. The test pits indicated that the area of the proposed leach bed does meet this requirement if the B-horizon is included. However, the area to north of the proposed each bed is unsuitable due to a steep slope and, by the report of the previous owner, the area to the east and south of the proposed bed is unsuitable because the soil above the bedrock was built up with fill in order to extend the level area of the back yard. Test pits confirmed the presence of fill. In conclusion, the leach bed proposed on the accompanying plan takes advantage of all the available space that meets Title 5, 310 CMR 15.00 requirements for locating soil absorption systems. Thank you for your consideration of this request. Very truly yours, Richard E. Cosa P.E. Robert Stover V k/2t /kGK i Vi V`L-_- NORTHAMPTON BOARD OF HEALTH PLAN APPRO ON -/ t Ernest 3. athieu,1LS.,MS,C.H.O. Director of Public Health TeL 413-5874214 Septic System Permit Payment Record Date: it 624707 Amount: $ *a& /1 Cash Check# 52:7 Property Owner Property Address 3}j dot New Construction Repair GREGORY LAPORTE 301 COLES MEADOW RD. NORTHAMPTON. MA 01060 ORDERO E i?y .qA No tar NA4P70N 53-7054/2113 8244420307 DATE tl-ZFi-07 Banknorth Mas sad,melt MEMO SE Pt)-C Petit,.^i— m� i: 2L1370511 51: 82 LOA 203070 02 7 $ So. ©o DOLLARS BB pert Test Witness Payment Record Date: / .Amount: 5 ���5L' aY/_ Cash: Check=: ' ° lri ./ /_ /1 Property Ovate Property Address New CoroPictior GREGORY J. LAPORTE IRENE C. LAPORTE. 301 COLES MEADOW RD. NORTHAMPTON, MA .01060-1101 Pay to the order of Repair frot 53-7054/2113 1157 D. 10 .12 7 e;'Y 0F n':D ='', t FrON i $ 7500 FRSTMASS. A SAN*OR11 CO NY_ FIRST MASSACHUSETTS BANK, N.A. 370 MAIN STREET ORCEST R MA 0100R r.,''PNE55 PE`-?e1 rot. 21 L3705451: 459a6429ie• 1157 ( F c� tee- -'c2 Dorso.,