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470 Septic Application Permit & Plans 1998 fir jtkilitItt FEE'S? — COMMONWEALTH OF MASSACHUSETTS Board of Health, MA. ION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Applii. M B?t '01 0 ct( ) Repair( ) Cpgrade((Abandon( ) - ❑Complete System VCdividual Components l s / Owner's Name &fir& 6 &E Loca �Ir .. empou RD_ � Address L h#10E7 /-SE- PatyoCc AAA blap/Parce' Lot# � Telephone# 413 53a_ Jbod Installer's Name \N� �� IIt-M �� ��0[. � fiAnn t, Designer's NameT A- r/N� M 6 Address S 7c/ 2# %Pi ins/ _ i L/")-n Address '20 MO Rn - 16./AAVEsp elephone# A. / - % %q 9 j - Telephone# (4I' S29 - 5211 Type of Building 51196.11. FAA,. cy Dwelling-No.of Bedrooms Other-Type of Building Other Fixtures Design Flow (min.required) Lot Sire No.of persons 6 Showers 0./{Cafeteria( ) Plan: Date Title Cll gpd Calculated design flow 3 3 0 Design flow provided 7 D Number of sheets Revision Date gpd Description of Soil(s Soil Evaluator Form No DESCRIPTION OF REPAIRS OR ALTERATIONS Name of Soil F:calua or - t h • . t Date of Evaluation ¥- 9-98 7 •at ti •I Rc6,trtasw S or -3 8eo ova No s& Jr&o 6-AL,LoAI SeSSir --pwiC Mqt„iA,p, E\lcr,N6- The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Sign t r Date .. Inspections COMMONWLALT] OF MASSACHUSETTS Board of Health, CERTIFICATE OF C►MPLIANCE F 3n Description of Work: Individual Component(s) iretomplete System The undersigned hereby certify that the SeWage Disposal System; tehstructed ,Repaired ( ),Upgraded),Abandoned( ) �lf lfue ( t1g4.. vv / / at a CS )e�e� C PaQp has been installed in accordance with the pro sions of 310 CMR 15.00-Tide 5) and��tipprovrd esign plans/as-built plans relating to application No. dated « Approved Design Flow 33% (gpd) Installer Designer: (0 - Inspector: 1I1. 7/�iiS' Date: The issuance of this9etad[shall not be construed as a guarantee that the system will function as designed. ✓ dr/h/' EE $30 COMMONWEALTH -OF MASSACHUSETTS Board of Health, DISPOSAL SYSTEM C®NSTRL _TI©N PERMIT Permission is ereebj'�y�granted to; Construct( air Up ra e( ) bandon( an individual sewage disposal system at I-// e l of /e iP as described in the application for �5 Skdate //)-7 V Disposal System Construction Permit No. Provided: Construction shall be completed within three years of the date of this All l cal c. dit Form 1255 Rev 5/96 AM.swlnn Co.Boston,MA Date CA l� Board of Health ust be met. FORM 11 - SOIL EVALUATOR FORM Page 1 of 3 No. Date: 47-07y-51 Commonwealth of Massachusetts 72or? 4 ,111°", Massachusetts Soil Suitability Aessment for On-site Sewage Disposal Performed By. C. Ler lc.s._ J'. U'-1 e4.k t Witnessed By: _..?t-.#.c-r e' ley t .-- Date: l/-d 5 Y r Imam Address or C°Lcs (lcndow Rd) Nt,..14nn-(04-nul f44 . 'Jew Construction ® Repair ❑ P6✓vn-s.u:, a.ti.�.m.. C or GS PHEL Aaine z% P6.1 re IC Cocci^-'S Tdlgdae, d a6 ICi c26 ST. /f/onr.rryf jo P/141 or86 U6-o n.7i 7 Office Review Published Soil Survey Available: No ❑ Yes El Year Published /?'T( Publication Scale Drainage Class C'knr/Ya" Sefn Soil Limitations Surficial Geologic Report Available: No ❑ Yes ❑ Year Published Publication Scale Geologic Material (Map Unit) Landform Flood Insurance Rate Map: Above 500 year flood boundary No Oyes Within 500 year flood boundary No Dyes ❑ Within 100 year flood boundary No ❑Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) Wetlands Conservancy Program Map (map unit) Current Water Resource Conditions(USGS): Month Soil Map Unit 'Lott L Range Above Normal ❑Normal ®Below Normal ❑ Other References Reviewed: DEP APPROVED FORM 12/07/95 FORM 12 - PERCOLATION TEST 6eatac PA 60- Location Address or Lot No. co/os /7Eedcw RI /1/o„ Awpt`c% Me/. COMMONWEALTH OF MASSACHUSETTS t)a rT`nv5 Poo"' , Massachusetts Percolation Test Date: 'j 'SY Time: 9; ocm0r_ Observation Hole # A tuft/0(d 3y Depth of Perc V 4 Cam/ (-)4 r(1-• r/ �k Start Pre-soak el Dann End Pre-soak rj ,' J 0 #)"i Time at 12" r 2 0 P Al Time at 9" S ; J i am Timeat6" 10 , ly0M Time (9"-6") 3 (2 Rate Min./Inch f a n ,4) f nob. Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed Site Failed ❑ Performed By: C hq ,/es J , %in ✓iccki Witnessed By: 16- icy Ile )/9 in) Comments: DPP APPROVED FORM-52'71'5 Location Address or Lot No. FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 C fry henrjn.0 aff On-site Review Deep Hole Number / Date:—Y-J5 1 r Time: 9; 609"4 Location (identify on site plan) %3c R.s«-.e(-. Ir%rtrw, et/1/— Land Use 0 Pr" old Fri/ Slope 1%) S'19 Surface Stones Vegetation a.Ca5 S Landform -feet 2cc _...... . Position on landscape (sketch on the back) --.. Distances from: Open Water Body Joel feet Drainage way Possible Wet Area -alp r.rfeet Property Line Drinking Water Well /JD feet Other Porn-la 1 1"-) Weather C'Lcn- Ye} AID feet 3.5.,, feet DEEP OBSERVATION HOLE LOG' Depth from Surf ace(Inches) Soil Horizon Soil Texture (USDA) Soil Color (Munselll Soil Mottling Other (Structure,Stones,Boulders. Consistency, % Graven 0-12 ig 1-/5 IoYrV/3 ()- 30 B Lis /0/0,,,g%'9 36 — C 4-/ C 3°yr5j'6 3(5'41 7.i yra%6 ' )o{ 0na " Lcnn/ s9-10( Parent Material(geologic/ %CPC,A / 7 I l Depth to Groundwater: Standing Water in the Hole: Estimated Seasonal High Ground Water: 3 0'' so't Depthtoseerocx: /6'7Li-, 3--Weeping from Pit Face: �I DEP APPROVED VOWS-Ilallae FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No. Co (es /1'tnd,w boI 1/a,r‘e9 fi(Y`°; pA' Determination for Seasonal High Water Table Method Used; Ea. Depth observed standing in observation hole ,-1° inches trEl Depth weeping from side of observation hole VJ inches Depth to soil mottles 3.0 inches ❑ Ground water adjustment feet Index Well Number Reading Date _ Index well level Adjustment factor Adjusted ground water level Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? )e6 S If not, what is the depth of naturally occurring pervious material? Certification I certify that on J u(yy /?93 (date) I have passed the soil evaluator examination approved by the Depaftment of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature f?1 e /7 —C_ - Date Y a s S 1 CHARLES 3. KANIECK1 1 t V V alley Road Soorhamuton, MA 03073 0g. DEP APPROVED FORM-II/07M Northampton Board of Health City Hall-Main Street Northampton,Ma. 01060 Attn: Peter McErlain Health Agent Re: Northampton- Coles Meadow Road Page property June 1, 1998 Dear Mr. McErlain: This letter is to inform you that the soil absorption on the Page property on Coles Meadow Road in Northampton,Ma was inspected and has been installed in accordance with the approved plan. The system was installed by Mr. William Ducharme of Northampton,MA. It is my opinion that with proper operation and maintenance it should provide trouble free service in the years to come. If you require any additional information,please contact me. Very truly yours; Timothy 70 Monta Westhampton, M <DefaWp-0 Markers,Length=0 feet NORTHAMPTON,MA-1 Markers.Length=0feet Name: EASTHAMPTON Date:5/7/98 Scale: 1 inch equals 2000 feet Location: 042°20'58.2" N 072 39'24.6" W Caption:George Page property Coles Meadow Rd. N'hampton Capyrght(C)1997,Maptech,Inc.