472 Septic Application & Permits 2007 SVE
Engineering
Planning
Landscape Architecture
Surveying
SVE Associates
377 Main Street
Greenfield, MA 01301
T. 413.774.6698
F. 413.773.0875
www.sveassoc.com
WE ARE SENDING YOU AS CHECKED BELOW:
® Attached
❑ Shop drawings
❑ Copy of letter
❑ Under separate cover via_
❑ Prints ❑ Plans
❑ Change order ❑ Forms
LETTER OF TRANSMITTAL
Date 10/25/07
To: John McCoy
472 Coles Meadow Road
Northampton, MA 01060
Attn:
Regarding: Disposal System
the following items:
❑ Samples
❑ Special permit
Job No. G1474
❑ Specifications
COPIES
DATE
NO.
DESCRIPTION
1
Form 1A: Application for Disposal System Construction Permit
1
Form 2A: Disposal System Construction Permit
1
Form 3: Certificate of Compliance
1
Form 9A: Application for Local Upgrade Approval
1
Form 9B: Local Upgrade Approval
3
10/24/07
G1474
Subsurface Sewage Disposal Plan (2 sheets)
THESE ARE TRANSMITTED AS CHECKED BELOW:
❑ For approval ❑ Approved as submitted ❑ Resubmit copies for approval
❑ For your use ❑ Approved as noted ❑ Submit copies for distribution
® As requested ❑ Returned for corrections ❑ Return corrected prints
❑ For review and comment ❑
❑ For bids due (date) ❑ Prints returned after loan to us
Administrative Assistant
COPY TO: Board of Health, Lavallee & Monahan Walt Thayer, File
If enclosures are not as noted, kindly notify us at once.
SVE
SVE Associates Engineering
Planning
Landscape Architecture
Surveying
SYSTEM INSTALLATION OBSERVATION REPORT
SITE INFORMATION
LOT# 472
STREET COLES MEADOW ROAD
TOWN NORTHAMPTON
JOB# G1474
DATE: 10-23-09
OWNER INFORMATION
PROPERTY OWNER JOHN McCOY
STREET ADDRESS 472 COLES MEADOW ROAD
TOWN NORTHAMPTON, MA
INSTALLER INFORMATION
NAME OF INSTALLER J.W. COTTON
STREET ADDRESS 5 WEST STREET
TOWN HATFIELD, MA
OBSERVATION RESULTS
DATE OF OBSERVATION: 10-22-09
( X ) 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:
( )
THE SYSTEM DOES NOT APPEAR TO HAV :- • N INSTALLED
ACCORDING TO THE APPROVED PLA :UT IS N COMPLIAN
TITLE 5. ENCLOSED IS A COPY OF 'E PLAN ' OW. . "AS
LOCATIONS AND ELEVATIONS. / '
COMMENTS:
pr
AS I MacLEAY, P.E.
SEND COPIES TO:
www.sveassoc.cam 371 Main Street
Greenfield,MA 01301
PROJECT ENGINEER
BOARD OF HEALTH
JOHN McCOY
J.W. COTTON
• WITH
UILT
PO.Box 1818
439 West River Road
Brattleboro,VT 05302
Tel.413 774-6698
Fax 413 773-0875 Tel.302257-0561
47 Marlboro Street
Keene,NH 03431
Tel.003 355-''.532
Fax 603 355-2969
PO Box 316
16 Beaver Meadow Road
Norwich,VT 05055
69 Grove Street
Rutland,VT 05701
Tel.802 775-1131
Tel.802 526-1111 Fax 802774-1151
Fax 802 257-0721 Fax 302 526-1113
Appendix I
SYSTEM INSTALLATION REPORT FORM
For each GEO-Flow Pipe Leaching System installed in Massachusetts, certified installers must complete
the following form in Its entirety. Copies of this completed form must be forwarded via fax or mall to(1)
the local approving authority and (2)ADS/Hancor.
Mail or fax a copy of this completed form to (1)the local approving authority and (2)ADS/Hanmr at:
ADS, Inc.
Stonybrook Industrial Park
58 Wyoming Street
Ludlow, MA 01056
ADVANCED DRAINAGE SYSTEMS,INC.58 Wyoming Street,Ludlow,MA 01056 (800)83-35 http. ads-plpe.com
33
Property Owner: John McCoy
Site Address: 472 Coles Meadow Road
City: Northampton, MA
ZIP Code. 01060
Installer's Name:
Installation Company's Name: J.W.Cotton
Co
Installation Company's Address: 5 West Street
Installation Company's City: Hatfield
State:
MA
Zip Code:
01088
Installed System Type(Approval): General
Remedial
Use: Yes:
Use: Yes: ti
Permit Number:
System Type: GEO-Flow
Design Flow: 330 Gallons Per Day
Date of Installation Completion: 10-22-09
Date of System Start-up: 10-22-09
Comments:
Mail or fax a copy of this completed form to (1)the local approving authority and (2)ADS/Hanmr at:
ADS, Inc.
Stonybrook Industrial Park
58 Wyoming Street
Ludlow, MA 01056
ADVANCED DRAINAGE SYSTEMS,INC.58 Wyoming Street,Ludlow,MA 01056 (800)83-35 http. ads-plpe.com
33
Commonwealth of Massachusetts
City/Town of NORTHAMPTON
Application for Disposal System
Construction Permit
Form IA
£Oa 57- 3 9
Number
Fee
SI
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
1. Location of Facility:
472 COLES MEADOW ROAD
Address or Lot#
NORTHAMPTON
City/Town
2. Owner Information
JOHN McCOY
Name
MA
State
01060
Zip Code
Address Of different from above)
City/Town
3. Installer Information
State
413-586-4977
Zip Code
Telephone Number
Name
Address
City/Town
Name of Company
4. Designer Information
Douglas J. MacLeay
Name
377 Main Street
Address
Greenfield
City/Town
State
Zip Code
Telephone Number
SVE Associates
Name of Company
MA
State
5413) 774-6698
01301
Zip Code
Telephone Number
t5forml adoc•06/03 Application for Disposal System Construction Permit•Page 1 of 3
Commonwealth of Massachusetts
City/Town of NORTHAMPTON
Application for Disposal System
Construction Permit
Form 1A
'number
Fee
Fee
A. Facility Information (continued)
5. Type of Building:
Z Dwelling
Other: Type of Building
❑ Showers
Specify other fixtures:
6. Design Flow:
Calculated Daily Flow:
7. Plan:
❑ Garbage Grinder(check if present)
Number of showers
2
Number of Sheets
SUBSURFACE SEWAGE DISPOSAL PLAN
Title of Plan
8. Description of Soil:
Number of Persons Served
❑ Cafeteria ❑ Other fixtures
330
Gallons per Day
330
Gallons
10/24/07
Date of Original
Revision Date
Parent material: SANDY LOAM See plan for detailed test pit descriptions.
E.S.H.W.T.: 14" Percolation rate: 28 MIN/IN
9. Nature of Repairs or Alterations (if applicable):
RELOCATE HOUSE SEWER OUT, INSTALL NEW SEPTIC TANK, DISTRIBUTION BOX,
AND PRESBY ENVIRO-SEPTIC FIELD
10. Date last inspected:
Date
t5forml a.doc•06103 Application for Disposal System Construction Permit•Page 2 of 3
OT IA3H iO(MOO YQ'f'77i''.r;7'^..:
MO Q3'iQ?"4A HAJ4
.01L3,LM.JM Am. M .I/t.,r
grafi 2'
Commonwealth of Massachusetts
City/Town of NORTHAMPTON
Application for Disposal System
Construction Permit
Form 1A
t0-4r: 4044( "Ad /epee 7
°or-31 Prou
Number
•
Fee 40/
9lz40/or
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_/lac the system in operation until a Certificate of Compliance has been issued by this Board
JO—3/_ o7
t5fomi1 a.boc•06/03
Lure
Applic,tion Approv
Na
Date
Application Disapproved for the following reasons
Date
/o - 3/ -07
NORTHAMPTON BOARD OF HEALTH
3/-47
PLAN
E neR..
Director of Public HMbl
1M 413-517.1314
Application for Disposal System Construction Permit• Page 3 of 3
Commonwealth of Massachusetts ,.„S
City/Town of NORTHAMPTON Number
Disposal System Construction Permit ` .uppet &zaznj
Form 2A
Permission is hereby granted to:
Name Name of Company
Address
City/Town
State Zip Code
to perform the following work on an on-site sewage disposal system:
❑ Construction
® Repair or replacement
❑ '.Repair or replacement of system components
472 COTES MEADOW ROAD
Facility Address
NORTHAMPTON MA
City/Town State
JOHN McCOY 413-586-4977
Owner Telephone Number
01060
Zip Code
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 cga;tructioi ust be pleted wit in three years of the date below.
aural /0 c/o7
Approved by V ' Date
Title
ISform2a.doc•06/03
Disposal System Construction Permit•Page 1 of 1
Commonwealth of Massachusetts
City/Town of NORTHAMPTON
Certificate of Compliance
Form 3
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
JOHN McCOY
Facility Owner
dress or Lot#
NORTHAMPTON MA
City/Town State
Designer Information:
DOUGLAS J. MACLEAY
Name
Designers issuance of System Installation Observation
Report shall constitute certification of work performed.
DSCP Date
SVE ASSOCIATES
01060
Zip Code
Name of Company
Installer Information-
efert--6110 S , A)
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
0/L1
App� .f
411 Signature/
t5form3.doc•05/03 Certificate of Compliance•Page 1 of 1
A
Commonwealth of Massachusetts
City/Town of NORTHAMPTON
Form 9A — Application for Local Upgrade Approval
Form 9A is to be submitted to the Local Board of Health for the upgrade of a failed or nonconforming
septic system with a design flow of less than 10,000 gpd, where full compliance, as defined in 310 CMR
15.404(1), is not feasible.
System upgrades that cannot be performed in accordance with 310 CMR 15.404 and 15.405, or in full
compliance with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410
through 15.415.
NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of
a new design flow to a cesspool or privy, or the addition of a new design flow above the existing approved
capacity of an on-site system constructed in accordance with either the 1978 Code or 310 CMR 15.000.
A. Facility Information
1. Facility Name and Address:
JOHN McCOY
Name
472 COLES MEADOW ROAD
Street Address
NORTHAMPTON MA
City/Town State
2. Owner Name and Address (if different from above):
01060
Zip Code
Name Street Address
City/Town State
413-586-4977
Zip Code Telephone Number
3. Type of Facility(check all that apply):
Z Residential ❑ Institutional
4. Describe Facility:
SINGLE FAMILY RESIDENCE
❑ Commercial ❑ School
5. Type of Existing System:
❑ Privy ❑ Cesspool(s)
UNKNOWN
❑ Conventional ® Other(describe below):
6. Type of soil absorption system (trenches, chambers, leach field, pits, etc):
UNKNOWN
t5fonn9a.doc•rev.7/06 Application for Local Upgrade Approval* Page 1 of 4
Commonwealth of Massachusetts
City/Town of NORTHAMPTON
Form 9A - Application for Local Upgrade Approval
A. Facility Information (continued)
7. Design Flow per 310 CMR 15.203:
Design flow of existing system:
Design flow of proposed upgraded system
Design flow of facility:
330
gpd
330
gpd
330
gpd
B. Proposed Upgrade of System
1. Proposed upgrade is(check one):
® Voluntary ❑ Required by order, letter, etc. (attach copy)
❑ Required following inspection pursuant to 310 CMR 15.301:
2. Describe the proposed upgrade to the system:
RELOCATED HOUSE SEWER OUT, INSTALL NEW SEPTIC TANK, DISTRIBUTION BOX,
AND PRESBY ENVIRO-SEPTIC FIELD
date of inspection
3. Local Upgrade Approval is requested for(check all that apply):
® Reduction in setback(s)—describe reductions:
REDUCE REQUIRED SETBACK BETWEEN A SEWER ABSORPTION SYSTEM AND A PRIVATE
WATER SUPPLY FROM 100'TO 65'
t5formga.doc•rev. ]/06
❑ Reduction in SAS area of up to 25%:
SAS size,sq.ft. °/4 reduction
❑ Reduction in separation between the SAS and high groundwater:
Separation reduction h
Percolation rate min./inch
Depth to groundwater
Application for Local Upgrade Approval• Page 2 of 4
Commonwealth of Massachusetts
City/Town of NORTHAMPTON
Form 9A - Application for Local Upgrade Approval
B. Proposed Upgrade of System (continued)
❑ Relocation of water supply well (explain):
LI Reduction of 12-inch separation between inlet and outlet tees and high groundwater
❑ Use of only one deep hole in proposed disposal area
❑ Use of a sieve analysis as a substitute for a perc test
❑ Other requirements of 310 CMR 15.000 that cannot be met—describe and specify sections of the
Code:
If the proposed upgrade involves a reduction in the required separation between the bottom of the soil
absorption system and the high groundwater elevation, an Approved Soil Evaluator must determine the
high groundwater elevation pursuant to 310 CMR 15.405(1)(h)(1). The soil evaluator must be a
member or agent of the local approving authority.
High groundwater evaluation determined by:
Evaluators Name(type or pent)
Signature Oate of evaluation
C. Explanation
Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible. (Each section must be
completed)
1. An upgraded system in full compliance with 310 CMR 15.000 is not feasible:
COST
2. An alternative system approved pursuant to 310 CMR 15283 to 15.288 is not feasible:
COST
t5fomi9a.dac• rev.7/06
Application for Local Upgrade Approval Paae 3 of 4
Commonwealth of Massachusetts
City/Town of NORTHAMPTON
Form 9A - Application for Local Upgrade Approval
C. Explanation (continued)
3. A shared system is not feasible:
NOT AVAILABLE
4. Connection to a public sewer is not feasible:
NOT AVAILABLE
5. The Application for Local Upgrade Approval must be accompanied by all of the following (check the
appropriate boxes):
® Application for Disposal System Construction Permit
® Complete plans and specifications
® Site evaluation forms
❑ A list of abutters affected by reduced setbacks to private water supply wells or property lines.
Provide proof that affected abutters have been notified pursuant to 310 CMR 15.405(2).
❑ Other(List):
D. Certification
1, the facility owner, certify under penalty of law that this document and all attachments, to the best of my
knowledge and belief, are true, accurate, and complete. I am aware that there may be significant
consequences for submitting false information, including, but not limited to, penalties or fine and/or
imprisonment for deliberate violations."
Name
DOUGLAS J. MACLEAY
Name of Preparer
377 MAIN STREET
Preparer's address
MA 01301
State/ZIP Code
t5form9a.doc•rev.7106
Date
/0 - 30_ o7
10/24/07
Date
GREENFIELD
City/rown
(413) 774-6698
Telephone
Application for Local Upgrade Approval, Page 4 of 4
Commonwealth of Massachusetts
City/Town of NORTHAMPTON
Local Upgrade Approval
Form 9B
The Local Upgrade Approval is to be completed by the local Board of Health and a signed copy provided
to the system owner.
A. Facility Information
1. Facility Name and Address
JOHN McCOY
Name
472 COLES MEADOW ROAD
Street Address
NORTHAMPTON
City/Town
2. Owner Name and Address Of different from above):
MA
State
01060
Zip Code
Name Street Address
City/Town State
Zip Code Telephone Number
3. Type of Facility(check all that apply):
® Residential ❑ Institutional ❑ Commercial ❑ School
4. Design flow per 310 CMR 15.203: 330
gptl
DOUGLAS J. MacLEAY
5. System Designer: Name
377 MAIN STREET GREENFIELD 01301
Address City/Town State,ZIP
® PE ❑ RS
B. Approval
1. Local Upgrade Approval is granted for:
® Reduction in setback(s)—specify:
REDUCE REQUIRED SETBACK BETWEEN A SEWER ABSORPTION SYSTEM AND A PRIVATE
WATER SUPPLY FROM 100'TO 65'
t5form9b.doc•rev.7/06
❑ Reduction in SAS area of up to 25%:
SAS size,sq.ft. °6 reduction
Local Upgrade Approval* Page 1 of 2
Commonwealth of Massachusetts
City/Town of NORTHAMPTON
Local Upgrade Approval
Form 9B
B. Approval (continued)
❑ Reduction in separation between the SAS and high groundwater:
Separation reduction
Percolation rate
Depth to groundwater
❑ Relocation of water supply well (explain):
ft.
min./inch
❑ Reduction of 12-inch separation between inlet and outlet tees and high groundwater
❑ Use of only one deep hole in proposed disposal area
❑ Use of a sieve analysis as a substitute for a perc test
List local variances granted not requiring DEP approval per 310 CMR 15.412(4):
List variances granted requiring DEP approval:
I_A2i ke 4
Approving Authority G
Print or Type Name and Title Signature
tsform9b.doc•rev.7/06
Date
Local Upgrade Approval* Page 2 of 2
No.dvdj=-3 THE COMMONWEALTH OF MASSACHUSETTS FEE
1L " / c71 BOARD OF HEALTH /eV C41 Ye/
/VC�C Fe D ISSPPOSAL SYST EM CONSTRUCTION PERMIT t L 7A.41/42.5-
' "
Permission is hereby granted to onstruct ( ) Repair ( t.pgrade (7') Aba.don ( ) an individual sewage
disposal system at z //i ✓ F e - 1 as described
in in the application for Disposal System Construction Permit No.
9 J
�S— )� dated
.//
Provided: Construe ion sh it be completed within three years of the date of this plI local conditions must be men
Board of Health
Date /6( 30 67
FORM 2 - DSCP CEP APPROVED FORM 5/95
FORM :255 ,REV 5/96. H�6�W HOasss WARREN Pu6lISHERS_EOSTO N PeiY' •—