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555 Septic Application Permit & Plans No E THE COMMONWEALTH OF MASSACHUSETTS PEI ,v,OQ BOARD OF HEALTH c .47 of or • - 268-749? 26- V865" APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION ° RMIT Application for a Permit to Cansi rucl (/Repair ( ) Upgrade ( 1 Abandon ( ) • Dc(omplete System ❑India id LI sponcn SO Ce)as Al encaow POLE' Si,apheb l\atinsan Utt 5_59 C ,es Nleacl w kr n1 dre s SB¢ 1 9/3—/''-- ,,p1:.., MA otot,o slur p.,a.t r -9or ww Flarri-5 4 A ,nenunc� �,1/4-ewn Envirerimen{a/ /� BOA °i00 {i5♦,y r� /•7A� :71330 \\\ 4f`L (G 7A- Vii/ I e( Bo I( 3(4 ClteS-fe tie�r�sMf� �6 Olola Ss - 2 IV! ( 3,Z 417/7 c 'tpI , l / rckp[ ic. Type of Building: cI oils R -1J rr., I, we_ILI Lot Size Sq. feet Dwelling—No.of Bedrooms 4 Garbage Grinder 04 Other—Type of Building No.of persons Showers ( ). Cafeteria ( ) Other fixtures Design Flow (min. required) 66D opd Calculated design flow 660 gpd Design flow provided 6 SO gpd Plan: Date 11/i4/OS Number of sheets 1 Revision Date Title Sawrye-1\isposn( Sy54-eror Description of Soil(s) Sec Soi ( Evn" . For,,-, I I Soil Evaluator Form No. Name of Soil Evaluator_M..Tincmpson Date of Evaluation 5/26/05 DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with y.m ��of Of TITLE 5 and furthel ag - soot to)place the system in operalion until a Certificate of Compliance has been issued by ir 47 Signed- / GK ,6 (_ct4/CC Date 1/+1 L[ C� p�� E� ARK T. Inspcc Nssf'i .., / // --���'/�� I� �� �1� L dr /� i J., • s Alt P^ trit!�"ii i - iaMir LS% I (Iri 7%/ a 06 FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 City of Northampton ��77 Board of Health Well Permit Number /-6Fi(7 ^0 I 'f1' Fee $ ©a APPLICATION FOR A WELL CONSTRUCTION PERMIT This application must be accompanied by a scaled plot plan, produced by a civil engineer or registered sanitarian showing the minimum distances required in Title 5 of the State Environmental Code. For new construction, requiring a septic system, the septic system plan submitted for the property in compliance with Title 5 requirements will be acceptable if the proposed well location is included. Application is hereby made to construct(x) or repair( ) a private well. GI7/ 704 � t � R0,1 Sai -1 Owner's Name 55`I et)L65 w4E40ow i2 & Street Address tad Ar nP Tb rJ 444 °I0 !0v Date `%550(0 - 71,27 Telephone Number City, State,Zip Code 551 eauti 'Vew01w Rcl Location of Proposed Well (if different from address) Tax Map # Parcel # For repair or location with city sewer: Scaled well construction plan has been submitted: yes ( ) no( ) n/a( ) For new construction: Septicsystem plan complies with Title 5: )1.tics stem plan shows location of well: Perm e of Applicant A6V la, Zoo 6 issued(date) yes pO no ( ) n/a( ) yes pi no( ) n/a( ) Date Permit expires one year from date of issuance City of Northampton NUMBER EE $ 2-006-10 I A BOARD OF HEALTH j_5_4_0 .a- This is to certify that 4_i� ' IIaLt.,. Cd NAME `i (2,tv fi )1A-66-401.t-- / /bo'vElpAriffn t4 ADDRESS Is hereby granted a Permit For 53-c- C�� `-rL-c,44.0e 42- This license is granted in co��nfp9aniry with the Statutes and ordinances relating thereto and expires LA101Y /D 7aZunless sooner suspended or revoked. /.Ja ✓ /0, . 2006, Board of Health LAWRENCE DESIGN& CONSTRUCTION 85 MOUNTAIN ST. 413-26&7099 HAYDENVILLE,MA 01039. PAY TO THE ORDER OF ID DA 64 47 AL7.4iYA1/2444 arVAJ Ban o m Massachusetts $ co.aJ LLARS e m 1: 2113705451: 824406490 0572 Drinkine Well Permit Payment Record �7 Date: /1//bin/bin Permit#c2c p 0/ Amount: $ J6'aCCaasshhh Check# S-0 2 /� Property Address/Location / M Property Owner New Construction Repair ID.ZS At.cc- Lo+ Massachusetts Department of Environmental Protection Coles Meato1.J Roar Bureau of Resource Protection —Wastewater Permitting Program Site Address or Map/Lot Number Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (minimum of two holes required at every proposed disposal area) Deep Observation Hole: Date: S/26/05 Time: ro: Weather: 0vcr4s54 Sdr 1. Deep Hoie NumberTP— 1 Location (Identify on Plan ): 2. Land Use: Woods Surface Stones: Nana Slope(%): I-Z Vegetation Oak Ma IOi_c (e.g.woodland, agricultural field.vacant lot,etc Landform. I<A - Position on landscape. 3. Distances from: Open Water Body Zooms ft. Drainage Way loo+ ft. Possible Wet Area Joe* ft. Property Line I°°+ ft. Drinking Water Well loo+ ft. Other ft. 4. Parent Material: >nL Unsuitable Materials Present: Yes 111"No❑ If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s)❑ Weathered/Fractured Rock ❑ Bedrock ate__ 6 7 " 5. Groundwater Observed: Yes ❑ No Q' If Yes: Depth Weeping from Pit _ Depth Standing Water in Hole Estimated Depth to High Groundwater. 44 Redoximorphic Features Coarse Fragments De Ih Soil Soil Matrix: (mottles) %by Volume P Horizon/ Soil Texture Color-Moist Depth Color Percent Gravel Cobbles Soil Structure Soil Consistence (In.) Layer (USDA) (Munsell) &Stones (Moist) Other 0-5" A SL Ioyes/Y I -5, �•� 51., 75YR 5/6 tom,o•JA lb- 0" 0 LS 7151g5/3 44" 1S1RSl6 svR SPA S/ I°°sj2- � �/z � S Additional Notes DEP Form 11 Sail Suitability Assessment for On-Site Sewage Disposal •Page 3 of 4 10.25 i1c.vc Lott Massachusetts Department of Environmental Protection C(es Meadow Road Bureau of Resource Protection —Wastewater Permitting Program Sfte Address or Map/Lot Number \ Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal A. Facility Information Owner Name S-Feo�e.� I<obtvsor HILLTOWN ENVIRONMENTAL CONSULTING P. O. BOX 226 Street Address 5t &les Meadow Psi Map/Lot: NORTH HATFIELD, MA 01066 /� (413) 247— 5464 City. No✓��FV`^lp�d^ State. MA Zip Code'. 0 1060 B. Site Information 1. (Check one) New Construction L] Upgrade❑ Repair ❑ 2. Published Soil Survey available? Yes L✓J No ❑ If yes: 1981 1;15940 C r E C k0 I+n n Year Published Publication Scale Soil Map Unit Soil Name Soil limitations Slope_ 3. Surficial Geological Report available? Yes ❑ No ❑ If yes: _ Year Published Publication Scale Map Unit Geologic Material Landform 4. Flood Rate Insurance Map: �/ � Above the 500 year flood boundary? Yes IJ No Within Within the 100 year flood boundary? Yes ❑ No Lv]/ Within the 500 year flood boundary? Yes ❑ No IJ Within a Velocity Zone? Yes ❑ No ❑ 5. Wetland Area National Wetland Inventory Map Map Unit Name Wetlands Conservancy Program Map Map Unil Name ,--/ 6. Current Water Resource Conditions(USGS) 05/05 Range: Above Normal ❑ Normal 1 Below Normal ❑ Mon hNear 7. Other references reviewed: DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal•Page 1 of 4 10.25 Acva Lot Massachusetts ntal Protection Odes MeaJD.., RJ• Nor 4.er,1 {,h Site Address or Map/Lot Number Bureau of Resource Protection Department of Environi me-Wastewater Permitting Program \ Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal D. Determination of High Groundwater Elevation 1 Z 1 Method used: ❑ Depth observed standing water in observation hole A. B. ❑ Depth weeping from side of observation hole A B. L" Depth to soil redoximorphic features (mottles) A. 44" B. S6 ❑ Groundwater adjustment(USGS methodology) A. B. 2. Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level E. Depth of Pervious Material 1. Depth of Naturally Occurring Pervious Material a. Does at least four feet of naturally ccurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Yes pNo❑ b. If yes, at what depth was it observed? Upper boundary: 1 Lower boundary: 68 F. Certification I certify that I have passed the soil evaluator examination*approved by the Department 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 /,_ / q r'•t•/� '- r_ - May 26 . 2005 HILLTOWN ENVIRONMENTAL CONSULTING Signs •re of Soil Evaluator Date P. a BOX 226 Mark Thompson April 29. 1997 NORTH HATFIELD.MA 01066 (413)141- 5464 Typed or Printed Name of Soil Evaluator 'Dale of Soil Evaluator Exam 1-1nes} r4 L\IeIA Noe4Anaw.P4 ' tvl}1/ Name of Board of Health Wtlness Board of Health DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 4 of 4 o ,zs A�x ;c < Le+ Massachusetts Department of Environmental Protection Cols y° earl btu Rd, \0°A)s„.r1- Bureau of Resource Protection -Wastewater Permitting Program site Address or Map/Lot Number \ Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (minimum of two holes required at every proposed disposal areal Deep Observation Hole: Date: S/zG/ps Time: 10:45 Weather: Overc>s+ Soy 1. Deep Hole Number'(P-2 Location (Identify on Plan ): 2. Land Use: Vv poi 5 Surface Stones: 4e„J Slope(%): I-2- Vegetation: 04 k {pine (e.g.woodland,agricultural field.vacant lot,etc Landform: K.a vnc Position on landscape. 3. Distances from: Open Water Body 20°4 ft. Drainage Way 10°`ft. Possible Wet Area 10°+ ft. i Property Line loo ft. Drinking Water Well I5D ft. Other ft. 4. Parent Material: 0 u+w a51- Unsuitable Materials Present: Yes ai No❑ If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock.R"@ 68„ 5. Groundwater Observed: Yes ❑ No Er. If Yes: Depth Weeping from Pit _ Depth Standing Water in Hole _ Estimated Depth to High Groundwater: 56° Redoximorphic Features Coarse Fragments Depth Soil Soil Matrix: (mottles) %by Volume (In Horizon/ Soil Texture Color-Moist Depth Color Percent Gravel Cobbles Soil Structure Soil Consistence Layer (USDA) (Munsell) _ &Stones (Moist) Other -4I- A SL IDYR5/Z loose c..,,,..t9 it- 4 3,4 5L- 7,fVP5/6 .1,.r ,LQ 14 66” C LS 7.c 5/3 s6" �svRVz. 5/ 107° S% rr",“,‘•e i0°Se 1 Additional Notes DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 4 '0 .75 Acve LOA Massachusetts Department of Environmental Protection C Ves Me.,�ow t() Bureau of Resource Protection-Wastewater Permitting Program Site Address or Map/Lot Number Form 12 — Percolation Test A. Facility Information 1. Facility Information s-+ep}nen. PA, nCotr Owner Name Me {� 1 579 C Ie5 a ciow I<oo tl Map/Lot Street Address City State Zip Code ■ Percolation Test Date: 5/z6/o5 Observation Hole # P- I P- z- Depth Of Perc 45 " 42" Start Pre-soak 10:02- ib:3Z End Pre-soak 10:17 io ; 47 Time at 12" 10 ;4-7 Time at9" I0t2.1 Ir:Sk Time at6" IU .Zg o ,S6 Time (9"-6") 1 mud S r1r� Rate - Min/Inch 3 Mi,thftI < •Minimum of 1 Percolation test must be performed in both the primary area AND reserve area. Site Passed Er Site Failed ❑ Performed By: Nf1 a✓k �norvNp S otn HILLTOWN ENVIRONMENTAL CONSULTING Witnessed By L✓r p5+ /" A+kleLA P. O. BOX , M NORTH HATFIELD, MA 01066 Comments: (413) 247-5464 DEP Form 12 Percolation Test• Page 1 of 1 Scutic System Permit Payment Receipt Neat Permit ib 6ltrDale:a/37Qk Const liepaii_ Amount: /iZ — Address Cash Check# 735/ an zmb Owner: i LAWRENCE DESIGN AND CONSTRUCTION 85 MOUNTAIN St HAYDENVILIE,MA 01039 -- 1-413-208-7099 PAY TO THE F z/ %� 3347 533-218 DATE LARS Sclk THE BANK OF WESTERN'': MASSACHUSETTS SPRINGFIELD,MA9<ArvusETrs FOR 1:0I &EO2488C9.0900 200 78 6 Pere Test Witness Payment Record ` Date: 5J(Z�Olor Amoounnt:: 33 op Property Owner att/� 'a'�J Property Address )1c 7'�- ,IkSiled-*Pet,tr/V New Construction /Repair _ ROBINSON PROPERTIES 24051 PH.413-58443011 4 CONZ STREET $li T.)/ '/NORTHAMPTON.MA 01060-4427 _ .S`_se-ro53-7003/2110 te DATE awcne 21 PAY �/,�' F�b ORDER OF (' '7 d'im /Ur.�r/ii ,y1—:� I $ .S—C,GG !II CCr T — DOLLARS a ';;.. � �r a SAVINGS BANK FOR in!! -Huey; Fee _ (let, ilkaita -7--P ecc 7 �. 6'0024050 1: 2118709351: i2704i85564 I"r.� „ rte _ me..� Howard Laboratories 62 MaIn Street - Hatfield, MA 01038 Tel. (413) 247-5533 Fax (413) 247-9599 henshaw Well Drilling. Client lint Lawrence WATER ANALYSIS REPORT Invoice Number: 123626 Sample Location: Coles Meadow Road Sampled By: HWD Date Sampled: 01/09/06 Date Received: 01/1.0/06 Parameter Results Limits Comments Total Conform Bacteria 0 colonies/ 100rol 0 colonies/ l00m1 OK Color 51 PtCo Color Units 15 PtCo Color Units Iron 1.32 mg/I 0.3 mm/! Manganese 0.055 mg/I 0.05 mg/I Nitrate U.09 mg/I 10 mg» OK Nitrite 0.002 mo/1 1 mg/I OK pH 7.55 oh Units 6,5 - 6.5 PI) Units OK Sodium 3 mg/I 28 mg/i OK Conductivity 0.37 mS/cm No Standard No Standard Turbidity 27.36 NH; 5 NTU Chloride 133 mg/I 250 mo/! OK Hardness 112 moll No Standard <50 soft >100 hard ND = None Detected Recommendations: this sample meets acceptable standards of potability. The parameters with an asterisk which are over thee limit should go down after a few weeks as the water and materials floating h:the well settle. Analyst: SL Date: 01/11/00 MA Certification, MA 00851 TYPE OR PRINT ONLY Massachusetts Department of Environmental Management Office of Water Resources Well Completion Report 143098 1.WELL LOCATION 1 GPS (OPTIONAL) LATITUDE _o _ ' " LONGITUDE 0 1 _ DATUM Address at Well Location r'1--. �'C_0A=°L ��c_Lf-k"�-`\W lk. Property Owner/Client -CA '. re Subdivision Name- Mailing Address 4-C) IN'‘l.TAsv -L.-T1 City/Town: *'-‘1"4^2-' \' :(ri C{ ' '\, City/Town. liGA, a°Lc.'v ,y\._ 1'll�- %\C ,-.Sv`\ Assessors Map Assessors Lot#: NOTE: Assessors Map and Lot 4 mandatory if no street address available Board of Health permit obtained: Yes 0 Not Required a Permit Number Date Issued 2.WORK PERFORMED - 8.PROPOSED USE 4.DRILLING METHOD 131 New Well D Abandon D Deepen 0 Recondition D Replace 0 Other ® Domestic 0 I rigafion D Monitoring 0 Municipal 0 Industrial 0 Other 0 Cable ❑ Auger © Air Hammer 0 Direct Push 0 Mud Rotary 0 Other 5.WELL LOG Water Bearing Zones Unconsolidated Consolidated 6.SITE SKETCH(use permanent tanamerts with distances) (l m m p - g 4, m° Other Material Rock TType Description JI ;Let ffd471.7,,C,...., From (ft) To(11) �6�J 'LL(5i4ti.•k. 1T >ce<a vs\t 7.WELL CONSTRUCTION 8. CASING Total Depth Date Complete Drilled _,1-*'. From (ft) To (ft) Casing Type and M terial Size I.D. (in) Well Seal Type "."1: t' _ , ; v�„ - h !- . _ ;y rl/ 9. SCREEN From (ft) To (ft) Slat Size Screen Type and Material Screen Diameter I 10. FILTER PACK/GROUT/ABANDONMENT MATERIAL 11. ADDITIONAL WELL INFORMATION From (fl) To (ft) Material Description Purpose Developed? lwl Yes 17 No Fracture Enhancement? 0 Yes -IX No Method Dis:piected? iiv. Yes 11 No 12. WELL TEST DATA (ALL SECTIONS MANDATORY FOR PRODUCTION WELLS) 13. STATIC WATER LEVEL (AL! WE LS) Yield Time rumosd Strumires to Tim er PECa';er!to Date ivtethod IOPM) (nrs & mini IF BGS) 1 so & sis il- O.G Deo h Err my Date Measure° 1 Ground Su lace (FT` _ Y-g 14. PERMANENT PUMP(IF AVAILABLE) 15,NAMEIADDRESS OF PUMP INSTALLATION COMPANY Pump Description C-1"Fd i?-r7 a- ♦ ri: Horsepower e,_ _j Pump Intake Depth ?I's-'F-' ' (ft) Nominal Pump Capaci y /s% (gpn) - 16. COMMENTS 17. WELL DRILLER'S STATEMENT This well was drilled, altered and/or abandone under my supervision, according to applicable rules and regulations, and this report is complete and correct to the best of my knowledge Driller Supervising Driller Signature c - -- e Registratlon tr I 1 I[.Pi - -• - - - No.2(gfith THE COMMONWEALTH OF MASSACHUSETTS Fee/50.40 Ns r}-LAwl f-itn BOARD OF HEALTH roe ay/{b///3 V17 DISPOSAL SYSTEM CONSTRUCTION PERMIT c. 2/6M, Permission is hereby granted to Construct ( l/1/Repa r ( ) Tpgrade ( ) Abandon ( ) an individual sewage • disposal system at , �� in the application for Disposal System Construction Permit No. ?l"UFLq V as described .dated ujitiieb Provided: Construction shall be completed within three years of the date of this permit All local conditions m t be met. Date ft/t2,-,-,'�4'ty. /3, 7BDb Board of Health FORM 2 - DSCP DEP APPROVED FORM 5/96 ERN Ilrr��ri1� T J. MAT'.: R.S., H.S, CH.O. C'RECTOR OF HEALTH FORM 1255 OREV 5/96) CHSW Hoses&WMFEN"'' PUBLISHERS- BOSTON No. .L. 0/ THE COMMONWEALTH OF MASSACHUSETTS c f tls Or Nor}wumpi-on BOARD OF HEALTH l.ti+/>m}j��3 ' • CERTIFICATE OF COMPLIANCE °z'6 6 1 Description of Work: Individual Component(s) Lys s.omplefe System tee° The unic rsiened hereby certify Oil the Sewage Disposal System;Eotstrucicd ) Repr ired( ),Upgraded( ),Ahandoncd( ) by: gAM"`_ i !._ , +f ■.,a / 6/336 lid q/3-5-ST-Y777 al � t '4 - _I/✓✓ ; ' i&IAI-etd, li has been installed in accordance with the provisions of 310,CMt 15.00 (Title 5) and the approved design pd is/as-built 20116 �/ i plans relating to:pplicati n Nu �-01 dated (r / (�5 Approve(' Design Flow (gin') 1 :hill pe-A / s_ Ucsignet._ . 1C. I/,TVn attJ Insp,. . . Datc_ __ ERN"T 1-eittnt to R.S—MSS GH.Ik The issuance of this certificate shall not be construed as a guvr�r`�SEOsh�t zhf Rem will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 •