423 Soil & Perc Tests BOARD OF HEALTH
MEMBERS
RICHARD P.BRUNSWICK,M.D.,MPH,Chair
ROSEMARIE KARPARIS,R.N.MPH
JAY REITMAN,M.D.
PETER J.McERLAIN,Health Agent
(413)587—1214
FAX(413)587-1221
CITY OF NORTHAMPTON
MASSACHUSETTS 01060
OFFICE OF THE
BOARD OF HEALTH
210 MAIN STREET,Room 8
NORTHAMPTON,MA 01060-3167
To: Lloyd&Anne Ewing
423 Haydenville Rd., Leeds, MA
From: Peter McErlain, Health Agent
Date: March 28, 2003
Re: Approval of Septic Repair Permit for 423 Haydenville Rd., Leeds
Enclosed please find the permit for the repair of your septic system at 423 Haydenville Rd.
Please inform the Board of Health when a septic system installer has been selected. You
are reminded that the septic system repair work cannot begin until the Northampton
Conservation Commission has reviewed and approved your septic repair plan.
Don't hesitate to contact the Board of Health office with any questions concerning this
matter.
Thank you.
r
HILLTOWN ENVIRONMENTAL
CONSULTING
P. O. BOX 226
NORTH HATFIELD, MA 01066
(413)247-5464
No.
FORM 11 - SOIL EVALUATOR FORM
Page 1 of 3
Date:
Commonwealth of Massachusetts
Norfk snp � , Massachusetts
,Soil Suitability Assessment for On-site Sewage Disposal
Performed By:
Witnessed By:
Mark Tha�,Pfor.
Pe-+e, M, Er t„~
Date
""S 42-3 -tayctei.vi Ile Riooad
/
New Construction ❑ Repair IJ
° 'Nxe, Lloyd EL.-nit
, 423 1-L ,Je,.v,/It Rai.
Leach, MA 01053
564 -SZ38
Office Review
Published Soil Survey Available: No ❑ Yes Et
Map 4
Year Published 198/ _..._.. Publication Scale / /(84-0 Soil P Unit 5;
Drainage Class ModerdlG1 y..Well. Soil Limitations Poor F.r(fir (n/e{ness
Surficial Geologic Report Available: No C Yes ❑
Year Published Publication Scale
Geologic Material (Map Unit)
Landforn _. ... .. _...
Flood Insurance Rate Map: 20167 0001 A
Above 500 year flood boundary No ❑YY/es E'er
Within 500 year flood boundary No LJ,,Yes ❑
Within 100 year flood boundary No Yes ❑
Wetland Area:
National Wetland Inventory Map (map unit)
Wetlands Conservancy Program Map (map unit)
�ec.
Current Water Resource Conditions NS/GS): Month 200L
R
Range :Above Normal ❑Normal Below Normal ❑
Other References Reviewed:
DEP APPROVED FORM-I2/07/95
Location Address or Lot No
1 0K\1 11 - SOIL EVALUATOR FOKM
Pagc 2 of 3
413 1-Et1JefwIne- Roatt l.eect5
On-site Review
Deep Hole Number -1 p- ) Date: I — 14 - 03 Time: x ; 00 weather S, V y 100
Location (identify on site plant ``. '
Land Use Lawh Slope (%) d Surface Scones Ivpy}Q..
Vegetation G✓rn SS ..
Landform I e..rrasce.--
Position on landscape (sketch on the back)
Distances from: n
Open Water Body I l8 feet Drainage way 1a— feet
Possible Wet Area i f R feet Property Line 14) fee! n.n. k/e n+ I t n A.
Drinking Water Well ZOO.} feet Other
DEEP OBSERVATION HOLE LOG'
Derain from
Surface Males/
Soil Horizon
Soil Tenure
¢IS OAI
Soil Cola,
(Munn&If
Sod
Mottling
Omer
(Structure. Stoner.Boulders. Consistency. %
Graven
-IC
A
SL_
i°' a3)LNone
-1raco.ol -0v4 tin Z.t..
14 - ZI
Bw
L5
IoYR41G
Nona.
Z6-% 9ra•re rIc ,I '-
Z I --jI :
3 C
2irtii}
1�9nne
30% 5raV4t
I005t, <hi*.9 .n.On•
9 1 -96
C Z
v S
NJana
block
Parent Meleee! ideologic'
rULE�aNN • EuEa`/PRO�Ua 0U PJS
F IvVavk
Oct,to Griurdweerr Standing Water ame how
Estvramo Seasonal wgh neovnd Water:
90 "
Jeothmeedrat N 0 n2
8G •'
Weeoiny ram Pit Face:
IIEY U'YRO'T.b 10101 la 0'.
kOLLTOWN ENVIRONMENTAL CONSULTING
P. O. BOX 226
NORTH 13ATF7ELD,MA 01066
t413)247• 5464
FORM II - SOIL LVALUATOR FORM .
Page 3 of 3
Location Address or Lot No. 423 :-(aydcnvt jje Road (tech
Determination for Seasonal Hgh Water Table
Method Used:
❑ Depth observed standing in observation hole
Depth weeping from side of observation hole
❑ Depth to soil mottles inches
❑ Ground water adjustment feet
Index Well Number
Adjustment factor
inches
66 inches
Reading Date Index well level
Adjusted ground water level
Depth of Naturally Occurring Pervious Material
Does at least four e naturally e s material exist in all areas
observed throughout the area proposed for the soil abso ptionsystem? e
If not, what is the depth of naturally occurring pervious material?
Certification
I certify that on 4-29-97 (date) 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.
Signature Date 1/16/03
DEP APPROVED POR 1- 1210719
MILL]OWN ENVIRONMENTAL CONSULTING
P. O.BOX 226
NORTH HATFIELD,MA 01066
(413)247-5469
FORM 12 - PERCOLATION TEST
Location Address or Lot No. 423 Hayclenv;Ile Raj
COMMONWEALTH OF MASSACHUSETTS
No,-.04„ „P4,2 , Massachusetts
Percolation Test'
Date: /IL Jo) Time:,
Observation Hole #
P- 1
Depth of Perc
34
Start Pre-soak
`J• . 16
End Pre-soak
9 ; 31
Time at 12"
9 ; 31
Time at 9"
•
9 • 34
Time at 6"
9 . 4I
Time (9"-6")
7 r--51n.I
Rate Min./Inch
3 r-,,1,911,l
' Minimum of 1 percolation test must be performed in both the primary area AND
reserve area.
Site Passed a Site Failed ❑
Performed By: 1\40,c 0,c kc I 1^6`^Psoh
Witnessed By: Pc1t-r M c t^,�
Comments: -- -
DEP APPROVED FORM-12/07/95
HILLTOWN ENVIRONMENTAL CONSULTING
P. O.BOX 226
NORTH HATFIELD,MA 01066
(413)247•5464
Describe the proposed upgrade to the system
Pcepince. eniri-e ..ryy{en , 5 c play.
Local Upgrade Approval is requested for: /
I� Reduction in setback(s) (Describe reductions) S.A.S. In 4.444.{lon W4« y C rn %A'
SA . S -fa properly the -(-.o,.. lo' -{z 1 3'
❑ Percolation rate for 30 to 60 min/inch Percolation rate min/inch
❑ Reduction in SAS area of up to 25%
(SAS size and%reduction) SAS sq ft Reduction %
❑ Reduction in separation between the SAS and high groundwater
Separation reduction ft Percolation rate mm /inch
Depth to groundwater ft
❑ Relocation of water supply well(Explain)
❑ 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 eleyation pursuant to 310 CMR 15.405(1)0)(1).The soil evaluator must be a member
or agent of the local approving authority.
High groundwater elevation determined by:
(Print or type evaluator's Name) (Signature of evaluator)
Explain why full compliance,as defined in 310 CM/2 15.404(1),is not feasible.
(Each section must be completed)
(Evaluation Date)
1. An upgraded system in full compliance with 310 CMR 15.000 is not feasible:
Li,.,ifed .Spare awnila61 e dva -fa -regcer4pAy f We 4-1cnds
2. An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible:
Akf neededp not Cost ¢t};clu,t
Department of Environmental Protection DEP Approved Form-320/02
Page 2 of 3
t
FORM 9A - Application for Local Upgrade Approval
Commonwealth of Massachusetts
Norfhanip'%ran
(City/Town)
,Massachusetts
Application for LOCAL UPGRADE APPROVAL
Title 5, 310 CMR 15.000
DEP Approved Form Required by 310 CMR 15.403(1)
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 15.417.
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 a septic system constructed in accordance with either the 1978 Code or 310 CMR 15.000.
Facility Address: 432 Nwyalen✓iI/e /road City/Town: LeciS
Facility/System owner: L�o c( C, nine Gwin
Address: 423,91-1, e ydenvl lle �octd 9
City/Town: L. 15 State: MA Zip: 6 10 53
Telephone: ( 413 1 SP+-5238 ,,.�,,LL
Type of Facility(check all that apply): L✓nesidential ❑Institutional ❑Commercial ❑ School
Describe facility ,,��,,/�
Type of existing system: ❑Privy ❑Cesspool(s) Lyuonventional System
❑Other(describe)
9?
Type of soil absorption systemkfirenchej'Chambers,leach field,pits,etc)
Design Flow per 310 CMR 15.203:
Design flow of existing system Link-now n gpd
Design flow of proposed upgraded system 432 gpd
Design flow of facility 330 gpd
Proposed upgrade of system is: 1 Voluntary ❑Required by order, letter,etc.(attach copy)
❑ Required following inspection pursuant to 310 CMR 15.301
Provide date of inspection / /
Department of Environmental Protection
FORM 9A - Application for Local Upgrade Approval
Page 1 of 3
DEP Approved Form-3/20/02
i
FORM 9A - Application for Local Upgrade Approval
3. A shared system is not feasible: Mole needed
4. Connection to a public sewer is1 not feasible: ,Sewer line not owen Watt
hCW ear IN nennr TuTInVC. •
The Application for Local Upgrade Approval must be accompanied by all of the following:
(Check the appropriate boxes)
Lam" Application for Disposal System Construction Permit
Z Complete plans and specifications
Site evaluation forts
❑ 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)
CERTIFICATION:
"I,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.
Facility owner's signature r aj f i ��.-r Date 3 //7/03
Print name 1_lotic. Ft �t�r�7cj U
Name ofpreparcr M4rL lr °i",-5o.n Date / l
Preparer's Addre$g5: Q,D. & Z2‘,
City/Town:/J. Haiiie(sr State: M4 Zip:6giaL
Preparer's telephone: (M47r, ).' 247'5444
NOTE: 310 CMR 15.403(4)requires the system owner to provide a copy of the local upgrade
approval to the appropriate Regional Office of the Department of Environmental Protection,Bureau
of Resource Protection,Division of Watershed Management,upon issuance by the local approving
authority and before commencement of construction.
Department of Environmental Protection DEP Approved Form-3/20/02
Page 3 of 3
owng
Facility/Sys
City/Town:
Facility Address
LOCAL UPGRADE APPROVAL
Issued Pursuant to 310 CMR 15.404 and 15.405
Facility/System
FORM 9B - Local Upgrade Approval
,, /ICommonwealth of Massachusetts
/vor4 Ao mpton
(City/Town)
,Massachusetts
r: I��p f ry�nrM.r rbt/Ly1/ Address: A13 `�!1cLeal- /QC
C'ei i I7 (J State: i114 n ip: ea,5",
q 1j AlLe-P-e-Cee% frown: /F ✓3'
Type of Facility: ry{y/Residential u Institutional ❑Commercial ❑School
Design flow per 310 CMR 15.203 gpd
System Designer: a4 ❑ PE
Address:
S x 3�Y6 -
City/Town: /U'� a�-y
Local Upgrade Approval is granted for:
Redu lion in etback(s) Spe
State:
-74, /$/ — n
:��alJi�jr7i)�!�rc�d�d-t�esr
Zip: O/O/p(o
❑ Percolation rate for 30 to 60 min/inch
❑ Reduction in SAS area of up to 25%
Percolation rate
(SAS size and%reduction) SAS sq ft Reduction
❑ Reduction in separation between the SAS and high groundwater
Separation reduction ft Percolation rate min/inch
Depth to groundwater ft
min/inch
/o
Relocation of well(Explain)
List local I lances granted not requir' g r EP
List variances granted requiring DEP approval:
I 5 412 fq):
40 / S ' /V��T`•_.��e�_'
Approvf �J he • i /si.;/a.,/(q/ Board of Malt .-}—
(' t or game and Title) (Signature)
The system owner shall provide a copy of this local upgrade approval to the appropriate Regional
Office of the Department of Environmental Protection,Bureau of Resource Protection,Division of
Watershed Management,upon issuance by the local approving authority and before commencement
of construction.
Department of Environmental Protection
DEP Approved Form-3/20/02
„Location Address or Lottt a 4', % -w,% dL'
Date 1 i 111
PERCOLATION TEST(S)
Time: Time:
Observation Hole #1 Observation Hole #2
Depth of Perc ZU ; Depth of Perc
Start Pre-soak ' ! Start Pre-soak
End Presoak q - �, End Pre-soak
Time at 12” Time at 12"
Time at 9" G r r Time at 9"
Time at 6" /; L< Time at 6"
Time(9"-6") (•�--�/ l� Time (9"-6")
Rate Min./Inch Rate Min./Inch
7
'minimum of 1 percolation test must be performed in both the primary area AND reserve area.
SITE 'SITE SITE SITE
PASSED — FAILED PASSED — FAILED
Performed by I Performed by
Witnessed by Witnessed by
Comments:
NORTHAMPTON BOARD of HEALTH— Title 5— Site Review
Deep Hole#: I
DEEP OBSERVATION HOLE LOG*
turn. Ub1 OF TVJO HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA
Depth from
Surface(Inches)
Depth from
Surface(Inches)
Soil Horizon
Soil Texture
(USDA)
Soil Color
(Muns4
Soil Mottling
Other
(Structure,Stones,Boulders,Consistency,To Gravel)
li l,
i/
j
L.
l0 f
I
�0
., ` 'sL.'.. •:�
Depth1c`gralndwatec 't•'/ffier ;;dy$...x y
I!W
Espnatad Seasonal frsitt Groondwa
Parent Mateiial(geologlc) :
''Deg9P.IO"B amd
•Deptipto grWnUwatec Slandingw :i
Weeping from Pit Face.-
Deep Hole#:
DEEP OBSERVATION HOLE LOG*
'L1IILI II I OF TVJO HOLES REQUIRED U EVERV PROPOSED DI=P-1-]AL APEA
Depth from
Surface(Inches)
Soil Horizon
Soil Texture
(USDA)
Soil Color
(Munsell)
Soil Mottling
Other
(Structure,Stones,Boulders,Consistency,%Gravel)
Parent Mats t l(geologicH
., ` 'sL.'.. •:�
Depth1c`gralndwatec 't•'/ffier ;;dy$...x y
I!W
Espnatad Seasonal frsitt Groondwa
q°II £ �_V ..an9l J $Sa3J�/ /1n2�lb
„ 9, 12 ss-b' �/ill
/ V
,.t/ It �` QJ ,nano) talc"0
61 z- 21,2'3
51 "a"°) t'l"1
9,81 ♦*Y I'8 111,11_"tdaS
3DNNyS1 Q.yiir -Sid 1c`+3hod Wog
S
N Olga
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1"11'.'7 ,W x ,21
4 fi -.
}„....t.=d.....J AML i
1
(,.ntnr.,y M.&j mi) .zz — -
E
7 £Zi7 f
6,.41 `aMg..wcolpa
\\1 �l bs- 01 101y -'ta15)
Soot )� Ir 5 pno11 �I itwarkli {2÷. .
1_1, 1.40-r/raj raV b -c I 5v ..na+515
aa..S.
No.
FORM 3A - CERTIFICATE UP' CUi IYLIANCE
Fee
COMMONWEALTH OF MASSACHUSETTS
/V
Board of Health, ori-harnp-{otn , MA.
CERTIFICATE OF COMPLIANCE
Description of Work: O Individual Component(s) 2/Complete System
The undersigned hereby certify that the Sewage Disposal System;
Constructed 0, Repaired (/Upgraded 0, Abandoned ( )
by: /o m e et-fo r
at: 4-13 HaydenvJlIe Rood (Egan ) Property )
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 3/10/03
Installer
Ap.r.ved Design Flow 432 (gpd)
s-
Designer: M ,_ Inspector
Date 7 /16/05
The issuance of this permit shall not be construed as a guarantee that the system will
function as designed. Xn
( a As'R4111 ✓��'y/Ce ti 0 3tL)
s Vo4ef, 7h-fe`rror (luni biny in NogSe_ No+ ye-P Canna-fed '{c SyS'fes
q{- 4ik'v 0-C iNSPec+iorn .
0104 5cphC #4nk 51r11 In
track-g (ltd.
D[P APPROVED FORM 5/96
Utfte . No+ ye* pcinyelia nd
. .
;•.•
• 40.
. .
`y,