502 Cert of Compliance & Permit No fa,'O
FORM 3A - CERTIFICATE OF COMPLIANCE
Fee
COTdRvtOT('WEALTV OP ?d?iSS9tCT141SETI'1'S f
Board of Health, Northampton, MA
CERTIFICATE OF COMPLIANCE
Description of Work: ( X ) Complete System ( ) Individual Components
The undersigned hereby certify that the Sewage Disposal System: Upgrade
by: pave Loven Construction
at: 502 Haydtnvi1le Road. Northampton
Homestead Inc. Project#: ala
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 Non g dated 10/6/09 Approved
Design Flow 660 (gpd).
Date of sub-grade inspection: 8/27/17
Installer
Designer:
Inspector:
Local ApprOvin9 Aut oritv
Northampton Board of Health
Date:
This certification represents no warranty, expressed or Implied as to the functioning or
longevity of the onslte subsurface disposal system. Rather, the plan and Installation are In
compliance with all applicable rules and regulations In effect at the time of plan submittal.
cc: Peter Flinker, 502 Haydenville Rd., Leeds, MA 01053
DEP APPROVED FORM 596
Q � Closeout Notes: - -- -
26/4,2- 1. Septic tank is equipped with an outlet filter. This is a
v Deck
maintenance item. Filter must be cleaned whenever septic tank I
is pumped, or every 3 years, whichever is sooner. Failure to
4 maintain filter may lead to system failure. I
g 2. Recommend pumping septic tank on a 3 to 5 year schedule, 1 Proposed 3
R depending on house occupancy. Bedroom
tn 3. A copy of this document attached in the basement/utility
area will keep this information available in future years for I
maintenance.
Shed I
1b 7 Infiltration Chamber Leachfield Use Title 5 sand -1
/ Add Beane"ts atraee DetalA - I
I for all fill requirements under units,minimum of 6"
between of units,and within 5 feet
mound' g units Note No ards required. '
t - NORTH
E
E CC- 117111 8 Dof e I
11ry1G1 X1111 [,( v,oil, ihttolith,
1 11�7f1111\11iiih l'« l TOM ail ear base B W ` .
SU 1141111 a • Elevatl n_uoaar Porch
inspection Detail 1
on Pon
• • New 1500 gallon•ale 5, 3
septic tank with outlet filter
lD
As-Built "A" "B _. . _. . . .. _ !
..
•
"C" 601/2 ft. 561/2 ft._—_._.. PL-._._ . . Boundary length.approx 188 ff
'rDr' 781/2 ft. 501/2 ft. , Land Area 375 ac.
"E" 98 ft.
"Fr" 31 ft.
"O" 29 ft. HAYDENVILLE ROAD
Date: Owner: �x° HOMESTEAD INC.
As-Built Drawing 10/5/09 Peter Flinker N
Existing Septic System ,r- THOMABa� Thomas S. Leue R.S.
502 Haydenville Ro. • �0°� �,ca
Scale: 1 : 20' Revision Date: / ,. 7z pest.
8/nA/12 Leeds, MA 01053 "rag Mt e' wildjai 1 rg,MA 01096
Except as Noted 4A[° se
Commonwealth of Massachusetts
City/Town of Northampton
Application for Disposal System
Construction Permit
FORM 3A - CERTIFICATE OF COMPLIANCE
No aO,
aoia -e(44)
Number
$ ao42 �
Fee /O`°
cols vt0T(w29ca'?(OrT MAss fusrrrs
Board of Health, Northampton, MA
CERTIFICATE OF COMPLIANCE
Description of Work: ( X ) Complete System ( ) Individual Components
The undersigned hereby certify that the Sewage Disposal System: Upgrade
by:
at: 502 Havdenville Road. Northampton
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 10/6/09 . Approved Design Flow 660 (gpd).
Installer:
Designer:
Inspector:
Thomas S. Leue, Homestead Inc.
Date: 8/ 02
Date:
Date: gv/9
The Issuance of this permit shall not be construed as a guarantee that the system will function
as designed.
t5formsla doc•O6/03
E COPY
Application for Disposal System Construction Permit•Page 4 of 4
Commonwealth of Massachusetts
et II City/Town of Northampton Number
Application for Disposal System $ "047-57
Construction Permit Fee /SD °°
FORM 2A - DSCP
No.#70/»'3'
Fee_ _ ,
COMMOMWWEA.La'V OP M?{SS9l0frrUSrETITS
Board of Health, Northampton, MA
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to: Uodrade an individual sewage disposal system at
5no Eaydenvi lie Road Northampton as described in the application for Disposal System Construction
Permit No. /0/21 dated /0/6/9 .(�C✓isec 7/T/2)
Provided: Construction shall be completed within three years of the date of this permit NI local conditions must be met.
Date 53. eV%°9 Board of Health
t5formsla doc• 6/03
FILE COPY
Application for Disposal System Constwctln Permit•Page 3 of 4
Commonwealth of Massachusetts Xi"?
City/Town of Northampton Number
Application for Disposal System $
Construction Permit Fee /52.9 c0
A. Facility Information (continued)
6. Design Flow:
Calculated Daily Flow:
660 Gallons per Day
660
Gallons
Plan: 10/6/09 Date of Original
Number of Sheets Revision Date 7
Title of Plan: Plan to Upgrade Septic System
8. Description of Soil:
fine sand
9. Nature of Repairs or Alterations Of applicable):
new complete system with tank and field.
10. Date last inspected:
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 thi o f H Ito qg� h.
Signature
Name
Application Approved By:
�/Lnrib/ hi45•)
Application Disapproved for the following reasons:
Date
7//2,11z.
Date 6/0/a
t5formsla doc•06/03 Application for Disposal System Construction Permit•Page 2 of 4
Commonwealth of Massachusetts
City/Town of Northampton
Application for Disposal System
Construction Permit
Form to
Number
$ / 22
Fee
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: upgrade on-site sewage disposal system.
1. Location of Facility:
Address: 502 Haydenville Road
City/Town:
2. Owner Information
Name:
Address:
City/Town:
Telephone:
Northampton, MA 01053
Peter Flinker
502 Haydenville Rd.
Leeds , MA 01053
585-5724
3. Installer Information
Name. LoVaa BTChukrn As stia-o LTprl
Address:
City/Town:
Telephone:
4. Designer Information
Name: Thomas S. Leue R.S.
Name of Company: Homestead Engineering Inc.
Address' 1664 CaDe Street
City/Town: w'll'amsb MA 01096
Zia R8'sen&ola. ao .
W a 5n4-knt PT $ 1 M /t
102.7
(1 13 6,5". 7504 (19Aa Lo✓anl.)
Telephone:
5. Type of Building:
Dwelling
Other: Type of Building
Showers
Cafeteria
413 628-4533
Garbage Grinder(check if present)
Number of Persons Served
Number of showers
Other fixtures
Specify other fixtures'.
Form 1A
t5formsta doc•06/03
Application for Disposal System Construction Permit• Page 1 of 4
BOARD OF HEALTH
DONNA C.SALLOOM,CHAIR
SUZANNE SMITH,M.D.
JOANNE LEVIN,M.D.
Benjamin Wood,MPH,Director
Javeda MIr,MPH.Heft Inspector
Patricia Abbott RN.Public Health Nurse
Heather McBride,Clerk
CITY OF NORTHAMPTON
MASSACHUSETTS 01060
OFFICE OF THE
BOARD OF HEALTH
(413)5B7—1214
FAX(413)587-1221
212 MAIN STREET
NORTHAMPTON,MA 01060
Onsite Septic System Construction Permit: Conservation Commission Review
NOTE: As of 1/1/11, Septic System Permits will not be issued by the Northampton Board of Health
until we receive this form signed by the Northampton Conservation Commission Staff Member.
The Conservation Commission can be reached by contacting:
0 Sarah LaValley,Conservation, Preservation and Land Use Planner
SlaValley@northamptonma.gov
Office of Planning&Development
210 Main Street, Rm.11,City Hall
Northampton,MA 01050
Property Owner: ?-4/- A/ �e/' Address: ��7 Zrda. /
Engineer 71Onna6 Cc
(.ec2e
Conservation Commission Conservation, Preservation and Land Use Planner
Date.
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