61 Title 5 Upgrade Application/Permits, Certificate of COmpliance, 2010 Commonwealth of Massachusetts
City/Town of Northampton
Application for Disposal System
Construction Permit
Form 1A
DEP has provided this form for use by local Boards of Health if they choose to do so
your local Board of Health to make sure that they will accept it.
Number
$ ism
Fee
Before using the form, check with
A. Facility Information
Application is hereby made for a permit to: Upgrade on-site sewage disposal system.
1. Location of Facility:
Address: 61 North Farms Road
City/Town: Northampton, MA 01060
2. Owner Information
Name:
Address:
City/Town:
Telephone:
3. Installer Information
Name:
Address'
City/Town:
Telephone:
Linda Merriam
61 N Farms Rd.
Florence, MA 01062
584-8856, 772-3330
4. Designer Information
Name: Thomas S.
Name of Company: Homestead
Address:
City/Town:
Telephone:
5. Type of Building:
Leue R,S.
Engineering Inc.
1664 Cane Street
Williansbura, MA 01096
413 628-4533
Other: Type of Building Dwelling
Showers
Cafeteria
Specify other fixtures:
Garbage Grinder(check if present)
Number of Persons Served
Number of showers
Other fixtures
l5lormsla doc•06/03 Application for Disposal System Construction Permit•Page 1 of 4
Form 1A
Commonwealth of Massachusetts
City/Town of Northampton Number
Application for Disposal System $
Construction Permit l=ee
A. Facility Information (continued)
6. Design Flow: f Gallons per Day
Calculated Daily Flow: 330
Gallons
7. Plan: 12/18/09 Date of Original
Number of Sheets 14 Revision Date
Title of Plan: Plan to Upgrade Septic System
8. Description of Soil:
loamy sand
9. Nature of Repairs or Alterations Of applicable):
New septic tank. pump chamber and infiltration chamber leachfield.
10. Date last inspected: 9/1/09
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 this Board of Health.
Signature
Name
,/ l e f r ac-r---.
Application Approved By:
Application Disapproved for the following reasons:
Date /.3/7/7
Date
//O
t5lormsl a cloc•06/03
Application for Disposal System Construction Permit• Page 2 of 4
No.
Commonwealth of Massachusetts -/
City/Town of Northampton Number
Application for Disposal System $ is0
Construction Permit Fee
FORM 2A - DSCP
Fee
COMMOMwngiLatf OP 'MASSAC('USTItS
Board of Health, Northampton, MA
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to: Upgrade an individual sewage disposal system at
61 North Farms Road• Northampton as described in the application for Disposal System Construction
Permit No. )'!o - / dated
Provided: Construction shall be completed within three years of the date of this pejw42 All local conditions must be met.
Date :2/�f//0 Board of Health
tsformst a doc•06/03 Application for Disposal System Construction Permit•Page 3 of 4
No.
Commonwealth of Massachusetts
City/Town of Northampton Number
Application for Disposal System $
Construction Permit Fee
FORM 3A - CERTIFICATE OF COMPLIANCE
Fee
COWN.O9f'W!9tLatf o 7it?ISS9t0hISIT' S
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: ooara le
by:
at: 61 North Farms 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 12/18/09 . Approved Design Flow 330 (gpd).
Installer:
Designer:
Inspector:
Thomas S. Leue. Homestead Inc.
Date:
Date:
Date:
The issuance of this permit shall not be construed as a guarantee that the system will function
as designed.
t5formsla doc•06/03 Application for Disposal System Construction Permit•Page 4 ol 4
Commonwealth of Massachusetts
City/Town of Northampton
Form 9A - Application for Local Upgrade Approval
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here Before using this form, check
with your local Board of Health to determine the form they use.
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
Facility Name and Address:
Name: Linda Merriam
Street Address: 61 North Farms Road, Northampton
2. Owner Name and Address (if different from above):
Name: Linda Merriam
Address: 61 N. Farms Rd. .
Florence MA 01062
Phone # 584-8856, 772-3330
3. Type of Facility (check all that apply):
X Residential Commercial
School Institutional
Other (specify)
4. Describe Facility: single family dwelling
5. Type of Existing System:
privy _ cesspool
X conventional system
Other (specify)
6. Type of soil absorption system (SAS) (trenches, chambers, pits, etc):
leach field, failed
7. Design Flow based on 310 CMR 15.203:
Design for existing system: unknown gpd (pot verified)
Design flow of proposed upgraded system: 330 gpd
Design flow of facility: Q gpd
Upgrade Form.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
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check
with your local Board of Health to determine the form they use
B. Proposed Upgrade of System
Proposed upgrade is (check one):
Voluntary
Required by order, letter, etc. (attach copy)
X Required following inspection required by 310 CMR 15.301
Date of inspection:
Describe the proposed upgrade to the system-
New septic tank, pump system and chamber type leaching field .
3. Local Upgrade Approval is requested for (check all that apply):
Reduction of setback(s) - describe reductions
Reduction in SAS area of up to 25%: SAS Size % reduction:_
U
X Reduction in separation between bottom of SAS & high groundwater:
Separation reduction: 3 ft.
Percolation rate. 5 min per inch
Depth to groundwater:32 in.
Relocation of water supply well (explain):
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:
ade Form.doc.rev.7/06 Ap•lication for Local Upgrade Approval• Page 2 of 4
Commonwealth of Massachusetts
City/Town of Northampton
Form 9A - Application for Local Upgrade Approval
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check
with your local Board of Health to determine the form they use
B. Proposed Upgrade of System (continued)
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 15.404 (1)0)0). The soil
evaluator must be a member or agent of the local approving authority.
High groundwater evaluation determined by:
Evaluator's Name: Aim e- Petr
Evaluator's Signature���
Date of Evaluation: 10/19/09
C. Explanation
Explain why full compliance, as described 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:
While controlling excess costs. this upgrade will replace what
is in place with a more environmentally harmless alternative.
An alternative system approved pursuant to 310 CMR 15.283 to 15.288 is not feasible:
Not needed, conventional system feasible.
3. A shared system is not feasible:
Not required. lot will support system.
4. Connection to a sewer is not feasible:
Connection not allowed to public sewer in area.
5. The Application for Local Upgrade Approval must be accompanied by all of the following
(check the appropriate boxes):
X Application for Disposal System Construction Permit
X Complete plans and specifications
X 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):
U
ade Form.doc•rev. 7106 Application for Local Upgrade Approval• Page 3 of 4
Commonwealth of Massachusetts
City/Town of Northampton
Form 9A - Application for Local Upgrade Approval
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check
with your local Board of Health to determine the form they use.
D. 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 knowing violations."
9
Facility Owner's Signature Dal
Linda Merriam
Print Name
Thomas S. Leue Homestead Inc. 12/18/09
Name of Preparer Date
1664 Cape Street Williamsburg. MA 01096 (413) 628-4533
Address and Telephone Number of Preparer
Upgrade Form.doc•rev. 7/06 Application for Local Upgrade Approval•Page 4 of 4
Commonwealth of Massachusetts
City/Town of Northampton
Local Upgrade Approval
Form 9B
DEP has provided this form for use by local Boards of Health if they choose to do so
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
Facility Name and Address:
Name: Linda Merriam
Street Address: 61 North Farms Road, Northampton
2. Owner Name and Address Of different from above):
Name: Linda Merriam
Address: 61 N Farms Rd.
Florence. MA 01062
Phone# 584-8856. 772-3330
3. Type of Facility (check all that apply):
X Residential Commercial
School Institutional
Other(specify)
4. Design Flow based on 310 CMR 15.203: 320 gpd
5. System Designer:Thomas S. Leue, R.S. Homestead Inc.
1664 Cape Street Williamsburg MA 01096 (4131 628-4533
Address and Telephone Number of Preparer
B. Approval
Local Upgrade Approval is granted for:
0 Reduction in setback(s)-specify:
0 Reduction in SAS area of up to 25%:
SAS size,sq.ft. %reduction
t5form9b.doc trey. 7/06 Local Upgrade Approval•Page 1 of 2
Commonwealth of Massachusetts
City/Town of Northampton
Local Upgrade Approval
Form 9B
B. Approval (continued)
0 Reduction in separation between the SAS and high groundwater:
Separation reduction ft.
Percolation rate 5min ranch
Depth to groundwater 12 in.
0 Relocation of water supply well(explain):
0 Reduction of 12-inch separation between inlet and outlet tees and high groundwater
0 Use of only one deep hole in proposed disposal area
0 Use of a sieve analysis as a substitute for a pert test
List local variances granted not requiring DEP approval per 310 CMR 15.412(4):
List variances granted requiring DEP approval:
Approving Authority. Northampton
(A/CO
Print or Type Name and Title
Signature
Date
t5formgb Got .rev.7m6 Local Upgrade Approval• Page 2 of 2
January 29, 2010
Ben Wood,MPH
Northampton Health Department
212 Main Street
Northampton.MA 01060
Dear Ben,
As a professional courtesy to the Northampton Board of Health,I have reviewed the plan and supporting
documentation submitted by Thomas Leue, RS. for the septic repair at 61 North Farms Road.
Local Upgrade Approval Re uest-In my opinion,this is an appropriate and reasonable request.If denied,
the finish grade of the system would increase by 1 foot in height. Fill would encroach onto the abutting
property requiring a deeded easement or requiring more extensive use of impervious barriers.And it would
change the existing drainage pattern between the two properties.
Plan review- Mr.Leue proposes a repair consisting of a new septic tank,a pump and pump chamber, and
a new SAS. Excellent schematics and details are provided on the plan for the tank,pump, and pump
chamber. The SAS proposed is biodiffuser chambers in a 6.25 x 50 bed configuration. Using the design
standards listed in DEP's most recently modified(June 30,2009) General Approval for Advanced
Drainage System Inc., I end up with a different design flow calculation than Mr. Leue. However,his
numbers are more conservative.
Plan Deficiencies noted-
// While the plan view shows a d-box and a narrative for the d-box is provided,the system profile
does not show a d-box or provide inlet and outlet elevations. Prior to the issuance of the permit,
Mr. Leue should provide this information on the plan.
2.) It is unclear to me whether all wetlands within 100 feet of all septic components(including the
tank and pump chamber)are shown on the plan view based on comments listed on the Title V
Inspection Form. Prior to the issuance of the permit Mr. Leue should confirm for you that all
components meets the Title Vsetbacks from wetlands and any addition requirements the
Northampton Board of Health may have.
Additional comments- The plan does not call for a vent at the end of the SAS.While Title V no longer
requires a vent for dosed systems, it still remains good engineering practice for systems with pumps. Mr.
Leue should weigh the benefits of additional ventilation with any potential drawbacks.
Please let me know if you have any questions.
Sincerely,
Judy Metcalf, RS, CHO
NORTH I
■ Remove stumps.
I/ — • •
Area: 2.0 acres I • E],_—j--
Arc-36: 10 x 2 units. 60.0 ft long x 6.25 ft. wide. Schedule 40 pressure pipe.Slope back to tank. I -_.-'1-"
F
III
1000 gallon concrete pump chamber. Garage
Locate alarm panel in basement. i
A _.. H I I ' 98 TBM: nail on
I 16" birch tree.
E - G I � ° y Elevation:
. 1 . 1 /
New 1500 gallon Title 5 septic - - �O o O r ! I E0 1
tank. Compartmentalized. - D___G- • 95 '
3 bedroom I I
"A" "B" "G" "H" House Outline 1 i
I '
"C" 16 1/2 ft. 29 1/2 ft. I co
N
"D" 20 1/2 ft. 37 1/2 ft. : I
m
"E" 12 3/4 f[. 32 3/4 ft. I I ' 6 it•4'
"F" 33 ft. 63 3/4 ft. porch 1 _ ..__. mc,
I _
i 40 mil poly breakout barrier, 3 sides._.. d
o_
10'
Driveway I( /
Town water in I
Inspection Port: see Detail.
Closeout Notes:
1. Septic tank is equipped with an outlet filter. This is a maintenance item, Filter must be cleaned whenever septic tank is pumped, or every 3
years, whichever is sooner. Failure to maintain filter may lead to system failure.
2. Recommend pumping septic tank on a 3 to 5 year schedule,-depending on house occupancy.
3. A copy of this document attached in the basement/utility area will keep this information available in future years for maintenance.
1 1 - I
, 1 t ... ,
Date: Owner: 4 HOMESTEAD INC.
As-Built Drawing 12/18/09 Linda Merriam 41 THOMAS
Existing Septic System hg LEUE 111 Thomas S. Leue R.S.
61 North Farms Ro- e x,,,2
Scale: 1 : 20' Revision Date: ^�, !- ; 1664 cape se.
4/6/2010 Florence, MA 01062 / .- teen s2tk*col'. Williamsburg,MA 01 096
Except as Noted 14171 628-4533
FORM 3A - CERTIFICATE OF COMPLIANCE
No. Fee
COMMONwncq'-f oT MISS ACJ-FUSET'Ts
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: Riverdrive Excavating
at: 61 North Farms Road, Northampton
Homestead Inc. Project#: 523
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.
Approved Design Flow 330 (gpd).
Date of sub-grade inspection: 1/27/09
��1vUN/ari✓tc
Riverdrive Excavating
Installer
dated 12/18/09
Date:
y - 6
Designer: Date: 4/6/10
Thomas
1664 Ca:,` t. W' amsbur• MA 01096
Inspector: s� Date' y/�
Local Ap vi Authority
Northampton oard of Health
This certification represents no warranty, expressed or implied as to the functioning or
longevity of the onsite 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: Linda Merriam, 61 N. Farms Rd., Florence, MA 01062
DEP APPROVED FORM 5/96