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589 Title 5 Application/Permits 1984, Soil Suitability 1984, 2013, Construction Permit 2013, As-Built, a/s/i$ Commonwealth of Massachusetts City/Town of Septic System Installation Checklist 4 y! �• M"�tg r arr`rff Feals B. Application Checklist (cont.) 2. Construction Inspection a) Building Sewer(310 CMR 15.222) All waste pipes tied into building sewer Schedule 40 PVC 4 or cast iron Minimum slope of 0.01-0.02 Pipe laid in continuous straight line Pipe laid on compact, firm base Cleanouts precede all changes in alignment/grade Cleanout provided every 100 ft. Ball material clean b) Septic Tank(310 CMR 16223) Tank is set level with 6°stone under (15 228) Tank is required size/loading per plan Inlet and outlet are at proper location (15.227) Tank is water tight(15.226) Outlet tees extend 6°above flow line Approved filter device placed at outlet Gas baffle installed at outlet tee Inlet and outlet tees on center line Approved Basement check ❑ Verify by reading pipe Visual Visual Visual Verify by visual/tape Verify by visual/tape Visual Check with level Verify with plan Verify with plan Test Verify by visual/tape DEP list Visual Visual Tank is baddlled with acceptable material Visual N/A Problem ❑ ❑ ❑ ❑ ❑ ❑ Li Approved N/A Problem Notes: I Ariero✓•c Septic System Installation Checklist 11-09.doc•date Form Name•Page 2 of 6 Commonwealth of Massachusetts City/Town of Septic System Installation Checklist B. Application Checklist (cont.) c) Distribution Box(310 CMR 15.232) Approved N/A Problem All outlet pipes at same elevatio Check by adding water W ❑ ❑ Number of outlets plan Number of laterals per Plan Per Inlet tee min. 1`over outlet Visual and w/tape ❑ ❑ D box set on level base Visual ❑ ❑ Top of D box 36" max depth Visual and wltape I% ❑ ❑ D box is water-tight Add water E,/ ❑ ❑ D box has a minimum of 2"thick wall and ❑ ❑ 12'inside dimension d) Pump Chamber(310 CMR 15.231) Approved N//AA Problem Tank is set level Visual and w/level in LGk ❑ Proper volume is provided Check plan and tank ❑ ❑ ❑ Float elevations set per plan Measure wltape ❑ ❑ ❑ Min.2'delivery line to D box Visual ❑ ❑ ❑ Number of pumps: ❑ ❑ ❑ Specified pump provided or designers ❑I ❑ ❑ approval for equal pump Correct pump sequence ❑ ❑ ❑ Covers set to grade ❑ ❑ ❑ Electrical permit provided ❑ ❑ ❑ 6'of stone beneath chamber Visual ❑ ❑ ❑ Chamber is water-tight Test ❑ ❑ ❑ Min. 9"cover provided Visual ❑ ❑ ❑ Correct loading provided per plan Visual on tank ❑ ❑ ❑ Notes' Septic System Installation Checklist 11-09 dos•date Form Name•Page 3 of 8 Commonwealth of Massachusetts .1'[ City/Town of Septic System Installation Checklist B. Application Checklist (cont.) e) Leaching Facility(310 CMR 15.240) Approved N/A Problem No frozen material used including back fill Visual LVY ❑ ❑ No clay, tailings or stones larger than 6'for ❑ ❑ cover material Soil at bottorVsides of excavation matches ai7 ❑ ❑ info on deep holes All impervious layers removed Visual ,,,—.--.7.--.7 ❑ ❑ No remaining NB horizons Visual V ❑ ❑ Groundwater conditions match plan and Visual/check plan ❑ El deep holes Vented if under impervious cover per plan [E] El (15.241) Vent is protected from precipitation ❑ ❑ and animal entry Cover of a minimum of 9'over leach area 1 ❑ ❑ Pipe slope equal to 0.005 Check w/transit ❑ ❑ Leach area per design(15241) (Per caef ii., 5 0 Excavation is level and at required depth Visual/cheth plan ❑ ❑ Removal of 5 ft material and replacement Visual/check plan (� El ❑ (if in fill) Back fill material is acceptable Visual L ❑ ❑ Final contours correct per plan Check with plan lJ ❑ ❑ Surface/subsurface drainage away from ❑ p leach area Final grade and side slopes are stable ❑ ❑ Distribution lines are capped, vented, or rte.' ❑ ❑ connected together Impermeable barrier(15.255[2)) ❑ ❑ Retaining wall inspected by PE ❑ ❑ ❑ Retaining wall is water-proofed ❑ ❑ ❑ Retaining wall/barrier is at correct ❑ ❑ ❑ depth/height Septic System Installation Checklist 11-09.doc•date Form Name•Page 4 of 6 Commonwealth of Massachusetts uCity/Town of Septic System Installation Checklist B. Application Checklist (cont.) f) Leaching trenches(310 CMR 15.251) Number of trenches: Depth of trenches. 4ef W dth of trenches: Trench spacing per plan Stone is double-washed[3/4°to 1W] (15.247) g) Leaching fields(310 CMR 16242) Length of field: Width of field: Min. of 2 distribution lines Separation distance conforms to plan Stone is double-washed(3/4'to 1W)(16247) h) Leaching Pits(310 CMR 15.253) Number of pits: ❑ ❑ Depth of pits: ❑ ❑ ❑ Stone is double-washed[3/4'to 1W)(15.247) ❑ ❑ ❑ Each pit has min. 1 20•access cover ❑ ❑ ❑ Piping network and configuration of ❑ ❑ ❑ pits/chambers per plan i) Tight Tank(310 CMR 15.260) Tank is set level with 6'stone under Visual and with level ❑ ❑ Tank is proper size per plan Visual with plan ❑ ❑ ❑ Pumping contract has been provided ❑ ❑ ❑ Covers to grade Visual ❑ ❑ ❑ AN alarm set at 3/5 tank capacity Check floats by raising ❑ ❑ ❑ AN alarm test on separate circuit Set off alarm ❑ ❑ ❑ Septic System Installation Checklist 11-09.doc•date z Approved NIA Problem Ind' / ❑ ❑ ❑ ❑ ❑ ❑ 5 11 ❑ ❑ Form Name•Pape 5 of 6 Commonwealth of Massachusetts City/Town of Septic System Installation Checklist B. Application Checklist(cont) j) Certificate of Compliance(310 CMR 15.021) As Built Plan Submitted Signed by Installer Signed by Designer Certificate of Compliance Issued Notes: Date Date Date — Date As' Bti. 91- MT� Septic System Installation Checklist 11-09.doc•date Form Name•Pepe 6 of 6 Checklist for Septic System Plan Review Application page attached to plan PE or RS stamp, date,signature Variances to property line setback distances must have Surveyor stamp — ONE Legal boundaries noted Easements noted — N0A- .- Dwellings and buildings existing or proposed noted 'R( Location of driveway or parking areas,other impervious areas Location and dimensions of reserve area(new construction only) System design calculations ❑ Garbage grinder,yes or no uB I Xnot disturbed during construction within 75k of facility North arrow Contours Deep hole location(s)and data Perc hole location(s)and data Elevations Names of approving authority and soil evaluator Location of water supplies, public and private o Within 400ft of system in case of surface water and gravel-packed public water supply o Within 250ft of system in case of tubular public water supply is( o Within 100ft of system in case of private wells(50ft from tank) Well statement, if applicable- / Location of any surface waters, rivers,vegetated wetlands XLocation of water lines and other subsurface utilities 1 1 Obserrved and adjusted groundwater elevations in vicinity of system Profile of system Locus plan to show location of facility,including nearest street Materials of construction and specs for system Gas baffle Pipe in center line of tank Double-washed stone - -- - - Schedule 40 PVC for trafficked areas, house to tank Distances noted from house to tank,etc. If dosing is proposed,design and specs of dosing systemv/R hen alternative technology is required,complete plan and specs including hydraulic profile Trenches preferred over beds Buoyancy calculations for tanks or components partly below groundwater level 3:1 slope outside of mound,toe ending 5ft from property line Local upgrade requests on the plan,all variances Local upgrade forms attached to the application a Does tocaSi J J. 0.a Vo ..-enlcd So ' or cjresu.r /i//l/ dot? smsltw, 16.3 downwG • S nth cv.L.1 10 �k BOARD OF HEALTH DONNA C.SALLOOM,CHAIR SUZANNE SMITH,M.D. JOANNE LEVIN,M.D. Benjamin Wood,MPH,Director Javeda Mir,MPH,Health Inspector Patricia Abbott RN,Public Health Nurse Heather McBride,Clerk CITY OF NORTHAMPTON MASSACHUSETTS 01060 OFFICE OF THE BOARD OF HEALTH (413)587—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 SLaVallev@northamptonma.gov Office of Planning& Development 210 Main Street, Rm. 11,City Hall Northampton, MA 01060 Property Owner: 664.,J/ cn) c lei- Address: Sr/ V Fe ieyt5 E . / vc Q iNNI S Engineer: Qo ad&-h4ht&P wdowhr R\;(ei, a u,is- 6. servafion mmission Conservation, Preservation and Land Use Planner Date: Liii6A3 r.�u„w gluten,water Level Depth of Naturally Occuring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? . If yes,what is the depth of naturally occurring pervious material? If not,what is the depth of naturally occurring pervious material? Deep Hole Number: F 3 Date: 3)29 Location(identify on site plan): Land UseNegetatioaifwn/grass�j Landform: Position of Landscape: Distance from: Open Water Body Possible Wet Area Drinking Water Well On-Site Review Time: ID:;5,5, Weather: Cool cast Slope(%): 3 - S Surface Stones Feet Feet Feet Drainage way Property Line Other T.P.# 1-1 Feet Feet Feet DEEP OBSERVATION HOLE LOG Depth from Surface (Inches) Soil Horizon Soil Texture (USDA) Soil Color (Mansell) Soil Mottling Other(Structure,Stones,Boulders, Consistency, % Gravel) i : - 16 -)LI A. i.� � � f N 13 lOyide r�lcs —&_,,I(J ° r< o.-s < . I`e''3-i 3 ,7?. -e'' ,7,- s5 -7 C SL JL kb r3 y °p° d- L /$-Yi C ' '0)' Paregt[,6pter01(geologic) C z 5 ! V v. Deptht d-rot i(water: Standing Water in the Hole: afU Estimated Seasonal High Ground Water: > f - -7" ail L {.o os' C . 4 S/e,. Depth to Bedrock: > Weeping from Pit Face: BOARD OF HEALTH MEMBERS JAY FLEITMAN,M.D.,ACTING CHAIR SUZANNE SMITH,M.D. DONNA C.SALLOOM DIRECTOR OF PUBLIC HEALTH XANTHI SCRIMGEOUR,MHEd,CHES, BOARD OF HEALTH CITY OF NORTHAMPTON MASSACHUSETTS 01060 OFFICE OF THE (413)587-1214 FAX(413)687-1221 Site Suitability for On-Site Sewage Disposal Date: 3(z g l i 3 Equipment Operator: Project Number_ Performed by: / /.it[• Health Inspector: ��77 J 46 ;�f Site Address 5-- New Construction O 212 MAIN STREET NORTHAMPTON,MA 01060 Client Name& Address / /7/ ?D? )o/ fere h Office Review Published Soil Survey Available: No ❑ Yes 7 Year Published Publication Scale Soil Map Unit Drainage Class Soil Limitations Surficial Geologic Report Available: No J Yes J Year Published Publication Scale Geologic Material(Map Unit) Landform — Flood Insurance Rate Map: Above 500 year flood boundary J Within 500 year flood boundary 7 Within 100 year flood boundary I _ Wetland Area: National Wetland Invetory Map(Map Unit) Wetlands Conservacy Program Map(Map Unit) —Current Water Resource Conditions(USGS): Month Range: Above Normal O Normal 7 Other References Reviewed: Below Normal J uVY •`f` --`YY^ Pere I-1 Time Measurement Time Measurement Begin Saturation 1D %/lam Begin Saturation End Saturation /Q SO End Saturation 9"depth Measurement �U 3 9 depth Measurement 6 depth Measurement /Y'3 /�q 6"depth Measurement Elapsed Time 9"to 6" Elapsed Time 9"to 6" Percolation Rate_ .<2 min. an G7,,.,, `; Bottom of Percolation Test Hole: 1 Bottom of Percolation Test Hole: - -- - ------ ---- Deterltdnation for Seasonal-Hieb-R'atr, Tabk Method Used Depth observed standing on observation hole> ❑ Depth weeping from side of observation hole inches ❑ Depth to soil mottles_inches ❑ Ground water adjustment inches. Index Well Number Reading Date Index well level Important: When filling out forms on the computer,use only the tab key to move your cursor-do not use the return key. nem Commonwealth of Massachusetts City/Town of Florence Certificate of Compliance Form 3 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 the local Board of Health to determine the form they use 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 Lauren Corbet Facility Owner 589 North Farms Road Street Address or Lot# Florence City/Town Designer Information: DSCP Date Tel:(413)584 5440 MA State 01062 Timothy E. U,• s R.S. Name Name of Company 4A� ,.. May 16, 2013 Sig • HY tfq\� — Dale Zip Code Excavating etc. -Montague, MA (413)834-3000 Name of Company May 16, 2013 Date Use of this system is conditioned on compliance with the provisions set forth below: No garbage disposal allowed The issuance of this certificate shall not be/constru d as a guarantee that the system will function as desi n �y i$a/X/% 1-2, , Approving Author // Sign t5fonn3.doc•06/03 Certificate of Compliance•Page 1 of 1 P/L 0l ,l Pump-out manhole 'C' Existing L500 gallon septic tank 'low boy' tank required. (see note botton of page) 1 Existing well AS—BUILT DIMENSIONS 'A' to 'C' = 14'-0' "B' to 'C' = 24'-6' 'I' to 'G' = 53'-0' ck/ Laundry wastewater line (Abandonded 4' pvc pipe) (not removed) pvc solid pipe Distribution box-'E' Velocity reducing distribution box -'D Inspection port 'F' 19b c1/4, T /per Inspection Gate at fenc P P/L port 'G' P ± \ Iron pin NOTE Qy Due to the presence of SQS ledge at/near the house, '% the new septic tank was `TP placed less than 10' from house. 223` eF AS-BUILT PLAN 509 North Forms Road Florence, MA. 01062 Installer, Michael John - Montague, Ma. 2 Infiltrator trenches (36'1 x 3'W)each May 15, 2013 Important: When filling out forms on the computer,use only the tab key to move your cursor-do not use the return key aX Commonwealth of Massachusetts City/Town of Florence Application for Disposal System Construction Permit Form 1A ,2o13 - 2 Number $ /5', 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:❑ Construct a new on-site sewage disposal system Z Repair or replace an existing on-site sewage disposal system ❑ Repair or replace an existing system component 1. Location of Facility: 589 North Farms Road Address or Lot# Florence City/Town 2. Owner Information Lauren Corbet MA. State 01062 Zip Code Name 589 North Farms Road Address Of different from above) Florence City/Town 3, Installer Information TBD Name MA State (413) 584-5440 01062 Zip Code Telephone Number Name of Company Address City/Town 4, Designer Information Timothy E. Maginnis R.S., LSE Name 70 Montague Road Address Westhampton City/Town State Telephone Number Zip Code Name of Company MA. State (413) 527-5291 Telephone Number t5formla.doc•06/03 Application for Disposal System Construction Permit•Page 1 of 3 01027 Zip Code Commonwealth of Massachusetts City/Town of Florence Application for Disposal System Construction Permit Form 1A Fee A. Facility Information (continued) 5. Type of Building: ® Dwelling Other: Type of Building ❑ Showers Specify other fixtures: 6. Design Flow: Calculated Daily Flow: 7. Plan: 2 Number of Sheets Number of showers ❑ Garbage Grinder(check if present) 6 Number of Persons Served ❑ Cafeteria ❑ Other fixtures 330 Gallons per Day 330 Gallons April 8, 2013 Date of Original Revision Date Title of Plan 8. Description of Soil: Sandy loam-Fine sandy loan with lam. stones and boulders 9. Nature of Repairs or Alterations(if applicable): Replace a failing subsurface sewage disposal system. Install a new 1,500 gallon (2 compartment) septic tank,2 new distribution boxes and two Infiltrator Trenches with 9 Infiltrators per trench. 10. Date last inspected: (Storm-Ia.doc•06/03 March 2013 Date Application for Disposal System Construction Permit•Page 2 of 3 Commonwealth of Massachusetts City/Town of Florence Application for Disposal System Construction Permit Form 1A 106 —2 Number Fee 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. for LAARC� hGC 2,c C3 Sign: re Date Application Approved By 11„p MN , 4./J�/'1 J; Name Application Disapproved for the following reasons: Date iffi /G, .W/3 t5formla.doc•06/03 Application for Disposal System Construction Permit•Page 3 of 3 NO. FORM 11 - SOIL EVALUATION FORM Page: 1 of 5 Commonwealth of Massachusetts Florence, Massachusetts Soil Suitability Assessment for On-Site Sewage Disposal Performed by: Timothy E. Maginnis R.S. Date: March 28, 2013 Witnessed by: Daniel Wasiuk - Board of Health Agent Location address: Lot # 589 New construction Yes 589 North Farms Rd. Repair Owner: Lauren Corbett Julie Fischer - 584-5440 Address: 589 North Farms Rd. Florence, MA 01062 Office Review Published Soil Survey Available Year Published 12/95 Publication scale : Drainage class: well drained Soil limitations: slope, moderate to rapid permeability Yes No 15 840 Soil Map unit: CmB (Charlton series) Surficial Geologic Report Avoidable Yes No Year published: Not referred to Publication scale Geologic material: Glacial till Landforn: Glaciated upland Flood Insurance Rate Map: Above 500 Year flood boundary Within 500 year flood boundary Within 100 year flood boundary Wetland Area: National Wetland Inventory Map ( map unit )! Not referred to Wetlands Conservancy Program Map ( map unit ) Current Water Resource Conditions (USGS), Month -December Range: Above Normal Normal Other References Reviewed: Soil Survey, Hampshire Co. No Yes Yes Below Normal DEP approved form - 12/07/95 FORM 11 - SOIL EVALUATION FORM Page 2 of 5 Location Address or Lot No. 589 North Farms Road - Florence, MA. 01062 Deep Hole Number N I Date; 03/28/13 Time: 9:00 an Weather: Clear, mild Location: ( identify on site plan) - South section of tot, see plan Land Use: Vacant field Slope: 5'L - 107. Surface Stones': Some Vegetation: grass Landform: Glaciated upland Position on Landscape ( see plan ) Distances from: Open Water Body: i 100' Possible Wet Area > 100' Depth from Drainage Way > 100'+ Property line 60'± Drinking Water Wetl: > 100' Ether: Surface ( inches) Soll Horizo Soil Texture ( USDA ) Soil Color (Munselo Soil Mottling Other.. ( Structure, Stones, Boulders, Consistency, ( ]. gravel) 0' - 12' Fill A S / L 10YR 4/3 N/A Friable, fine roots, dark brown wavy boundry 16'- 24' B S / L 10YR 4/6 N/A fine sandy loam, friable, med roots 28' - 72' C L / S 10YR 4/3 N/A Loose, sand, stones, Ig rocks, boulders Parent Material ( geologic ): Sand /grvt, Weeping from face: None observed Depth to Groundwater: None observed Estimated Seasonal High Groundwater: N/A Depth to Bedrock': > 72" Indicates ESTIMATED SEASONAL HIGHWATER V DEP approved form - 12/07/95 FORM 11 - SOIL EVALUATION FORM Page 3 of 5 Location Address or Lot No. 589 North Farms Road - Florence, MA. 01062 Deep Hole Number # 2 Date: 03/28/13 Time'. 9:45 an Weather: Clear, mild Location: ( identify on site plan) - South section of lot, see plan Land Used Vacant field Slope: 5'L - 107. Surface Stones: Some Vegetation: grass Landform: Glaciated upland Position on Landscape ( see plan ) Distances from: Open Water Body > 100' Possible Wet Area: > 100' Depth from Drainage Way: > 100'± Property line: 30'±- Drinking Water Well: > 100' ❑there Soil Horizon Surface ( Inches) Soil Texture ( USOA Soil Color (Munsel) Sou Mottling Omer ( Structure, Stones, Boulders, Consistency, ( % gravel> Parent Material ( geologic ): Sand /grvL Weeping from faced None observed Depth to Bedrock > 84" Depth to Groundwater: None observed Estimated Seasonal High Groundwater) N/A Indicates ESTIMATED SEASONAL HIGHWATER V DEP approved Form - 12/07/95 0' - 18' Fill 18" - 22" A S / L 10YR 3/3 N/A Friable, fine roots, dark brown wavy boundry B Missing 22'- 84' C S / L 10YR /43 N/A Loose, sand, stones, Ig rocks, boulders Parent Material ( geologic ): Sand /grvL Weeping from faced None observed Depth to Bedrock > 84" Depth to Groundwater: None observed Estimated Seasonal High Groundwater) N/A Indicates ESTIMATED SEASONAL HIGHWATER V DEP approved Form - 12/07/95 FORM 11 - SOIL EVALUATION FORM Page 4 of 5 Location Address or Lot No 589 North Farms Road - Florence, MA. 01062 Deep Hole Number N 3 Date: 03/28/13 Time: 10:00 am Weather: Clear, mild Locationv ( Identify on site plan) - South section of lot, see plan Land Use: Vacant field Slope: 5% - 107. Surface Stones: Some Vegetation: grass Landformi Glaciated upland Position on Landscape ( see plan ) Distances from: Open Water Body: > 100' Possible Wet Areav > 100` Depth from Drainage Way: > 100'+ Property line- 50'± Drinking Water Welt > 100' Other: Soil Horizon Surface ( inches) Soil Texture ( USDA ) Soil Color (MunselD Sou Mottling other. K Structure, Stones, Boulders, Consistency, ( % gravel) Parent Material ( geologic )': Sand /grvl, Weeping from face: None observed Depth to Groundwater: None observed Estimated Seasonal High Groundwater N/A Depth to Bedrock. > 84' Indicates ESTIMATED SEASONAL HIGHWATER V DEP approved form - 12/07/95 A S / L 10YR 3/4 N/A Friable, fine roots, dark brown wavy boundry B S / L 10YR 3/6 N/A Friable, fine roots, It. brown, stones wavy boundry 18'- 42' C'1 S / L 107R 3/6 N/A fine sandy loam, friable, med roots 42' - 59' C-2 S / L 10YR 5/6 N/A friable, stones, Ig rocks, boulders 59' - 84' C-2 S / L 10YR 5/5 N/A sand/grvl, stones, Ig rocks, boulders Parent Material ( geologic )': Sand /grvl, Weeping from face: None observed Depth to Groundwater: None observed Estimated Seasonal High Groundwater N/A Depth to Bedrock. > 84' Indicates ESTIMATED SEASONAL HIGHWATER V DEP approved form - 12/07/95 FORM 11 - SOIL EVALUATION FORM Page 5 of 5 Location Address or Lot No. 589 North Farms Road - Florence, MA. 01062 Determination for Seasonal High Water Table Method used: Depth observed standing in observation hole: None observed Depth weeping from side of observation hote' None observed Depth to soil mottle: None observed Ground water adjustment: > 84" -Index Well Number: . . . Reading Date:.. .Index well level Adjustment factor Adjusted groundwater level. N/A Depth of Naturally Occurring Pervious Material: Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system 2 YES I certify approved analysis experience and expertise performed training described in 310 CMR 15.017 If not, what is the depth of naturally occurring pervious Certification that in November 1994 I have passed the soil evaluator examination by the Department of Environmental Protection and that the above was performed by rye consistent with the required training, by me consistent with the required Signature; I(.fwub E Akni Timothy E. Maginnis RS ate: 04/10/13 DEP approved form - 12/07/95 material 2 TIMOTHY E. MAGINNIS #982 sto/STERE9N /TAR U DEP APPROVED FORM F 9C TIMOTHY E. MAGINNIS #982 AFC/STEREO, A s• • FORM 12 - PERCOLATION TEST Page 1 of 1 Location Address or Lot No. 589 North Farms Road - Florence, MA. 01062 Florence , Ma. COMMONWEALTH OF MASSACHUSETTS Site Passed n Site Failed Performed by: Timothy E. Maginnis R.S. Witnessed by: Daniel Wasiuk Board of Health Agent PERCOLATION TEST Date: March 26, 2013 Time Time Observation hole ft # 3 Dept of perc test 40' Start pre-soak 1015 am End pre-soak 10:30 am Time at 12" 10:30 am Time at 9" 1034 am Time at 6" 10:39 am Time: ( 9" - 6" ) 5 minutes Rate: minutes / inch <2 mpi Site Passed n Site Failed Performed by: Timothy E. Maginnis R.S. Witnessed by: Daniel Wasiuk Board of Health Agent e � ) (i„•Firel1 t rrxK r�l H PERCOLATION TESTIS) I Time: I I Time: I 1 Observation Hole #1 Observation Hole #2 Depth of Perc Depth of Perc Start Pre-soak Start Pm-soak End Pre-soak End Pre-soak Time at 12' lime at 12" Time at 9' Time at 9' Time at 6' Time at 6' Time(9'—6') Time(9'—6") Rate Min./Inch Rate Min./Inch I -minimum of 1 percolation test must be performed in both the primary area AND reserve area. • a Performed by _.... .. Witnessed by I I Witnessed by Comments: I On-Site Review 9- k7 4^--, .ocatioMddress or Lot# e,i l 6— Owner f1. Address A 1 I i I Time Weather Date r O '-1 L4 _�/ Engineering Firm Idgntity on Site Plan Land Use Vegetation - - Engineer or Sanitarian Slope% Surface Stones Landform 'osdion on Landscape .. I ... Distances from: I Open Water Body feet Drinking Water Well.. feet feet Property Line`. Other feet feet Possible Wet Area feet Drainage Way I Deep Hole M: I DEEP OBSERVATION HOLE LOG* MINIMUM OF TWO HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA Depth from Soil - on Surface(Inches) Soil Texture (USDA) Sail Color (Munsell) Soil Mottling Other (Structure,Stones, Boulders,Consistency,%Gravel) 0- 11 ) C ) 31_,- 1 i0 of C 3/j u �1S Fi, G� ,0, 7 I uroB1 rr .- -,ter. f- e i y o r`" r oto C,' .. C Depth to Bedrock Depth to grountlr. Standing W Depth to groundwater. Standing r in the Hole �/pw` Face Weeping fro m Pd Face N v-�t M1tl Estimated Seasonal High Grou Water -_r6 -i HOLE Deep Hole#: DEEP OBSERVATION LOG* 'MINIMUM OF TWO HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA Depth from Surface(Inches) Soil Horizon - /� f Soil Texture (USDA) SL � L Soil Color (Munsell) , , � 5y' i& i Soil Mottling Other (Structure,Stones.Boulders. onsstency,%Gravel) o .., ( ic i - ID - '7 yd Parent Materiai(geFlcgic); rr `f-if :RePihto liddrocky, --t-� _._._ Depthlojro dle4.p tardy$- 4 ..:.-'S1�a J eying om P Fa AI SSmaIaE on,?I t[Ih;Gro W r"lg'-,:'; ti (1_,-(. _Seal c NORTHAMPTON BOARD OF HEALTH PERCOLATION TEST DATA Owner Lot # 9 C.A..' J..J Engineer/Sani Date Excavator 6 Pert Rate min/in Depth to water min/in min/in min/in Witness Fee Sketch of Lot w/ Location of Test Holes Witnessed by No as THE COMMONWEALTH OF MASSACHUSETTS C„430ARD OF HEALTH rflgir f Od iiki--- gpptiratiuit fur lispnat ttfurkz TattntrurttDtt f rrtnit Application is hereby made for a Permit to Construct CC..X) or Repair ( ) an Individual Sewage Disposal System at: 589 Worth Farms Road Location• Lot No.or aar s /Ln(aw�r',,trce�q ' o'r 1b e�ttp '�5• o 1'.a—A`0i ' aa3s qa� �-� tIIarsat or a t' - "" r.,5nle�W 1Mz '-- K{d- 'it i,ICAAA44 Sq. feet t Type of Building Size Lot q Dtheri—Type of Bedrooms 3 Expansion Attic ( ) Garbage Grinder 1(0 ) Showers — Cafeteria ( ) Other—Type of Building No. of persons ( ) L Other fixtures r 339 gallons. ti g 9, ga] person per dax. Total daily Pow Design Flow p}yptpVgr 1 Q2 width 3aT,- Diameter DeQth...� 4y' Septic Tank—ii laid capacity 1 hras Aratength 7 t tuoh s ft. sl � Width 1 � Total Length 3 Total leaching area 4� Disposal --\o. Diameter Depth below inlet Total leaching area sq. ft. 3 Other Distribution No ) z Dosing tank Oercr Distribution box (x g O'Keefe Associates Date Fa.y 2 e 14.64 Percolation Test Results Performed by u " 10 Depth to ground water a bat ur 2 1 04 - .l Test Pit No. 1 minutes per inch Depth of Test Pit 1 gr .. Depth to ground water p, Test Pit No. 2 minutes per inch Depth of Test Pit 'Inter ?�IcWr7,. in v�i5xxe.s.se.d._�or....tha.Bnard._oS...HEa1th. 0O 9-1 0-9" To-lsoil 9-27" Subsoil, 27-1011" Sandy Till. Description of Soil 0-9" + 27 Subs Oil 2%-101}" Sandy Till. Ii-2, 0-9 Temsoih 9 u W UNature of Repairs or Alterations—Answer when applicable Agreement: eration unt JOHN A. O'KEEFE III •pACah@Ba1Ap igned agrees to install the aforedescrihed Individual Sewage Disposal System in accordance with 1T IE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in tificate of Compliancgned been is d J t board of of I� wK .___..0 fib ei the folioeving reasons' ermit No by THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Ian or NORTHAMPTON (firrtifiratt sf tllumplianrt THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed CD ) or Repaired ) at 589 North Farms Road has been installed in accordance with the provisions of TITLE ofI The State Sanitary Code as described in the application for Disposal Works Construction Permit No e' - c � dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE Inspector Installer THE COMMONWEALTH OF MASSACHUSETTS g BOARD OF HEALTH 3 - Y y OF NORTHAMPTON No Disposal Works Tsnstrurtisn 1rrmit Permission is hereby granted Lawranna.-GOrbett to Construes�CA or Repair ( ) an Individual Sewage Disposal System at No $t 69 North Farms Road street G / C i -� l- C -1 "�� « as shown on the application for Disposal Works Construction Permit Ilia D red ,(155..)n i DATE 11 f/1V /! c Hoarbe Health FORM 1255 HOBBS 5 WARREN. INC., PUBLISHERS Ern THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CITY OF NORTHAMPTON 3Ji grnnu1 ii7nrlta 7 nai et inn Permit .-... Permission is 111�� reby granted to Construct (// or pRReeqpair j,,) an1,nr 'luaal Sewage D wosal System at No SO.C1 "".t�✓`M 61A/1Av++--d,.'�`sA p 9/0 as shown on the application for Disposal Works Construction Permit o_a 3__ . . Date ..Q � of lth DATF FORM 1255 A. Al VqW ULK C.. BOSTON by THE COMMONWEALTH OF MASSACHUSETTS 0/74„ BOARD OF HEALTH OF `?nRTi'AMPTQTJ atrrtifiratt of fbom}Tliaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (a) or Repaired ( ) at 589 North Farms Road has been installed in accordance with the provisions of TITHE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No 43 _ dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE inspector Installer