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680 Title 5 Application/Permits 1966, 1981, 2001, Site/Soil Evautation, Inspection 2011, Water Analysis 2001 HOWARD LAB-Crel8STOF NEW ENGLAND, INC 750 North Pleasant Street Amherst, MA 01002 - Phone: (413) 549-8260 Fax: (413) 549-1850 MA Lab License: M-00851 WATER ANALYSIS REPORT Analyzed.For: Wright Builders Sample Location: Lot 3, Off North Farms Rd Address: 48 Bates St. Northampton, MA Northampton, MA 01060 Sampled By: HWD Date Sampled: 1/18/02 Telephone: commendations: See enclosed MA DEP Interpretations sheet for parameters marked with an asterisk. this sample meets acceptable standards of potability for the parameters tested, except for those parameters narked with an asterisk (*). analyst- BA 'hecked Bv: Jonathan S. Beg Laboratory Supervisor Date: 1/22/02 PARAMETER RESULTS LIMITS COMMENTS Total Coliform Bacteria 0 colonies/1o0ml 0 Colonies/looms OK pH 7.44 pH Units 6.5-8.5 pH Units OK Manganese 0.014 inn 0.05 mg OK Hardness 30 mg3 No Standard <50 SOFT. >I00 HARD Conductivity 0.08 mS/cm No Standard No Standard Chloride 11.6 mg/I 250 me OK Iron 0.04 mg/I 0.3 men OK Sodium 1 me 28 mg/1 OK Nitrate 0.0 mg/ lomg/1 OK Nitrite 0.003 mgl 162s OK Color * 17 P[COCOIOr Units 15 PtCo Color Units Turbidity 2.39 Nru 5 NTU OK commendations: See enclosed MA DEP Interpretations sheet for parameters marked with an asterisk. this sample meets acceptable standards of potability for the parameters tested, except for those parameters narked with an asterisk (*). analyst- BA 'hecked Bv: Jonathan S. Beg Laboratory Supervisor Date: 1/22/02 Kuehner's Inspection Services 168 County Road Southampton, MA 01073 Phone (413) 533-3031 TITLE 5 INSPECTION At the request of Mr. Steven Franks, an inspection of the septic system located at 680 North Farms Road, Northampton, MA. was performed on November l4, 201 I. The septic system was in normal operation at the time of the inspection. The inlet and outlet baffles were in place and functional. The septic tank was pumped to allow for inspection. The pump chamber was inspected for proper operation, and found to be in good operating condition. The alarm system was functioning properly. The soil absorption system (at a remote location)was located , inspected and found to be functioning properly.. It is my opinion based on information available that this septic system meets the passing requirements of Title 5 (310 CMR 15.00) at this time Problem Areas: 1. None: Recommendations: 1. None This report is based on conditions existing at the time of the inspection, and is not intended to project, guarantee, or warranty the fixture operation of the septic system_ For further information please refer to the attached inspection report. Inspector: Karl M. Kuehner Inspector: Owner information required every page. Important When Tilling out forms an the computer,use only the tab key to move your cursor do not use the return key. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 680 North Farms Road Property Address Steven Franks owner's Name Northampton City/Town MA 01060 11/14/11 State zip code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information 1. Inspector: Karl M. Kuchner Name of Inspector Kuehner s Inspection Services Company Name 168 Count Road Company Address Southampton City/Town 413 533-3031 Telephone Number MA Stale Si 124 License Number 01073 Zip Code B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority -( /14/11 nspecto Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time This inspection does not address how the system will perform in the future under the same or different conditions of use ride 5 Offirsl InSpednen Form Subs/dace Sewage Disposal Sys/en-Page 1 of required for pane. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 680 North Fames Road Address Slcccn Franks Name Holvoke B. Certification (cont.) MA 01060 11/14/11 State Zip Code Date or Inspection Inspection Summary: Check A,B,C,D or E /always complete all of Section D A)System Passes ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments 8) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes' , "no" , or not determined" (Y, N, ND<)for the following statements. If "not determined."please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exflltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. A metal septic tank pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ ❑ N ❑ ND(Explain below): tie 5 Official Inspection Form.SubsuFare Sewage of 17 Owner information Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 680 North Farms Road Properly Address Steven Franks Name Northampton MA 01060 11/14/11 CDvfTown State Zip Code Date of Inspeclion 8. Certification (cons.) B) System Conditionally Passes (cont.) ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection (with approval of Board of Health). ❑ broken pipe(s)are replaced ❑ V ❑ N ❑ ND(Explain below): ❑ obstruction removed ❑ V ❑ N ❑ ND(Explain below). ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below) ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: Lf Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1.System will pass unless Board of Health determines in accordance with 310 CMR 15.303(I)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool - privy is within 50 feet of a bordering vegetated wetland or a salt marsh Titles Official rmm.Subsurface Sewage Rsposal system-Page of 17 Owner information for Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 680 North Fanns Road Properly Address Steven Franks Owners Name Northampton MA 01060 11/14/11 City/Town Stale Zip Code Date of nspedinn B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS) and the SAS is within 1 00 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance.- "This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 0) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or No to each of the following for all inspections: Yes No O El O El of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or pending of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6" below invert or available volume is less thanl/2 day flow Tale 5 Official Inspector Form 9rbsurkm Sewage as/oml System-Page 4 of 17 required Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 680 North Fames Road Property Address Steven Franks Owner's Name Nortffunpton City/Town MA 01060 11/14/11 State Zip Code Date or Inspection B. Certification (cont.) Yes No ❑ N Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped. ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ N Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ N portion of a cesspool or privy is within a Zone 1 of a public well. ❑ N Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® portion of a cesspool or privy is less than 1 00 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. .1 E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either yes or no to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ ❑ ❑ ❑ ❑ the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area - IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered ]veitin Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. rule 5°Moat Inspection Form Disposal 6r9em Page 5 <CN Owner information is required for every page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 680 North Fanns Road Properly Address Slccen Franks Owner's Name Northampton MA 01060 11/14/11 City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicatd vdd di'nb'as to each of the following. Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? n ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® n Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS) on the site has been determined based on: Existing information. For example, a plan at the Board of Health. Determined in the field Of any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)1 D. System Information Residential Flow Conditions: Number of bedrooms(design): q Number of bedrooms (actual) q DESIGN flow based on 310 CMR 15.203 for example: 1 10 gpd x#of bedrooms): 668 gal/day Title 5 0111001ln oo b • ovioga Disposal System-Page 6 of 17 Owner information is required for every page. - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 668 gal/dap Property Address Steven Franks Owner's Name Northampton MA 01060 11/14/11 Cirvrtown State Zip Code Date of Inspection D. SYSTEM INFORMATION Number of current residents'. Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Ye s ® No Seasonaluse? ❑ Yes �I No Water meter readings, if available(last 2 years usage (god)). well 3 residents Detail: Sump pump? Last date of occupancy. Commercial/industrial Flow Conditions: Type of Establishment ❑ Yes ® No present Date Design flow(based on 31 0 C MR 15.203)'. -- ---------- — Gallons per day(gpd) Basis of design flow(seats/persons/sq ft., etc.y. Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? I Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Title 5 0Hmal Inspection Form Subsurface Seven Psposal Svstm-Page 7 or 17 Commonwealth of Massachusetts • Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 668 gal/dat Property Address Steven Franks owners Name Northampton MA 111060 11/14/11 City/Town Stale Zip Code Date el Inspection D. System Information (cont.) Last date of occupancy/use (describe below). Dale General Information Pumping Records: Source of information Realtor)pumped once since installation system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons gallons Determined at time of pumping How was quantity pumped determined? Reason for pumping. Type of System: to inspect tank Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. I I Other(describe)'. Title 5 or5c.ai inspection con subsurrace sewage Disposal System•Page 8 of Commonwealth of Massachusetts 5�i ft Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 680 North Farms Road Properly Address Steven Franks Owner information is required for every page. Owner's Name Northampton MA 01060 11/14/11 City/Town Stale Zip Code Dale of Inspeclion D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: installed 2004 info from original permit Were sewage odors detected when arriving at the site? Building Sewer(locate on site plan)_ Depth below grade: Material of construction'. ❑cast iron ®40 PVC ❑other(explain)- Distance from private water supply well or suction line. ❑ Yes ® No 18" feet >100 feet feet Comments (on condition ofjoints, venting, evidence of leakage, etc.)- Septic Tank(locate on site plan). Depth below grade: Material of construction ®concrete ❑ metal If tank is metal, list age 8""below grade feel ❑fiberglass ❑ polyethylene J other(explain) years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ® Yes ❑ No 126" x 68"x 64" Sludge depth 6" Title 5 Official ion Fomr Subsurface Swage omes"I system-payed of 17 Information is required for Alok Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 680 North Farms Road Properly Address Steven Franks Owner's Name Northampton Oity/Town MA 01060 11/14/11 State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? 21" 16" measured at tune of pumping Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etch. Grease Trap (locate on site plan): Depth below grade'. Material of construction: feet P1 concrete ❑metal ❑fiberglass ❑polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping. Date ride 5 Official Inspection Fmn.Subadace Sewage Deposal System Page 10 of I i Owner information is required for every page Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 680 North Fauns Road Properly Address Steven Franks Owners Name Northampton MA 1111160 11/14/11 Cilv/Town Slab= ]lo(PP e nee( 11 cp r D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade. Material of construction: ❑concrete ❑metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity Design Flow. Alarm present. Alarm level: Date of last pumping'. gallons gallons per day ❑ Yes ❑ No Alarm in working order: ❑ Yes ❑ No Dale Comments(condition of alarm and float switches, etc.)- •Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Title 5 OPoaaI Inspection Form Subsurface Sewage Psposal Sysiem-Page I I of 1 owner information is required for every page ifis Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 680 North Farms Road Properly Address Stoy en Franks Owner's Name Northampton atyinwn MA 01060 11/14/11 Stale Zip Code Dale or Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Equal Eon to all Icgs Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.). SAS located in a remote location from house Pump Chamber(locate on site plan): Pumps in working order ® Yes ❑ No Alarms in working order: ® Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): all components operating properly Soil Absorption System (SAS) (locate on site plan, excavation not required). If SAS not located, explain why. thins-09/08 Title 5°Moat Inspection Form Subsurface Sewage olspoal Systen-Page 12 of Owner information IS rewired for every page. r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 680 North Faints Road Properly Address Steven Franks Owner s Name Northampton MA 01060 11/14/11 City/Town State Zip Code Date al Inspection D. System Information (cont.) Type: n leaching pits leaching chambers leaching galleries leaching trenches leaching fields overflow cesspool innovative/alternative system Type/name of technology. number. number: number: number, length'. number, dimensions. number 1(1 X 42 bcd Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Cesspools(cesspool must be pumped as part of inspection)(locate on sae plan): Number and configuration Depth -top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No 09/08 Title 5 Onicil Inspection Finn Subsurface Sewage Disposal System.Page 13 of 17 (hangs ;id-on-nation 14 required for et nett Pogo toms-O3M8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 680 North Fars Road Property address Sloven Franks Owners Name Northampton MA 01060 11/14/11 Max.Town Serve Tp code Dale of nsparon D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Privy (locate on site plan). Materials of construction.- Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.). Title 5 Official Inspection Form Submdace Sewage Disposal System-Page 14 0 Z"- Ovvner information s required for every page 151 -09N0 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 680 North Farms Road Properly Address Steven Franks Owner's Name Northampton MA 01060 11/14/11 Clly/Town Stale hip Code Cate of nspeq;on D. System Information (cont.) Sketch Of Sewage Disposal System'. Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 1 00 feet. Locate where public water supply enters the building. Check one of the boxes below hand-sketch in the area below ® drawing attached separately see attached drawing line 50Nmal Inspection Form Subsurface Sewage Deposal System-Page 15 of 17 Owner information is required for every page �. A Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments G%II North Fanns Road Property Address Steven Franks Owner's Name Northampton MA 01060 11/14/11 CM/Town State hip code Date of nspection D. System Information (cont.) Site Exam: id Check Slope Level ® Surface water None ® Check cellar do • Shallow wells None Estimated depth to high ground water: 45 inches feet Please indicate all methods used to determine the high ground water elevation. • Obtained from system design plans on record If checked, date of design plan reviewed: 10/24/01 Date • Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database- explain You must describe how you established the high ground water elevation. Viewed site, information from pcmiit on file with BOH copy of pert data included Before filing this Inspection Report, please see Report Completeness Checklist on next page. Title 5 Official Inspection Fam,.SubvM1ace Sewage Pawnee!Syee -Page le of 17 Owner information is required for every page 15ms 05'108 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 680 North Farms Road Property Address Steven Franks Owners Nam Northampton C1ty?Town MA 01060 11/14/11 State Zip Code Dale of Inspection E. Report Completeness Checklist ® Inspection Summary A, B, C, D, or E checked Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information -Estimated depth to high groundwater Z Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file Title 5 Official Inspection Form SAsutace Sewage Disposal Ststen-Page 17 of LEGEND AC =20.5' BC=25' AD=30.5' BD = 17.5' 1000 gallon pump chamber 8" BELOW GRADE remote SAS ystem#3 B 680 NORTH FARMS ROAD alkout basement garage 1500 gallon septic tank 8' BELOW GRADE to North Farms Road well KUERNER'S INSPECTION SERVICES INSPECTOR: Karl M. Kuehner NO SCALE: OLIVER t w is C r iabe jIdentify Page I of 1 Measure 0 m lnlp://maps.massgis.slalc.ma.us/map_ol/olivcr_php 11/14/2011 OLIVER tw .;. titC rat _ { Measure 011 c 8 'nom.eA. Ro n Page 1 of 1 TIdentify hllp//naps.mafsgisstalc.ma us/map_ol/olivecphp 11/14/2011 Determination for Seasonal High Water Table Method Used: a Depth observed standing in observation hole inches a Depth weeping from side of observation hole inches }i Depth to soil mottles 3(o inches a Ground water adjustment feet Index Well Number Reading Date Index Well Level 4 Adjustment Factor Adjusted Ground Water Level Percolation Test Date: (0I9i,19(0 Time: 3.5/ Observation Hole 4 lQ "/ (- a Depth of Perc II /—f �J S/ n Start Pre-Soak 3:17 3. 55 End Pre-Soak 3. 32 `f:/o Time at 12" 3 ;32_ 4: 10 lime at9' 3: 36 9 -3% Time at6' 3'. 1" 5: 17 Time (9' — 61 Jc 91 Rate MinJInch 5/3 1-fin/in . 13 . 6 rnitiin Site Suitability Assessment Additional Testing Needed: Performed Sy: hia i,eW ,Snkor Witnessed By: ?efYr )lcrr/ah, Site Passed Sae Failed ❑ Comments: Certification Number: aadoc 2 On-Site Review Review Deep Hale Number N '/ Date 42(o/16 Time 3 35 Weather Sonoy 9O° Location (identify on site plan) Land Use brv>DLM hS Slope (%) 5% Surface stones /(lo-Ali.— Vegetation I/ARO/NO FY w obQS Landform roLu/Jd TF RRFhiAU Position on landscape (sketch on the bads) Distances from: Open Water Body 7/DO feet Drainageway >)O 0 feet Possible Wet Area 7100 feet Property Line 5 2 0 feet Drinking Water Well 7100 feet Other DFFP OBSERVATION HOLE LOG Depth from Sulam (ides) Sc d Horizon Sad Texture (USDA) Sod Calor (Monsell) Soi Mooing Other (Sauctvre.Stones, Boulders, Com'amncy,Y.envoi) O g AA A? 5 L- /OM 3/3 MASSurEA Fit)ASLc 4 r, s % ,,/ � MA5S1vE/ Frt149<t' 8-- zZ 8 t /OY4l/ 5% $4SS)t' fRM & 22 A'- '1/ " B� c ES L .5Y� ��� �3� �6 r� n� FR/A3 44VErts of 6/R47EL- v L.- S 5y 5/3 6 Y 4/1 sntimFim 41 7Z C! by9/C' Fmk,/ ri.ry 72 /OS C� L S 5Y513 C M('gi- S-le% Parent Material (geologic) % Z<> Al- "n°A-5t Depth to Groundwater: Standing Water in the Hole: AaNg Weeping from Pit Face 1� Estimated Seasonal High Ground Water. 36// s a-doc Deep Hale Number 6 -Z Daze Location (identify an site plan) Land Use WOtD L-ot Slope (%) Vegetation HARD/ SOT wopDS Landform DRu rnr-: Position on landscape (sketch on the bark) Distances from: Open Water Body 7 IOb feet Possible Wet Area 7 10D feet Drinking Water Well >In(7 feet On-Site Review aZed,/86, A ids Time <:00 Weather —ant 3 5 6 _ Surface stones NONE Drainageway >100 Property Line Other feet 720 feet DFFP OBSERVATION HOLE LOG Depth Iran Surface cinches) Soil Horizon Sad Tennure Sod Color (Munson) Sail Mottling Other (Structure.Stones. Boulder; Consistency.Y.Gravel) O— 9 " 9-r 20< ,/ ZUl_ T I /r n ql'I - 72 t ° 72 —110 A r a LA �/C C t CZ 5 L SL FS LS L S (0 Y 3/3 l6YR 4/4 z.5y4/4 5y 5/3 S Y 5/3 Sea 1OYRs/n 63 15° 5y4 /2 0 Y4Y ( MASSwc, ra)AOLE MASSIVE, h Rlgry_E MASSIVE, FRi 40LE STpATIF/EO c gp&EEL LAYERS of STRATIFIeD c RAVEL File 4 PLATY GRAVEL 5-1060 aarent Material (geologic) Depth to Groundwater. sadoc p RU GLACIAL, ouTwrycH Standing Water in the Hole: A/flA_ Estimated Seasonal High Ground Water. Weeping from Pit Face: NO4_) 9 5" / �� N. ✓ nM e wu o$ \ ,v° (R ) f� n 66p PROPOSQD b <, 70.1! 'SEPTI,C TANK I . 5 ) ihOP OS D dgoq GAL ' PUMP{0"WAMBER '(TO SYSTEM 3) TBM=',$PIKE IN 8" BIRCH z A EL $SUM D)92 � I I I ) 1' P' QL ) 7 I i tA� s , j1 !P CE ' ARFA)— 7.�1 RE �I� I� a I — 15" HICKOR , 4KE. IN M—S , EV.I. = 178.22 (ASSUMED) I , • Ima1e u tr CC NaU °I Tp ( AD CHECK' DCATICN - SYSTEM 3 !-RESERVE AR SYSTEM 1 RESERVE AREA PROPOSED PUMP CHAMBER PROPOSED. 1 .: -AL SEPTIC TANK, TBM=SPIKE IN 14 F --- ELEV.. =--13933 (ASSUMED) POSED -1 FIELD X 42') TEM 3; 147.5 10' PROPOSED LEACH FIELD (30' X 42) SYSTEM 11 Pler1 app. 'e., en • by o jne : subject,to us Cello Design Fnsu and verify 1 IEA m 7_1 147.5 !vas Saila with these a NORTHERN WOOL PLAN OF PROPO SYSTEMS FOR NORTHAMPTC LEACH FIELD (30' X 42") SYSTEM 2 TEM=SPIKE IN 24' OAK ELEV. = 144.62 ASSUMED SWEET MEAD( DATE: OCTOBER REVISED:NOVEMI HERITAG REGISTERED PRC COLLEGE HI POE SOUTHAMI (4 4487-0 '404 No. Commonwealth of Massachusetts A/or714tampLon , Massachusetts Site Suitability Assessment for On-Site Sewage Disposal Date /Z(o/%tG 1 Performed By: Or/Mew Sock e Certification Number. Witnessed By. Purr MC Erla,n Location Address or Lot No. ZCr # 3 Alorifl ?Agfris Ro FaRm ER��/ RECO20EO AS aeT +M(o/ NORTH FARm$ RO. /J02T44mvroru Owner's Name,Address and Td.k 6 13)-_j 8 4 - 17 1 1 /rEViAJ HEAr� /97 'VO27/1 nA e.c ST. N rrHAsn%naJ, MA at 54, New Constructions { Repair o Office Review Published Soil Survey Available: Year Published 19 S 1 Drainage Class Surficial Geologic Report Available: Year Published No ❑ Yest Publication Scale I .1 5840 Soil Limitations Save Nom Yes ❑ Publication Scale Soil Map Unit I B/ S.A,Qa$ OeT/✓ESS, ?EcS Stoc-+Ly Geologic Material (Map Unit) Landform Flood Insurance Rate Map' Above 500 year flood boundary No ❑ Yes Within 500 year flood boundary No* Yes ❑ Within 100 year flood boundary No Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) Wetlands Conservancy Program Map (map unit) Current Water Resource Conditions (USGS): 199 f Month 7-701-Y Range: Above Normal-xi. ormal Normal ❑ Below Normal ❑ Other References Reviewed: U.S. 4 . S. ToPOARA?HlcAL. mrp zsadoc 2 On-Site Review Deep Hole Number 6 - I Date 6/Z06 Time 3 35 Weather 50noy ?O Location (identify an site plan) Land Use Lint)DLANbS Slope (%) 5 a/o Surface stones iLr}7ti— Vegetation NARD/sb FT c.) oLOS Landform ti Lurid ?F72RAIA) Position on landscape (sketch on the back) Distances from: Open Water Body 7(DO feet Drainageway >/00 feet Passible Wet Area >100 feet Property Una 5 20 feet Drinking Water Well 7)00 feet Other DFFP OBSERVATION HOLE LOG Depth from Surface (inches) Sod Hanson Sad Texture (USDA) Sod Color (MunseI) Soil Mottling Other (Structure,Stores,Boulders, Consistency,T.Gavel) ? ii i� g,r 2 z 22 q/�� f� v I/ ill 72 72 - to a" A P BL, 3/ c C,/ Cz 5 L SL FS L, i._ S L S /61R 3/3 / to Y4.1 �sY� � 5y 5/3 5Y s/3 5°% IY c� 36,� 6 Y 4/1 my9/(9 MASsftz, FR/ABLt` MASSluE FRIA n3«' pJASS-R PK/A.3L'. /?ASZSV€ Frzix34F 6Aver“ Of 4fegUcL- SrngDFlm F/RM/ J'G.A%3' C7 must S to Parent Material (geologic) TUc7/— AL etl(n-w&01i Depth to Groundwater. Standing Water in the Hole: N0N saadoc Weeping from Pit Face:: Estimated Seasonal High Ground Water. 3(011 3 On-Site Review Deep Hole Number w-Z Date 6/Z6/p6, Time 4:00 Weather -Iony OUD Location (identify on site plan) Land Use WUOD Lot Slope (%) 5 a Surface stones NONE Vegetation HARD/ SOT WCPDS Landtorm Di2,6 llJ Position on landscape (sketch on the badq Distances from: Open Water Body 7 100 feet Drainageway it 00 feet Possible Wet Area 7 I(70 feet Property Line 7 Z 0 feet Drinking Water Well 71(7n feet Other DF.FP OBSERVATION HOLE LOG Depth from Surface (inches) Sad Horizon Sad Texture (USDA) Soil Color (Munson) Solt Mating Other (Snvcura,Stones.Sodden. Consistency.%Gravel) 0— 9 I 9 - 20 ZL�N Ql a n 91 l %Z 1041 A (> F VC C CZ 5 L L ESL_ L S LS io YR 3/3 /6YR -1/4 25Y4/9 5 y 5/3 5Y5/3 5'/0 10YR6Mo g45" 5 Y 9 /Z l0Y 4 / (0 MASSNEn Frlge.LE MASSIVC, Ffttgr&LE MASSIVE, F,e,nr3LE 3TATIF/Ep GRAVEL LAYErtc o>= 37-RATIF' D FRAi./EL F/RM, PLA7y CRAVEL 5-I0% Parent Material (geologic) Depth to Groundwater: sv.dcc (� ROGLAcIn., oLTuJ,\CA Standing Water in the Hole:A)r)/JE Weeping from Pit Face: N6NS Estimated Seasonal High Ground Water. • 51' Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole inches ❑ Depth weeping from side of observation hole inches zkf Depth to sail mottles 3(o inches ❑ Ground water adjustment feet Index Well Number Reading Date Index Well Level 4 Adjustment Factor Adjusted Ground Water Level Percolation Test Date: 6i12(,71?Co Time: 3 51 Observation Hale # h -/ 6- a Depth of Perc ?A 51 " Start Pre-Soak 3. ) 7 3. 55 End Pre-Soak 3. 3 2 470 Time at 12" 3132 4: 10 Time at 9' 3: 36 1 '3C, Time at 6' 3 . i 1 5. 17 Time (9' — 61 5- 4 Rate MinJInch 5h h,gip . 13 . 6 rain/in Site Suitability Assessment Additional Testing Needed: Performed By: irlailhew Snkor Witnessed By: refer lac Cr/din Site Passed Site Failed ❑ Comments: Certification Number: ssa4cc FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No. ronmEnLy RECORDED AS Lo! # (o NORTH PArmis ROAD, Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole inches ❑ Depth weeping from side of observation hole inches ® Depth to soil mottles 3(9.. inches ❑ Ground water adjustment feet Index Well Number Reading Date Index well level . .. Adjustment factor Adjusted ground water level 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? YES If not, what is the depth of naturally occurring pervious material? Certification I certify that on (pi249/Q (0 (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 '/r , /C�15.017. Signature ) "bxt Date DEP APPROVED FORA*•I2/O>195 Almer Huntley Jr. & Assocs. Inc. Surveyors - Engineers - Landscape Architects 30 Industrial Drive NORTHAMPTON, MA 01061 (413) 584-7444 J B 90 H3/ -far kevm xIafey SHEET NO CALCULATED B♦ MSS CHECKED BY SCALE NT S. OF , DATE 11/13/9(. DATE TEST PIT GRAVEL ACCESS I EST-FIT I. C PAILD rOu NO RTHRN1 5 � D UP 34/90 UP 35 /91 �F NOTE LOT N A RS C.OI Almer Huntley Jr. & Assocs. Inc. Surveyors - Engineers - Landscape Architects 30 Industrial Drive NORTHAMPTON. MA 01061 (413) 5847444 JOB 9G - 131 for hey In Her ey SHEET NO I OF CALCULATED BY MSS DATE 11i3/9 CHECKED BY DATE SCALE N.T.S • b�uv1 u IN A VPROX, 1T NOTE Loi Nth 0 � 0r, 0e 0z FEF5 SHOWN AIDE CURRENT Almer Huntley Jr. & Assocs. Inc. Surveyors - Engineers • Landscape Architects 30 Industrial Drive NORTHAMPTON, MA 01061 (413) 584-7444 J 8 c/69 . 13/ for keuin #ea- ey SHEET NO OF 1 NORTH FARM 5 N • RJR CALCULATED BY M TS DATE X1//3/%(0 CHECKED BY DATE N.T S. SCALE COUNTRY WM -► ox. SO(JTm ft-\ PEfcC Z PERC I LOT to _ LOT Co PEfc VERC I ` T LOTS LOTS P I tv N �q s /LIT 99 173 , Ali-KOK • WEST FP--� TRIPLE PAITT MARKS ON TREE ON SOUTH WEST PROtl?TY LIN£ 1EHOTE LOT. UMBERS SHOWN A I ' FAT �.� at J V'ar Elk a� I 1 a; 1 I 1 2Fi J 3711 r ,aK A 'A 5 h' f0 c ; >;Y /9 .g _ i.: 3i. W- CY911C X=" c3N/' IC' l Ed - CC N.M / J/Idi3 I rwr • .-/ -- 1r X02 NO/L//2/21 S/1 i I — - ,1/d/ /121177 3r' 009 � , C _57� )' .3i • L__ OPTIC TANK DISTRIMUTIOIJ BOX- NUMbE2 OF OUTLETS AS REcYm RETD extsrlNG GROUA/D SFWLF.. PIPE' - SIZF 43 NOTED ON PLAN - ALL JOINTS TO 6E WAT. ERTI6 JT - SLOPE I/87FT. MIN- NEtweR APES FROM DISTR18UiloN ea(TO SE NOI -PERFORATED AND LAID LEVEL FOR AT LEAST o/•F_ LENGTH OP APE . 18"M1N—y 3b°MAX. 1 1• - 6' O` o.C. L//N-117-5 LE4CN ( NUMBER OF FIPF-S VA TIES Wr'U WID1T4) PLAN VIEW Nr c 4-I PERFORATED PIPE - NCWE 41/400' &MOM OF TRENCH TO BE "1ORIZONTAL y8" ro Ya° t/' I, HASHED STONE /4"r° I72 •MASMEDSTONE SIDE VIEW -H aim LOAM & SEED Yr COVER j 10"MIN. 2 MIN. ° ° 2" MIN' u I 4°PERF ' _0— a '. G MIN. X- SECTION ENISU GRADE NOTES: ALL WORK To 8E DONE IN ACCORDANCE WITFI STATE SANITARY CODE- TITLE re .. OBSERVATION PITS R808ES8l;O 28: LOCATION: A] Bor awski. No. Farms Rd. MAIISNG ADDRESS: 9 ' 0" NORTHAMVTONT 18AS&.1)1060 1.O'T ',1, 3 'III ' 3 OTS SILT SERVER: 6" 1 ' 0" SAND AND GRAVEL 2 ' 6" KN..........„ SILT]' COMPACT LAND & GRAVEL C-rouc.s.i_c, 8 '0" Groundwater Perc .:cite 2 .0 & 3. 6 MIN/ Perc Rate a ounci Groundwater Peru P!r P'rc Rate nvo 'niyht est AI MEP. HI INT! EY, ]R, ° ASSOCIATES, INC. SCRVEYOei • ENGINEFRS - PLANNERS PA' a 1 _ nu, SAHNNYI,1 • PIIIiNION':I - SHOA]AMOS '7NI 'SiL.LVI:Xi'SV 9 ' 111 '.1.I LI,Nl III )1 AVIV lull. '.IghinI. •l' , 010d 310" sa4rnpunor9 � '•.G aaup I I I • 1 I 1 I I I I I —__ o,eu .Jed N 1%NIII 9.._ y O_=` 1o.I .I RN/11:2 i9 (INVS ,LOVd •IJI ,.9 ,Z , 'I:1lALg:, , 0 . F. I I 1 110 , I I!__..' - - 1 11 '.'1 „9 i 1 i ,. _. E I.,T. £4 .1.p'i El'd•11 :t13A9:9°;d0 LL/ T179 : '.LVO I SSMId(1'i ;l:CIIt/1i 090 Lu '.173V1,7 'NO:cdw+rlr7m!T—_ __. _ .-1)); SW Jo,i_ON_____.__._ 0 1 11/2,0 1 51,31 NO7171.0 isaO Z 3o Z 3'JVd P.'eDMMONWEALIII IDF MASSAC IUSETIS Board f/]eaten, oY haroPfori ,MA APPLICATION FOR DISPOSAI. SYSTEM CONSTRUCTION PERMIT Application bra Permit to Construct* Repair( ) Upgrade( 1 Abandon( I - Al-Complete System O Individual Components L� Narf-h ems Road (WoruvrnWoods) )wn r N 'llr 5weei-Meadow R-aperhes LLC 46 &Fes t5f_ Marma/Tpbn Map/Farrel« z Lena _ f f 0 _A 'Jddrr" a 'e -Ilnrpb..wra (413) 59(a—SZ37 lnstallersName Address I,. 'raepharrea ! _Wa MLI, D 'p ' N • Nerifage Surveys Tne. A 11 is CoII ae Highway e Clark Sf. —_..nsi (443 S71 el 7/ AC 'Mfg A • 'rtde,bonhs 4Y,)571- 0 x/S,Ut1/4_ w1� Type of Building House_ 2 n — oh0 04/1-1 1,,I sn• 36707 `— w�-1I�t. Dwelling.Na of Bedrooms 4 Red rmm5 Garbage grinder nJ Omer-Type ofBullding 90-o1 pasnns shavers( I.Carer e1U( )her Fixtures Design Flow 011111 rug:med (n(DO gpd Colt:dr-a drsiw,maw (a(n£? D 'g Ilou lnhn;ded (0(08 ghn Plan Date 0C+0)er 74 sZCO 1 Nnn,bm of ahem 7 Readon Date WO/CM her 7/371X11 TIT, Northern W00r15- Plan of Propau'-1 Se aI�ge. I�Ieof'al,Sybkrns F,ir Ruse I zy3 De.rapeou ofSod(s) See. 51 - 2n i-7 far 501 1p Sold Ephraim-Form Nu. Nam,.olSoil LL,ILIaat Mark Ree((Date ar LV.Jnmmn 5131la_ N/L(/ol DESCRIPI ION OF REPAIRS OR.ALI LRAFIONS The unden • y ed. • all d ve describe_ fnr.M1er ogre Itr sp Ittal In al Sewage b' raaal Spt nt accordance with the pmt ons of'TITLES and C.nifimnr /f I Ranee has been looted by the Board of Health, Ua . l/�// tth) f Inspections COMMONWEALTH ry0i NIIASSACIIUSEF[S Board flmnten, M itt rm,P-T '' CERTIFIC I'6 06 COMPLIANCE Desuipdon of Work: o Individual Comlmment(s) Complete sham Theun]agned hereby certify that the Sewage Disp ISnom Connnintd( I.Itepattrd( b Uygradol( 1.Abai by. l-' L W( 7 — •co_ //J .• has bee applic ran Nr Installer The muame of ndti permit shall }t .nrnf9l >IR I tn•5laultl C7 e,1 lag RIMS aWni _Up- 9''r /AA DID gliOlowwj b$ (yp.D ,t en.rat .42114 a;e.....�' ill . il all/ ti ., �y hI a/- ? / /ti' COMMON\V E)1EH1 OF MASSACII USLI'IS Bond Jllml0i,X141P7 (/%/// i ti ..1L1- DISPOSAL SYSTEM CONSTRUCTION PERMIT. permission(s ereby granted to;Cons - -(kj Repair Upgrade( ) U tl (fie tin rod id7.3 /✓&? 44i ( h7 Disposal SystenLonstruction Permit No.;/- 3/ Baud��" , 7'%� Provided: Construct/11 shall bs((DTI:rod I ' Date 1--.) ricd:4i 1g. 1.1 sal )' t ed 11 a:Oration ill' f die date Or 1.1.01,1711 ri (1> 1 t Lr"huh nlmdrL • -...Gr SrPlw Nog)- %.5 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF zVLe�Za�az LI Apptirntinu far 3lispnstti Marks Clanstrurtinn jrrmit A; 4 Vr cifW Application is hereby made for a Permit to Construct (P- or Repair ( ) an Individual Sewage Disposal System at: .4-91- 3 h 2- 6 o L ion dress or L t h kik Installer Address Type of Building Size Lot y? 13 3 Sq. feet Dwelling—No. of Bedrooms 3 Expansion Attic ( ) Garbage Grinder (s- Other—Type of Building No. of persons Showers ( ) — Cafeteria ( ) Other tures -0¢$- Design Flow ,S gallons per person per day. Total daily flow (33.0 3( L3 ji gallons. Septic Ta Liquid capacity/COtgallons Length Width Diameter Depth Disposal Trey—No. / Wldth..aO Total Length 30 Total leaching area 6.eleli sq. ft. Seepage Pit No Diameter Depth below inlet Total leaching area sq. ft. Other Distribution box (X) Dosing Percolation Test Results Performed by Test Pit No. 1_..3.rO minutes per inch Depth of Test Pit 9 Test Pit No. 2 minutes per inch Depth of Test Pit % - v . Description of Soil 414-f Date 64./77 O Depth to ground wate p, et Depth to ground water 4,-ors S 1 paw - - Nature of Repairs or Alterations—Answer when applicable Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to operation until a Certificate of Compliance has be • issued by the board . le lth. r „ ...`,-CCZ_ tip(/'/ Application Approved By Application Disapproved for th oliowing reasons• Signed in accordance with place the system in Permit No Issued Date by at THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE LTH oF Olrrtifiratr of Tamp iaurr THIS IS TO Cf, T he Iividual Sewage Disposal System constructed ( ) or Repaired ( ) has been installed in accordance with the provisions of T Trr 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No 9/- iS dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE n SYSTEM WILL FUNCTION SATISFACTORY. DATE J0- 30— ti Inspector /2 Installer No ")' l±; THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH —y Disposal rFarks Qtonstrurtion 1 mit Permission is hereby granted t• ,--4 } 7 f" I"' " to Construct ( 'or Repair ) an Indivirlupl Sewage,Dispopal Sy at No l ' 6 see as shown on the application for Disposal Works Construction Permit No ,, /-sT Date 4.-, v /A / - - `hoard of Health DATE C. FORM 1255 HOBBS & WARREN. INC., PUBLISHERS c 7 No FEE THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -ity OF Northampton. ppliratian far flinpaaal iltarka Tuuntrurtian 1 rrmit nation is hereby made for a Permit to Construct ( x) or Repair ( ) an Indioidual Sewage Disposal tem at: North...Ea rms..Roa d. Location•Address or Lot No. Richard..-&..JnAnn-.Picard 1.AJ...Adams...Roa.d.Iidydgavi11e Ma,_ Owner Address Iosta:ler Type of Building Dwelling—No. of Bedrooms Other—Type of Building No. of persons Other fixtures Design Flow 55 gallons per person per day. T Septic Tanlh .squid capacity gallons Length Wi Disposal IHMeFt—No. ._. Width 20 ' Total Length Seepage Pit No Diameter Depth below inlet Other Distribution box (X ) Dosing tank ( ) Percolation Test Results Performed by RPB-Huntley As Test Pit No. 1...3_. 52- minutes per inch Depth of Test Pit Test Pit No. 2 minutes per inch Depth of Test Pit Address Size Lot 47.733 Sq. feet 3 Expansion Attic ( ) Garbage Grinder (x ) Showers ( ) — Cafeteria ( ) otal daily flow(330 x J . 5) 495 dons. dth Diameter Depth 30 ' Total leaching area 600 sq. ft Total leaching area sq. ft. sociates Date 6/14/77 9 '-0" Depth to ground water 8 '-0n Depth to ground water Description of Soil 6" OTS -- J '-011 Silt -- 2 '-611 Sand & Gravel 5 '-011 Silty Compact Sand & Gravel Nature of Repairs or Alterations—Answer when applicable Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of=IT 12, 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed Application Approved By Application Disapproved for the following reasons Date Date Date Permit No Issued No ! 73 THE COMMONWEALTH OF MASSACHUSETTS FEE F BOARD. �ilet HEALTH Licitt OF.Application for LBispnnttl Marko Ql n itruriinn Vomit Application is hereby made for a Permit to Construct (4 or Repair ( ) an Individual Sewage Disposal System at: ~theca / `sk% • Installer Type of Building. Dwelling— No. of Bedrooms Other—Type of Building Other fixtures_ 1 - 3 Y Addre•r 'Address Size Lot Sq. feet 3 Expansion Attic ( ) Garbage Grinder ( ) No. of persons Showers ( ) — Cafeteria ( ) Design Flow -7 d gallons per person per day. Total daily flow 3 c'in. Septic Tank—Liquid capacity /v 4gallons Length Width Disposal Trench—No Seepage Pit No Other Distribution box ( Percolation Test Results Test Pit No. 1 Test Pit No. 2 gallons Diameter_ Depth Width Total Length Total leaching area `1 0 0 sq. ft. Diameter Depth below inlet Total leaching area sq. ft. Dosing tank ( ) Performed by Date minutes per inch Depth of Test Pit Depth to ground water minutes per inch Depth of Test Pit Depth to ground water Description of Soil Nature of Repairs or Alterations—Answer when applicable Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been Issued e,hoard hpplth. sift "iYT%' `� �i'"�K� )if Application Approved By Date Application Disapproved for the following reasons' Permit No Date Issued ;)Cw cd is SIG Date by THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAL TH // lirrtifiratr of To*flamer THIS IS TO.CER/IF$, _T?„.e the Individual Sewage Disposal System constructed ( ) or Repaired Installer at has been installed in accordance with the provisions of Article X,I of The State Sanitary Code as described in the application for Disposal Works Construction Permit No 1 dated I- r in, the ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. , . r �. . o- t r . _,-S.6 -. Inspector "i' ?3 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r ,✓ OF /jI.I. .. I:7.1 flinprniat orko nuOrgaiun 41ernttt Permission hereby granted n-� ` ) to Construct..( ,) S{epa/2,( ) Individual ,Seafage.Disposal System at No SS r :7 :'A Street as shown on the application for Disposal Works Construction Permit No • r Dated_ '' Y- n 'r+/i�-o•-� Board of xwa- FEE DATF FORM 1255 HORS & WARREN. INC.. PUBLISHERS NoO/-3/ COMMONWEALTH Of MASSACHUSETTS Board of Health, Nor lhampian , MA. APPLICATION FOR DISPOSAL SYSIEM CONSTRUCTION 5156—Y0181 7Sa' Application for a Permit to Construct* Repair( ) Upgrade( i Abandon( ) - »Complete System ❑Individual Components L 6 North arms Road (Northernkfoods) Owner's Name 5weel.MevdowPraperhes1—ec Map/Parcel# 2 �3i <It , .i �iCddress P 1f> ' E 1111_ • _. • I.ot# (3 Installer's Name Address Simi" Telephone# type of Building HOUSe ]welling-No.of Bedrooms )ther-Type of Building )ther Fixtures 8a-le5 . Nor t �r/ Telephone# (4i3 ) 596 _8 z g 7 rp Designer's Name Heri l,6 Q 9 rSlirVC.y5 Snc . Address C411'/e H)9ilway d C/ark ) i% Tcle h # 4 Re rmm p one 1 .// I ;or u'rp 'oat) 0/✓4y )esign Flow (min.required) Co 1p0 gpd Calculated design(low Ran: Date ()C+Ohef 24 r�1 Number of sheets 2 id e 0rll ' / 0 Lot Size 351709 Garbage grinder iif No.of persons Showers ( ),Cafeteria( ) sq.ft Co1DA Design flow provided (D CD 8 gpd Revision Date NOVC•M t her 78, 2001 Lie I 11. •• 1 oil Evaluator of Soil(s) Set 5ka2T' 26f, 2 fn'r of arlc093 oil Evaluator Form No. Name of Soil Evaluator k v Re,e ESCRIPTION OF REPAIRS OR ALTERATIONS 123 Date of Evaluation S131161 /WO/ re enders rther afire- t. of pia the sys m on until aI Cer[dicate f �j rn ante has been issued by the Board of Health. 'ned P %i//�a l Date ve described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and erati ;pectins OF)/ COMMON\% LTGI OF MASSACHUSETTS Board of Health, Mier 4./ Am CEPTITI ';,TE OF COMPLIANCE Description of Work: LI Individual Component(s) .mplete System The un> gned hereby certify that the Sewage Dispos 1 S• tem; Constructed ( ;.Repaired ),Upgraded ( ),Abandoned ( ) by. et L wt I+ • . ) l.:I] iii a _ has been install d ccord.nce with dte .rovisions of 81 t A \ dated MR 15.00 (Title 5) a d'(he teYproted design plans/as-built plans relating to application No. / t - aimed Design flow (gpd) 1 De i_t , I In spec[ I: '/IL Hie issuance of this permit shall not be ton kj,�, Date: P construed as a guar�ttt a mffi the ay. __ w action designed. COMM©NWF$ui ©PMASSACHUSETTS Boa:d of Health, J - /..- /. MA. DISPOSAL SYST . 1 CONSTs LIMON PERMLT'•': Upgrade( ) Abandon(.,.) __ _ lisposal SystemConstruction Permit No. A — 3/ " dated/�—x;J`�—/O rovided: ConstfuctDn shall be completed within th4ee e as tt O.rb of o date of tlt �,et [. �Igr.nitoudi[I m 1255 Rev 5,96 pM-Sam Co.Boslan'1A oard of Health C FEE 7�GfJ'.,_,t.. Installer 7.9 'ex-mission fs erebygranled to; Construct( Repa t /0t 3 /1/61/? Ai!✓ FEE i`' as described in application for Date /) —/C( tt