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844 Title 5 Applications/Permits 2003,2005, Site Restriction, Soil Survey, As-Built, Inspection Report 2003 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 844 North King Street Northampton,MA Owner's Name: Bill Chunglo Owner's Address: 844 North King Street Northampton,MA 01060 Date of Inspection: 04-24-03 Name of Inspector:(please print) Michael Lavigne Company Name:_Environmental Design.Inc. Mailing Address: 101 Old Ferry Road Northampton,MA 01060 Telephone Number: 413-585-5020 CERTIFICATION STATEMENT 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 _ Needs Further Evaluation by the Local Approving Authority X Fails Inspector's Signature: Date: A—A/0s 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. Notes and Comments ****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. Title 5 Incnectinn Form 6/15/2000 naee I Page 2 of I1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 844 North King Street Northampton,MA Owner: Bill Chunglo Date of Inspection: 04-24-03 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 or in 310 CMR 15304 exist. Any failure criteria not evaluated are indicated below. Comments: B. 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. Answer yes,no or not determined(Y,N,ND)in the 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 enfiltration 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 will 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. ND explain: 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 if(with approval of Board of Health): _ broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: 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 ND explain: obstruction is removed Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 844 North King Street Northampton,MA Owner: Bill Chunglo Date of Inspection: 04-24-03 C. Further Evaluation is Required by the Board of Health: 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 15303(1)(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 or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 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 100 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 has 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 and volatile organic compounds indicates that the well is free from pollution from that facility 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: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 844 North King Street Northampton,MA Owner: Bill Chanel° Date of Inspection: 04-24-03 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No X X Discharge or ponding of effluent toy thesturface of the ground orrsourf overloaded o or clogged SAS waters due to anoverloaded or clogged SAS or cesspool unknown Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than'/:day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped unknown Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or bibutary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility dded Chas eu ethea far ammonia oni criteria nitrogen and nitrate nitrogen is equal to or less than 5 pp ta p inv are triggered.A copy of the analysis must be attached to this form.] YES (Yes/No)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. 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 You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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 II 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 "yes"in 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. Page 5 of I1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 844 North Kinn Street Northampton MA Owner: Bill Chun r>f Date of Inspection: 04-24-03 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? N/A Were as built plans of the system obtained and examined?Of they were not available note as N/A) X Was the facility or dwelling inspected for signs of sewage back up? X Was the site inspected for signs of break out? X _ Were all system components,excluding the SAS,located on site? X _ 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? X 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: Yes no X Existing information.For example,a plan at the Board of Health. X Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(6)] Page 6 of 1I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM SYSTEM INFORMATION Property Address: 844 North King Street Northampton,MA Owner: Bill Chunglo Date of Inspection: 04-24-03 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): N/A Number of bedrooms(actual):3 or 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): N/A Number of current residents: 2 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no):Yes Of yes separate inspection required] Laundry system inspected(yes or no):No.assumed in failure to be tied into new system. Seasonal use:(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): N/A Sump pump(yes or no): No Last date of occupancy: Current_ COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sg0,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Once,per owner's recollection Was system pumped as part of the inspection(yes or no): No determined? If yes,volume pumped:_gallons--How was quantity pumped Reason for pumping: TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system 1D-box not located,system flooded.] Single cesspool Overflow cesspool _Privy Shared system(yes or no)Of 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) Tight tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 20 to 25 wars,per owner Were sewage odors detected when arriving at the site(yes or no):N Page 7 of I1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 844 North Kin¢Street Northampton,MA Owner: Bill Chunelo Date of Inspection: 04-24-03 BUILDING SEWER(locate on site plan) Depth below grade: exits sub-slab Materials of construction X cast iron 40 PVC_other(explain): Distance from private water supply well or suction line: N/A Comments(on condition of joints,venting,evidence of leakage,etc.): No problems noted. SEPTIC TANK: X (locate on site plan) Depth below grade: —33^ Material of construction: X concrete metal fiberglass polyethylene other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: —7' x 4' x 4' Sludge depth: N/A Distance from top of sludge to bottom of outlet tee or baffle: N/A Scum thickness: N/A Distance from top of scum to top of outlet tee or baffle:_N/A Distance from bottom of scum to bottom of outlet tee or baffle: N/A How were dimensions determined: N/A Comments(on pumping recommendations,inlet and outlet tee or baffle bake condition,structural u of ali t,top badly d leveels as related to outlet invert,evidence of leakage,etc.): structurally unsound,could not inspect,must be replaced. GREASE TRAP:N/A (locate on site plan) Depth below grade: Material of construction: 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 844 North King Street Northampton,MA Owner: Bill Chunk) Date of Inspection: 0424-03 TIGHT or HOLDING TANK: N/A (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: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: N/A (if present must be opened)(locate on site plan) 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.): System completely flooded,could not locate D-box,no knowledge whether one exists. PUMP CHAMBER: N/A (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL FORM INSPECTION ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART C SYSTEM INFORMATION(continued) Property Address: 844 North King Street Northampton,MA Owner; Bill Chuaalo Date of Inspection: 04-24-03 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Partially excavated,flooded leach trench encountered. Type leaching pits,number: leaching chambers,number: leaching galleries,number. X leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): flooded trench located,system in failure. CESSPOOLS: N/A (cesspool must be pumped as part of inspection)Qocate on site 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 or no):_ Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: N/A (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.): Page 1U of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 844 North Kin Street Northampton,MA Owner: Bill Chunglo Date of Inspection: 04-24-03 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet. Mate where public water supply enters the building. S � < � Page II of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: $44 North King Street Northampton,MA Owner: Bill Chunglo Date of Inspection: 04-24-03 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 5 to 6 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: X 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: Deep observation bole dun,no water,no weeps to beyond six feet. To: The Northampton Board of Health From: Bill Chunglo, 844 North King Street, Northampton Date: May 28, 2003 Re: Waiver of Garbage Disposal Requirement- Septic Repair As owner of a residential property at 844 North King Street,Northampton I am herewith requesting a waiver of the Board of Health regulation which requires that all septic systems be designed to accommodate a garbage disposal. I have submitted a plan for the replacement of my old septic system with a new septic system which would comply with all of the requirements of Title 5 but with the limited "percable" space on my lot, it is not possible to fit in the 50% larger system required for a garbage disposal. If the waiver is approved, I will file a deed restriction with the Register of Deeds office, which prohibits the future installation of a garbage disposal. Thank you. Sincerely, William Chunglo ENVIRONMENTAL DESIGN, INC. 101 OLD FERRY ROAD NORTHAMPTON, MA 01060 1-413-585-5020 October 8, 2003 Board of Health 1 (rl 5�- Town Offices Northampton, MA 01060 re: Inspection of Septic System Repair, Chunglo Home, 844 North King Street Dear Board: On October 1, 2003, a representative from our office performed an inspection of the septic system repair installation referenced above. The system was installed by J. C. & Company of Northampton, MA. Our representative found that the system appears to have been installed properly and in general accordance with our system plan dated 05-25-03. The as-built locations of relevant system components have been documented on the attached sketch. If there are any questions, please contact our office. Sincerely yours, I hereby certify that the above referenced system was installed in accordance with Title V and the approved syste/r\design prepared by Environmental Design, Inc. 0 I1I-1/Or"" J. C. & Company, Northampton, MA 102 100 - - 1500 Gallon Septic Tank - I8"BG. 98- - - 94— Red Maple 102 100 —98 / \ r Qj wanWV:at=l Yii!Jo- 92- - 508'+ Plastic J." Risers 90 a Existing 4 BR Home # 844 N AS-BUILT (n.t.s.) Chunglo Northampton, MA 10-01-03 9 — —92 TBM: Bottom of House Siding at Comer Shown. Elevation-100.0' 0- Hydrant NORTH KING STREET (a.k.a. Rte 5) HUNTLEY HUNTLEY ASSOCIATES, P.C. SURVEYORS•ENGINEERS•LICENSED SITE PROFESSIONALS November 9,2005 Northampton Board of Health 212 Main Street Northampton,MA 01060 Attn: Mr. Ernie Mathieu, Health Agent RE: 844 North King Street,Proposed Residential Dwelling Huntley Project No. 04-113 Dear Mr. Mathieu: On behalf of our client, Mr. Kenneth Patel, Huntley Associates, P.C. (HAPC) is pleased to present the revised On-Site Sanitary Sewage Design for 844 North King Street. The percolation tests and revised Sanitary Sewage Plan have been completed and designed in accordance with 310 CMR 15.00, Title V requirements. As we discussed on site, we are requesting a variance from the 75-foot setback for leachfield to wetlands, as the site constraints provide only a 50-foot setback or greater at the nearest point. As we have already provided the applicable review / processing fee, please find enclosed the revised plan entitled On-Site Sanitary Sewage Plan located at 844 North King Street, Northampton,MA. Our client would like to obtain your approval as soon as possible. Please contact me if you have any questions or comments. Sincerely, HUNTLEY ASSOCIATES,P.C. Mark McClusky Senior Engineer cc. Ken Patel,Property Owner Tris Metcalfe, Architect D. ERNEST J. ?Al H1.U, F;,S., M. C.H.O. DtiECt1.I R--b H __F FUaLIC QL1 DATE: [/Gn /.S, Zdc�S -wen grom, RS, M.S., CII4 RMECrOR OF NEM N'\04-1 3P \wain \ rrsu\O4113NX3 Mc 30 INDUSTRIAL DRIVE EAST.NORTHAMPTON, MASSACHUSETTS 01060.(413) 584-7444.Fax(413) 586-9159 1585 STATE STREET.ScHENEcTADY, NEW YORK 12304.(518)393-4767.FAx(518) 393-3510 16-18 REYNOLDSAVENUE.ONEONTA, NEW YORK 13820.(607)432-3300•FAx(607) 432-8313 HUNTLEY HUNTLEY ASSOCIATES, P.C. SURVEYORS•ENGINEERS•LICENSED SITE PROFESSIONALS March 28,2005 Northampton Board of Health 212 Main Street Northampton, MA 01060 Attn: Mr. Ernie Mathieu, Health Agent RE: 844 North King Street,Proposed Residential Dwelling Huntley Project No. 04-113 Dear Mr. Mathieu: On behalf of our client, Mr. Kenneth Patel, Huntley Associates, P.C. (HAPC) is pleased to present the following On-Site Sanitary Sewage Design for 844 North King Street (and adjacent lot). As I have discussed with you, our client seeks tentative approval for our Septic System design from the Board of Health (BOH) to obtain a conditional Building Permit. It is understood that official percolation tests and test pits will be completed in accordance with Title V, and if non-favorable conditions are revealed, a redesign the existing leachfield at 844 North King will be required to accommodate both dwellings. Please find enclosed the Application for Disposal System Construction Permit, our company check for the $100 Application Fee, and the proposed plan entitled On-Site Sanitary Sewage Plan located at 844 North King Street,Northampton, MA. Please contact me if you have any questions or comments. Sincerely, HUNTLEY ASSOCIATES,P.C. Mark McClusky, P. Senior Engineer cc. Ken Patel,Property Owner Alec MacLeod, Wetland Scientist Tris Metcalfe, Architect .:\04-113P, w\AD,,.AEORRE,n.ETTEE5\04113ao11:.Oa 30 INDUSTRIAL DRIVE EAST•NORTHAMPTON, MASSACHUSETTS 01060•(413) 584-7444 •FAx(413) 586-9159 1885 STATE STREET.SCHENECTADY, NEW YORK 12304 •(518) 393-4767.FAx(518) 393-3510 16-18 REYNOLDS AVENUE.()NEONTA, NEW YORK 13820 •(607) 432-3300•FAX(607)432-8313 E3Yg N ti"-4 re-, pi066 Ah /rig No. FORM 11 - SOIL EVALUATOR FORM Page 1 of 3 Date: _S7/7.2/1/(J Commonwealth of Massachusetts ,k/cr—t/aJnp4fr., Massachusetts Soil Suitability Assessment for On-site Sewage ,DispoMal S,'%B2q3 Performed By: _rnl.r_.hn-•er_� � ' � _. Witnessed By: "te_+t` M� "'... Date: la Add=or 8.914 NJ. K;L Vew construction ❑ Repair Office Review Published Soil Survey Available: No ❑ Yes agi Publication Scale Soil Limitations Year Published Drainage Class Surficial Geologic Report Available: No FT Yes ❑ Year Published Publication Scale Geologic Material (Map Unit) Landform Flood Insurance Rate Map: 0�- Above 500 year flood boundary No Oyes rry Within 500 year flood boundary No Pies n Within 100 year flood boundary No gYes ❑ Wetland Area: National Wetland Inventory Map (map unit) Wetlands Conservancy Program Map (map unit) Current Water Resource Conditions(USGS): Month Range :Above Normal ❑Normal Below Normal ❑ Other References Reviewed: Soil Map Unit DEP APPROVED FORM. ENVIRONMENTAL DESIGN INC. 101 OLD FERRY ROAD wvss NORTHAMPTON, MA 01060 413-585-5020 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. 8 fig e . .n2,--c.'-L On-site Review 4t3 Deep Hole Number Date:. 8/03 Time:..Mid-- Weather CFO-) '- o . ff Location (identify on site plan) Sera� - � �- /r Land Use ...L.u.)i-- . Slope (%) 3 - /0 Surface Stones if-613 -DO- Vegetation ..9+-aS'S 'f Landform P(s+'.... Drainage way >. 2O feet Property Line 7 ,O. feet Other _.... Position on landscape (sketch on the back) Distances from: Open Water Body -7/00 feet Possible Wet Area 7..n) feet Drinking Water Well "'LOA . feet DEEP OBSERVATION HOL J .brtvCwc N ti E LOG. k Depth from Surface(Inches) Soil Horizon o -5484. flT,)ctO( H8° Loa C1 /00" )ad" C2 0 - 40" 112 -/0.2" Soil Temure (USDA) Soil Color (Munson) m7Jenl SL Loyey/y S' 3 r"y/g CL S-2 Lai,9 .2SYW S Soil Mottling Other (Structure,Stones,Boulders,Consi tency, % Fr`// F1/ ems ' Co,;tld A J ^ dyTu p_AgSl_- PepthtoBedrock:yvk Parent g Material(geologic) and I g W.� i-n G/ " Weeping from Pit Face: U�- t-- DeDthtoGrwntlwater: Standing Water in the Hale:S._/-962—r n Estimated Seasonal High Ground Water: /00 DEP APPROVED PORN(-12/07(95 ENVIRONMENTAL DESIGN INC. 101 OLD FERRY ROAD NORTHAMPTON, MA 0106') 413-585-5020 Location Address or Lot No. 8 'v A( FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Determination for Seasonal High Water Table Method Used: U Depth observed standing in observation hole. inches ❑ Depth weeping from side of observation hole inches N Depth to soil mottles) /“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 observed throughout the area proposed for the If not, what is the depth of naturally occurring pervious material exist in all areas soil absorption system? y CS-- pervious material? Certification I certify that on ,k4v Vg (date) I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. DEP APPROVED FOP)1=111071 Date ENVIRONMENTAL DESIGN INC. 101 OLD FERRY ROAD NORTHAMPTON, MA 01060 413-585-5020 Location Address or Lot No. FORM 12 - PERCOLATION TEST 81/4( A/. i6i714. COMMONWEALTH OF MASSACHUSETTS �p , Massachusetts Percolation Test' /77,d— y Date: ....c. ��%8/0.� Time:. . . ! Observation Hole # `-P Depth of Pere 6 6 o Start Pre-soak y/_0y End Pre-soak //: J 9 Time at 12" /l ; / 9 Time at 9" //: 46 Time at 6" /7 3 9 Time 19"-6") J3 Rate Min./Inch S-- Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed xi Site Failed 0 Performed By: Witnessed By: Comments: .... !/1; e/ -Pe-74r // /CGY DFP APPROVED FORM-12/07/95 ENVIRONMENTAL DESIGN ENC. 101 OLD FERRY ROAD NORTHAMPTON, MA 01060 413-585-5020 PERCOLATION TEST(S) Time: Time: Observation Hole ® Observation Hole #2 Depth of Perc Depth of Perc Start Pre-soak Start Pre-soak End Pre-soak End Pre-soak Time at 12" Time 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 'minimum of 1 .• bon test must be•irforrned in both the.rims area AND reserve area. SFGE.; t~ r ; t SITE PASSED °"' SED _; FAILED ._ Performed b Witnessed b Performed b Witnessed b Comments: NORTHAMPTON BOARD of HEALTH— Title 5— Site Review Lott/ i _I R i Use tatiort;a r- r, n landscape Y` onbeSi);`. "W,ta iD,mer,Cl DEEP OBSERVATION HOLE LOG* •MINL■1UL1 OF TWO HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA Soil Horizon Soil Texture (USDA) Soil Colo ' Soil Mottling (Munson) Other (Structure,Stones,Boulders,Consistency,% le#: ,. DEEP OBSERVATION HOLE LOG* 'MINIMS( OF TWO HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA an Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other (Structure,Stones,Boulders,Consistency,%Gravel) :hes) C el C tonal(geologic) I DeethAoBedrock I Standing Water lope Jd1e,Ej Imo'NeePi(g from Pet F,ace1 groundwater, nated Seasonal High,GroJDd Water `, DEEP OBSERVATION HOLE LOG* •MINL■1UL1 OF TWO HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA Soil Horizon Soil Texture (USDA) Soil Colo ' Soil Mottling (Munson) Other (Structure,Stones,Boulders,Consistency,% BOARD OF HEALTH MEMBERS ITHIA DOURMASHKIN,R.N.,Chair ISEMARIE KARPARIS,R.N.,MPH HARD P.BRUNSWICK,M.D.,MPH DETER].MCERIAIN,R.S.,MPH Health Agent (413)587-1214 FAX(413)587-1221 May 30, 2003 Mr. William Chunglo 844 North King Street Northampton, MA 01060 CITY OF NORTHAMPTON MASSACHUSETTS 01060 OFFICE OF THE BOARD OF HEALTH 210 MAIN STREET,Room 8 NORTHAMPTON,MA 01060-3167 Re: Waiver of Garbage Disposal/Sewage Capacity Requirement— 844 North King St. Dear Mr. Cunglo: On May 29, 2003, the Northampton Board of Health voted to approve your request for a waiver of the septic system design regulation to allow the repair of the septic system on your property at 844 North King St, Northampton. This waiver is based on the fact that you currently do not have a garbage disposal and your stated intention to place a restriction on your deed, prohibiting the future installation of a garbage disposal. Enclosed is a sample copy of a recently filed deed restriction. Your lawyer can use this as a guide when drawing up your deed restriction. Once the deed restriction has been filed, please send a copy of the filing confirmation to the Board of Health office for addition to your septic system records. Pleas feel free to contract me at the Board of Health office with any questions. Thank you. Peter J. McErlain Health Agent afatile Orwstra- awry/ revalintrierani SlrL IMBENISPE.7444 rigreasessare Doc: 992216415 OR /6663/0194 06/03/2002 10:12 RESTRICTION I,11.11111111111a owner of the real estate known and designated ash a Northampton, Hampshire County, Massachusetts by virtue of a deed dated WIS11.11.1 from WS and -- and recorded with the Hampshire County Registry of Deeds in Boot'- Page_ hereby impose the following permanent restriction upon said premises, into perpetuity: Due to the design of the septic system a garbage disposal will never be install on the premises. This restriction is applied to the subject premises in compliance with the Waiver of Garbage Disposal/Sewer Capacity Requirement issued by the City of Northampton Office of the Board of Health dated May eaq. �0o3. WITNESS my hand and seal this ' COMMONWEALTH OF MASSACHUSETTS HAMPSHIRE, SS. The personally appeared the above named MIS and acknowledged the foregoing to be his free act deed fore me. Notary Public MM Commission Expires: ATTEST: HAMPSHIRE, Matiwyseroe314.1,,REGISTEL MARIANNE L. DONOHUE �� BOARD OF HEALTH THE COMMONWEALTH OF MASSACHUSETTS Fee t of NG r CM�Ywp� APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( I Repair (S1 I!p_rade I I Abandon ( 1 - 'Complete S■stein ❑Individual Components 81-t Li NorTL `INA \ rneau.n C' anp.t•a,,.I= 2. Nt Install) Y4untc A dre Telephone c ill c.kb,gl2 Oaocr 844 N. r,)9r relephone' Type of Building: Dwelling—No.of Bedrooms Other—Type of Building Other fixtures No.of pc ns Lot Size feet Garbage Grinder ( Showers ( ). Cafeteria ( ) Design Elow(m;n eyuired) M A gpd Calculated d csign flow gpd Design flow providedc0Bgpd Plan: Date S' Number of sheets r,2Y✓/ Title Description Soil Evaluator Form No. N//4 Name t f Soil Evaluat 8" Revision Date (O —N—O3 — — ption of Soil(s) � orm /ate w (Date of Evaluation $'8103 A(eu i5'fa DESCRIPTION OF REPAIRS OR ALTERATIONS LR S ATE l IONS C '- X /2 ' x /.S- /—z..w. The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees not to place she%tem in one/'on until a Certificate of Compliance has been issued by the Board of Health. --Signed i..,/1 Date Co .3 -©3 Signed � /Li i. Inspections FORM I - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 ��-�YSYllabaSYY0 THE COMM WEALTH OF MASSACHUSETTS 2 i,271.41" fr(LIOARD OF HEALTH I,' •TE OF COMPLIANCE�ComP,etesystem Individual Component(s) Upgraded( ).Abandoned( ) ascription of ed hereby Repaired( )-UPS ' he undersigned herLbr certify that the Sewage Disposal System:Constructed i - J . . approved design P l€Pd) > Approved Design Flow [h the roris�'ns of 310 CMR 15.00 (Title >) and the been �� V V( Dote � Inspector ! . stem will function as designed. t tae srel installed in En- accordance /1 Q ,. /• dated Mans relating to application No _ /o Installer j C ' 6 guarantee DesiTher. , FORM 5196 DEP APPROVED Theissuanceof FI certificate OF GOMPLbANCE construed as ______ CERTIFICATE OF ___' •. FORM S - ./.. / FFE TH OF MASSACHUSETTS T 1 HE COMMONWE/c / OF HEALTH � , 1,/ � <tl �0 yti, �FBdil BOARD ��.� EM CONSTRUCTION PERMIT Abandon ( ) an individual d scribed as L DISPOSAL SYS ) upgrade ( ) nban described dated �.epan (x ge Permission is hereby granted to 'o in the application for Disposal ,� 71. Board of Health Provided: Construction shall he completed within three years of the date of nstruct ( disposal syste m at ondmons t'he met. System Construction Permito' s permit/ h ca}< Date DSCP DEP APPROVED FORM 5/96 FORM 2 ' BOSTON PUBLISHER'S- 116W HOB056 WPPflEN FORM 1255 REV 5561 � THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Cl OF IU Crl �.d APPLICATION FOR DOSAL SYSTEM CONSTRUCTION PERMIT - to Construct ) Upgrade ( ) Abandon f ) - Qnnplao System �', Individual Components Application for n Permit Ch ^y t fS/'1 /L°°Jsi'NAi.,� Street— 9i3 - St " d- 0 / 9 ? C �drnen /.,L . L .�v,i to iv/rn ii/ UrS�Sn Deuyne ✓ Adress .6 Vii — s✓ - s-si“ Telephone f Wel S"re i' f AI,p.ParceI An, Iv.,n.r.San Addre■ 7daphonoe to Type S/- /e ,� /5;4 re)ee Lot Size Sq-feet Dwelling g —No. q ✓ Garbage Grinder (AAP Othe ri--—No.of Bedrooms — Other—'Cypc of Building_ No of persons_ <F' _ Showers ( ). Cafeteria ( ) Other fixtures d Calculated desip flow gpd Design flaw provided y S/�pd Design Flow(min. required)_0 -? Number / (( d x/c7 Revision Date / Plan: Date OS -'�° - ° 3 Atumbcr oC sheets - i'e s - -_-5frn /° Title_ Se w 4:/ P �;S�t s 1/ .Sy 5 i-C ^^ yam° .j a�° n.m (Sec a Cr. c.,,pe-ny/'..� r Pi or t ) Description or Soil(s) 'S i ^�y /1/ ,j La v,'� n e Date of Evaluation e S -Or-PS Soil Evaluator Form No. v�Ii Name of Soil Evaluator / Lza�t,r.,rl6a('e j ( `ffr 'xiz'xtS DESCRIPTION OF REPAIRS OR ADCERATIONS N °`^� w1+4 us 2 .,_. ISo 0 e_(les 5ef -is- ¥bvsLL . The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TRU 5 and further agrees not to place the system in operation until a Certificate of Compliance has been iissssue by the Board of Health. Signed Zd vi QIi( r .. Date �� - CCII Inspections FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 No. % THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH CERTIFICATE OF COMPLIANCE Description of Work; D Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System:Constructed( ). Repaired( ).Upgraded( ).Abandoned( ) by. at 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 Approved Design Flow fend) Installer Designer: Inspector The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 Date No. F2! THE COMMONWEALTH OF MASSACHUSETTS )4(/jt< /✓tpf.Z-BOAR D OF HEALTH DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is here t' gted to Co s ruct ) R pyir ) Upgra e ( ) Abandon ( ) an individual sewage �` �t(R as described disposal rvstcm at � in the application for Disposal System Construction 1 — 03 .dated r7 - -.5-�-3 .etion Permit Na / Provided: Construction shall he completed within three years of the date of this permit. I of:co ns m rct. Date /MU/ c eDezT3 Board of Health-r� de-/7- /`,�-/ FORM 2 - OSC% DEP APPROVED FORM 5/96 FORM 1255 (REV 5/96) H6W 2 HO6esa WARRENrM PUBLISHERS-BOSTON No (200-5---/0 THE COMMONWEALTH OF MASSACHUSETTS FEE �/56, —" UoMINApTopJ MASSACHUSETTS ele.e116637 cApplication fur !lepuea{ ,Sgstem Construction Permit Application is hereby made for a Permit to Construct ( )or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. g4`f ton, twc- nizirr Owner's Name,Address and Tel.No. oft •Kfiuu4TN exmi, HT cot't 57-0147 M1-HPNG'00 µA ot060 %113)33} L1i7- ma Al A. 0to60 Installer's Name,Address.arid TT-eell..,NNooy..r+� mot^ s%�x6 9, —11,2,3, .1, ``-' Designer's yName:Address and Tel. No. 30 2LLdv sa op AC. /OT—/7 Vy No• i - rmJ _ 01060 `'TT /k✓ a''141/4 Ad ' d I ' Type of Building: Dwelling No of Bedrooms Other Type of Building Garbage Grinder(50 No per Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow / / //0 gallons per day. Calculated daily flow 5-5") gallons Plan Date 3%8/05 X 5/25105-^ Number of sheets a Revision Date rrloBCOs Title Old-SR'F_ SANiTArkt S¢w$L Dar o+AL Description of Soil F,-E SAUzi Laeµ 0uTWorSH Nature of Repairs or Alterations(Answer when applicable) Date last imp aid: Agrem �"r 1 � ` 19/ G' & _`7 Th 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. Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. oVU �� Date Issued _.4w A THE COMMONWEALTH OF MASSACHUSETTS 2.7, E MASSACHUSETTS errtificute of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System installed (v� or repaired(replaced( ) on by has been constructed in at dated accordance with the provisions of Title 5 and the for system col System one Construction c ermh No. . Use of this system is conditioned on compliance with the provisions set forth below: The issuance of this certificate shall not be construed as a guarantee that the system will function as designed.This Certificate expires on -Hy ' .p+�,l n DATE Inspector 7,21.- ' !s 2 cJ THE COMMONWEALTH OF MASSACHUSETTS No �w ' �/. i , i>* t', MASSACHUSETTS Pisposttl e*gStem Construction Permit Permission or repair granted to to construct ( i{or repair( )an On-site Sewage System located at FEE and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his.'her duty to comply with Title 5 and the following local provisions or special conditions. All construction must be completed within two years of the date below. ,. DATE - Approved by - FORM 1255 Rev.3/95 A M.SUININ CO.-BOSTON.MA I p. LS THE COMMONWEALTH OF MASSACHUSETTS BOARD6 OF HEALTH e 07 O F '4 /VOI fl m(7-0 APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit m Construct ) Repair [ ) Uporade ( ) Abandon ( ) - [S(Complete System Et Individual Components C FEE '3 0' /dos z“/ v.pp lreuon or, - tX 44 ki-e-ri4 kt.rx: _v7,nf% Mt k6 ,vuti toA76L (t iNao l/1- Cott)Z- S?RTFT • /✓DCIIM Address -354— 6,-Ln GAJ Location `dap Parcel Pal a Telephone 'iuAri ADel t. 45 l-c Lot Ding Ndmi IMDU 7 of O I i i Art %t A5% b... ��• r Installers Name Address a 1 3 — St,-}„t i ep i (Q Tele, oov'S 'sheer., Type of Building: 2/✓QL//l Dwelling—No of Bedro m Other—Type of Buildin Other fixtures Desig Plan: Title Lot Size Garbage o-of persons Sq.feet nder (X) Showers ( ), Cafeteri Flow(min /D gpd �s cS Nu W Snm1it Cale r ted design no her of she.ts ply gpd evision Dat ign flow provide gpd Des ption .oil Evaluate a e of Soil Evaln'dLOT DESCRIPTIO RS OR ALTS ATIONS The undersigned ag=-s to nstall the above TITLE 5 and further agree not • place the system Signed Inspections scribed Indivicual Sewage Disposal S stem i •, cordance with the provisions of operation un a Certificate of Complies m has ��-n issued by the Board of Health. Date FORM I - APPLICATION F DSCP DEP APPROVED • -M 5/96 THE COMMONWWWRtLTH OF MASSACHUSETTS BOARD OF HEALTH CE FICATE OF COMPLIANCE Description of Work: ❑ divsdual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System:Constructed( ).Repaired( ).Upgraded( ).Abandoned( ) by: FEE 16to Oka a474 at has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the rign plans/as-built Approved ed plans relating to application No. dated pP Design Flow Installer Designer: Inspector Date The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 No.S!-°y-7-�-{ V THE COMMONWEALTH OF MASSACHUSETTS Fee /✓ ' 77 BOARD OF HEALTH # Yf// DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to Construct (I/) Repair ( ) Upgrade ( ) Abandon ( ) an individual sewage disposal system at in the application for Disposal System Construction Permit No. dated Provided: Cons���n��l��mplcted within three years of the date of this permit.All local All local c�be met. UU ll// 7�/1YI I Date Board of Health FORM 2 - DSCP DEP APPROVED FORM 5/96 FORM 1255 IREV 5/96, �HSW) HOBBS a WARREN"M PUBLISHERS- BOSTON