79 COC 2017 �. Commonwealth of Massachusetts
.,.,:-.:1----7. . ILS �
City/Town of COPY Certificate of Compliance
pante
F Form 3
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with
the local Board of Health to determine the form they use.
This is to Certify that the following work on an On-Site Sewage Disposal System
important:When
filling out forms ❑ Construction of a new system
on the computer. A.Repair or replacement of an existin s stem
use only the tab g y
key to move your ❑ Repair or replacement of an existing system component
cursor-do not
use the return Has been done in accordance with Title 5 and the Disposal System C stru on Permit(DSCP):
key
j� 070/ 7
7� 9g / 7
Y!:...__ I i DSCP Number
iiiJJi Mary Fitzpatrick and Sandy Blackmon DSCP Date
Facility Owner
',...1)([ 79 Old Wilson Road
Street Address or Lot N
Northampton MA 01060
CityrTown
State lip Code
Designer Information.
Alan E Weiss, RS Cold Spring Environmental Consultants Inc
Na Name of Company
L"-- 09.22.2017
Signature
Date
In5aper Information
G c‘ RIVER DRIVE EXCAVATING
Name
TOM WANCZYK Name of Company
09.22.2017
Signature
Date
Use of this system is conditioned on compliance with the provisions set forth below.
It was recommended that you pump tank every two years.
i ;
ii.,...-„,
lith i ;, , -
The issuance of this certificate shall not be construe as a guarantee that the system will function as
desAned.•
W ez /// Rp
Approving Autholilf �
Signature
%I/i� ��? a� T
.
' / i../zi.,;7/ /,/1 , Date
t5tonn3.doc•06/03 •
Certificate of Compliance•Page 1 of I
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EW 14'X 38'
$ LEACH FIELD AS BUILT
•N o 09.22.2017
----- M --•
- (aka lot#6)
__r_ _a to M:44 L:23
I�� r_ _ _ __ MTN:::cx 9ucv SCALE: 1”=30'
I °K TAN,' 25,000 SF+1-
D.BOX L----�
1 a kJ r 1
I �~;0 30' 5.././.... �1
1,..711/1/-194.1.41.5,41.31,1. = 10' Z EXISTING 3 BR
I/ I� f DWELLING
33' I 14�••- �:.
4.2,4 i • SCALE IN FEET
: .: i I DRIVE . 0' 30' 60'
TBM1=100` 90'
Fite. . (TOP SILL
t
4
4 ! + 9r~ 125.00'+1-
`;— I — — ,
OLD WILSON ROAD
XISTING LEACH TAI/ .S AND STONE TYPICAL D.BOX(WATEF
`PUMP MID GEMO•IE;
GRAVITY SLOPE SEPTIC SYSTEM OPERATION AND LEGEND. j/'� /"0Li
/�/ oa
MAINTENANCE NOTES FOR HOMEOWNER. To
1.)HAVE TANK PUMPED EVERY 2 YEARS.PUMP&CHAMBER CHECKED ANNUALLY. PERC HOLE LOCATION, NUMBER MET I FIRST 2'0!
2.)MAINTAIN AREA OVER SEPTIC SYSTEM AS GRASSY TP-1 TEST HOLE LOCATION, NUMBER
ESTIMATED WATER LINE MIt�.6"SLI LE
OR SIMILAR GROUND COVER. -E-ELECTRIC WIRES
3.)DO NOT PLANT ANY TREES OR DEEP ROOTING 6__ =Emission==Emission=SHRUBS WITHIN 10 FEET OF SYSTEM. � PROPOSED
coNrouR
4.)USE ONLY LIQUID DETERGENTS&LOW FLOW WASHERS. -—86PPROPOSED CONTOUR PLACEON STABLE o""'BASE OF 3r4 TC 1.1/7
-USE CONCRETE BOX WITH 7 MINIMUM WAL
-FILL'AITHWATERFORFINALLoxON.
WELL LOCATION
5.)WIPE ALL OIL AND GREASE FROM COOKWARE AND DISPOSE IN TRASH -uSE(S OUTLE'MINIMUM)a box(U{Unoergourx
NOT SEPTIC.
6)All Toilets and Faucets must be confirmed to not be leaking,because one leaking
fixture can fail a septic system in ONE DAY GRAVITY SLOPE SEPTIC
L: I:NEC FROM H[ND v 1 i STEM,4 1. HAVE TANK PUMPED EVER
CONNECTIONS FROM HEATING SYSTEM,AIRCONDMONERS,
SUMP PUMPS,WATER WELL FILTRATION UNITS AND HEAT PUMPS 3.1 DO NOT PLANT ANY TREE
ARE NOT ALLOWED,SANITARY WATER CONNECTIONS ONLY PERMITTED. LOW FLOW WASHERS.
ao/T"/,
• / ` /5041
Commonwealth of Massachusetts /�J/G� a`
L,.J
7g
City/Town of
f Septic System Installation Checklist `
- -y
B. Application Checklist (cont.) �� LAL5`J
-1cr'
2. Construction Inspection
Approved N/A Problem
a) Building Sewer(310 CMR 15.222)
•
All waste pipes tied into building sewer Basement check 0 0
• Schedule 40 PVC 4' or cast iron
Verify Py reading pipe fid0 0
Minimum slope of 0.01-0.02 Visual 0 0
Pipe laid in continuous straight line &OP 44'‘ . 0 0
Pipe laid on compact, firm base CD IZI
0 0
Cleanouts precede all changes inVerify by visualltape ❑ 0 0
alignment/grade
Cleanout provided every 100 ft
Verify by visuaUtape
Backfill material clean 0 0
Approved WA Problem
b) Septic Tank(310 CMR 15.223)nk ���s
Tais set level with 6'stone under Check with level C) C)
(15.228)
Tank is required size/loading per plade,
n Verify with plan lid
0
Inlet and outlet are at proper location Verify with plan 0
0(15.227) c(2 --- 0 0
Tarn is water tight(15.226) Test
Outlet tees extend 6' above flow line Verify by visuaUtape 0
Approved filter device placed at outlet DEP list C) ❑
Gas baffle installed at outlet tee Visual 0
El
Inlet and outlet tees on center line Visual 0 0
Tank is bacl'ilied with acceptable material Visualrti -
0 0
0
Notes:
Form Name•Page 2 of 8
Septic System Installation Checklist 11-09.doc•date
N
Commonwealth of Massachusetts
t;♦ - City/Town of
ti Septic System Installation Checklist
r►
B. Application Checklist (cont.)
c) Distribution Box (310 CMR 15.232) Approved N/A Problem
Ail outlet pipes at same elevationCheck by adding water L--"i:
❑
' Number of outlets Win.--- -- Number of lateralsper Plan ----------
Inlet tee min. 1"over outlet • •: tape ❑ []
D box set on level base / U ❑
Top of D box 36" max depth _ Visual • /tape
D box is water-tight Add water Y i ❑
• D box has a minimum of 2" thick wall and
12'inside dimension ❑ C ❑
d) Pump Chamber(310 CMR 15.231) Approved N/A Problem
Tank is set level Visual and w/level ❑ ❑
Proper volume is provided Check plan and tank 0 ❑ 0
Float elevations set per plan Measure w/tape ❑ ❑ ❑
, Min. 2" delivery line to D box Visual 0 ❑ ❑
Number of pumps: - — _... ❑ 0 ❑
Specified pump provided or designers
approval for equal pump ❑ 0 ❑
Correct pump sequence 0 0 0
Covers set to grade ❑ 0 ❑
Electrical permit provided 0 ❑ ❑
• 6'of stone beneath chamber Visual ❑
Chamber is water-tight Test ❑ 0 0
Min. 9-cover provided Visual 0 0 0
Correct loading provided per plan Visual on tank 0 ❑ 0
Notes:
Septic System Instagstlon Checklist t 1-09.doc•date Form Name•Page 3 of 8
Commonwealth of Massachusetts
0k•
I. t. City/Town of
Septic System installation Checklist
B. Application Checklist(cont) - __-----,___--.-. _._—�_
e) Leaching Facility (310 CMR 15.240) Approved N/A Problem
No frozen material used including back fit Visual ❑ ❑ ❑
No clay, tailings or stones larger than 6"for ❑ ❑ ❑
cover material
Soil at bottom/sides of excavation matches ❑ 0 ❑
info on deep holes
All impervious layers removed Visual L: ❑ ❑
No remaining NB horizons Visual ❑ L; ❑
Groundwater conditions match plan and
deep holes Visual/check plan ❑ 0 ❑
Vented if under impervious cover per plan ❑ ❑ ❑
(15.241)
Vent is protected from precipitation
0 ❑ ❑
and animal entry
Cover of a minimum of 9"over leach area ❑ ❑ ❑
Pipe slope equal to 0.005 Check w/transit ❑ • ❑ ❑
Leach area per design(15.241) ❑ 0 0
Excavation is level and at required depth Visual/check plan ❑ 0 ❑
Removal of 5 ft material and replacement
Visual/check plan ❑ ❑ 0
(if in fill)
•
Back fill material is acceptable Visual ❑ ❑ ❑
Final contours correct per plan Check with plan ❑ 0 ❑
Surface/subsurface drainage away from ❑ ❑ ❑
• leach area
Final grade and side slopes are stable 0 0 0
Distribution lines are capped, vented, or ❑ 0
0
connected together
Impermeable barrier(15.255(2]) ❑ ❑ ❑
Retaining wall inspected by PE ❑ 0 0
Retaining wall is water-proofed ❑ ❑ []
Retaining waltbarrier is at correct ❑ ❑ ❑
• depth/height
Septic System Inetalation Checklist 11-09.doc•date Form Name•Page 4 of 8
•
1+ Commonwealth of Massachusetts
C ityf1own of
' Septic System Installation Checklist
B. Application Checklist(cont.)
j) Certificate of Compliance(310 CMR 15.021)
As Built Plan Submtted . _
Date
Signed by Installer _
Dais
Signed by Designerdais --___.�___-_�
Certificate of Compliance Issued
Date
Notes:
Septic System Installation Checklist 11-09.doc•date Form Name•Pape 6 of 6