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79 Perc 2017 City of Northampton Board of Health 2 017 t 212 Main Street ~ E Northampton, MA 01060 413-587-1214 PERC TEST WITNESS FEE Permit Number: $200.00 per 3 hours Fee Collected: ' L $75.00 per hours after 3 hours Perc Test Date: a'11(7 EE'S A L APPLICATION MUST BE SUBMITTED 10 BUSINESS DAYS PRIOR TO THE SCHEDULING OF A PERC TEST /(tO Application for Percolation ("Perc") Test Date of Application:Home Owner Name: / e/// �G� ' /6/4.61.4110- Address: 77 /qG{))// City/Town/State/Zip Code: !lt'/2`iCe (,#& c/c2 a SOIL EVALUATOR LICENSE NUMBER: R.S./ EngineeroADlaG� PHONE DRESS 33 Old ld en Ftomield d• , C S f'LIGt '71 !�O 7 D / 1/3 -. 323 -5757 E-MAIL z �cmmcnSfe net ISS EXCAVATOR back-hoe operator) rO gi 6 / _/�s e Kca v4 611ADDRESS f . /C((!( // PHONE (.I Ver- lir- ,/k y CHECK LIST 1 c ❑ New Construction LTJ" Repair/Upgrade ***Number of Lots to be Perc Tested—New Construction only- Give Lot Numbers*** E Dig Safe Sign-Off: Gas/Electrical ❑ Trench Permit/Info Sign Off from DPW (413) 587-1570 For Board of Health Use Only 5JeL/ J LI( 1/02 7 f4-tetAlt) e/sS NAMp �� - �° CITY : of NORTHAMPTON 1•" i PUBLIC HEALTH DEPARTMENT .„,.,.A.. � ' 4 'I Q:� fi e Public Health Director-Merridith O'Leary.RS VIOL I Municipal Building-212 Main Street-Northampton,MA 01060 s::" Phone(413)587-1215-Far(413)587-1221 ".., w htip:.hrmv.northamptonmagov.145%Health Public Heal Prevent,Promote, Pro Site Su' •�.. 't�• or 0 Site Sewa_e Dis 'sal Site Address; Al° ' , 4C)ctda Date: g l I7 Client Name: 6,ry F - & Address: R2'�l+) r "v �g .4 ',/ e '�,� Project Atumber. /� Performed by:A!G ) I geee.../eAr7�j ) /J • k Health Inspector: / /(�hf/L s,v Equipment Operator: ///"���fe� Shew Construction:E Repair OFFICE REVIEW Published Soil Survey Available:Yes No❑ Year Published: Publication Sca a �S.oiil Map Unit Drainage Class Soil Limitations Surficial Geologic Report Available:Yes p� No❑ Year Published: Publication Scale Geologic Material(Map Unit) Landform Flood Insurance Rate Map: Above 500 year flood boundary❑Within 500 year flood boundary❑Within 100 year flood boundary ❑ Wetland Area: National Wetland Invetory Map(Map Unit) Wetlands Conservacy Program Map(Map Unit) Current Water Resource Conditions(USGS): Month Range:Above Normal7f Normal❑ Below Normal ❑ Alf Other References Reviewed: 4 , , `/� e Dv/ tit/Lt Percolation Test Results Perc 1-I Time Measurement Time Measurement Begin Saturation Begin Saturation I 1 i'/ A in End Saturation r 5d End Saturation 9"depth 9j0 9"depth Measurement / 4/ Measurement 6"depth 1,ia 6"depth Measurement f►/f Measurement Elapsed Time 11klf Elapsed Time 9"to 6" 9"to6" /3' Percolation Rage <2 min./in i Percolation Rate: Bottom of Pe .c , a ole: 3 1'►'N I N r�18ono of Percolation Test Hole: H6) 212 Main Street Northampton,MA 01060 ' 1 Ph(413)587-1214 Fax(413)587-1221 `t • DEEP OBSERVATION HOLE LOG#1 Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other(Structure,Stones,boulders,Consistency,%Grave!) (Inches) (USDA) (Munsell) 0-1� to i 047 la-X SSL 0 ( .441 5 - e, 5; 9/i y1 No Li1 /tioNe DEEP OBSERVATION HOLE LOG#2 Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other(Structure,Stones,boulders,Consistency,%Gravel) (Inches) (USDA) (Manse!!) J51. 12 l72 • Parent Material(geologic) Depth to Groundwater: Standing Water in the Hole: ,! Depth to Bedrock:> ON Estimated Seasonal High Ground ,r .> Weeping from Pit Face:'� �e 0� e� ---• ( " 5e4-rl&-') 212 Main Street,Northampton,MA 01060 Ph(413)587-1214 Fax(413)587-1221 PLAN REVIEW - SYSTEM COMPONENTS City/Town /a/d64-7044/ Application No. PO/7-4 Lot Number Address OWNER9/JOna 4/c �G7 h f—i e/ OWNER 79al , ,ADDRESS ( i TELEPHONE # ( ) � f9‘7 DESIGN ENGINEER\SANITARIAN 4,t/ f4 P i5 5 FACILITY DESIGNED FOR A. ''Single or Multifamily dwelling # Bedrooms 3 Garbage Disposal yes no Total Design Flow gallons per day B. Other (describe) Design Basis 3 3v Total Design Flow t"--3ci gpd COMMENTS or PROBLEMS: aror,, Vf (4.51,)/ Pager 1 of 16 4j7 BUILDING SEWER ITEMS TO NOTE: if Pipe diameter Schedule of pipe 4v 17fr ' Watertight joints e x/j 'tJ 9 /6" Slope (min for 4"pipe is 0.01 or 1/8" per foot; desired slope is 0.02 V /Are; or %"per foot) R/ Invert elevation at building t X '5 1. (/ Length Alignment and grade Wholes required at changes in both alignment and grade.) Manhole (Must have metal frame and cover at grade) Pager 2 of 16 SEPTIC TANK /7"-'7 Tank size at least 200 % of desi flow (minimum tank size is 1,500 gal) A/ 2"-3"drop from inlet to outlet �� OjrfC:(3 Minimum 4' liquid depth Tees extend 6" above flow line Inlet tee 10" below flow line (minimum) Air space (3"above tees, 9" above flow line) /O 2 2 Depth of outlet tee (minimum 14") y6t/!Oti Access manhole over center of tank and each teems Number of compartments= Gas baffle on new construction Septic tank detail provided Buoyancy calculation (if necessary) On 6"crushed stone Og _tee r khoo Zdt f5 s (THe vc.iNs ethyl) Pager 3 of 16 DISTRIBUTION BOX ITEMS TO NOTE: /!r Inlet elevations Outlet elevations Drop (inlet- outlet) ---(1) 9 Y� © -- = c, J Sump (6" minimum) Baffle or inlet tee All outlets at same elevation ventilation Manhole cover to grade # of outlets 4/" size of outlets (diameter) Distribution laterals: No. Size Detail Provided Pager 4 of 16 532S71 3 Q� ACH FIELD Items to note: '/v he/ei--7-Li • / Dimension of field(s): Length 3U Width ! / ✓,off Number of fields Field separation (10 ft. min) Total area provided for disposal (sq. ft.) X14/0)14 lx ( w x no. of fields) • i Gallons of treatment provided: // Bottom area x loading factor(from 15.242)= 3PAa gal. (must be equal or greater than design flow) Note: Leaching area must be increased if garbage rinder is used. Elevation of bottom of the field e t/ (must }' r 5 ft above max. high groundwater depending on perc rate.) Number of distribution pipes Type 5Pe 3S Length (100'max.) l v ll Slope (min. 0.005) qc# — 75' Spacing(6' max.) V-- Depth of stone beneath pipe (min 6") Plan states stone is double washed 2" cover of 1/8" to %"stone over pipe crown —inds capped -1.-Itigregate depth 6" minimum and 12"maximum , -Depth of cover material above stone (min.9") Construction of leaching facility in fill? Yes No oX,Fill is specified as TitleV on plan Certification on fill submitted V Fill is specified for 5' around entire system /eparation between lines (6 ft maximum) Separation between lines and edge of bed - four feet maximum. 5-302 5r x 7"/ (1`' ager 5 f 16 LEACHING TRENCHES Number of trenches ,length\ (max.100')widthmin.24 Depth of stone beneath pipe (6" n ( ) Leaching area available bottom= length x width x no. trenches= sides =length x depth (2'max)x w x#of trenc s sq ft. TOTAL = sq ft. note: the effective depth shall be equal to the dep of the trenches below the invert of the distribution pipe up to maxi m of 2 ft. Leaching are requirements: Total leaching area (bottom plus sides)x loading factor=gallons treated Loading factor is based on perc rate (see 15.242) Total gallons treated by system design must be>design fl or system LEACHING AREA REQUIREMENTS SATISFIED? Yes , No (note: leaching area must be increased if garbage grinder is used) 17 Ground water elevation: t or 5 feet separation 1/between trench bottom and • . high groundwater. Trench spacing 3 x effective width or depth whichever is greater t/ Trench width 4 ft maximum //A/6e slope (min. 0.005 slope, or 6"per 100 feet) ackfill depth (min. of 9") —7 Ends capped distribution lines exceeding 50 ft are vented. iameter of distribution pipe (min.3") istribution line orifice (min.3/8, max 3/4") The area between trenches shall be designated as reserve area only where the separation distance between the excavation sidewalls is at least six feet. Fill is specified as Title V on plan Certification on Fill submitted Fill is specified for 5" around entire system Pager 6 of 16 PLAN REVIEW CHECKLIST GENERAL INFORMATION CHECK TO VERIFY THAT THE PLAN INCLUDES THE FOLLOWING REQUIRED INFORMATION: !'MASS. REG. SANITARIAN, or MASS. P.E. stamp and signature S ale of 1"=40' for plot plan Scale of 1"=20'for system component details //Legal boundaries of the facility being served including easements which could affect the impact the system installation/performance. 67 ll dwellings, buildings existing and proposed impervious areas Location of all existing and proposed impervious areas Location and dimensions of the system including reserve area NN f Design calculations: Sewage flow gpd,_ - KSeptic tank size required ex/5-t— jpd " " "provided d gP N h arrow, existing and proposed contours Lo ti and log of deep hole observation test $0:079 l date of test existing grade elevations for each test Pager 7 of 16 PLAN REVIEW CHECKLIST(cont.) Name of approving authority representative Name & approval no. of soil evaluator Location and results of perc test ate of perc test Location of water lines and other subsurface utilities on facility `/,Observed groundwater elevation in vicinity of the system mplete profile of the system A note on the plan listing all variances to the provisions of 310 CMR 15.00 and local requirements sought in conjunction with the plan Location and elevation of benchmark within 50 to 75 feet of the facility which is not subject to dislocation or loss during conjunction of the facility A Alf dosing system is proposed: complete design and specifications of the system dosing chamber capacity; required ,provided number of dosing cycles, depth of cycles Pager 8 of 16 PLAN REVIEW CHECKLIST (CON'T) Recircula 'ng Sand Filters Comp to plans and specifications hydrauli rofete location of th treatment works and nearest existing street street and lot num er Pager 9 of 16 DOSING TANK Dimensions L x W x D = Vol. Number/s e of siphons Number and s:e of pumps (No. , Capacity P gpm Discharge size Manholes to grade Groundwater elevatio• (min. 1 ft below inlet) Pump controls Alarm (on separate power cir it) Buoyancy calculations (if needed) Pump system calculations Pager 10 of 16 LEACHLNG CHAMBERS/PITS ITEMS TO NOTE Manufacturer Installation Bed Formation Number of beds oft •nches Length Width Depth Leaching area available: bottom: (length x width x no. of pit = sides: (2 x (length x depth (2'nlax.)+ , x (width x depth (2'max) x# of pits. Total leaching area available= sq. ft. LEACHING AREA REQUIREMENTS: Total leaching area(bottom +sides) x loading fa• or from 15.242 gals. This must be greater than or equal to the design flow for the system. Increase leaching area if garbage grinder is used. Distribution Trenches: every 20 feet Beds: area for pipe not to exceed 60 x 60 feet Spacing Trenches: 2 x effective depth or width Beds: 4 feet between excavation sidewalls. Manholes (min -one 20"access per unit; a 24"diam for>2,000 gal units) Stone around chamber('12" to 48"of 3/, " to 1 '%"stone) 2"cover of 1/8" to 'A" stone 4' separation between max. high GW and trench bottom? Yes No Pager 11 of 16 PLAN REVIEW-SYSTEM SITING Performed By Approval# ,. Witnessed By. Date Location Address or Lot Number: Owner's Name, Address and Telephone No. Office Review Published Soil Survey: NO YES Year Published Publication Scale •• Soil Map Unit Drainage Class Soil Limitations Surficial Geologic Report Available: No Yes Year Published Publication Scale Geologic Material(Map Unit) Landform Flood Insurance Rate Map: Above 500 year flood boundary No Yes Within 500 year boundary No Yes Within 100 year flood boundary No Yes Pager 12 of 16 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: Minimum setback distances (where applicable) shall be shown on the plan for the proposed disposal facility(septic tank and soil absorption system.) Soil Absorption Septic Tank System(SAS) Property line 10 10 Cellar waWiaground imming pool 10 20 Slab Foundation 10 25 Water supply pre line 10 / 10 Surface waters (except wetlands) 25 50 Pager 13 of 16 Septic Tank SAS Bordering vegetated wetlands, salt marshes, inland and coastal banks 25 50 SURFACE WATER SUPPLY 7Reservoirs and impoundments 400 .--- 400 Tributaries to SWS 200 200 aK Wetlandstributaries bordering SWS or thereto 100 100 Certified Vernal Pools 100 100 Private water supply well or suction line 50 100 PUBLIC WATER SUPPLY WELL /______Gravel packed 400 400 '0/ Tubular 250 250 Irrigation well 10 \\___ 25 Open, subsurface,or surface drains which discharge to SWS or tributaries thereto 50 100 Pager 14 of 16 Soil Absorption Septic Tank System Other open, surface or subsurface drains (ex- cluding foundation drains) which intercept seasonal high groundwater 25 50 Other open, surface of subsurface drains (ex- cluding foundation drains 5 10 Leaching and catch basins & drvwells 10 25 Downhill slope N/A 15' (min) to top of 3:1 slope Inspection Port(s) Magnetic Tape Correct#of deep hole per code revision Note: slope stabilization shall be provided (including retaining walls) when an adjacent downhill slope to a disposal facility is greater than 3:1. Pager 15 of 16 PLAN REVIEW CHECKLIST GENERAL INFORMATION CHECK TO VERIFY THAT THE PLAN INCLUDES THE FOLLOWING REQUIRED INFORMATION: V. REG. SANITARIAN, or MASS. P.E. stamp and signature f of 1"=40' for plot plan Scale of 1"=20' for system component details Legal boundaries of the facility being served including easements which could affect the impact the system installation/performance. All dwellings, buildings existing and proposed impervious areas Location of all existing and proposed impervious areas Location and dimensions of the system including reserve area l [/ Design calculations: Sewage flow gpd Septic tank size required gpd "provided gpd V North arrow,existing and proposed contours Location and log of deep hole observation test date of test existing grade elevations for each test Pager 7 of 16