710 Perc Records 6-12-97 � T
FEE
COMMONWEALT1r OFLMASSACRUSETTS
Bo rd of Health, lhy q r`h VY1��C�l �. iVIA.
APPLICATION F DISPOSAL SYSTDI CONSTRUCTION PERMIT
.pplication for a Permit to ConstructX5 Repi ir( ) Upgradc( } Abandon( } - J Complete System U Individual Components
!,)cation J CT{1�_llfrY15 Reard r fhe S Owmer's Name
Map/parce?# 211 Address5h&t1
Lot# L4 Telephone# (413) 586 ..8
Installer's Naine I}esigner's Name Nel- fa. e. 3vrve c5y -I r--
Address Address l . PO.&X 1
Telepbanett Teleplyone# 7'� (�L`5b 6c1Ugiar" T
- .... — —
Ype of Bililding HOUi5L Lot Size 91. sq.ft.
/a'7'.gLtivtd�t�
,welling-No.of iicdi•ot7tns Li I(Zile) Gar age grin(er( }
►Hier-'Type of Building M _ � No_of persons Showers{ },Cafetetia{ }
Other Fixtures
•esign Flow(twin.required) y�,�{� gpd Calculated design flow��� Resign flow provided�{� _gpd
Ian: nate .jCino(ll. 4 11*O,,3 Nt4nibrr of sheets Revision Dake Marc i, zO t ZW
itle No rer v�c�ctici� F�E(l.l^ nt -Pre) 0cwg4e- Dotpo6od 5vskm, Parcd 'f
escriptionofSoil{s} ODFC_- B&II `601— l-"'
Al 1z.
,-,11nator F'orut No. ! Naine of Soil E� luator fAf R�e�� Date of Evaluation � �
ESCRIPTION OF REPAIRS MUTE En I
nlf?Cleaf-J-1 Pie-ld
I
OF MqS
E v ' and
he undersigned agrees to install the above described Individual SewaID , sal System in accordance withthe aYovti � �irther agrees to not to place the system in operation until a Cempliance has been issued by the i13 ird of alth. m
FWEISSE
gned 1+ Nti 9623 ti
1
- ]'FE
APR 2 3 11998 COMMONWEALTH OF MASSACHUSETTS
Board of Health,
CERTILICATE Of COMPLIANCE
)escription of Work: ❑Individual Component(s) ❑Complete System
'Ila:tindersigned hereby certify that the Sewae Disposal System; Constructed( ),Repaired( ),Upgraded { ),Abandoned ( )
t
.as been installed in accordance with the proviso of 310 CMR 15.00 (Title 5) and the approved design plans/as built plar►s relating to
pplication No. dated Approved Design Flow (gpd)
:lstaller I —
lcsiguer: Inspector: Date:
lie issuance of this permit shall not be construed as a guarantee that the system will ftmction as designedi
N v U COM AONWEALT11 OI; ASSACHUSLTTS .
F r ri t� IWA.
Bo rd rJHealtl:,
0
1-0 z
DISPOSAL SYSTEM CONSTR 'CTION PERM11
I i4irishereby T �rttc r (.onstrtct( Repair( ) Upgradc( ) Abandon( ) anin(cliviidualsewagedispos. system
1r.�- j i/� �•�['�'S�rF'�k cljibeci in the application for
WS 161 ,stertr Construction Permit N ,,[ 1,dated �l �
'rctlntq-f- Cottstrtrctiolt sltall be cttmpl�rtccl witllill three vearS of the cl<tte bf this;l� mi All local cattctitic�lnittst be met•
germ 1259:fT,&50 AM.Sulkin Co.BOSlorl,MA D.to / ioard of Health
t i
I
No d.�/ THE CO
:W
NIMOII7WEAi.TH t7 i' MASSACHtJS T'fS :.' ."'F6E', '
OARD OF HEALTH-
OF
APPLICATION FOR ISPOSAL SYSTEM CONSTRUCTION PERMIT
application f(tr a Permit to Construct R .i, ( ) Ul,g,.de ( ) Abandan ( ) ❑Complete System 0 Individual Components
lvd j � '&W
Lekxtion 0 ner's Naine
7/66 AJO
11a}uParcei� res �
Lot p Ughone 9 — l
j h'f.1J71"IAWK�
Irmaller's Name �-De ' ers Nam
AlThK
Address �..
Telephone x it
'ype of Building SIN t 4:tc r - m)Lx'I Lot Size ` q.ft.
)welfstig-No.of Bedrooms Garbage grinder(-K
)cher-Type of Building No.of persons_�Showers
)(her Fixtures
)cs ign Flow(inin.required) _ " Q gpd Calculated design flow Design now provided LdI `9p(i
'lan: Date 1t7 Malt `_ umber of sheets j Revision Date
itEc R U F �J j�
)cscription of Soils %. +-j +� Akl �' V 4 m� /
oil Evaluator Foran No. I Name of Soil llvaluator Cr N Date of Evaluation
)ESC:RIPTIQN OF REPAIRS ORAIXERAT1 DNS
"tie undersigned agrees to install the above escribed Individual Sewage Dispose#System in accordance (with the provisions of TITLE 5 and
itrther agrees to not to place the system in peration until.a Certificate of Compliance has been issued by the Board of Health.
igued Date
uspectious
i
�'clidl4t i i - S(li'L h'!'ALL'A'I'OR FORM
Page I of 3
No. � Date. � 1�
Commonwealth of �assaclhi�setts
` oR`fl�rrt PTD0 , Massachusetts
Soil SuiLdiii' Aisessment or On-siie'Soka DISAW4L
Performed By: lINA& Date:
Witnessed By: MC i d - ���Lii 1 0��5-��•,
ux".0 ,week,d Lo. - o»�r�w O! eF�T PA"PE E S
u.. Ak,9:71f FAP-M, �omu..um (,ate t i t Cz-D C.A}
utepmm t N�i 1-tr4-,�+�(7-1�1�V• Yv1 r'�
lewConstruction M<1ze3alr ❑ - 3
Office Review
Published Soil Survey Availa le: No ❑ Yes -
Year Published (4 (.... Publication Scale Soil Map Unit 6u c
Drainage Class W DRA+AJEQSoil Limitations AAvf)tW j� 5c,4 jq41
Surficial Geologic Report Av Table.No ❑ Yes ❑
Year Published .- Publication Scale-
Geologic Material (Map Unit)
Landform- (-1 %C-1.14.1.a ......4/PA H.w
Flood Insurance Rate Map:
Above 500 year flood boundary No C1 Yes DEr
Within 500 yeah flood boundary No 2/yes 11
Within 100-year flood bound No L''TYes ❑
Wetland Area:
National Wetland Inventory ap(map unit)
Wetlands Conservancy Progra) Map (map unit)
Current Water Resource Cond tions(USGS): Month
Range :Above Normal ❑N rural ' ❑Belvv Normal ❑ -
Other References Reviewed:
DEP APPROM FOW4.13.07195
• t I
I
rap 4f
v
Deep Halt Number Date:
Time. -Weather C—LiEAC
fZIC062
Location (identify on site plan)' . I -
Land Oso 1.,P4,AvD �fog.La;j— Slope (% 4 Surface Siones
Vegetation - je4ect-1 -
Landform
Position on landscape is etch on the back)
Distancos from:
Open Water Bodj, feet Drainage way fact
Possible Wet Are It 4- /$a' feet Property Line too 'feet
Drinking Water :4 11 N/,4 feet Other f 3oo' Fgm je.;,4P
'HOLE LUG
DEEP SERVATION
Depth train Si.018CO Saii Houton Soil Textute Soil Dow Soil monijimia Other
tlntnesl lV$0Al (Munsell! Istrums.Stones, Bouldtf I,
'5AAo1Y YK 3/4 141 RC,475- -
q- -94 "
5AAi,/ 16 A+/( tqlA
LoA A
Y 4/32 M A,
Parent Material (geologic) LbACI A C _rt LL,. Depth to Bedrock:
Qegth to Qrowndwatjr; Standing Water in the Hole: Aj111 Weeping from Pit Face: AJ'Tt'
Estimated Seasonal Hion Ground Water: AIIA
F0k%I 12 - PERCOLATION TEST
COMMONWEALTH OF MASSACHUSETTS
AiO NAMp-�Z)nl; Massachusetts
Percolation Test
Date: iUNE 12-1 Iq9 Q Time: q ,.,00AvA -
Observation Hole #
Depth of Perc �� �► ��°' 3 /, .
Start Pre-soak
10
End Pre-soak
Time at'12" ti 1 - 3a
AL
Time at 9" A v �� �� y
i 44 A-M
Time at 6"
; 3* AAAA
Time i9"-6"1'
i2 �►�u��S d � ti.v t5
Rate Mina/inch �1P L AA-?t
Site Passed Site Fa fed ❑
Performed By: � . f
Witnessed By: P Lt Pr&
Comments:
,r N
F'�►ttaji!U-f MODLA11ON TA1'
-w.....r.�rgr�t�tt'1S1r7�rS!!.6:fi'k:'.•r '•' t.00i d1't:Ot'HO:. _ �.,...,......_._•.............�.-•{•-_y,. .._..:.�.,. y
4,�'+
MONWEAC
• � ,Massa�et>asetti
i Permlation Test. `>
d Dater
Ot+"Mdon Nolo 1 {
LMpth of Yore
Start Yrrsosk "( f "1 :.� • '}.`�-..
IEnd ptrso*%
'r
WHO at ir
7�ions at 9' 0
•luno ai 6' f' � ^ � -_ _.. - ...
I
Tornio t9`•6'! ,... _ r - ....... -i •- - ..._
• .. ,. - - f e if'�raJkuJL .:_"• �'1 � --•'-'�'- til �v
'IMr�inaum Ot��£j`Oenl` tiotf fast amst lw peefjooniasl Tn bath the Wknwy arcs MIO
Sora " 00 -SJteF,eiYd .❑ -
1M1fi8rsaasa8 fay:
77
L4:
OtrarsaO��iieRN-wfM
414
IINX�
• , , ,pad,,,/;�aa� , jar ,j�� I . . ♦ . �� , , .
417ft
7
'lit 't/� ` •t
t�
IOpt
t
cr
IIIIi � I (4,,.•�6�t. 4�- 700 h
1 t'.
u� �� �+• ,,. +....," ••+ tip . r 4
' NV
i
'
I
OF FF rJ_ 1
,1 Y COMIONNNILA R Of MASSACHUSETTS
iNN;S � �
SL'2 Boa�dofHealth, /�t'M- 6 jM' U , MA.
1 T� � I ATION TOR DISPOSAL SYSTE 1 CONST UCTION� MR.MIT
pplicatiob it to Gonstnict(01 Rep ir( ) Upgrade( ) Abandon( } - 0 Complete System 0 individual Components
Location to Owner's Name ]
Map/Parcel# ii.a.�. ,q� '• 2o _ t JL¢Gft. _ o Address (aa J �l��.i►' ��'3NL�
Lot# Telcphone 1. 513 ^..q 3•
Installer's N arne k Designer's Name t� M t1 l Aw i s S
Address Address L � '
Telephone# Telephone* 52 7 -5 Z-11
pe of Building 5w z� Ltit Size I z aw-&q ft..
welling-Rio.of Bedrooms Garbage grinder(�
ether-TtTe.of Building No.of persons Showers� Gaf—me 6.}-
ther Fboures
esign Flow(min.required) Q gpd Calculated design flaw•!!J��� Design flow provided -7gpd
lan: Date /0-.75 q0 timber of sheets Recision Date
itic P4,661 Or PROdO660 , S u / aL
esa iption of Soil(s �- d +� Z U s -17 '
_ Name of Soil Evaluator�. MA AMI t tate of Evaluation
.ill Fvaluator Form No. �1!
ESCRIPTION OF REPAIRS OR ALTERATI NS
i
he undersigned agrees to install the aboveescribed Individual Sewage Disposal System in accordance with the provisions of T rU 5 and
trther agrees to not to place the system in peration until a Certificate of Compliance has been issued by the Board of Health.
,gncd Date
tspections
i
COM �'ONTNATLALTN OF MASSA',GIUSEITS FEE
B ),d of Mealtli, NIA.
I r
EIRTIFICATE OF COMPLIANCE
lescription of Work. U Indhidual Componelut(s) J Complete System
'he undersigned hereby ccrtift,that the Sew,ge Disposal System: Constructed Repaired Upgraded Abandoned
t
as been installed in accordance with the pi Osions of 310 CAM 15.00 (Title 5) and the approved design plans/as-built plans relating to
pplication No. dated Vproved Design Flow_(gpd)
11"tallcr
Inspect()].: Date:
he issuance of this permit shall not be cons-rued as a guarantee that the"em will function as designed.
ts q C� Ir,
COMMONWLVIR Of, ASSACIMS-ETTS
10 9) 0 CL Board of Health, xu
> DISPPO-AL SYSTEM CONSTRUCTION K-RMIT
0 Q 0
yPtPiQfj5 hereby -tted-w; Consti, Ict( Repair( ) Upgrade( Abandon( )anindixidtialsew-age(lispo-salsy.,,tem
y qai
.-D r-4
9i--1 0� bed in the application for
42,o r—�tA -v"X, i,�( .-
1:&,stem Constructiont Permit N.. -5fE,-2-7 dated
�f IVIe ca
;fflfi
btvx*4 Construction shall be completeduithin three years of the date 0 this M kjj� JcOndjtjqp6,rrz,4stbemet.
-d of Health
irm 1255ftfi.15,'96 AN Sittig Co."On.MA Date //P', 4Aow
c
Sample #4862
HOWARD LABORATORIES, jNc
50 North Pleasant Street
Amherst, MA 01002
MA Lab Lie# X-40851
WATER ANALYSIS REPORT
lyzed For:Robert Bates Sample. Location:710 North Farms Road
-ess: 68 Shelfield Lane Northampton, MA 01060
Florence, MA 1060
Sampled By: RENSHAW WELL DRILLING
Date Sampled: lb/14/97
phone: (413) 584 8439 Date Recei.ved:10/14/97
Parameter jesults Limits Comments
Total Coliform
Bacteria 0 cotanies/100mL 0 colony/100mL OK
pH 7.9� pH Units 6.5-8.5 pH Units Ox
Manganese 0.7, mg/L 0.05 mg/l
Hardness 94. mg/L No Standard <50 soft, >100 hard
Conductivity 0.27 ms/cm No standard
Chloride 89. 2 mpg/L 250mg/L OK
Iron 2.3 mg/L 0.3mg/L
Sodium 9.0 mg/t 2amg/L OK
Nitrate 0.1 mg/t 10mglt OK
Nitrite 0.00 Mg/1 t atglt OK
Color 78 PtCo CoLor Units 15 Pt Co Color Units
is
Turbidity 13 .it NTU 5 NTU
ammendations: Iron, manganese, color and turbidity are normally elevated
newly drilled wells. Use water for 30 days then rejest the parameters that
elevated levels.
s sample does meet acceptable standards of potability for public water
plies except for the parameters marked with an asterisk (*) , however,
re -are no state or federal standards for individual use of well water.
lyst: JB Date: 10/14/97
--ked By: Jonathan S. pqg
Laboratory Supero' or
i
w i
Department of tnvirgnmental Management/Division of Water Resources
VEa;L COMPLETION REPORT
WELL LOG TION GEOGRAPHIC DESCRIPTION i
Address �t
M (S} EW of
ttsar) rcfal
CityrrowXI
MM_ ,_ t t
Wait owner tSCr �'c •�,- �, F_c
Address N E W at
�,. [mr.to fnnthsl t...�[ctrctej 4
Board of Neagh permit obtained: yes Q no L2 intersect
f�1
WELL USE WELL DATA
Domestic 5� Public Q Industrial Q Total well depth i j Q ft.
Monitoring Q Other Depth to bedrock ft.
Water-bearing rocklunoansolidated material:
Method drilled-,A:_, _k r,
Description
Date drilled . �r. 191''7 Water bearing zonas:
CASING 1)From j,C C To : 2�
Type f 2)From To
Length._)_.2_tf. Dia(t.D.)_�,_In.
8)From To
Length into bedrock r':� ff. Gravel pack well: dia.
Protective well seal: dia.
Screen:
Grout Q Other pie_ Slot# length from to
t
STATIC WATERILEVEL(all welts)
Static water levei(lbelow land surface
ft. Date ft'�g���r
WELL TEST(pro uction wells)
Drawdown 1$�_ft. after pumping hr. T.; min.at gpm. i
z
Now measured,' Recovery ft. after_�_ hr. min.
LOG of FORMATIONS COMMENTS
Materials Prom To
7 Driller—_Z11, Sir' s
.t,.s Firm .-
t
Address - Ii
•f City/Town
Supervising Drifter Reg.#
S+pnarure of supsrvsmg registered weH t1r81er
Pismo
pot hmrJy I
BOARD OF HEALTH CONY
tion Address or Cot# 77 <
Note NUUW Bate lime 1 Weatlser I
-ovation :den' onsite plp ,
t..aad Use I 2ope % Surface Stones F
Vegetation .
t..andform
taro on sketch on flee back
t?istau•ices fraaro:
sen Water Body ao feet I D4nkkq Water Wd feet Prqw4y tine feet
ssible Wet Area u-0 feet DfakiNe Way feet 01her leer
DEEP OBSERVATION HOLE LOG"
Hole#f: 'MMM IU OF TMNO UOM K-QUMM AT EVERY PROPOSW DISPOSAL AREA
xe ban SaliolUm. Sol Tedm San Conor• Sol Offer
;a S 43ouldeis, .74
j I
J
t � - y1 � - _
l t.
eEt
111** V�P . WkOM PEC8rwyRW0Wto } R
SSaS" ^^W,. WW
' "•K•�
C DEEP'013SERVATION HOLE LOCa°
Hole M OF rwo HOLES REQUiftED AT EVERY MOPOSEO DISPOSAL Am
A bom Son HWbDn Sd To*" : :. Sal Cabr. Solt
- Stones.l3addecs, .x
1 t✓j ��{
Ball 'a6k .
b waberin�e taste I ..^ w .__tEars Pit Fars
E*nated&&"A dWaler
A dtti s
FORM 11 - SOIL LVALUATOR FORM
Page 3 of 3
Location Address or Lot No. zv-ol
&term axion fim Seem analffigh Water Table
Method U%ed;
Depth observed standing in observation hole..41 inches
❑ Depth weeping from sid of observation hole inches
Depth to soil mottles 7� inches
Ground water adjustment feet
Index Well Number .. . I_ Reading Date ... Index well level
Adjustment factor .. ........ Adjusted ground water level .14'ON6 6135dRVEP
Depth of Naturally Occu ring,Pervious Material
Does at least four feet of naturally occurring pervious
rvious material exist in all areas
observed throughout the area proposed for the soil absorption-system?
if not, what is the depth of naturally occurring pervious material?
Certification
I certify that on (date) I have passed the soil evaluator examination
approved by the DipArtment of Environmental Protection and that the above analysis
was performed-by ime consistent with the required training,expertise and experience
described in 310 CMR 15.017.
Sign i�tura Date 4-
DEP APPROM FOILM 1210719S,
` Post x
y
-site Revi°, W
Deep Hole Number Data: (01- Time. IlWeather CZtfi�=�G o/
Location {identify on sitelan) _
Land Use Gf ZAjvQ Fv. X47 Slope too) { . `aft Surface Siones 50 E
Vegetation OAC_7-. ►j� P�,v -Ae_cH ASH
Landform Ti Lt. Qt 0 +€
Position on landscape (sk tch an the back) ...
Distances from.-
Open
ront;Open Water Body �1�G feet Drainage way feet
Possible Wet Area ts'o f feet Property gine!.(40° feat
Drinking Water W II )� feet Other � '3o-a ' �,� -v AA 12Cr�,p
DEEP 013STRVATION HOLE ]COG
i
Oeptn from Swtata Sara Hor,:an SO Tamura Sa,l Cour Sar+l atottlow other
ttaertiest tus0A1 .Wunsell) (Structure,Stories.90wWra.
Cons,stency. % Grwer,
7
4/q-, 01.AVkL
too.,
Parent Material (geologic) 6,Lv&,c_iA . b t
, Depth to Bedrock: j
peDth to Grcwndwater; Standing Water in the Hole: Weeping fI rom Pit Face:
Estimated Seasonal Mrgn Ground Water: �yC