468 Application Disposal Construction Permit 41-10-19 Cominonwealth of Massachusetts II),(
City/Town of Northampton Number
Application for Disposal System s r� ��
pp p Y
Con truction Permit Fee
Form 1A
DEP has provided this orm for use by local Boards of Health if they choose to do so. Before u ' e orm,
check with your local B and of Health to make sure that they will accept it.
A. Facility I formation
Application is here y made for a permit to:
Upgrade On-sit Sewage Disposal System.
1. Location of F cility:
Address: 468 Coles Meadow Road
City/Town: Northampton, MA 01060
2. Owner Information
Name: Coles Meadow Properties LLC
Address: 52 Ward Ave.
City/Town: Northampton MA 01060
Telephone: 413-575-7581
3. Installer Info mation
Name: Harris and Gray
Address:
City/Town:
Telephone:
4. Designer Information
rmation
Name: Thomas S. Leue R.S.
Name of Com 'any: Homestead Engineering_ Inc.
Address: 1664 Cape Street
City/Town: Williamsburg. MA 01096
Telephone: 413 628-4533
5. Type of Buil ing:
Garbage Grinder(check if present)
Other:Type of Building homes Number of Persons Served —
Showers _ Number of showers _
Cafeteria _ Other fixtures
Specify other fixtur s:
t5formsIa doe-06)03 Application for Disposal System Construction Permit•Page 1 of 4
Commonwealth of Massachusetts
City/Town of Northampton Number
Application for Disposal System $
Construction Permit Fee
A. Facility Inormation (continued)
6. Design Flow: 660 Gallons per Day
Calculated D ily Flow: _660_ Gallons
7. Plan: 10/3/19 Date of Original
Number of She is 1 Revision Date
Title of Plan: Plan to UQurade Septic System
8. Description f Soil:
loamy sand
9. Nature of Re airs or Alterations (if applicable):
New e 'c 'toutlet filter and alec filusing E1jen
technology.
10. Date last ins ected: 8/29/19
B. Agreement
The undersigned grees to ensure the construction and maintenance of the aforedescribed
on-site sewage di�posal system in accordance with the provisions of Title 5 of the
Environmental Co Ile and not to place the system in operation until a Certificate of Compliance
has been issued b this Board of Health.
Signature y Date 0 C4 P-0 19
Application Approved By:
Name C d Date to I 2ct
Application Map roved for the following reasons:
t5formsla doc•06/03 Application for Disposal System Construction Permit• Page 2 of 4
Cominonwealth of Massachusetts
City/Town of Northampton Number
Application for Disposal System $
Construction Permit Fee
FORM 2A - DS P
No. Fee
COMMOM'WEA elf OF %W.%;ACgfW.TI'T'S
Board of Health, Northampton, MA
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby g anted to: upgrade an individual sewage disposal system at
68 Coles Meadow Road, Northampton as described in the application for Disposal System
Construction Permit N dated
T-
Provided: Constructic n shall be completed within three years of the date of this permit. All local conditions
must be met.
Date Board of Health
t5formsia doc•06/03 Application for Disposal System Construction Permit•Page 3 of 4
Comrnonwealth of Massachusetts
City own of Northampton Number
App ication for Disposal System s
Construction Permit Fee
FORM 3A - CERTIFICATE OF COMPLIANCE
No. Fee
COMMON'W!EMT CW %WS%C1fV S!ETVS
Board of Health, Northampton, MA
CERTIFICATE OF COMPLIANCE
Description of W rk: ( ) Complete System ( X ) Individual Components
The undersigned h reby certify that the Sewage Disposal System: upgrade
by: H tris and Gray
at: 468 Coles Meadow Road, Northampton
has been installed In accordance with the provisions of 310 CMR 15.00 (Title 5) and the
approved design p ans/as built plans relating to application No.
dated 3 Approved Design Flow 660 (gpd).
Installer: Date:
Designer: Thomas S. Leue, Homestead Inc., Date:
Inspector: Date:
The issuance of his permit shall not be construed as a guarantee that the system will
function as designed.
t5formsl a doc•06/03 Application for Disposal System Construction Permit-Page 4 of 4
5 on
Commo I wealth of Massachusetts
City/Town f Northampton
y: a Form A - Application for Local Upgrade Approval
DEP has prc ided 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 your IoTl Board of Health to determine the form they use.
Form 9A is to be submitted t I the Local Board of Health for the upgrade of a failed or nonconforming septic system
with a design flow of less tha 10,000 gpd,where full compliance, as defined in 310 CMR 15.404(1), is not feasible.
System upgrades that canno be performed in accordance with 310 CMR 15.404 and 15.405, or in full compliance
with the requirements of 310 CMR 15.000, require a variance pursuant to 310 CMR 15.410 through 15.415.
OTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of a new
design flow to a cesspool or orivy, or the addition of a new design flow above the existing approved capacity of an on-
site system constructed in a cordance with either the 1978 Code or 310 CMR 15.000.
A. Facility Inforrhation
1. Facility Name and Address:
Name: Coles Meadow Properties LLC
Street Ad ress: 468 Coles Meadow Road, Northampton
2. Owner N me and Address (if different from above):
Name: Coles Meadow Properties LLC
Address: 52 Ward Ave. .
Northampton MA 01060
Phone# 413-575-7581
3. Type of F cility (check all that apply):
X Re idential _ Commercial
Sc ool _ Institutional
Other(specify)
4. Describe acility: three homes in one structure.
5. Type of xisting System:
pri _ cesspool
X co iventional system
Ot ier(specify)
6. Type of soil absorption system (SAS) (trenches, chambers, pits, etc):
Prop ;ed is a leach field.
7. Design low based on 310 CMR 15.203:
Design for existing system: 660+ gpd
Design flow of proposed upgraded system: 660 gpd
Design flow of cility: 660 gpd
Upgrade Form.doc-rev.7/06 Application for Local Upgrade Approval•Page 1 of 4
<C\ Commolwealth of Massachusetts
City/Town of Northampton
Form A - Application for Local Upgrade Approval
DEP has pr vided this form for use by local Boards of Health. Other forms may be used, but the
information rust be substantially the same as that provided here. Before using this form, check
with your local Board of Health to determine the form they use.
B. Proposed Up rade of System
1. Proposed upgra a is (check one):
Voluntary
_ Required y order, letter, etc. (attach copy)
_ CX Required ollowing inspection required by 310 CMR 15.301
Date of inspection:
2. Describe the proposed upgrade to the system:
New septic tank and leachsystem.
3. Local Upgrade Approval is requested for(check all that apply):
—Reduction of setback(s) -describe reductions:
_Reduction in AS area of up to 25%: SAS Size: % reduction:
,X Reduction in separation bet2"n
of SAS & high groundwater:
Separation r duction: fQ Qom( C� - mod AD b 't-
Percolation rate: min ch 1 t3S CaZn uj ) rf 0.
Depth to gro ndwater:_4411 r� t J �i 1� � S,�Qa Vol Ck
_Relocation o water supply well (explain): WC- 0'P 7 aah`�I i� - 4- J A- K)i
a R-e rL 0Y'l In I I ►1 Of -
_Reduction of 12-inch separation between inlet and outlet tees and high groundwater
Use of only one deep hole in proposed disposal area
_ Use of a siea analysis as a substitute for a perc test
_Other requir ments of 310 CMR 15.000 that cannot be met- describe and specify
sections of t�e Code:
Upgrade Form.doc-rev.7/06 Application for Local Upgrade Approval-Page 2 of 4
Commonwealth of Massachusetts
CitylTown of Northampton
b Form A — Application for Local Upgrade Approval
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information rnust be substantially the same as that provided here. Before using this form, check
with your local Board of Health to determine the form they use.
B. Proposed Up rade of System (continued)
If the proposed upgr de involves a reduction in the required separation between the bottom of
the soil absorption s stem and the high groundwater elevation, an Approved Soil Evaluator
must determine the igh groundwater elevation pursuant to 310 CMR 15.404 (1)(i)(1). The soil
evaluator must be member or agent of the local approving authority.
High groundwater aaluation determined by:
Evill
v luator's Name: Bri Eichstaedt
Ev luator's Signature: v� Az'
Da a of Evaluation: 9/27/19
C. Explanation
Explain why full compliance, as described in 310 CMR 15.404(1), is not feasible. (Each
section must be mpleted)
1. An upgraded sy tem in full compliance with 310 CMR 15.000 is not feasible:
The red ced offset to water o cost savings.
2. An alternatives stem approved pursuant to 310 CMR 15.283 to 15.288 is not feasible:
Conventio4ial system is sufficient.
3. A shared syste is not feasible:
Not necessra .
4. Connection to a sewer is not feasible:
No public sewer in area.
5. The Application or Local Upgrade Approval must be accompanied by all of the following
(check the appropriate boxes):
X Application f r Disposal System Construction Permit
X Complete pl ns and specifications
X Site evaluation forms
_ A list of abu ers affected by reduced setbacks to private water supply wells or property
lines. Provide p oof that affected abutters have been notified pursuant to 310 CMR
15.405(2).
_ Other(List):
Upgrade Form.doc-rev.7/06 Application for Local Upgrade Approval•Page 3 of 4
Commonwealth of Massachusetts
Cityfrowr of Northampton
Form9A - Application for Local Upgrade Approval
DEP has pr vided 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 your Io' I Board of Health to determine the form they use.
D. Certification
1, the facility owner, certify under penalty of law that this document and all attachments, to
the best of my knowledge and belief, are true, accurate, and complete. I am aware that
there may be si5inificant consequences for submitting false information, including, but not
limited to, penal ies or fine and/or imprisonment for knowing violations."
JAACr IjO G o
Facility Owner's Sign tura D e
Coles Meado Properties LLC
Print Name
Thomas S. Lee Homestead Inc. 10/3/19
Name of Preparer Date
1664 Cape Street. Williamsburg, MA 01096 (413) 628-4533
Address and Telephone Number of Preparer
Upgrade Form.doc-rev.7/06 Application for Local Upgrade Approval•Page 4 of 4