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. I :B=51.D No. THE COMMONWEALTH OF MASSACHUSETTS FEE

BOARD OF HEALTH _~~I~aW~~L-_OF __ ~~~~~~~{~~ ________ __

APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Appli ca tion for a Permit In COnSlTlJ('\ ( ) Rcp<lir ~ LJp!!rad .... ( ) Ahandoll ( ) ~11PICh.~ System 0 Individual Components

SID ~Jli lA·. Lor 1-9 i 11 ~ Bw:;~t,; L,J.:a li,m ;, lD f')!) IJd ~ '3'+/ 'ifM hv--J+ OICOL

M~n:..:I~ L Lf 15' "2..C; (" - 0 2-..2:'0' Lpi # ~~~r~~+c~ ·rpt'" :,-k"ue-v

ln ~I,\lIc r"~ Naill ": P'O, f30~ 3'< / ~ .A,D':1:"::.t 'm 1/ Bu)O « -Addr .. · .... ( 'f 13"). ~5'f.a - '3'-/DiJ""'''' 33/Z--

T..:Icphon..: II Telephone /I

Type of Building: '21 "\71 e ±.wv.:lV h.. U~ Lot Sile Sq. feet Dwelling - No. of Bedrooms ________ Garbage Grinder (1)0) - Y"eYYIdJc.O Other - Type of Building No. of persons _____ Showers ( ). Cafeteria ( ) Other fixlures ___________________________________ _

Design Flow (mip. required) ,?'3V Plan: Date B 13/9 "I

31 D gpd Design flow provided __ gpd

Title ~ I ~ I f-"", evisio)1 Date ____ _

Descript ion of Soi I (s) -;;:====~N;;;-;;;-;;r~iE~;;,;;-;;;:-1tr,~~[S~~~~;;-;;;~E;;;;h;;;-;;;;;;-::::::Tt?Q'fjIT= Soil Eval uator Form No. _____ Name of Soi l Eva luator Date of Evalua tion __ C{-'=.J..1--'--_

DESCR IPT ION OF REPAIRS OR ALTERATIONS ___________________ __

~ Signed 1-7I'H"1t~~yv.~bl-f:P"P'_f~---------':l'\; Date -.<Lj'-<L-"<J'-I-+--------

Inspecti s ________________ ~~~~L-----------------------------------------------__

FORM 1 - APPLICATiON FOR D5CP DEP APPROVED FORM 5196

No. 99-17 FEE LriV THE COMMONWEALTH OF MASSACHUSETTS

.i/-w./,-.v5-+- BOARD OF HEALTH

CERTIFICATE OF COMPLIANCE Description of Work: D Individual Componenl(s) '!i-Complete System

). Repaired~. UD,,,adle< The undersigned he reby certi fy that the Sewage Disposal System: Constructed (

:~: ;;~"i~&d~:$+V-+~ has been Installed In accordance WIth the provlSlOns of 310 CMR 15.00 (TItle 5) and the approved

plans relaK'g,to :fhcato1nINo.~--(7 dated . Approved Design F101= .Jgpd)

Insta ller~ }f-~ \J !M: ~\I;t 8i31qq De"gn~.fu-t/w.~Gv:I~' S/t?/"I'Lspector 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. THE COMMONWEALTH OF MASSACHUSETTS

-L../frv,.:..:....:.-'----1-w:.::....:::S--'I-___ B OA R D 0 F H EA L T H '\

DISPOSAL SYSTEM CONSTRUCTION PERMIT

FEE

Permission is hereby gra~~9 to C ) Repair <:1:') Upgrade ( ) Abandon ( ) an individual sewage • disposal system at --"'-"-'O~__'_r;'_..U1UdU_.YC__l._LL-'--.--_ ____ __:;;;:;_- -------___:;""--,as described

in the application for Disposal System Cons~uction ~ermit No. __ .L7£'-''-'-.-J.(----'7'-__ , dated a? {, /YP~ . Provided: Construction shall be completee within three years of the date of this er onditions must be met

Dale c:;:;."'9'"?~} /9'£1 - Board of HealtlL.,;,p.!s<I~~~_';'<L~' ~~""-FORM 2 - D5CP"" DEP APPROVED FORM 5/96 ~~

FORM 1255 (REV 5/96} ~ H08BS & WARREN T~ PUBLISH ERS • BOSTON

--- --- --------- ---------------------

RECEIVED JUl 2 2 1999

'J .. . ! .. ;,; ... ' .?\l~3.1,~'-"~ "'''-'':': ,. illS-+ :::> •. ,~ .. " .Li"."--... -.;;:I'" •• , lli·" ···~·· .. Tl~+ ,.. ,li.i.i.; ~ ... ,.,-.<-+:::s;i.i.:.!:-• .,n>-.'.

7778 AMITY REAL ESTATE TEL "3-256-0226

5-20/ 110

AMHERST. MA 01002 . r,;?>- ,,$ 30 BOlTWOOD WALK ~

:;".~;~~g,,,._~-grl}JLa§,,Af:dQ;d,r $ /t;(},rJO

_ /f)1f#-c(j~d Ie c /4~ . .1>1----- 'DOI.I.AI<5

~ ~ .~Shawmut Bank ') ~ '-l1o~lOn , Massadlusclt ~ _ ~,/ ~ . ~ <J "tc~1u:!. ,£ . . p ,or. /' / ~~? , " F{)K~J!.I .. ' ;:J. \'," , ~ .;yrz: ~ lJ . --

,:Ol.l. 0 2Db: 3b 223Sl,b ( 7778 I I .'ilL .......... '" +.s. ," •... i . . IiU!O;;::+ ::5t." ..... ,,,"..-;Ji£;)· ..• "iI' .. ," :a::5i ..... Ii"" .. ~··mE .. ,·Q.::;s···· fi!ll .... ,,'L.., ';:-:.<: .... ..... "l.,. ... ,., ..... .. ,! ... ,,JJ

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No. ____ _

FORM 11- SOIL EVALUATOR FORM Page 1 of 3

Date: '7 ~olo- 7'1

Commonwealth of Massachusetts , Massachusetts

Soil Suitability Assessment for On-site Sewage Disposal

Performed By: .. ~!!..t.T. .... ~~-'I.:!':?:! ............ .... .................. _. Witnessed By: n ..• ,J.;A .. I/.!..r!.. ....... Z!.Jl~ .. ~.'?IA/ll/ . · ............. n ..... . .. ..

Date:

<-- ........ S""'/d /1-1 .. J.! /~ .... . .. ......... ....... ..................... .. ................................ .

i.it,,-A'~ w . 8" r; I'I~Z ..s7o /11, ef r;l1"'-. S"

.:zs-3 ~ <S"f. 2.

ew Construction 0 Repair r:a---. -----~------------~~ Office Review

Published Soil Survey Available: No 0 .Yes D

Year Published Publication Scale Soil Map Unit

Drainage Class .... Soil Limitations

Surficial Geologic Report Available: No DYes D

Year Published Publication Scale

Geologic Material (Map Unit) Landform · ................................... ............................................................................................................................... ..

Flood Insurance Rate Map:

Above SOO year flood boundary No DYes D

Within sao year flood boundary No DYes 0 \l!ithin 100 year flood boundary No Dyes 0 WetlllIdAz=

National Wetland InvCZltory Map (map unit) Wetlands Conservancy Prognun Map (map unit)

Current Wale!' Resource Conditions (USGS): Month

Range :Above Nonnal ONonnal o Below Nonnal 0

...... _-_._-----_._--_ .. -_. __ ._ ---_ .. _ ............. - ... _-_ ........... .

Other Rd'aaKOtS R.eviewe:I: ______________ ---, _______ _

.-

FORM 12 - PER COLA nON TEST

Location Address or Lot No. _--=C>=--'7:.....:.d......::./7,7.-'-','-'.!""'-"/'--"L,"'-~s::.::·y-__

COMMONWEALTH OF MASSACHUSETTS , Massachusetts

Percolation Tesf

Date: 7-.;20- '7) Time: 9.' (50 .

Observation Hole # I Depth of Perc '/:S-

/.

Start Pre-soak 9 : /0

End Pre-soa k Cf': .:2r

Time at 12" 7' : .,J..·r

Time at 9" q: :28

Time at 6" 9.' 3 v: '-/c

Time (9"-6") C'

vr-

Rate MinJlnch I f cl M 1/1 ; ..... .

• Minimum of 1 percolation test must be performed in both the primary area AND reserve IIrea.

Site Pllssed ~ite Flliled 0

PerlonmedBY: ___ ~~~6~~~)~~\ ~[~~/~~~~ ____ ' ~~~'~V~:_I~~~~~~,~c......::., __________ _ Witnessed By: _......:=_==:u~::::( ~'4:Ll::C/.£..t .s;;,..(~=/'.,,"-..;;~.!..N;.:3'''-'CZ-'''-'-'=..q:..J('-<' #~-......::.> __________ _

Comments: .

FORM 11- SOIL EVALUATOR FORM Page .2 of 3

Location Address or Lot No. C3'"7o /7'7, clef!.,

On-site Review

Deep Hole Number Date : 7::.~ - 9 f Time: Weather y ..... ,v ..... r location (identify on site plan) Land Use ._. . .__ . _ ... Slope (%) Surface Stones VeGetation _ . ...... .

landform

Position on lends cape (sketch on the back)

Distances from:

Open Water Body

Possible Wet Area

Drinking Water Well

fee! feet

fee t

Drainage way

Property Line

Other

fee t

fee t

DEEP OBSERVATION HOLE LOG'

Oepth from Soil Horizon Soil T eX'ture Soil COIOf Soil Other Svrlaet (Inches) (USDAI lMunsell) ~onrlng (Structure, Stones. Boulders. Consistency. "-

Graven

(8" . ,c:; (/

I"",f""" /cJ)"~ /<4-~-e. 6,'H;4-~ L g#p(, ry

3'1 " ;::;/f /CJ",.. Utcj'( .;J, rrS/~ ~ //!$ c· ~'17% J' ~ -n::J t4 //'

( Vd,..-"" .s;If 4-1J rj'( /vo r- l-6eT/<reJ!l /o/,I<. ,.

I3w L/ .--. sY' 31; ~(I/~~ -;;(~S h( k ~, ) . y' 7" (. /0 Y<l?5Y /Y'- t(!' c / -I/PJ L J..J'-/ _

y . 8 r~ fZ.- . I' ('2- (( ,.<-/\ ) /0"'-"-0

070 'j:J- 'f.c.

MrnlMU '" Of:/ Hvu~ i~uul"'O Af tv n cO L "'tA _101"';"( 'geoloQi<:l _________ --",...,,.- l)o¢RD8ocRct: ______ -:-___ _

DoRlI!!9 g'oyndw".r: SW>ding Wo'" in 11\0 Hoi.: __ ..:.."7-° _____ WHping from Pit Foe:.: __ -<;('-'/'.0:. • .:;/ _. ___ _

&IimcIod SoaonoI Iftgll G-ound W.,.,: ____ --t.f ..... 'Z<....d"--____________ '--___ _

DU AJ'!"Rovm POI1wl· 1lIt'7"S

.... - '.

FORM 11" SOn.. EVALUATOR FORM Page 2 of 3

Location Address or Lot No. _______________ _

On-site Review

Deep Hole Number Date: Time:

Location (identily on site plan)

Land Use .. Slope 1%) Surlace Stones

ValOetation ~ ... . .

Landlorm Position on landscape (sketch on the back)

Distances Irom:

Open Water Body

Possible Wet Area

Drinking Water Well

leel

leet

leet

Drainage way

Property Line

Other

leet

leet

DEEP OBSERVATION HOLE LOG"

Soil Color Soil

Weather

Other Oepth from Soil Horizon Soil T .xturt Surf.cr (Inches) IUSDA, lMunsell) ~onltng (StruCture. Stones, Boulderl. Consistency. "

Gr,wi)

, ,,1I1'Il/iw M OF 2 HUU~ I~UUIH~\J A I t \ ~T <" "",L.AM~

"-- ........ , Cgoologicl ____________ _ ~~'---------------------O!ptt1 to Groyndwater: Standing WafM in !hi Hole: ________ _ WMping from Pi! Face: ____ ,.;... ___ _

~ ~ ~~ ~ W~~, ______________________ ~ ____ _

DEl" ..uTROVED roaM • J,lJI"7"S

\

FORM 11 • SOn. EVALUATOR FORM Paae 1 of 3

No. ____ _ Date: r /ZO I ~'1 , . CommoDwealth of Massachusetts

JI. h? IJ t r..> f- . Massachusetts Soil Suitability Assessment for On-site Sewaze Dis,posal

Performed By:. B.ob.~r..i .. Sh\f.(~ .. .. u _..... Date: 7 ( ?f?./ 9'i ... Wimesscd BY: .uD.fA.v.'..id ... m.u Za ".:'Q'?" l'1.$ E;'u:.u.uuu.mu u.. ... u.'uuuuummuuuu" u.uuu

::::--« 7/D M ;ddle ~.r Subcl ; V, L.o+-"2..

L DtlC(.i f)e 60 j«.1+ Z

? ID fYlidd U 0+. A IIY\ /" '-u'.s ~ M;q () / DD '"'Z-ewe COnstruction 0 Repair 's4'

~------~----------------------~ Office Review .

Published Soil Survey Available: No DYes % . :;n:::I~:: I'L-!tq~m( m .. S:i~b~:::~~o!~le ... {~~~~~/k.:,~U~.it .m fJ1~~·: : uu Surficial Geologic Repol1 Available: No D Yes D

Year Published Publication Scale

:!;!~ Material (M!~ uuE.u~~:? ? u •••••• : ••. ::::::·:::::" : :u::: : ::.::: : ~:::":...::::::":::: ':.: ... :".:.::.:::::":"::.::: Flood Insurance Rate Map:

Above 500 year flood boundary No~es D

Within'SOO year flood bo~dary No DYes H Within' 100 year flood bounduy N~YesD Wetland Area: NatiODAl Wetland IDventory Map (map UIIit)

WedIIIds Conservancy Program Map (map 1liiie)

Current Watct Resource eoDditions (USGS): Month n/ RInge :Above Nonnal ONonnal DBelow Nonnal !"\ OIlIer R.cfaaK:es Reviewed: --

i ..

FORM 11· SOn. EVALUATOR FORM Page 2 of 3

Location Address or Lot No. --,50:::...!... I ::::,.D ~fI7....:...:..::ld:::::....=..d-,-1 ("----...::.&_+-_, _~_ h. eYs + (LiJrl'qine 8o:fYh)

On-site Review

Deep Hoi. Numbet Ju_ Date: ]j?o/ Cf1 Tlllla: Ie f.)c;, Weather C[!&t o_ 25- "" Loc.uon (lde~fy on lite plan) ~. .. . ... , • ..?ee.. . "-j1L •. ,"',, ...... _ . . _ .. __ .,_ .. _. __ ._ ... ____ ...... . . UncI UN I ~ __ ..... _. . . Slope (%) } - ' .0 Surface Stones . . ....:::::-i:l::~~_ .. ..... _.... .. . w.

Vegeutlon _ . ...a. v'¥'L. '. " .. ..... ' . .. ' . __ " .. . .. .... . ___ . _ __ . _ _ .' ___ . ___ ,_,_., .. _ ..

UncIform .~c-> 2 ...K!/'o..f..<...,

Polition on landsc.pe (.ketch on the back) ." Distances from:

Open Water Body I C;o feet:!: Possible Wet Area 100 feet .... Drinking Water Well '2-CO feet-r

Drainage way I '" 0 feet ~ Property Line t <:l 0 feet-l­Other

~ ---"I dl'V J1 vJ 0. -It ~

DEEP OBSERVATION HOLE LOG·

Depth from Soil Horizon Soil Textl..Irt Soil Color Soil Othor Surf."" IInchll) (USDA) (Munsell) Mcnhng (Structure, Stones, BouId .. , Consistency. '"

Gr.wl)

0-\ 8 Fi 1/ L.iA Pv-.'1 )Q't e. r JIl vtor.J- rvi <1..1 I.e.... '- CA vY\

..

18 - 51 '::,1/ Vr:SL lo'iR.~I~ 2,$'Is/", y"I\ ~lv:> ~ -tv f;'11 ;tot-

/0 'fP-}/3 IO~'f.5/8 we4~s ' -34 - !('D Ab r ')L-- V'J"v1(

46 - 5"'-1 Bwb F L.') I D'fl!.'l~ VI ool\..L. Y::y ;c0U-

PL.? Iv f~ ¥/9 € SL-i' ~;rl'Y\

; / I' (., 5~ILJ11fo 5'4- g 8 - /0/ c'Z V( ~L-- 2 .'if'i/ t- /o iM/v F;r.M .

ur ~ t1ULt!> I AI.' '''T ... .,. r D;J=.a~ ____ ~>~I~O~ __________ _

I!!p!blp G!puo!!lw"O! : StMding W_ in tho Hole: ~.,-~Vl,;..V...;N...;;;,;;c ___ Weeping In>m PitF_:....:..IIi"",i !):;.:,h.,;:V;.;:;_;;. • . ___ _ (),l" &8. ' S.-...... High Ground Water. ____ J,j!1"-'"''--_____________ --' ____ _

i.

lID' APPRovm POlIN • UlV7"S

FORM 12 - PERCOLATION TEST

Location Address or Lot No. 510 [f) \ d d fe s+-

COMMONWEALTH OF MASSACHUSETTS AWl he~5-1- . • Massachusetts

Percolation Test·

Date: 3-/20).'1 Cf Time: __ '1: _D.~_~6f() . Observation Hole # I Depth of Perc I S If

Start Pre-soak q:\D End Pre-soak

9:2."5 Time at 12"

9', Z.C; Time at 9" 9 " 1.. g Time at 6" 9: 3 Lf : 4'> Time (9"-6") {p; '1':;

Rate Min./lnch 1 ', It;

• Minimum of 1 percolation test must be performed in both the primary area AND reserve area.

Site Passed J2" Site Failed 0 ...... -............. _ ........ _ .... _ .. __ ..... _ ... _ ... _._._ .............................. _ ......... _._ .... _ .. -.. --.............. .

Performed By: --I-R ..... o"-b~("""v......L.t_-""'w-hL..:....;y...:::c..~'(" ____________ _ ~~~By:~[)~~~v~~~~~) __ ~~4~v~~~~~;~~~?~k~._· ____________ --__ ---------Comments: ________ __________________ 0 __ _

, . FORM 11 - SOn. EVALUATOR FORM

Page 3 of 3

Location Address or Lot No. 00 Phdd{a 61. I ~;pjNl's-l-( LDrl'"~fl]e 8o.fet,..;. z.)

Determination for Seasonal ,Hirh Water Tobie

Method Used:

o Depth observed standing in observation hole ",." ... ", .. o Depth weeping from side of observation hole ,,, ..... . o Depth to soil mottles 8'-1 inches o Ground water adjustment ...... feet

inches inches

Index Well Number ..

Adjustment factor .

Reading Date . Index well level

Adjusted ground water level

pepth of Naturally Occurring Pervious Material

Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? ~'5

If not, what is the depth of naturally occurring pervious material? --

Certjfication

I certify that on r.e! (q9 3 (date) I have raSSed the soil, evaluator examination approved by the Depilrtment of Environmenta Protection and that the above analysis was performed by me consistent with the required·training, expertise and experience described in 310 CMR 15.017.

Signature ~=21 ~ Date ' 7/2.0(99 ,

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DEEP OaSIRVA'TION HOLa

PERCOLATION Tllr

DECIDUOUS TRU

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WATEA SUPPLY UNIIPRESSURE)

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SOIL INYESTIGATION

Test Pit EL. 9(". OQ~ , Estimated Seasonal H~h GlOund Wate( EL. 35; 00 . Bedrock EL. > 8t...OQ Class ....L. soils.

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Water supply weUs within 200 feet and wetland resource areas wUhin 100 (eet of the proposed soil absorption system are as shown on the planview. Deep observation hole log and percolation test results are in attached Soil Suitability Report. Soil Investigation and percolation te~ting by Robert Stover, Certified Soil Evaluator, and witnessed for the .Board of Health by Q..vid 2.CO' ... O"Lf.,' Ie. ~ on / {7,.o l<tq ,

DESIGN CRITERIA

Design flow is for a l. bedroom house Wl-th(l~ a garbage grinder . Proposed septic tank: I Ii 00 gallons. C;tQrb .. ,c.. ~"'i,.,Ja-- ~ +a. .Dc.

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DESIGN CALCULATION

Required Flow: 110 gpd per bedroom. Total required flow 3 330 gpd.

Effluent Loading Rate: Percolation Rate ~ < 5 minutes per inch. Class _I _ soil •. Effluent Loading Rate ~ 0.' " gpd/.f.

Proposed !oil absorption system: Z. I e.a.c..1-l + re..,.., c.h.e S 50' I e""<3 by .3' w;d~

( , '~ by I' 1o .. leu.> d\,>~ lil"\e Bottom Area: <;;0 II l l. -rre J = Sid.waIlAra.: (so')(")4 'Sia;!': ~ Total Leaching Area: •

300 sf Zl29..sf 500.f

Soo:sf X O./LI 'j pUs+' ~ '370 9Pd Total Required Capacity ~ ..3J.Q gpd (o'k)

GENERAL CONPITIONS

1. This system repair plan i. prepared In accordance with TiUe 5, 310 CMR 15.00. Conslructlon shall conform to these regulations.

2. The installer shall notify the designer of any unusual conditions and .hal not modify the plan without the written consent of the designer.

3. All debris In the site area shall be removed and disposed of In accordance with the law.

4. There ill nD guarantee expressed or Implied to any user of a .y,tem Installed pursuant to this pian.

S. The Installer shall netify the designer when the system excavation Is ready for Inspecllon and the designer and the Board of Health when the Iystem Inslallatlon 18 complete and prior to placement of the cover materlal for ftna! inspection. NotificaUon shall be 48 hours prior to the time of inspection.

6. The on·site sewage disposal system shall be pumped and Inspectad as necessary and at least once every 3 years. .

CONSTRUCTION NOTES

1. Any topsoil. subsoil, stump •• ston~ debriS. or olMr impervlou~ materials . encountered during excavation shall be removed from th~ area of thllt . .Ieaching tranches. from five feet arqund !h~ lranch •• and from whereverlln i. 10 be placed. Any fill placed In or adjacenllo the trenches shall be a clean granular .and & conform '0 the specifications of Tille 5.310 eMR 1'.255(3);

2. The fini.hed grade above the soil absorption system shall have a minimum two percent slope to shed surface runeff away from the system.

3. Dlaturbed areas ahall be loarned. see,ded and mulched until otable vegetallon is established .

4. The pipes exiting the distribution box shan have the same invel! alevatlon and .h .. be level for a minimum of the first two feet.

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5. Existlnllsept!c tank shall be pumped. OSI b d d flip< '*, ~ . <II'1d remove"" . e. Any pal! of existing .0U absorption oYltem encountered during excavation nWS

shall be disposed of In accordance wllh the requirements of !he Board of " Health.

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I I ~I I...OWIiO R. '1,\.27 ' 5

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~ PLAN OF SEWAGE DISPOSAL SYSTEM REPAIR

510 MIDDLE STREET, AMHERST, MASS.

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LORRAINE W. BOGARTZ 510 MIDDLE ST., AMHERST, MA 01002

SCALE, A~ SI1D"'~ I APPROVEiI 8V

cATE: a/3/qq ORAWN 8Y ~ \0,) s

! PROFILE OF SYSTEM DRAWING NUMBER E SECTION AT "A-A": LEACHTRENCHE:S SCALE: H: 1""10' V 1""3' P.O. BOX3312,AMHERST,MA01004_3312 ~ SCALE: H: 1" '" 10' V: 1"" 3' . 413256-3400 '.

5 .. _ . ~ . ..- -· - .

AMHERST CIVIL ENGINEERING RICHARD COSTA, P.E, { ROBERT STOVER

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