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412 Septic Permits & Water Test J FFF COMMONWEALTH OF MASSACHUSETTS Board of Health, %JCACPAMFOIJ MA. CATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT to Construct(/Repair( ) Upgrade( ) Abandon( ) - VIComplele System ❑Individual Components T/ y I y ri.n-anon /.{✓ntDON Roan Owner's Name i /// J lw,tX., l tl5 Map/Parcel# Address lark Telept n crtZ, — 734(7 Installer's Name Designer's Name jtv.r.CA �y ilA A &ln1 A115 Address Address oAl M Mak)'�'q Fisv2 — W PMii Telephone# Tele hone# P (4i.3) ,5 2 ,SZ 9 1 Type of Building 5 tit G.l.-E PAM t Ly Dwelling-No.of Bedrooms 3 Other-'type of Building Other Fixtures Design Flow (min.required) 33 0 gpd Calculated design flow Plan: Date 9-1 -99 Number of sheets 4- Title Pi Asi Of PR.PosED SoHSort-FAGF 6CiLsiA 6E 0 I.ot Size 4.365 Aese sq.ft. Garbage grinder No.of persons w Showers(PC Gdeesnr( ) 4 9S Design flow provided 504- gpd Revision Date 9—) - 77 tsPa5 -L Sy sr it Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator R. eRrr ant Date of Evaluation jO-22 - qec HUNJZ./ Asset,41E DESCRIPTION OF REPAIRS OR ALTERAS IONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date Inspections No. COMMONWEALTH OF MASSACHUSETTS Board of Health, MA. CERTIFICATE OF COMPLIANCE FEE Description of Work: 7 Individual Component(s) 7 Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ().Repaired ( ).Upgraded ( )_Abandoned ( ) hv: at has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. dated Approved Design Flow (gpd) Installer Designer: Inspector Date: The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. 32 / I' Ap FEE #7J COMMONWEALTH OF MASSACHUSETTS APPLICATION FOR 'DISPOSAL SYSTEM CON' TRUCTION PERMIT Complete System ❑Indisidual Co Type of Building 5.h)GL<% fAM t c>1 Dwelling-No.of Bedrooms •� Other Type of Building Lot Size sq.It Garbage grinder 4--7 No of persons CO Sht sue{—) Other Fixtures Design Flow(min.required) .i13D gpd Plan: Date©/— COQ Number Tide P-RtJ aF Q,pesW s �tr4 4/S(7i'Y Design flow prosided�vN•O 6 gpd Calculated design flow heels ass evision Date O/ —63"od (4•1 s 41/41- ¢.A — Description of Soil(s) //'' ,�,,// Soil Evaluator Form No. Name of Soil Evaluator MVCiLQ1 14,20.Date of Evaluation DESCRIPTION OF REPAIRS ORAITERATIONS CC r) The undersigned agrees to further agre- o et to igned tall the Inspections v above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and to.• ' operation until a Certificate of gmS.)ras been issued by the Board of Health. !fj 4 Date /^5 No 39'-f9 CONIMONWL LTII Of MASSACIIUSETIS Board of health, /VOrliN ORIO, , MA. CERTIFICATE Of COMPLIANCE Description of Work: ❑Individual Component(s) •Complete System // The undersigned hereby certify that the Sewage Disposal System; Constructed 04,Repaired ( ).Upgraded ( ),Abandoned ( ) bv, DOFFY t, ULlAFCD bCVIVE9.7OwW tCAi//Y CM •FA, at /i/Z AI/D//BON /1°49D/L EXP.S)M9 has been installed in accordance with the pr ions of 310 CMR 13.00 (Title 5) and 94 approved design plans/as-built plans relat No. 37 '79 dated / —s'ZO°"Approved Design Flow application Installer DOFF/uI/ULAKD ��_�-T�.j1�^�� 0.9»0 �'-. /(OLf/9N Date 6- 24"ZO 2 Designer: 6140.14 A9H6/ANDS Inspector. The issuance of this permit shall not be construed as a guarantee that the system will function as designed. FEE /ai g to Owver's Name,D Gp ..4_ i '/ e��Local ion a C/� 2 Map/Parcel# t I i Address /r N y. �/ _. O Lot# t 'Y0. ' Installer's Name i AO re Designer's Name 1 - I • j))5 . �7 /Address T/Y �' � - I" , i I � , , `���• LTelephonea ,ki 477 Tele hone, !'�,,� P " —. _: £ L9 Type of Building 5.h)GL<% fAM t c>1 Dwelling-No.of Bedrooms •� Other Type of Building Lot Size sq.It Garbage grinder 4--7 No of persons CO Sht sue{—) Other Fixtures Design Flow(min.required) .i13D gpd Plan: Date©/— COQ Number Tide P-RtJ aF Q,pesW s �tr4 4/S(7i'Y Design flow prosided�vN•O 6 gpd Calculated design flow heels ass evision Date O/ —63"od (4•1 s 41/41- ¢.A — Description of Soil(s) //'' ,�,,// Soil Evaluator Form No. Name of Soil Evaluator MVCiLQ1 14,20.Date of Evaluation DESCRIPTION OF REPAIRS ORAITERATIONS CC r) The undersigned agrees to further agre- o et to igned tall the Inspections v above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and to.• ' operation until a Certificate of gmS.)ras been issued by the Board of Health. !fj 4 Date /^5 No 39'-f9 CONIMONWL LTII Of MASSACIIUSETIS Board of health, /VOrliN ORIO, , MA. CERTIFICATE Of COMPLIANCE Description of Work: ❑Individual Component(s) •Complete System // The undersigned hereby certify that the Sewage Disposal System; Constructed 04,Repaired ( ).Upgraded ( ),Abandoned ( ) bv, DOFFY t, ULlAFCD bCVIVE9.7OwW tCAi//Y CM •FA, at /i/Z AI/D//BON /1°49D/L EXP.S)M9 has been installed in accordance with the pr ions of 310 CMR 13.00 (Title 5) and 94 approved design plans/as-built plans relat No. 37 '79 dated / —s'ZO°"Approved Design Flow application Installer DOFF/uI/ULAKD ��_�-T�.j1�^�� 0.9»0 �'-. /(OLf/9N Date 6- 24"ZO 2 Designer: 6140.14 A9H6/ANDS Inspector. The issuance of this permit shall not be construed as a guarantee that the system will function as designed. FEE /ai g to CHECK OR FILL IN WHERE APPLICABLE No' ' THE COMMONWEALTH OF MASSACHUSETTS FER BOARD OF HEALTH di Fy or 4109 71—A 0 kleil in-Lc: -2 Appliratimt for Dir3pusal Illarkr, Cmuitrurtion tirraid Application is hereby made for a Permit to Construct (x) or Repair ( ) an Indisidual Sewage Disposal ..44, &n Po. oi 4 t 41,5 T./ LA,n-■ 0—si 6(7(ill Az col_ or Lot No. SyStECI at: Oaner Address Installer Address Type of Building Size Lot...L2...5(.2./4...Sq. fLiZ Dwelling— No. of Bedrooms ....3 Expansion Attic ( ) Garbage Grinder ( x) Other—Type of Building a No. of persons Showers ( ) — Cafeteria ( ) Other fixtures Design Flow EalZ.k gallons per person per day. Total daily flow 4 95— gallons. W m Disposal Trench— No Ccit Width ia Total Length k Q Total leachinEases Depth sq--ft -fdh•el Septic Tank—Liquid capacity/C90.gallans Length Width Diaeter Seepage Pit No Diame:er Depth below inlet Total leachingle4"")" - sq. Other Distribution box ( ) Dosing tank ( ) Percolation Test Re Performed by 0 7 - Hy"1 ley ,Asaiictoz- Date a - / 0 — 15/ Test Pit No. 1 _..2Lia.el Mute; per inch Depth of Test Pit Depth to ground water Test Pit No. 2 21 li minutes per inch De::h of Test Pit Depth to round water Description of Sion Q' e Tr,. /=0.1 5'I(14 I BIS' ,,I•peri %Sang /4 d c.-,I 146 ‘73 o we(•t-r-r C-7 row C 6-4-' ek-Ier 44t 9=63 " Nature of Repairs or Alterations—Answer when applicable Agreement: The undersigned agrees to install the nforedescribed Individual Sewage Disposal System in accordance with the prods:oils of TI TL 5 ef Sinte Sanimr, Cede — The undersigned further agrees not to place the system in operation until a Certificate oi Compliance has been issued by the board of health Signed Application Approved By Application Disapproved for the following reasons by Permit No Issued_ Dale Date Date Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF Catifirtar of Compliant, THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ) Installer has been installed in accordance with the provisions of Ti T1 5 of The State Sanitary Code as described in the at application for Disposal Works Construction Permit No dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE Inspector • +flug 11 S3 11: 25a Martha Fredenburgh 413-323-7532 p. 1 abed `•nd00Zt 66- 1J-bfV `Z ttv Sec Et4 !113M 11JV 1VA 13 :45 ,ue5 21 Quabbin. 2n'k+a1 .0 a or orb Box 1192 Stadler Street, Belchertowa, MA 01007 ��JJ// 413-323-7134 Artesian Well Date' 12-2-97 Nam:Colin. Valley Sample Report Date' 12-3-97 Address 58 Bond Street E. Lonameadov, MA 01028 Collected By: Daniel Berard Trot Supply: Well Sample Location: OAL 4585 No ' 1 Wright Nright Builders Soong Man. Lab # 02454 412 Audabon street Northampton, NA Leeds) TESTED FOR RESULTS MAX. RECOMMENDED LEVELS Total Colllorm Bacteria Neg Poe or Neg Fetal Conform Bacteria Neg Po8 or Neg MAW 0 1.0 mg/1 Nitrate 3.88 10.0 mg/1 pH 6.67 6.5-8.5 AIRsBaity 46.0 No Limit Don .14 .30 mg/1 Maltpaeae .02 .05 mg/1 Copper 0 1 .3 mg/1 Sulfide 38.0 250 mg/1 Chloride 10.9 250 mg/1 BASS= 36.0 No Limit Coadactivity 190.0 NO Limit Total Dissolved BoBdg 125.4 500 mg/1 'forbid*, 4.4 5 NTE Odense 0 No Limit Sodlam 6.90 20.0 mg/1 ^. Reach we only for Sore items listed above sad oa dm above collected date. Except for the fspowiag ,the monk woe band to be within aeeeptebk level+for D.E.P.Drinking water Staededs. t,,e then are say annlau on this fort, dp60 do sot hesitate to tall this office. David Fredmbtq►, Director abed `•nd00Zt 66- 1J-bfV `Z ttv Sec Et4 !113M 11JV 1VA 13 :45 ,ue5 CONNECTICUT VALLEY ARTESIAN WELL CO., Inc. PERCUSSION DRILLING 58 Bona St•PO,Box 424•Ent Longmeadow,MA 01028.0424•(413)525-7856•(413)267-4236•FAX(413)525-4112 Date: 7:),) From: �� )L•K FAX,TRANSMITTAL COVER sIIEET To: Connecticut Valley Artesian Well Co.. 1nr. Message: 4,1)7aiz_ 94 YS5 Loa -597 - 9a- 6 This transmittal contains A, pages including this cover p.ngc. Please forward the transmitted document to Iho port) named re:sUm1 as possible. In the event that you have not received all the pages rent or hose encountered other problems with this transmission, please conlarl the solider al (413) 525..7656. aped •`adOOZI 56- 11-61w ∎ZI IF sag Eit, PUMPS FILTERS GRAVEL WELLS INDUSTRY FARMS HOMES !113M lea 1VA 10 :A9 3ua5