52 Septic Upgrade Request & Permit 2010 BOARD OF HEALTH
MEMBERS
SUZANNE SMITH,M.D.
DONNA C.SALLOOM
JOANNE LEVIN,M.D.
STAFF
Benjamin Wood,MPH
Director of Public Health
Patricia Abbott,R.N.,Public Health Nurse
Aimee Petrosky,Health Inspector
Heather Mcbride,Clerk
May 19, 2010
CITY OF NORTHAMPTON
MASSACHUSETTS 01060
OFFICE OF THE
BOARD OF HEALTH
RE: Local Upgrade Approval 52 Autumn Drive.
Dear Board Members,
212 MAIN STREET
NORTHAMPTON,MA 01060
There has been a request for a Local Upgrade Approval at 52 Autumn Drive. In 2008 the
Board approved the same variance request, but for a different plan. With the submittal of a new plan
the Board must vote again. Based on 310 CMR15.410 I recommend to the board that we approve
the variance request.
Aimee Petrosky
Health Inspector
Northampton Health Department
212 Main Street
Northampton ma 01060
Dennis R. Lacourse
238 Park Street
Easthampton MA. 01027
May 7, 2010
City of Northampton Board of Health
RE: 52 Autumn Drive repair
Dear Aimee,
I do not recommend that you approve this permit request until the following
changes to the plan have been made.
Plan should be designed for Garbage grinder spec's.
Date Received:
Title V Checklist
Owner: t LLe•6 Re naooN Address: S-2- Ann 1 -wt
Engineer: 5, t'.' ' Installer: L„ VA Ilzy
Z P 5 Make sure 4 copies of the plan are submitted (do not accept permit
application until we have 4 copies of the plan)
Give the permit a number (use computer based log)
Make copies of all documentation including checklist
I // Send Copies to Dave with two of the original design plans and put
originals in gimee's Box
Dave Approve Plan. Send letter to BOH noting approval or corrections
that need tg be made. Also send a copy of the checklist.
plans.
Once letter from Dave is received AP or BW will sign permit and stamp
Before we issue construction permit staff must make sure installers
name is on the application AN' ins a er as a p . us. DO NOT
ACCEPT MONEY OR PERMIT I INSTALLER DOES NOT HAVE PERMIT.
Contact home owner or installer that plans have been approved.
J
Either mail them or have them come pick plans and permit up.
AP will schedule Final Inspection and contact Dave
VV Fin al inspection is passed and "as built" received.
iCert,/of compliance Issued.
/CLOSED
4 ■
COMMONWEALTH OF MASSACHUSETTS
Board ofH i0U /949/�'t/NA.
ICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Spplication fo a Permit to Construct( ) Repair Upgrade Abandon( ) -XComplete System ❑Individual Components
FEE P➢
2plo\,- Y
Location G ,€ p4R4qo� 4(/
Owner'sName £-ZttXl /2/ZgY/2_40/U
Map/Parcel# �^�%flV �' 4't
Address 5 Ate;7v / •/ X) Q� a�
/5a
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Lot# /VQ2�-i Ai/4
Telephone#*0/ -/ �� ^ 4 z o In
IYJ,�'u%�v/1
Installer's Name A 41 lC�(IIJ- 1'IUM:'1Gh I� "�;
i
Designer's Name /a�jief__d/9 r Sit/WY
/1�G/
Address r of st.,✓yyhrer
Address /0Q//}GT KZ Lain
Telephone# . Qi3.. 5jQ, - 04 ° 4
Telephone# 1/43 - F/fi i8/7
Type of Building /I Y 5 7 ,0 T/,/G /7P79 n Lot Size a/57.--- sq.ft.
Dwelling-No.of Bedrooms (3 Q .rcd�i�T
9/SN 6✓�/�e- 51�'U Garb/,age grinder ( �S
Other-Type of Building G/ J`%� 4 /"/ % n No.of persons 63 Showefth Cafeteria(4.)/62
Other Fixtures 7 / �'-'r / L2/t-t' &�1. , -,/ /s,O Ei/iP�01
Design Flow (min.required) 33tl x/L t..gpd Calculated design flow 7 9� Design flow provided T 9W gpd
Plan: Date /7�.e/L AO 07 0/Kulmber of sheets /
Revision Date
Title %°°' ( 'S/5 r r2 w/o/0 re/e_ c 1U t44!16'c/
Description of Soil(s) ie0 jT7/,-Liy4T%J /
Soil Evaluator Form No. Name of Soil Evaluato 4405 r%Q / to of Evaluation / /3 /" "�
/4 S/26/L14-J 7 0%7
DESCRIPTION OFREPAI s O ALTERATION.
COt2-7/1 e ,sy1loin uFJ9,n2ct ki 3/0
C MJy2 /S. 0 ,4-4a1 / 7, des-'/evu / pr
B0/V AP & s
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 X Date
Inspections