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Lot 6 Septic Application & Plans FEE 75 COMMONWEALIII OF MASSACHUSETTS Board of Health,MORTW+mprre tJ ;111. ATION FOR DISPOSAL- SYSTEM CONSTRUCTION PERMII to Gonstruct(y1 RepairO Upgrade( ) Abandon( ) - 7 Complete System ❑Individual Components Location IDLES 03/3gA0191.3.) RD Owner's Name tc i aVILDaFS I Map/Parcel# 1� Address ZS Sycv,A ti,s, I-+lIoLey MA EDP* Telephonc# /4.`''37) 544- 42n ° l liuraller3 Same t �7 . hvlt � Designers Name'rt..-o Mk6.iN k Address RAOLel M Address 7oMosrn- 'E RP- lW� Mpsm�o+l.MA Telephone# (443.) SZ-) — $2q1 Telephonen fq..s,3) / 'c--4`j -35 Si. _ rope of Building Sit &Le. Dwelling-No.of Bedrooms Other-Type of Building 4- Lot site Ac ej .l rr Garbage grinder 44 No of persons Qi Showers 34.-c ` °^ ( ) 00hc r Fixtures Design Flow (min.required) 440 gpd Calculated design flow eta(0 o Design flow provided (u 93 gpd Plan: Date (.,'1t-10 I Number of sheets 0-- Revision Date Title LeAcs- rN14- (3c ) Syffd - L.01- ti /- Description of Soil(s) 5eb�LAtJ * t Sc.- c ■wl- { P L* Soil Evaluator Form No Name of Soil Evaluator 0'L✓ttGV(LSt Date of Es-a nation Y-13 -00 DESCRIPTION OF REPAIRS OR AI TERATIONS 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 UC - Date fie'sC' Inspections O; v3 COMMONWEALTH OF M:ISSACIILISLTTS FEf CERTIFICATE OF CCIhIPEIANCE Description of Work: 7 Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System:. Constructed ( ),Repaired O_Upgraded O,Abandoned ( ) by 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 wBl function as designed. CD\1h1ONW A'LTII OF , 11\SS GIDSI:TTS Board of flea//h.MO R-t ilrfrr0N MTJON FOP 1)ISPOS t SYSIDI ITONSINITION 1?LPNII Construct( Repair( Lpgrade( ) Abandon( ) - J Complete System ]Individual Components Type of Building 51 /1/4/6-4-E Dwelling-No. of Bedrooms Other of Building Other Fixture. Deign Flow (min.required) 4 Plan: Date [n- ti-10I Title Le 4C, J.14 (360 //^^ Description of Soil(s) 5r2 fLkv . 'SO` - +' rLVMt- r/L Soil FAAnator Form No. Name of Soil Evaluator 0./Az_ck,(2s / 4 I.n sae al•IFAGRt -.4' Garbage grinder&'jr" No of persons 8 Sh osun. VCFinfite++wsi( 40 gpd Calculated design flow (0lo0 Number of sheets 0 SysTdk - LVT R Design flow prmided 643 cpd Winn Dam DESCRIPTION OF REPAIRS OR ALTERATIONS Date of It 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. - j`;_-•�.-. Date Inspect lour Owner's Same (jaRGvMc gva-oa'ts I Location gS WI&ADOItJ Map/Parcel# Address ZS sic v p UT5.- NAOLe7 WA hoi# ( Telephone# 413) 544' 42'1 a Instaper.Name r...po.1 f ")tCAvAIi ON De.igners Namei-,AA.0-ht kVA-t,w » p..S Address NAD M A; Le Adches 90 MOZTf dE RP- W iivsm onli R•\ Telephone# C4.A�� ,�49 —`,3,46 Telephone# 04A3) ;in - 52g1 Type of Building 51 /1/4/6-4-E Dwelling-No. of Bedrooms Other of Building Other Fixture. Deign Flow (min.required) 4 Plan: Date [n- ti-10I Title Le 4C, J.14 (360 //^^ Description of Soil(s) 5r2 fLkv . 'SO` - +' rLVMt- r/L Soil FAAnator Form No. Name of Soil Evaluator 0./Az_ck,(2s / 4 I.n sae al•IFAGRt -.4' Garbage grinder&'jr" No of persons 8 Sh osun. VCFinfite++wsi( 40 gpd Calculated design flow (0lo0 Number of sheets 0 SysTdk - LVT R Design flow prmided 643 cpd Winn Dam DESCRIPTION OF REPAIRS OR ALTERATIONS Date of It 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. - j`;_-•�.-. Date Inspect lour No. (% C011ONWEALIhIOF I;• SS:\Clll'SFITS soar(oflleaIIk. 4 i2 f7�-�" � �'t. 1-Li. CEPTIFICATE OF COINPL1;\N!CL Description of Work: J Individual Component(s) J Complete System The undersigned hereby certify that the Sewage Disposal System: Constructed O,Repaired ( I.Upgraded O,Ahaud FFF: at has been installed in accordance with the provision of 310 CMR 13.00 (Title 5) and the approved des application No. dated - Approved Design nose (gpd) Installer g Designee Inspector Date: The issuance of this permit shall not he construed as a guarantee that the.system will function as designed. No. (. d COMMONWEALTH WEALTH OF >IASS,\CIILSFITS Board of Health. 11.4. DISPOSAL SYSTF11 I'ONSINC: ION PEI/Alf Pet r mission is hereby granted to Construct(, Repair( ) U pgrade( at -L ti �'g..( CS 111-f_e" yCC4Ge-'f c/ Disposal System Construction Permit No. !! -"P ,dated Abandon( ) an individual sewage disposal system as described in the application for Provided: Construction shall be completed within three years of the date of this pt nuh. all local coudittens must he met. F0552 1255 Rea 5 9s vim.swan ta.BUSlDr MA Date Board of Health Location Address or Lot No. Co FORM 12 - PERCOLATION TEST CoAQ i% (\n,a (?S COMMONWEALTH OF MASSACHUSETTS kor\-\n0,w„0-t,n , Massachusetts Percolation Test` Date: 471-voc, Time:. 3:aQ Observation Hole # Depth of Perc 6o " sc>° Start Pre-soak %:a5 5i:/s End Pre-soak 3:410 4:30 Time at 12" 3: 410 4:30 Time at 9" t/:06 4:37 Time at 6" S:35 Li: 446 Time (9"-6") 79 ynfv,. ll. m;h. Rate Min./Inch a7 YY,iiniin. '1// � n,;0,/'pi Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed tE Site Failed ❑ Performed By: Dervrvts Witnessed By: 10e.3/4-er Alc-Er llr Comments: _................... ... . DEP APPROVED FORM-12/07/95 Location Address or Lot No. C, FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Cole lieutlpw rJ. Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole _.. inches ❑ Depth weeping from side of observation hole inches ® Depth to soil mottles tf2, `Inches ❑ Ground water adjustment feet Index Well Number Reading Date Index well level Adjustment factor Adjusted ground water level Depth 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? yes If not, what is the depth of naturally occurring pervious material? Certification I certify that on lJn.lem`Pet`f5 (date) I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the r quired training, expertise and experience described in 310 CMR 15.0 Signature DEP APPROVED FORM- 1:07:95 Date 97/5/00 On-Site Review Deep Hole Number 'a. Cate 4//3%0 G Time 4000 Weather Clear Location (identify an site plan) Land Use Jasldenhal Slope (%) ? Surface stones 40 To Vegetation L-coodla).d Landform ( 1in Distances,frorm Open Water Body doe 1- feet Drainageway vLc c feet . Possible Wet Area o 4" feet Property Line SC.' feet Drinking Water Well In /d feet Other -DEEP OBSERVATION HOLE LOG Came.'mm St4aca (tncnesl ;Soil H:r.z:n Sc,l Texture (USDA) Soil Color (MUnseLI Soil Mott l:rc Other (Stmcure.Stones.Boulders. Consistency. Y.Graven O TO S- To Vo ace TO ZS 6 C 5�� 5h, J/ 5/L oY 313 7.S YA 4/c. �.SYK 4I4 non erucrl c■rw.r Pr Gable, ro.vel ' 5 fp 9 Parent Material (geologic): hm.&\ \-t\\ Depth to Bedrock i(.;" flenth to Groundwater Standing Water in the Hale: none Weeping from Pit Face: na... Estimated Seasonal High Ground Water:154-' ii. t. 41 tit No.: Commonwealth of Massachusetts tior I-1-\aw.p Fo n Date: A.pri11,1996 , Massachusetts Site Suitability Assessment for On-Site Sewage Disposal Performed By:. Otnvii 5 'I41 • Co-c ow-s e Certification Number. I1/95 Witnessed By: P61,r )4cFvlin Location Address or Lot No.: a, Cc&t .A4eaetow rtk. Owner's Name,Address and Tel. i #: kOvr &C»\IQ a5 Sylvia Wt9hfs lApa, s ti(.4 °ins New Construction fir] Repair ❑ Office Review Published Soil Survey Available: No ❑ Yes gl Year Published $I Publication Scale l:15c%40 Soil Map Unit 10/Cre Drainage Class uRtt Mo.,n ea Soil Limitation tlore. Surficial Geologic Report Available: No ® Yes ❑ Year Published — - Publication Scale -- Geologic Material (Map Unit) Landform •M n Flood Insurance Rate Map: Above 500 year flood boundary No ❑ Yes Es Within 500 year flood boundary No ® Yes ❑ Within 100 year flood boundary No © Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) Wetlands Conservancy Program Map (map unit) Current Water Resource Conditions (USGS): Month mart- 9,00 Range: Above Normal ❑ Normal ® Below Normal ❑ Other References Reviewed: On-Site Review Deep Hole Number 1 Date 4713 too Time 3:c6 Weather dear Location (identify on site plan) Land Use Ce.St61240444.\ Slope (%) ? Surface stones 10 To Vegetation .A,eO alp-no. Landfonn Ckwv\in Distances from: Open Water Body 'abn * feet Drainageway none feet Possible Wet Area 2.on* feet Property Line 36.: feet Drinking Water Well n/c1 feet Other DEEP OBSERVATION HOLE LOG Deotn from Surface (inches) Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other (Structure,Stones,Boulders. Consistency,%Gravel) d it Co Co, TO 20 ao To ya 4a j 0 7a A w C, C a Vt. 5/L n^/S Vt. io VR 3(3 IbYR S/4 7.SVR Va S V!2 y/4 5% GA-clew,, asA 44 7.SVR 44 Loose, vavl5,grru...la) EtiMy¢ m xeive (-6..we svco WI (-inn a ar sbn�e,{ able Parent Material (geologic): %°,\ s'■i1 Depth to Bedrock 73." Depth to Groundwater: Standing Water in the Hole: none Weeping from Pit Face: Acne Estimated Seasonal High Ground Water.Ya PERCOLATION TEST(S) Time: Time: Observation Hole #1 Observation Hole #2 Depth of Perc 'I Depth of Pert Start Pre-soak Co 1- Start Pre-soak End Pre-soak End Pre-soak Time at 12' Time at 12" 7 Time at 9' Time at 9° Time at 6" Time at 6" Time(9"—6°) lime(9'—6") Rate Min./Inch Rate Min./Inch 'minimum of 1 percolation test must be performed in both the primary area AND reserve area. Performed by by - ---- Witnessed by J I Witnessed by Comments: • ' I NORTHAMPTON BOARD of HEALTH- Title 5 - Site Review Location Address or Lot# k� c, /� p,,, V\ /I Owner (1 V� `-- -�Q YOVwnLer'r's V`�^^ Date t- ,v� (71'u" Time Soil Color (Munsell) Address Other (Sta¢ture.Stones,Boulders,Consistency.%Gravel) Engineer t (, a.PA- -- Weather Phone# Land Use %Slope Surface Stones J. ` Y oa .j"— Landform I Vee°tation Start Time Li I-) PosNon on Landscape(sketch on the back) Distances Drinking Water Well 1( . Stop Time 3 ', '4 feet Property Line feel Water Body feet j Possible Wet Area feet Drainage Way eel Other feet DEEP OBSERVATION HOLE LOG* Deep Hole#: 69 — I `MINIMUM OF TWO HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA Depth from Surface/Inches) Soil Honzon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other (Sta¢ture.Stones,Boulders,Consistency.%Gravel) o 1 I - A }} . II/ rV ‘ s G (O" 4 CH •� -� d J Gy'6-L Atiti'iLn. J. ` Y oa .j"— Parent Mania'.(g ologic) I ) Depth to Bedrock Parent Matdal(geologic) I Depth to Bedrock I Depth to groundwater Standing Water in the Hole I Weeping from Pit Face I Estimated Seasonal High Ground Water / DEEP OBSERVATION HOLE LOG` Deep Hole#: IG - �_ 'MINIMUM OF TWO HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA Depth from Surface(Inches) Soil Hatton Soil Texture (USDA) Soil Color (Munseli) Soil Meting Other (Slnlcture,Stones,Boulders,Consistency,%Gravel) v —c6 1\ Sk__ Ih (741 ��., Gy'6-L Atiti'iLn. J. ` Y oa .j"— Parent Mania'.(g ologic) I ) Depth to Bedrock Depth to groundwater: Standing Water in the Hole >7 L. Weepinq from Pit Face dj) w.---' Estimated Seasonal High Ground Water No. FORM 11 - SOIL EVALUATOR FORM Commonwealth of Massachusetts , Massachusetts Performed By: / .G.SEIEEf.1f(A-2..fi.CSO,;..IBTeS..../ 4-_ Witnessed By: LncLt44i&) Date: Date: -5-1/5103 r,`°""`/Qa4cioT Tp4svorn of S6-s-cis 47MAow R&AD NotrH Amp mu MA New Construction ® Repair ❑ o...I .Be 'CL_ norm t..." S6.S coce.f /376460‘).) RoAI, AJot7HRMpn&, MA Office Review Published Soil Survey Available: No ❑ Yes Year Published /.48.1... Publication Scale /Chia YQ_ Soil Map Unit Drainage Class V//S Soil Limitations .S!chY.! Surficial Geologic Report Available: No ® Yes ❑ Year Published Publication Scale Geologic Material (Map Unit) Landform Flood Insurance Rate Map: Above 500 year flood boundary No ❑Yes El Within 500 year flood boundary No ®Yes ❑ Within 100 year flood boundary No 0Yes ❑ Wetland Area ' National Wetland Inventory Map (map unit) Wetlands Conservancy Program Map(map unit) crE. Current Water Resource Conditions(USGS): Month Range :Above Normal ❑Normal ®Below Normal ❑ Other References Reviewed: gA DU APPROVED FORM-rLFnft t eG."EESr e. P_oiN FORM 12 - PERCOLATION TEST Location Address or Lot No. Aa3acc.�T 70 9=SouTFI of 6s tEl m(q✓xu.) RD COMMONWEALTH OF MASSACHUSETTS MoeTNgrnpmo Massachusetts Percolation Test' Date: s� y f o 3 Observation Hole # Depth of Perc Start Pre-soak End Pre-soak Time at 12" Time at 9" Time at 6" Time (9"-6"1 Rate Min./Inch sv " 729 9yy 9vv 9y8 9s y Time: . __ _ z S? " loot /0/7 /0/ 7 /02/ /026 42/17P-z- • Minimum of 1 pe colation test must be performed in both the primary area AND reserve area. Site Passed ® Site Failed ❑ Performed By: R.F &si to ASSoe hoc Witnessed By: .33LTLe /YIczed_A N Comments: s ' 51PAe.4T,ON REQL1/e_cb/ sq< mossrSt LoCATfb ace Noctf J.E1,66 007(&» /10GSAzt rBPorvminuur bo7Aivcs me/17 BL ® LS741fu1f/e2 By .9 t66&sr7CLd %AUL sQeveyoz DEP AMovmloW-uimsf -Peet Tll7 Fee $kLJCL Ko71) Y,E Z OP 6 -/-rr A-r,oa or' N4'p ot2e JP,71cn)Noll O–FocATron) or rite 7 on E — E .565" cdrr.aaoua xoaa COCLp��� EAen) kAwo A 2cA /Jo ScatL- pGL /2EAL(L)?G m&n)TS FPa p ear/A4 TZ_ AU. Notes E. f7a ‘Q ED6E GF 4—�— Cc /;'711:.Y: Gcfi:_--'—r [-)9t/E»47-7" ESTThe Bever ecrH ? A �3of76 FORM 11 - SOIL EVALUATOR FORM Location Address or Lot No. 41.aigce,i7- TO 9-,STN of 4s ro,/FSMA//dow .e0At3 /VoErngmpT ",, ma //QnOn-sil`View Deep Hole Number Date:if/a/oj Time:_ Weather CCegre Location (identify on site plan) Land Use 1.0oo,b.... Slope (96)3 r6 Surface Stones AMANY. Vegetation LIb VQ.J S Landform J�-QJJ•'1L1/�) .S�o} . _ Position on landscape (sketch on the back) Distances from: Open Water Body /001- feet Drainage way _..... _ feet Possible Wet Area /OOP feet Property Line __ _ feet Drinking Water Well /DOI feet Other . Peen Material twalogiel O o Tu.>9SI F Isolutt stamina wear to S.Hate: ate t.ainsre Seasonal High Ground weer. /08" t——t tett /08 p Weeping from Pit Fecal .DEY Dar ertgovW roast-nnnss TEPG 7/s- Foams Isar"- Lori? )461 L/ OFD DEEP OBSERVATION HOLE LOG' sY�ryw o Sol lwcan sear Tana sal on tall Sol Menang Otter ISmacne..Stones.a- 0-s.Consistency. % te o - y y -2I 21 33 33 - JOB /08 /{ 8w GI G 2 R-LC46L sAnAiy LoA n, Loamy sum coAAeese�_. SqNb a- 6,eaveC. CamQAC7 l..-o4 y Gad✓ L rovn)z foyiey'6 1oyietlY )oyley16 - yuL oakele • — covy bene.F4ci /.Cy„(z Lance smf)f, 4- G&AI' W1 TN ewuDLE Sroctf 4— C838LCj CDmr>ACT tmesc JAluD 4-GMAtt WITH ECUQLS v A FGW _5013 A)6 ULAe SToa j q eo ase • YWYIL 1W'2 WY rs H PS HIL4.101111t0 SI k**HY MM nu.n.e�.-.--- Peen Material twalogiel O o Tu.>9SI F Isolutt stamina wear to S.Hate: ate t.ainsre Seasonal High Ground weer. /08" t——t tett /08 p Weeping from Pit Fecal .DEY Dar ertgovW roast-nnnss TEPG 7/s- Foams Isar"- Lori? )461 L/ OFD FORM 11 • SOIL EVALUATOR FORM Location Address or Lot No. ADSAo_n)r 73 9tt om OF '#SESG✓FSft' bo to e.04b, /11oArfAmp7a., ma On-site Review Deep Hole Number _Czr_ Date:13/ 3 Time.._ __ Weather C £qe Location (identify on site plan) Land Use -WQCACb__ Slope (%)-3-6 Surface Stones "4,L1Y. Vegetation 2YLI?+000 S _. Landform U JL o?? Position on landscape (sketch on the back) Distances from: Open Water Body /ooh feet Drainage way Possible Wet Area /001 feet Property Line Drinking Water Well /ODl feet Other feet feet DEEP OBSERVATION HOLE LOG' • Depth from Surface(naps) SW Horizon Sei (US Texture sea Carer than..O sap Mending Other (Swetaa,Star,&t WO Consistency, % 0 — y Ay- z7 27 HO yo -116 A 8 . 6I • G .Z. SAiony Loath L mY n CageSe GRAVCC ro>e3)2 iOyey�6 f°y1291y loyty/6 /JOW E AW1NreFACc L nct Co4Cre SANts 4- GPAVt/. (sTH &oUkt L SYOaf F- antpacpT� Lr�AescJA.uD4-C2Aut C WITH WUIJda $ A FfW SUB A6 UEAC SYow_ q.(BBCdS - �Mr3AC G C V MLWMUM OF 2 HULkS Prete Material(g.alogic$ CO 7w GSM oaad.t.tiro.dwner: Staring Water in the H.I.: Dze.y FiWrrd S.a.ael Kph Grand Ware•. >/LArf S ov.pptOVaa POEM-DAMS Weeping from*Pacer .DEY 4)LPi 7WS7 Foe-Tsar"- 20tH FORM 11 - SOIL EVALUATOR FORM Location Address or Lot No. 4bGAc£A)T To 54c Swrg of Sag cCct 671m4bow Rn4b /Ostal4 Peron)/M 4 Determination for Seasonal High Water Table Method Used: ® Depth observed standing in observation hole a?Y_._ inches ® Depth weeping from side of observation hole-e' ._ inches ® Depth to soil mottles _._-- -._ inches F`"`L °3sMevcA ❑ Ground water adjustment _ feet Index Well Number _ Reading Date .. _ Index well level Adjustment factor _........___. Adjusted ground water level Death of Naturally Occurrina 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? V S If not, what is the depth of naturally occurring pervious material? Certification I certify that on /994 (date) I have passed the soil evaluator examination approved by the Department of Environmental 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 DFS APPROVED FORM-I2/01M Pat TEST Foz �Rt)C6 40rel TA6L6 oF6 TYPE MINT ONLY . Massachusetts Department of Environmental Management 118346 Office of Water Resources NI Completion Report Address at Well location. Subdivision Name: City/Town: Assessors Map Board of Health permit obtained: Yes El _Assessors Lot e: Property Owner: Mailing Address: City/Town- 0 5 NOTE: Assessors Map and Lot# mandatory if no snot address available Not Required ❑ Permit Number psi Issued Q New Well ❑ Deepen ❑ Re•ace ❑ Abandon O Recondition ❑ Other_ estic ongoing dustrial ❑ Irrigation ❑ Cable ❑ Municipal C�7 Air Hemmer El Other [C Mud �p��-t-a�a'.r vx Consolidated i'Y.A, .: f Auger i Direct Push o Other_ a ' Unton • ashes From (ft) To (ft) , Lowenti Other nIMI ■• •n MM. �■.■■■■■ ,..Ni_ prennormi..... .1111').ii ammt. wenn. ..itirn,..6900111talainagagalt , Rock Type Total Depth Drilled 200 Date Drilling Complete lo/6 /oa Casing Type and Material Sae O D (In) Well Seal Type Via 'rt'ik# h.f.:*giicr.L.:ti,4: Screen Type and Malone) Screen Diameter From(tt) To(ft) Material De option Purpose Developed? ❑ Yes ❑ No Fracture Enhancement? ❑ Yes 127 No Method Disinfected? M.Yes 0 No Date Yield Time Ppm Methodal�(GP�M) /(hrs & mi fa-,at:._ ?8otigr nit+rc4:: • Drewdown to Time Recovery to ) (Ft. BGS) (hrs& min) (Ft. BGS) Pump Description Pump Intake Depth Date Measured Horsepower nal Pump Capacity (gpm) • well was drilled and/or abandoned and r my supervision, according to applicable rules'. regulations, and this report ' •mplete and ••r =,'to the best of my grrowledge. Registration k.I 1 1 9 16 I I Finn: - Bah1c1 3ei, Iiaw ng Driller Signature • Date' i'2//6/0.2- Rig Permit$: I 1 I 0 12 I I N077E: Well Completion Reports m st be filed by the registered well driller within 30 days of well completion. BOARD OF HEALTH COPY HOWARD LAB Phone WATE Analyzed For: Bercume Builders Address: 25 Sylvia Heights Hadley, MA 01035 Telephone: Sample# 10388 RATORIES OF NEW ENGLAND, INC. 750 North Pleasant Street Amherst,MA 01002 413) 549-8260 Fax: (413)549-1850 MA Lab License: M-00851 ANALYSIS REPORT Sample Location: Lot# 6, Coles Meadow Northampton Sampled By: H W D Date Sampled: 2/6/03 Harr RrrPh.,.d• - si PARAMETER RESULTS LIMITS COMMENTS •• 1 Y\ Total Coliform Bacteria 0 Colonies/ IOOmi 0 Colonies/100ml OK pH 8.05 pH Units 6.5 i 8.5 pH Units Units OK Manganese 0.117 mg/I 0.05 mg/ * Hardness 140 mg/I No Standard <50 SOFT, >I00 HARD Conductivity 0.51 mS/cm No Standard No Standard Chloride 400 + mg/1 250 mg/I Iron 0.30 mg/ 0.3 roe OK Sodium 27 mail 28 mgt OK Nitrate 8.0 mail 10 mail RE-SAMPLE • Nitrite 0.115 mg/I 1 mgt OK C010r * 143 PtCO Color Uniu 15 PtCo Color Units Turbidity a 28.6 NTU 5 NTU a Recommendations: See enclosed MA DEP Interpretations sheet for parameters marked with an aste isk. This sample meets acceptable standards marked with an asterisk(•). Analyst: AK Checked By: Jonathan Be Laboratory Sup of potability for the parameters tested, except for those parameters Date: 2/10/03 FORM 3-CERTIFICATE OF COMPLIANCE -7J7 Commonwealth of Massachusetts NORTHAMPTON, Massachusetts Certificate of Compliance This is to Certify, that the On-site Sewage Disposal System installed (X) or or repad/replaced ) on g/nyoz) by Cam-E �/ for ROY GIANGREGORIO at LOT 6 COLES MEADOW ROAD AUG 2 9 2000 {` P_PTOF =:T 1KS ws€° ca has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. /4"— Cc) dated bbl 4100 Use of this system is conditioned on compliance with the provisions set forth below: The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. The Certificate expires on Date FA2Wet) Inspector