48 Soil Suitability Assessment 2005 o .,
tllitimsrai
-_- y ?C ._. EVALUATOR FORM
?age 7 alsill
Date: I I .7 !0 S
?1assarhu at'ta=
X es. :'aeTi tor On-site Sewa'e E. tosat
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-..tat a b ished Publication Scale
19riatinme Class Soil Limitation=
cation=
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- P!:biish..d '::blimtion Scalia
Gaologic tiintanel (Map
Liindfrman
flood Imummoi Rate "Mao:
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Address or Lot No
FORM 11 - SOIL EVALUATOR FOR
p(1ryL .-
J Ncl-' C,4JnttifQ
On-site Review
Jeep HOle Number (1 Date: I -7 10,5 Time
Location (identify on site plan)
Land Use V\✓td:� Slope (%1
!sgetation 01'a(-2S _
iandform CAttrwl.)A1 WAIN
Position on landscape (sketch on the back)
Distances from:
Ooen Water Body )(CC feet Drainage ,way .7IOC
Possible Wet Area 7 ebb feet Property Line jO
Drinking Water Well ourV feet Otner
JO
W4r
rW1
Weather
Surface Stones '.10 *'
feet
feet
C1 ?„`14C.
r(_
DEEP OBSERVATION HOLE LOG'
Depth ham
Surface nnanesi
Son Honzon
Sail Tenure
IUSDAI
Soil Color
(Mum•(()
Soil
Morthno
Over
(Structure. Stones. Boulders. Conant rc.. `,
Gravel)
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t 120
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w MINIM
OF 2 HOLES AkQUINkLI At EVerlY PROPOSED OISPOlALMtA
Plaint Wool Ipdopict
d ClUtt s T\ orweer
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FORM 11 - SOIL EVALUATOR FORM
Page 3 Aft;
Locanion Address or Lot No. b WI Hu W t-1 �C!✓v����Z/"
Determination for Seasonal High Water Table
Method Used:
J Depth observed standing in observation hole inches
E Depth weeping from side of observation hole inches
J Depth to soil mottles -7120 inches
J 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? y.c4
If not, what is the depth of naturally occurring pervious material?
Certification
Zt
certify that on (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 J , Ube
DO Aerfovm row-an
Date
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use the return
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Commonwealth of Massachusetts
City/Town of NogiThkAaMsTaN
Certificate of Compliance
Form 3
DEP has provided 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
the local Board of Health to determine the form they use.
This is to Certify that the following work on an On-Site Sewage Disposal System
❑ Construction of a new system
❑ Repair or replacement of an existing system
® Repair or replacement of an existing system component
Has been done in accordance with Title 5 and the Disposal System Construction Permit(DSCP):
DSCP Number
Vicki Joyce
Facility Owner
48 Dunphy Drive
Street Address or Lot#
Northampton
City/Town
DSCP Date
Designer Information:
Timothy E. Maginnis R.S
Name Name of Company
j� l �. w — R.' February 28, 2005
Signature • Date
Installer Information:
Mark Lavalley Mark Lavalley
MA.
State
01060
Zip Code
Name Z Name of Company
February 28, 2005
.1t 12
gnaure en / Date
Use of this system is conditioned on compliance with the provisions set forth below:
The existing septic tank has remained in place. A new SAS and distribution box have been installed.
The SAS is 4 Trenches @ (401 x 3'W x 7D) each
The issuance of this certificate shall not be construed as a guarantee that the system will function as
designed.
Approving Authority
Signature Date
t5form3.doc•06103 Certificate of Compliance•Page 1 of 1
Pere Test Witness Payment Record
Date: �/?/Q S Amount S S2
Property Owner (/„f.{
Property Address /1 •
New Consrruction Repair te
Pay to the
Order of
1
VICKI E.JOYCE
48 Dl1NPHY DRIVE
FLORENCE,MA 01082
For
193
Date 7—C3 53-71692118
kb CkCAtiyhnn $ Cat—C2
FLORENC N• BANK.
N
toad men.
L
1: 2i187i-688f: Di 23 09728 ii"
Dollars 8
c, 0
0 193
Septic System Permit Payment Receipt
03
Permit#700.7 Date: OS—Const Repair
Amount:'47SDV Cash
Address:"Lt Q
Owner: U
Check-PL./5d
SIMMIIMMINSSI
152
VICKI E.JOYCE 92-05
4519 MONITOR WAY
NORTH LAS VEGAS,NV 99931-4339
N-ttr1U4 w
6314
Dated C5
75 t5 C
to it 'der of N�°
SCL_t i12c_ r — _— n far el
a
Bank ofAmer ���
Alamo LS 122400721
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Memo Wit:y'�4 ` C- �
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