75 Application & Permit 2004 I
NO}. (/[4- j( , THE COMMONWEALTH OF MASSACHUSETTS FEW ,Ci -
c
BOARD OF HEALTH /✓�aii% -
City OF Northampton %J
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
ion for a Permit to Construct ( ) Repair Or) Upgrade ( ) Abandon ( ) - ❑Complete System ®Individual Components
75 D by Road
Linda Wheeler 1.
Location
Owners Name
75 Dunphy Road, Northampton
Address
413-586-3853
Nap/Parcel P
- ..
Lot R
Loven Exec. & Const. , David Leven
Telephone
Paul B.-batch, PE
Installer--s Name
230 Reservoir Road, Westhampton
oes;gne(a Name
57 Munn Rdedd Monson, MA 01037
Address
113-527-5184 ;
Address
413-267-3696
rdephone ft
Idtephoncr
fype of Building: single family home
Dwelling—No.of Bedrooms -3-
- Other=Type of Bwldtng No.of persons
Other fixtures
Lot Size15,037 Sq.feet
Garbage Grinder ( )
Showers ( ), Cafeteria ( )
Design Flow(min. required) 330 gpd Calculated design flow gpd Design flow provided S5e gpd
Plan: Date June 7, 2008 Number of sheets -3- Revision Date
Title Repair, On Site Sewage Disposal System
Description of Soil(s) 0-11"=A=LS, 11"-22"B=LS, 22"-60"+=C=LS
Soil Evaluator Form No. Name of Soil Evaluator Pau,. Hatch Date of Evaluation June 7, '^9
DESCRIPTION OF REPAIRS OR ALTERATIONS Relocate or replace existing septic tank, new dosing
chamber, install new soil absroption system in fill with impervious barrier, waiver for
depth from four feet to three feet to groundwater
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of
TIRE 5 and further agrees not to place the system in operation until a Certificate of Compl an e ha been ued by the Board of Health.
Signed Date
Inspections
FORM I - APPLICATION FOR DSCP DEP APPROVED FORM 5/96
No. -!r*-. ',)/
Description of Work:
The undersigned hereby ce
by:
THECOMMONWEALTH OF MASSACHUSETTS
Northampton BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
❑ Individual Component(s) 12't.omplete System ,/
y that the Sewage Disposal System'Constr4cted( ),Repaired(q.Upgraded(Abandoned( )
FEE L,Y
at 75 Dunphy Road
has been installed in accordance with the provisions of il0 CMR 15.00 (Title 5) and the approved design plans/as-built
plans relating to application No. '/ ( . dated / �, - Approved Design Flow 397 (gpd)
•
Installer 0".( n / VrAl � .. •- _ _ i
Designer:Paul Patch, PE Inspector ./,hr /1 /� Date ,'� 1
� ,` >{ t
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
THE COMMONWEALTH OF MASSACHUSETTS
Northampton BOARD OF HEALTH
FEE
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to Construct ( ) Repair (IiJ Upgrade ( ) Abandon ( ) an individual sewage
disposal system at 75 Dunphy Road as described
in the application for Disposal System Construction Permit No. mr/ 477 -3/ dated "J /%/ c.'LGI I.
Provided: Copstruction shall be completed within three years of the date of this per iti All local conditions must be met.
Date (/'t -O, .-CiTh c) Board of Health 7-kil-e e1 Let G'
FORM 2 - DSCP DEP APPROVED FORM 5/96
FORM 1255 (REV 5/961
e� Hoses a WARREN TM
PUBLISHERS-BOSTON
Ile