135 Septic Applications Permits & Compliance frrie�a�/
•
COMMONWEALTH OF MASSACHUSETTS���
Board of Health, htDP'it�HmO)44 ,MIA.
CATION FOR DISPOSAL SYSTEM ONST Utz JTiON PERMIT
Cnnstrnetg) Repair( ) Upgrade( ) *indent ) ❑Complete System JIndvidual C.
Local t D nopr DRwF L6f r/
M
Owner's Na AMJry�p I
9
flap/Parcel#
Address "^
(
� T' =' Y^�n 0
Lot# L6T ai «.27-7037
Telephone# (4\-3) ,Q.11 _ 2017
Installe�Y�ComPECi �ieCAV�tN�
Desi Names
gne"- l uL
✓`^-AG :Nr✓1S R S
Address j t r f. 7r6
ddress 70 J.T. P 1 d3a e' •lo
Telephone# (41 ) 4 ,c . 3l e 4 Telephone# 4v3 52.- ..c']t/
Type of Building
Dwelling-No.of Bedrooms
Other-Type of Building
StNG-LE G'a,v„4L■ b*Ovvve:
4
No.of-person
Lot Size d .kCR, 'rs[(rfe..
Garbage grinder lC
S Showers#.-#J eifetnit ( )
Other Fixtures /
Design Flow (min.required) 448 gpd Calculated design flow l06 a Design flow provided iflQ� gpd
Plan: Date Oct 9 O 3 Number of sheets
Title rc..n rSO . : ..ice�AC6 1 'L ► 54-61J
Description of Soil(s) 5, l'-" � i� S^'t V a L,
Soil Evaluator Form No. Name of Soil Evaluator I.1d-.A/-c JUJJLS Date of Evaluation ���,,��� ��rr'�{{
DESCRIPTION OF REPAIRS TERATIONS l il•F X15 Ls l �Q_ IJGI.f.) rocEszuti Ins)
il-- 664
' r
The enders' •c ins n e above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further .. syste•� ' . •--a Ion until a Cer�d mate C rice een issued by the Board of Health.
Signed VDam J eg
• fityl' !
Recision Date G "2 3- b !i'
Inspections
A A'
AI 4tb
Nevi — (7
COMMONWEALTH OF T" ^\SSSA'CCI USLTTS
Board if Ilea1th, / i.:1 ✓S AM.
CERTIFICATE OF COMPLIANCE
Description of Work: ❑Individual Component(s) ❑CCmplete system
The undo signed heiebv cc lib-that the Sewage Disposal Sy3tegt C cost acted Repair ).Upgraded ( ).Abandone
d ( )
bv: / b i/a- y ir ;— >4g— J/ 6,V
FEE
7?`
J
C4,1g/63i
has been installed in accordance with the - y sions of 310 CNIR 15.00 (Title 5 ) and the appio'ed design plans/as-built plans relating to
application No d nU / / ) dated Approved Design Flow l (gpd)
) �` �/
Installer Y/5 0( � t �r'l ,. / � 14G�"7
Designe 1//I ✓i)71 1 iA • / Insp uut _ II CV i `""` — Dale:
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
No.i .Para'/
COMMONWEALTI1 OF M SS. CI IJSLTTS
MA
DISPOSAL SYSTEM CO1N'STRUCIION PERMIT
Permission is herebgranted to; Construct(/Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system
as described in the application for
FEE /
Lin"i // ;J
at J�(l 1-- ,J 441A,44.
Disposal System Construction Permit No .irf ' .dated CO 2-
Provided: Construction shall be completed with n three years of the date o All local conditions must be met.
Form 1255 Rev Stns AM Sulkm Co Boston MA Date 06 ( Board of Health p Pc ermit'5 ' r
No 2005--51
THE COMMONWEALTH OF MASSACHUSETTS
ASSACHUSETTS
c&ppliratinn fur !ispusal c*gstem Construction 13ermit
Application is hereby made for a Permit to Construct ( ) or Repair(l7 an On-s'te Sewage D'
Location Address o
/35-
of No,
System at
• P
Si
Y
Installer%Na
U
Addres
m� and Te
w
r
Type of Building:
Dwelling
Other
Design Flow
Plan Date
Title
Description of Soil
Se 6107• .rt.)
rn'S
Designee]s Name,Ad•res and Tel.No.
rill"- Me 444-4.1.4-
0
L 'its
r
No. of Bedrooms
Type of Building
Other Fixtures
N
4(3 - 5
7
Garbage Grinder
No per Persons Showers( ) Cafeteria( )
or I
alto n per day. Calculated daily flow 610 1241“013) gallons
•1' !- an'a'l
44M fie
mrer of
heels
•. N Ilfl
Revisir Date
d81 et _
rick/
bN 71145- lien_
N Lure o Repairs o A rations,.(Answer whe• ap di .ble) (Il
QCs: • I I I
Date la" inspected'
Agreement:
The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-site sewage disposal
system in accordance with t rovisions of Title 5 oft Ato Environmental Code and not to place the system in operation untila
Certificate of Compliance en issued by t d of HealtS.L zt/ /6
Signed � y
Application Approved
Application Disapproved for the following reasons
Date
Permit No
egov s'r 31
Date Issued
JJ9/ajl36
THE COMMONWEALTH OF MASSACHUSETTS
izi"74/4 ';) MASSACHUSETTS
Certificate of Qlontplinnee z
IS TO CERTIFY, that.the On-site Sewage Disposal System insta{(ed( )or repairer)/replaced 1/)on
%"- ,,r/4„s. j by w LN046/..m r for z d>�/-/7,t%1 �A f7711/�A -
at `• J has been const ucCed in
accordance it the provisions of Title 5 and the for Disposal System Construction Permit No �dt�.5- 37 dated
.
P¶ a i is Use of this system is conditioned on compliance with the provisions set forth below:
The issuance of this ce ificat✓shall pot be gonitrued as a guarantee that the system will function as,designed. This
Certificate expires on '-0 2 P/T7P %rT( page
DATE
No2m5-37
^ Inspector
i
/THE /1461,472,COM COMMONWEALTH OF MASSACHUSETTS
C.A4 If MASSACHUSETTS
Dish s Sustem Construction Permit
�p �1 C r
Permission is hereby granted to �/�� �"2�� �
to construct ( )or repair( )an On Sewage System located at
4
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her
duty to comply with Title 5 and the following local provisions or special conditions.
All construction mu
9/; 3/T
DATE
t be cofnpleted within two years of the date below.
Approved by
FORM 1255 Rev.3/B5 A M.SIILO W CO.•BOSTON,MA
f
No
THE COMMONWEALTH OF MASSACHUSETTS
Sl
MASSACHUSETTS
Fri
cApp!icatiun for !i$puzui System QZAn$trurtiDn Permit
' Application is hereby made for a Permit to Construct CL or Repair( ) an On-site Sewage Dispo al System at:
Location Address r t os Nn.
L o f 4
135bvA,p) tt2wE
Oxmer's Name Ad d Tel No. 5P1-5-90
p1 7l6Wt p/VE2 m vAPM/ 2,31-4.0)
135punttil DR, MD e-Titr4 ribli MA-
Instigea Name.Add d xw TefyQ
%4T3)
Mr. ner. as a Td.No-
" +3 5,n-S7-9/
5Gf- 3(64no Ams,
cAersThA-0,p v-■ . f ket O\C2
uvt � l{�.�
Type of Building:
Dwelling No. of Bedrooms
Other Type of Building No per howers(1i)-GefetTnTr
Other Fixtures
l-1
Garbage Grppder(. )
Persons i9f S
Design Flow
14140 gallons per day. Calculated daily flow 61.0 4 flifitLi C63)gallons
Plan Date�� (Yft6 /* 4Qt/(AT/OA/Numb of sheets Revision Date
Title I7• ' • iUAI ,A ♦te
Description of Soil
O'L A
S
Nature of Repairs or Aqllterations(Answer whe applicable) • e R- ) I►f a - n
Oa) SAS AS K660712677 sy De/cia G.vC/wf - 77 nyelei.uv S t'Nr/G.-
SA4 !7 ' a,rg/SF e- D/tr./-S lacT' A+OD SyiTFM,f/S--/A) (OA/taLb4cr i'/*iits-
Date last inspected: (94 %.3/05 tfitirt Down-(SC 6,714 CC.--- A Co).vdi i` miot t✓ 41--
Agreement:
The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-site sewage disposal
system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a
Certificate of Compliance as been issued r •'s Board • He
Signed
Application Approved by Date
Application Disapproved for the following reasons
Date /0/03,J65
Permit No tear- 39
Date Issued
THE COM NWEALTH OF MASSACHUSETTS
-_ MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERT/FY�hat the On-site Sewage Disposal System installed( )or�reQaired/replaced(141;
by _ !d:ISs II II a. for ill AeY7i1C.N/ rnUl�j'J�� OLov5.7.-
at 135 Di P toe T y has then constructed in
accordance with the provisions of Title 5 and the for disposal System Construction Permit No. .204:15.-la dated
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. This
Certificate expires on
DATE
�z6's-3S
Inspector
at
T CO
WEA,TH t� SSACHUSETTS
MASSACHUSETTS
Certificate of Qtonrpliance
THIS IS TO CER TIPP.71retf n -fritg)isposal System instal�4x. pairgi SaB'�pedl 3Wr»Du r ��11 �I`"' ���t �N/�n�' for ^^I(r7Y1
accordance with the provisions of Title 5 and the for Disposal System Construction Permit No
�as.he n cuostructed in
G`-K� 37J dated
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. This
Certificate expires on
DATE Inspector
Na T�&-25-J3(J N
THE COMMONWEALTH OF MASSACHUSETTS
MASSACHUSETTS
!isposal *stein Construction Permit
13RLc,C Coca? c2 `4 o-J O CfrODR 49(e57-FI
Permiss'o s hereby granted to
to construct( ) or repair( )an On-site Sewage System located at
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her
duty to comply with Title 5 and the following local provisions or special conditions.
All construes y O st be cgt}tpf a within two years of the date below.
/0
DATE
FORM 1255 Rev.y95 A M.BOLNIN CO.-BOSTON MA
Approved by
ft—
D 1085
Applica
NITP
Location
I Map/Parcel
Lot#
COMMONWEALTH OF MASSACHUSETTS (FEE / (/ �j
Board of Health, 1540P-'(�(pMrp,a T / _
CATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMII / �
to Construe %) Repair( ) Upgrade( ) Abandon( ) - O Complete System ❑Individual Component 0/JP 31
CONP PAVE °
Installer's Name Coo
Addre
Telephone
ype of Building
welling-No. of Bedrooms
ther-Type of Building
Cher Fixtures
sign Flow(min.required)
ral1N`G.
G-LE
Owne
Address Po
Telephone#
Designer's Namee
Address 7o
Telephone# 4.
AM I
SI
a
Lot Size.J .eZ/cg -t
Garbage grinder(Y-
No.of persons Showers
4—� gpd Calculated design flow (t b Q
in: Date •� O
t_ Number of sheets
AC6
It
scripdon of Soil(s)
Evaluator Form No.
iCRIPTION OF REPAIRS Ifie
Are
node
rer
ed
svons
RATIONS
' — s Sz•CsN
t, s."L. Safk-
Design flow provided Io43 d
Revision Date (�
Name of Soil Evaluator T.z ra �a �
Date of Evaluation
e above described Individual Sewage Disposal System in accordance with the provisions of
site 'on until a Ce i Cate 7TIT.E5and
j+ "Wiatr a has em issued by the Board of Health.
D
e
COMMONWEALTH OF MASSACHUSETTS
Board of Healtk
---� M4.
FEE
CERTIFICATE OF COMPLIANCE
Mon of Work: O Individual Component(s) ❑Complete System
dersigned hereby certify that the Sewage Disposal System; Constructed
( ),Repaired O,Upgraded O.Abandoned ( )
n installed in accordance with the pro
ion No. dated
r:
ance of this permit shot..,..•.. _.
sions of 810 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
. Approved Design Flow (gpd)
Inspector:
FORM 3A - CERTIFICATE OF COMPLIANCE
CERTIFICATE OF COMPLIANCE
Description of Work: Individual Component(s) X Complete System
The undersigned hereby certify that the Sewage Disposal System:
Constructed X Repaired_ Upgraded_ Abandoned
by: Dionne Management Team - Justin Dionne
at: Lot # 4 - Dunphy Drive - Florence Massachusetts
*** This system has been installed in accordance with the provisions of 310 UvIR
15.00(Title5) and the approved design plan / as-built plans relating to the
application No
dated: October 2 2003 Approved Design Flow: 695 gpd
Installer: Bruce :d+".cr IL,d ` ,�_ eld, MA.
Designer: Tim
Date: November 29 2004
The issuance of this permit shall not be construed as a guarantee that the
system will function as designed.
BOARD OF HEALTH OFFICE OF THE
MEMBERS
ROSEMARIE KARPARIS,R.N.,MPH
XANTHI SCRIMGEOUR,MHEd,CHES
JAY FLEITMAN,M.D.
STAFF
Ernest J.Mathieu,R.S.,M.S.,C.X.O.
Director of Public Health
Richard Meezywar,R.S.,Sanitary Inspector
Patricia Abbott,R.N.,Public Health Nurse
Madeline Neon,Clerk
BOARD OF HEALTH
CITY OF NORTHAMPTON
MASSACHUSETTS 01060
Board of Health. Northampton
212 MAIN STREET
NORTHAMPTON,MA 01080
(413)587-1214
FAX(413)587-1221
CERTIFICATE OF COMPLIANCE
Description of Work: D Individual Component(s) ® Complete System
The undersigned hereby certify that the Sewage Disposal System;
Constructed liRepaired D Upgraded D,Abandoned❑ .
by: sd e` �cQ /y /✓5/4 /✓ 9/iiss�3�6��
at lei qI oJy g4
has been installed in accordance with the provisions of 31 0 CMR 1 5.00 (Title 5) and the
approved design plans/as-built plans relating to application No
dated Approved Design Flow (gpd)
Installer l ��
Date 7 ' -W. -eV
The issuance of this permit shall not be construed as a guarantee that the system will
function as designed.
Oj bats f torta, laadao eddei%
212 Man Sheet
7101te as teeit, 71I 01060
let. 413-587-1214
lax 413-517-1221
Title V Certification of Compliance
TO BE FILLED OUT BY THE SYSTEM DESIGNER
DESIGNER SIGN-OFF
Pursuant to 310.CMR 15.00 of the State Environmental Code:Title V,Minimum Requirements for the
Subsurface Disposal of Sanitary Sewage,Section 15,021 (3),the Designer of a system is required to sign
this form as a condition for issuance of a Board of Health Certificate of Compliance for the onsite septic
system
This is to certify that the onsite sewage disposal system that I desi,ned as: new construction
✓ repair(existing system)
at 1366 D✓M Prty WAVE on OCT 13, 2oa5 DWCP number
(Date)
(Address)
has been constructed in compliance with 310 CMR 15.00, and all local requirements. Any changes to the
uuguml approved ptam have been tcllceicd nu an as-built plan that has been subtmned to the Board of Health.
170 IMPAIIPIGAIe Rc°AD
c PCI-t prow MP..
(A9msss)
T,iwthy E. Mp(;WMS R5
(Pnnt Designer's name)
f0al4�o4
NOTE:This certification represents no warranty,expressed or implied as to the functioning or longevity of the on-site
subsurface disposal system.Rather,the plan and installation are in compliance with all applicable rules and regulations as are
in effect at the tune of plan submittal.
11,6 SYSTM t Arts I&& fi WO Ry 3 C. e <<n pql.% c$ nM51ati MA-.
patat 73 SG 4 commit 47Jalvini6 au silt, -me TF3M WAS Rsrt1Cv&t.
116 el.amio i of Riltd,A. of S DA,c r4S besv ueQ t3 UNt,Lo un1.
i-Lwsa, e-yS M LS Pc o✓G Glyto✓.vOwpi
BOARD OF HEALTH OFFICE OF THE
MEMBERS
ROSEMARIE KARPARIS,R.N.,MPH
XANTHI SCRIMGEOUR,MHEd,CHES
JAY FLEITMAN,M.D.
STAFF
Ernest J.Mathieu,R.S.,M.S.,C.H.O.
Director of Public Health
Richard Meczywor,R.S.,Sanitary Inspector
Patricia Abbott,R.N.,Public Health Nurse
Madeline Heon,Clerk
September 7, 2005
Dionne Management Team
ATTN: Justin Dionne
P.O. Box 355
Northampton, MA 01060
BOARD OF HEALTH
CITY OF NORTHAMPTON
MASSACHUSETTS 01060
Re: Dunphy Drive -Lot#4-Northampton, MA
Dear Mr. Dionne:
212 MAIN STREET
NORTHAMPTON,MA 01060
(413)587-1214
FAX(413)587-1221
On or about October 20, 2004, a final inspection was conducted of the installed septic system at the property
referenced above. Following the inspection a Certificate of Compliance (Number 2004-18) was issued for the
installation of a subsurface sewage disposal system for this property.
Following the issuance of said Certificate of Compliance, a driveway and a subsurface perforated drainage pipe
were installed within 50 feet of the soil absorption system(SAS). During a site visit that I conducted on this
date I observed leachate from the system breaking out of the side of the embankment near the southwest corner
of the leaching field. I also observed that soil had been removed from this area around the leaching field in
order to install the driveway and the drainage pipe in its location. As a result, it appeared not possible to meet
the 15 foot effluent break-out distance requirement for the SAS as required by Title-5 of the State
Environmental Code.
Therefore, the Board of Health hereby temporarily suspends the Certificate of Compliance until such timc that a
satisfactory solution is found to correct the situation in compliance with Title-5. When compliance is achieved
the Certificate of Compliance will be re-issued.
If you have any questions,please contact me at 587-1213. Thank you for your attention in this matter.
Ernest J. Mathieu,R.S.,M.S., C.H.O.
Director of Public Health
Cc: Matthew Murphy, Owner
Dunphy Drive, Lot 4
Northampton, MA 01060