179 Applications & Permits & Certificates of Compliance No.
FORM 1A -APPLICATION FOR DSCP
Fee eh
COMMONWEALTH OF MASSACHUSETTS
Board of Health, Northampton ,MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to: Construct ® Repair ❑ Upgrade❑Abandon ❑
® Complete System
❑Individual Components
Location 179 Westhampton Road
owners Name Northampton Associates,Inc.
MaplParcel#36-087,43-005,43-006,43-075
Address 25 Main Street, Suite 445,Northampton
Lot#3
telephone#413-586-5340
Installer's Name Sovereign Builders,Inc.
Designer's Name Paul B.Hatch,PE
Address 135 Southampton Road,Westhampton
Address 57 Munn Road,Monson,MA 01057
Telephone# 413-527-8001
Telephone#413-267-3696
Type of Building:single family dwelling
Dwelling-No. of Bedrooms -3-
Other-Type of Building
No, of persons Showers O, Cateteria()
Other Fixtures
Lot Sae 30,195 sq.ft.
Garbage grinder yes ® no ❑
d/p/ PAUL
S HAC
Design Flow(min. required) 495 gpd Calculated design flow 495 gpd
Design flow provided 525 gpd
Plan: Date Jan. 3, 2003 Number of sheets 3 Revision Date
Title On-Site Sewage Disposal System, Lot#2, #169 Westhampton Road
Description of Soil(s)0-4"=A=SL, 4+-24"=B=SL, 24"-76"=C=SL,
Soil Evaluator Form No. Name of Soil Evaluator Timothy E. Maginnis
Date of Soil Evaluation October 24, 2001
DESCRIPTION OF REPAIRS OR
ALTERATIONS
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance
with the provisions of TITLE 5 and further agrees not to place the system in operation until a Certificate
of Compliance has bee issued by the Board of Health.
Signed (/pJ i� ii Date
Inspections
DEP APPROVED FORM 5/96
FORM 2A - DSCP
No. Fee
COMMONWEALTH OF MASSACHUSETTS
Board of Health,Northampton MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to: Construct ® RepairE Upgrade❑ Abandon pan individual
sewage disposal system at 179 Westhampton Road
as described m the application for Disposal System Construction Permit No.
dated
Provided: Construction shall be completed within three years of the date of this permit.All local
conditions must be met.
Date Board of Health
DEP APPROVED FORM 5/96
No
FORM 3A - CERTIFICATE OF COMPLIANCE
COMMONWEALTH OF MASSACHUSETTS
Board of Health, Northampton
MA.
CERTIFICATE OF COMPLIANCE
Description of Work: ❑ Individual Component(s) ® Complete System
The undersigned hereby certify that the Sewage Disposal System;
Constructed Repaired Q Upgraded ❑ Abandoned ❑
by: Northampton Associates,hie.
at: 179 Westhampton Road
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
InstallerSovcreign Builders,Inc.
Approved Design Flow (gpd)
Designer:Paul B.Hatch,PE Inspector
Date
The issuance of this permit shall not be construed as a guarantee that the system will
function as designed.
DEP APPROVED FORM 5/96
DARE) OF HEALTH OFFICE OF THE
MEMBERS
MARIE KARPARIS,R.N.,MPH
-1 SCRIMGEOUR,MHEd.CHES
JAY FLEITMAN,M.O.
STAFF
it J.Mathieu,R.S.,M.S.,C.N.O.
Director of Public Health
leorywor,R.S.,Sanitary Inspector
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 01060
(413)687-1214
FAX(413)687-1221
CERTIFICATE OF COMPLIANCE
Description of Work: 0 Individual Component(s) ® Complete System
The undersigned hereby certify that the Sewage Disposal System;
Constructed 10 Repaired 0 Upgraded 0, Abandoned 0
by Bob Obear
at 181 Westhampton Road
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 525
Installer Cooper Excavation
Designer Paul Hatch
Date
(grid)
September 9, 2004
Inspector
Refer to attached inspection provisions
dated September 9, 2004
The issuance of this permit shall not be construed as a guarantee that the system will
function as designed. -
ATTACHMENT
INSPECTION PROVISIONS
ON SITE SANITARY WASTE DISPOSAL SYSTEM
September 9,2004
for
181 WESTHAMPTON ROAD, NORTHAMPTON
I, Paul Hatch,PE,designer and inspector for the sanitary waste disposal system constructed
at 181 Westhampton Road,Northampton did not have an opportunity to inspect the prepared base
of the soil absorption system before fill was placed in the excavation or the fill placed in the
excavation before the stone bed and distribution laterals were installed. Also I did not have an
opportunity to inspect the impervious barrier installed along the westerly and southerly sides of the
soil absorption system.
Mr. Bruce Cooper, Cooper Excavation, installer of the sanitary waste disposal system has
confirmed that all unsuitable soils were excavated and that the bottom of the excavation was a loamy
gravel as described by the soil evaluator, Mr. Timothy Maginnis, R.S. in his report of October 24,
2001. Further,Mr. Cooper has confirmed that the fill used was in compliance with the provision of
310 CMR 15.255(3), commonly referred to as Title V fill.
Mr. Cooper has also confirmed that the liner installed as shown on the as built plans was a
competent barrier material,that is,without seams or other openings that would allow leachate from
the soil absorption system from flowing out through the fill embankment.
s/n Paul B.
s/n Bruce Cooper, Cooper Excavation
B. Hatch Consulting Engineer
n Road, Monson, Massachusetts 01057 (413-267-3696)
January 17, 2003
Mr. Peter McErlain
Board of Health
210 Main Street
Northampton, MA 01060
Re: 179 Westhampton Road
Sewage Disposal System
Variance Request
Dear Mr. McErlain:
This is a request for variance from the Board of Health Regulations in which the
minimum distance from a wetland boundary is 75 feet. We request that the minimum offset
distance from the wetland boundary be reduced to fifty feet.
The reduction in offset distance is necessary for this site because of an isolated wetland
essentially bisecting the property from east to west at approximately the middle of the site.
This site is currently improved with an existing mobile home. This mobile home shall be
removed for construction of the new home proposed.
Reasons for granting this request are:
I. There is an existing home on the site therefore there is not a change in the impact
of the wetland on a subsurface disposal system.
2. The wetland is an Isolated Wetland which under the Massachusetts Wetland
Protection Act does not have a buffer.
3. Under Title V, 310 CMR 15.211(1), setback distance to a Bordering Vegetated
Wetland (BV W), for a soil absorption system is 50 feet.
If you have any questions or would like to meet with us, please call.
Very truly yours,
a531o13C
OF HEALTH
NBERS
WICK,M.D.,MPH,Chair
hRPARIS,R.N.,MPH
mMAN,M.D.
RUIN RS MPH
th Agent
587-1214
0 587-1221
4, 2003
pton Associates, Inc.
Street, Suite 445
pton, MA 01060
CITY OF NORTHAMPTON
rampton Associates, Inc.
MASSACHUSETTS 01060
OFFICE OF THE
BOARD OF HEALTH
210 MAIN STREET,Room 8
NORTHAMPTON,MA 01060-3167
ary 30, 2003, the Northampton Board of Health reviewed and approved your request to reduce
ick distance between the isolated wetlands and the sewage disposal systems proposed for Lots 2
and 179 Westhampton Road, Florence.
ack must now be a minimum of 50 feet per Title 5, 310 CMR 15.211(1).
:ic system construction permits for these lots will be issued upon receipt of the permit fee, ($751 lot)
to the city of Northampton.
re most likely aware, the Northampton Conservation Commission must be informed of your
s to undertake construction within the buffer zone of a wetland.
ontact the Board of Health office with any questions concerning the septic permits.
)U.
y yours,
McErlain
gent
lorthampton Conservation Commission-