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THE COMMONWEALTH OF MASSACHUSETTS
BOARD 9F HEALTH .u/t::'w,,/ .... u ... u of .... dm~£...rCmu. mm.uuu mm.mu.m.
l\ppliratinu fur ilispusal 1!tifurlw illuul1trurtinu Jrr_ ..• "" Application is hereby made for a Permit to Construct
Syst<m at: ) or Repair ( v( an Individual
....... (Q~~L.;ST.a:z:(f'-"' ... :1?~.<9.p.. ...................................... . . . ..............................................•...................................•...•.......... Location - Address or Lot No.
~gl.~.e.§~P..c::.IIl."tE.!;..=-:PIJ,.-,!£.&t?.~.'!J!.!!6:..CE.".!:E-.~.. . .. LO.(a4. .. t:?:1&.(!!I. .. ;5z, .. Lh:?1!!£.e~r,..tJ2tl. .. QI.!2i).z... ... .
___ ._P...~ .. y._ •• ~._._._L_.':-?...rs.l_~~~. __ ._. __ .. _._ .... ____ . ______ ._ ........... _ ... _. __ ._._ ....... _._. __ . _________ ..... ___ . __ ~~~:~.s.~_ .......... __ ..... _____ . _____________ . __ .. . Installer Address
Type of B~ild~ . . Size Lot ... ~ .................. : .... Sq. feet Dwelhng No. of Bedrooms ... ~ ...................................... ExpanSlOn Atllc 0/.) Garbage Gnnder ~o) Other - Type of Building ............................ No. of persons ........................... . Showers ( ) - Cafeteria ( )
Other fixtures ............................................... ....................... .............................................................................. . Design Flow ... :;r .... ... u .............. u .. l.l.9.uugallons per ~~~er day. Total daily flo\Vu ........... uu .......... S~Q..uugaJlons. S . T kLI··d . /,<""d A II L I /2CtJ·· \\'"d 058·· . 6".5" epuc an z,1 capaclty_ .. ~~.Y._ga ons engt 1. ____ . _____ ._ ... 1 th ____ ... __ ....... Diameter ...... .......... Depth ............... . Disposal Trench No ...... 3 ........... Width .... :3G.:: ....... Total Length .... 2.1O'· ....... Total leaching area ...... l.w.5::<A.sq. ft. S'DEwALL Seepage Pit No ........ ....... ...... Diameter .................... Depth below inlet... ................. Total leaching area. ................. sq. ft. Other Distribution box (1&J) DosinJ; tank 0'0) .y. .; Percolation Test Results Performed by1::!.$.".17;e.~MTK€!!.Ai'd.<R.ift.'!!F.~ . .cb!?/f. .... Date .. ~ .... :.!.. ....................... .
T P·" I .,. Q' . h D I {T p. \ 50" D \ 02." est 1t 1 .... 0. . ..... "-l . .... minutes per mc ept 1 0 est It................... . epth to ground water. ...................... . Test Pit No. 2 ................ minutes per inch Depth of Te.t Pit ........ ............ Depth to ground water .................... ... .
Description of Soil . .T.Q .. li:::T~~:~~;:;:~::T.~::~:p.:;:i;~~~~;:~~:::ii..:!.;;g:~;;~:;;;:zf;;.;;li.~·.~·;;~~:.ii;.~.·.;.;:6.~.;;;:.
N~~·~~~··~f·R~~~i~~··~~·· Ai~·~;~~i~~~·=·~~~~~~~·;··~h~·~·~~~i·i·~bi~i:~;;;;~~~~~~:~~~;..~~.~~~~~~~;.~~~~~.~£&~~{l~~~~~~~~~ .. !,ff. fI!:. H. .. 7J#.€d.!' !!.~,r. •................................................................................................................................................................ Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code - The undersigned further agrees not to place the system in operation until a Certificate of Comp iance has been issued by the board of health.
J~ Signed ·ew,N.t1;...~?JIt:::e. ........ . ................ . Application Approved By d~V ....~r[f.'zry,*L. .. .. .. Application Disapproved for the fall ng r. aronr: ....... ...................... ........ .
6-7-0 1/ ~Z·'?2~t.
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Permit No. 7" '1- t Do"
Issued
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THE COMMONWEALTH OF MASSACHUSETTS ~ ~ ':l~ ~ BOARDL:HEALTH ~ ( !
jq<,yA,! OF /J,.,,<--!"..~ 10/;'(' 71 QIertifi.cnte of QIomplinn.ce
) or Repaired ( ---r
DATE ..
------------- - ---------------------------------------- --------------~.
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THE COMMONWEALTH OF MASSACHUSETTS
Application is hereby made for a Permit to Construct (
System at: ) or Repair (vi an Individual Sewage Disposal
...... §.~~. __ ~_[!3.I.~.y.;!/ ... £'?t.!,~L ............................... _.:: ... . . ..................................................... ··········_·····.···._ .. n._ ....... _ ...... . Location· Address or Lot No.
~~.~!:::9 .. f.l. ;:.~=~f:.1::U_~.~ .. ;:-?N .. -:.:-.... :-.. .. .:J ... .. -!;. ': •• : •• ( ••• :.::': •• _ •••• . .. c...,.~~.':t. _. t:!..!. . :I.!;.'I.. .. ~.!. ... L.I.'- .(!!.~~_"f: . .;...!~_.!.!./!:LJ2J.!=1.f;J.z._ .... ?"v L L V I Owner .................................... JJ. ... ~ ............................................ .
- Address
Installer Address
Type of Build~ _ '". \ .' , ize Lot ............................ Sq. feet Dwelling No. of Bedrooms ... ;? .................. \ ................... Expansion Att\c ~. ) Garbage Grinder r" ) Other - Type of Buildillg ... ........................ -\No. of persons ........... ...... \ ......... Showers ( ) - Cafeteria ( )
. Other fixtures ····I;~····· ·· ·· · ·: ............ "l?:; .. ~:;< .. : ... ~........... . .... .\...... .... ·······················3·0··················· DeSIgn FlowZ ..................... · ............... .. gaUotlS per 1""'""n per . Total da,IX f!ow ... : ...................... "J. ............. gaJlons. Septic Tank rZid capacity./.,fqg .. gaJlons - Length .. t. ?.G! ..... Width .. .;:?:Q ..... :'Diameter ................ Depth';;'::~ .:: .... .. Disposal Trellch No . .... 3 ............ Width ... ~~~ ..... l.. Total Len th ... 2..1.~ ...... Total leaching area. .. ..Iw.s::«> .. sq. ft.ilo= ",~ ,,, Seepage Pit No ..................... DiameteL. ........... : ...... Derth below i lel... ............... Total leaching area. ................. sq. ft. Other Distribution box {~ J ) Dos!;tJi · tank «,,) _. . . _ ..; Percolation Test Results Performed by<;:).<.P.f.U ... ~'K MI'((!{.,b:l!.~(d-!!!.~JJ.!. /:/. ..... ~te.~ .. :.i:.? ......................... .
T P· N I 3Q' . h D I If T P' \ 50" D h d 1<.>2" est It 1 o. _____ .... _____ .mmutes per mc ept 1 <\1 est It ... .... ...... ___ .___ ept toP- oun water ........ __ .... ______ .. . .
Test Pit No. 2 ...... : ......... minutes per inch Depth 01 Test Pit .. ................ '. De~\th to. ground wateL. .................... .. --t-- I \
Description of Soil_T.~._!.~:~~~i~:::~ ~~:~: ::::i~:::~:~~~::~ : ; ~~~~: :~~:~_ ~::: :n::!.~:~:: ;:.::~;~:Z~.J;.-I~;:~.~-_·{; ... ·; .. _~·.~.~_~.-E;.~.·.·~ .. 6.·~i~;-.·.· -.... --_ .................. -..... -.. -.......... --........ --_ .......................................... ~- .. -.... -........... --........................ __ . __ ....... ------.... -.. -.-.. _-_ .................... . ---_ ...... _ .. -._._.- -_. _._ .. .... .. ................................ .............................. .... . ~ .... ............ ............ :':::-............... ............................................•....... Nature of Repairs or Alterations - Answer when applica~~~:.r.1. ~: .. ()!.(:~ .. -!(, ... /l~~ .. ~~!!., .. ~.~TI~:.C!::{~;y. !3.c:(w .. f ........... . • !::.€.B.t;.':.~ .. T!?.'::~ .~.t.~f~! ........... ........... .......................................................................................................................................... . Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code - The undersigned further agrees not to place the system in operation until a Certificate of Com liance has been issued by the board of health.
J SIgned f.ti-""~~"'" ';,;c ApplICation Approved By a~ ~ If,/l t-Y-ryI Application Disapproved for the foil ing
"'" Permit No. . Issued o.~ .... .......... .. :). .. .
THE COMMONWEALTH OF MASSACHUSETTS
by .. THlS~~ Ct.RTr.~J:;~t::.htIndlvidual Sewage Disposal System constructed (~~~.~~.~~ired (...--')
C. t f J' 0. r;,./ )2,,:Z "",~:",,'
THE COMMONWEALTH OF MASSACHUSETTS
9'1- , No ........................ .
~ BOARD O~ HEALTH ......... I.a.I.4J,!.,L ....... oF .. 4~ .................. .. ..
Form 1255 ~ HOBBS" ~AAREN TIll Publlshera
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AMHERST S-/17/9<1 .JS(.~"'!' TOWN OF ?'d).{.J!'EI( ,.. SeN,,,i,- U I c..tC.... .-c.,., « /'114"~ Sr 00
: PERC TEST DATA SHEET Pd' /60 -
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DATE LOCATION ~6'l. J'771rliJi.( "74.. J LOT SIZE
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BY y. p . E./RS 11 -, e... ~ SC~-;;- FIRM .r,,--... OBSERVED Z,WW""l !/.. ' _. BACK HOE OPERATOR -r; t I.t< 1),. Vi r (c/C'f'''': TELE BENCH MARK
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David Zarozinski Amherst Health Department Bangs Community Center Amherst MA 01002
Richard Scott, P.E. 31 Shutesbury Road Pelham. MA 01002
October 28. 1994
Re: Septic System Repair at 669 Station Road Pioneer Senior Center
On Thursday October 27. I conducted an as-built inspection of this newly repaired septic system. The as-built dimensions are shown in "clouds" on the enclosed plan copy .
AI I system components are installed. In plan view the piping is shifted a small amount to preserve landscape trees. This smal I shift wil I not affect system performance and the field location remains over the test pits.
Elevations In the pump-fed leach trenches were spot checked at approximately twelve locations. The results are al I within a tolerance of +/-.01 feet and all pipe pitches are in accordance with Title 5.
The switches and alarm were checked by manipulating the floats. They appear to be properly set to dose approximately fifty gallons of effluent to the distribution box during each pump cycle.
Work remaining to be done as of Thursday afternoon was to crush and bury the discontinued septic tank. provide new risers on the tank and pump chamber. then to backfill all system components. Once the remaining work is complete. my recommendation is that you approve the installation for use.
If you should have any further questions on this proJect please don't hesitate to call me.
cc: Jean Murray Paul Lussier
~:~~ Richard Scott P.E.
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