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FEB •.... ~O __ , ,\l' 0 II"
THE COMMONWEALTH OF MASSACHUSETTS .1Sj) z6 ",,~,,\.,\\ f ~,f;"""
.... row~~:~~.~:k\~:~.~~.~ ............. ~ /!~~DI ,f; ~~\ :3 rK ..... _ 1\ppliratiult fur 1.flinpunal Burkn Qlultntrurtiult Jrrnijt I ~ R.S. '" :
; , Application is hereby made for a Permit to Construct (,/'J or Repair ( ) an Individual Se~~ge isposal /'
"""'" '* ... * """, Systemp..o
..... .I..s: ..... jQ . .I.. ..• ~-ty ........ ::r..B.I!"t..l.Ul>:J ..... W~L .. . '" .... Location . Address r
..................... _._ ........ __ ......... 5..7: ._ ... _. ______ ._._._._._._ ...... _:~~~!..~!_~~.' II , , \ 7'\ or Lot No.
. ... :tOO .. S£4..-6.o.a .... lS..DoA .. ,. .. AM.~eLfo:t. ............ .
................. !!I.(}.t!!/l!~.!I..tr:~.~.m.4..~ ............................ . ........... .M!"~ .... .uo.oa1a. .... L1..Ue.C&\e.C£... ............. . ,- .s Own,,_ ................... l;; ... O .......... :rn./Y .. R ........................................ .
Installer Address
Type of Building Size Lot ... 4.~~.J.35 ....... Sq. feet Dwelling - No. of Bedrooms ............. £hc~~ .............. Expansion Attic ( ) Garbage Grinder (v( Other - Type of Building ............................ No. of persons ............................ Showers ( ) - Cafeteria ( )
Other fixtures ..................................................................................................................................................... . Design Flow ............................... s::5:" ..... gallons per person per day. Total daily tlow ................. il:<ls ................ gallons. SePlic Tank - Liquid capacity.1600.gallons Length ................ Width ................ Diameter ................ Depth .............. .. 9i.~f.~'¥I~b !'Io ....... 1 ........... Width ...... .!.!.' ...... Total Length ...... :!.~ .. ~ ..... Total leaching area. .. :1a~ .. m .. sq. ft. Seepage Pit No ..................... Diameter... ................. Depth below inlet .................... Total leaching area .................. sq. ft. Other Distribution box ( Vi Dosing tank ( ) Percolation Test Results Performed by ..... F .. AA.EI.llaS ........................................... Date .... fi../.!..j.8..1: .............. .
Test Pit No. I ........ ~ ..... minutes per inch Depth of Test PiL .. ..lO" ...... Depth to ground water ......... '1.~ .. ~.~. Test Pit No. 2 ................ minutcs per inch Depth of Test Pit. .... __ ........... __ Depth to ground water ................ _______ _
Description of Soil ... e.n.dos:~J?:::::::: :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: .... : .... :::::: ...... : ______ .... : .. : __________ : .. : ________ ::: __ :::: __ : __ : __ ::: ____ .... __ __
Nature of Repairs or Alterations - Answer when applicable .............................................................................................. .
Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the Stc.1.te Sanitary Code - The undersigned further agrees not to place the system in
~~::~":::fi::;;"": '" fi~~~~:~~:::-::~_ili/~::::: Date
Application Disapproved for the following reasons: .... .......................................................................................................... ..
jr3/ (1 Date
....................................... ~.. . ............................................................................................................. ]) .......................................... .
Permit No..... ................................................ Issued. ............. d'.. .'1..£ .................... ..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.......... """." ..... ""."." ...... OF ..... ........ ...... ........ """",,.,, ............. "." .. " ...... .
Qlertiftratr nf Qlumplinnrr THIS IS TO CERTIFY, That the Ind:vidual Sewage Disposal System constructed ( ) or Repaired ( )
by .................................................................................................................................................................................................. .. Inst31ler
aL ................................................................................................................................................................................................. .. has been instal1ed in accordance with the provisions of TITlE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.. ....................................... dated ............................................... .
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY.
DA TE............................. ................................................... Inspector ................................................................................... .
" - - _._------.... THE COMMONWEALTH OF MASSACHUSETTS
(k 'J \ N o ... o..~ ......... ..
...---;---r BOARD 9'L~EAL TH ....... ...... "jt:24!J .... oF.. 1JlJJI({i§..r.. .................. __ .. FEE~D.. .........
Permission is hereby !~~~~'.I .. ~.ff:.:.J~~.=~~.~ .. ~~~~ ............................................ . to Construct ( Xi or Repair ( ) an Individual Sew~ge Disposal System
:: ::;,;:·;;;;:;:;;:;;;;::;;~~;~!:,;,~,=;.~:=!:Fi ..••... ;;;;; ......•. &~j~~.::~ DATE ...................... 2.b/!.~=.............................. Boa' of Heal'h
FORM 1255 HOSBS 8r WARREN. INC .• PUBLISHERS
• No .... ............ _....... FEX ..... __ ._.~ ."TM .. ""',
", ," THE COM M ONWEALTH OF MASSACHUSETTS ,'\'\~\.'" Of "'I#~""
BOARD OF HEALTH /~<. f\i'-~-TOWN ....... OF .......... A.lhliERbT.......... ........... ......................... f! ~Dl.lJK '0. ~
.. Co.) tP.'1"-' ~ _
Application for IDi.!ipo.!iul lffiIorks <lIolllifrudiun Jrr~t I :a R.S. "'~ Application is hereby made for a Permit to Construct (,,/) or Repair ( ) an Individual S~"")lge ,/
Systes:n at : "" 1c * , .... ' ................ __ !QJ:. ... ti.Tv ........ :::r.B.l!r./..J..u.na ..... WI1:'i...... . ................... __ ................... 5.1: ..... ________ ._'~':::~0!.o 0 0.0""
'- .... Locatioll · Address ( "or Lot No .
........... .M.r~_..L'\Ooa.I.~ .. L1..Ue.\.d!.\~c.~.............. . ... 3:.00 .. ~-b.o.n .... ~o.o.~:f\=he.c!>.t .. _ ... .
.................. k.D ................. );.'QT.JI...¢:................................ . ............. m.O/1J.r.tt~'!!!..€!..~~:'.w. .. ~ ................ _ ...... _ .. _ ... . Iu&ta!ler _o\ddress
Type of Building Size Lot ... 4..?t.4.35 ....... Sq. feet Dwelling - No. of Bedrooms ............. :(;,hl..~~ .............. Expansion Attic ( ) Garbage Grinder (vi' Other - Type of Buildillg ............................ No. of persons...... ...................... Showers ( ) - Cafeteria ( )
Other fixtures ...................................................... .............................................................................................. . Design Flow ......................... ...... s:s:-..... gallons por person per day. ·Total daily flow .......... ....... iI1.s:: ............... gallons. Sq;Lic Tank - Liquid capacity.1500.gallons Length ................ Width ................ Diameter ................ Depth ............... . gi.I'f.~\c~!Ji}) !'Io ....... ~ ........... Width ....... l8..' ...... Tot,J Lcngth ...... :5.'?.~ ..... Total leaching area .. :laZ, ....... sq. ft. Seepage Pit No ........ ............. Diameter .................... Depth below inlet .................... Total leaching area .................. sq. ft. Other Distribution box ( Vi Dosing tank () . Percolat ion Test Results Periormed by ..... £..AA.EI.llas ........................................... Date ..... ~/.!./8..1 ... ........... .
Test Pit No. L ...... 0 ..... minutes per inch Depth of Test Pit ...... .IO'~ ...... Depth to ground water... .... .. 1.'. .. ~.~. Test Pit No. 2 ................ minules per inch Depth of Te5t Pil.. .................. Depth to ground water ...................... ..
Description of Soil ... e.ndos:~a?::::::::: ::: : :: :::::: ::: ::::::::: : :: : ::: : :::::::::::::::::::::::::::::::::::::::::: : : .......... ::: ........ ::::: .......... :::::: .... : .. : ........ : ..... '::::::.':::::::.
Nature of Repairs or Alterations - Answer when applicable ................................... ........................................................... .
Agrcclllcnt: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the pro\"isions of 71 TLE 5 of the State S~nitary Code - The undersigned further agrees not to place the system in operation until a CcrtiliCJ.te of Compliance has been issued by the board of health.
~d.''' '' '';j '''''''' ' ' ' ''' ''''''''''' '''''''''''''''''''''''''''''''' '''''' ''''''''''''' ..... 7~ ;Ai ............ -.. .. Application Approved By ............ \...:s::-:~,.... ................................................. .. ..... .JIHt.C ............ ..
Date
A pplicatioll Disapproved for the followi>:g reasons : ....................................................................................... _ ............... ___ _ ................ ~~::;: .. ~~::::::::::::: .. :::::::::::::::::::::::::::::::::::::::: ..................................... ~~~~= .. ~~.: .. :·~~~~·::J)Z;~~~~~:::.·:~----
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........ ..................... .. ... ....... OF ... ................... .... ........... ............... .. ..... ..... .............. ..... ..
<lItrlifirutr uf <lIuutpliUtttr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructc'(\ ( ) or Repaired ( )
by ........................................................................................................................................................................................ _____ _ l nstal1er
al.. ................................................................................................... _ ............................................................................................. .. 1:", heen il1sl"llc<\ in ocronbnce wilh the prov isions of TITU'~ 5 of The State Sanitary Code as described in the applic.1.tiol1 for D ispo5."ll \Varks Constru("tion Permit No. ____ .. __ ..... . .... .................. .... dated ... .. _ .. ..... . .... .. ...... .... . ..... _ .. . __ .... .
T!-!E !SSU.e.~!C~ O~ TH!S CE::'!FJC~.TE S!-~AtL ~IOT BE CONSTRU~D AS A GUARANTEE TH T THE SYST~M WILL fUNCTION SAT!SFI,CTO!'tY.
D1\ T E .............................. ................................................ .. Inspcctor ................................................................................... .
•
DI::: E·P SO'lL LOGS
\
LOCATION 8=61,..../t: W060fJ
Lo 1:. "IJ. 57
.so; / ,--O-S" To?.fO; I
Su6so;!
DATE d<Ay Ii /'144
OBSERVER rd, ;::-,. /; 0 J
~
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7'/"- /0' ;=; ,....-. +0 c. t> .... .P '" c.- it- iI / J W' ,.-fl.. .f 0 ,..., ~
(.0 bj,/~J ",,,,,of or ... vd.
0' , . GROUND WATER 12. - .ff .. -t-.J]a.(j~
-,-------,
GROUND WATER ________ _
Puco/a.bo" Rg,te. Q"C 32 I'
(p :-,.., ; ~ lin c /.....-
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GROUND WATER __ -_______ _
GROUND \oJATER __________ _
· .
, '
· PLAN SHO VJ.IN G . SE WAG E· DISPOSAL For: Arnhtrst. Wood'::J
'1'j 1'3 'Pine. Sf: 'Phi I ",de.! phia. I Pa..
A l:: Amherst Woods Amhen,f I MA. L.ot # 57
Inc.. +-0(" bo(\a.ld '5c.a.\e: 1"=40'
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· . . PROf \ LE' Of SEPT\G 5'{SIE M B,(: ~Rt.'Ut.R\CK A.. ~\L\os
o AT € : All rav.:.t 5, I ~ K:S"
SCALE~ VERT. ,""3'j \-IoRIZ. '''=10'
2 0 8
===t 1& I~ 16 1° S 'l , !/ '$'~ ,-:-~~ ~
...... It II 'r-!J>s, "-f -" II tr. q,.' '\ -::.." --s<:~>: F",\\ L,,~ lb' C·t,.\. ISO 1= 15'
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CA LC.~L7R I o~~ 3UrMs@l{O~"53 +5': ~~Ulro:l 1e~c. "R<u:-~. tOM,('\.I,nc.h
J Le~~di1-" I< "3'l' ~ "102.Sq.F't".
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elf l
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Specrf"lcQ.·bons: AI\ fY\Q.te.nQIs and COf\'Struct.10'" WIll be.. \(\ accorda.nce WIt\-) the.. COY'f\fY\or.weoJt:h c~ f'l\a.~~Q.C.~\..\.~e.tt:..s t.r. Q. 1;:. StQte. E",v, c'ol"\fV\U\ta..1 Code. I Tt t.le.. s:
3, f" b'AMe.ie-1"" Hpt.('r'les
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,--. • ,
LEWIS & COOK SURVEYORS, INC. P. O. BOX 1196
BELCHERTOWN, MASSACHUSETTS 01007
DEC 05 1989
RICHARD A. LEWIS, P.L.S. RICHARD L. COOK TREASURER 413-283-7238
PRESIDENT 413-323-7124
Board of Health Boltwood walk Amherst, MA 01002
Dear Mr. Zarozinski,
December 1, 1989
I have inspected the subsurface sewage disposal system at 15 Trillium Way on November 29,1989 for Ronald Nayler, contractor Stoney Excavation.
The system was substantially constructed as designed.
~;~ Robert F. Sheehan, P.E.
I--~~-• , f"
it
.---"
.. , r9- j ? N,p, ............... ...... .
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH JP"':-''7 ...... oFI+M~:2f ........................... ..
.Appltrutinu fnr ilinpnnul lItlInrkn mnttntrurtinu Jrrmit Application is hereby made for a Permit to Construct (
System at: ) or Repair 0( ) an Individual Sewage Disposal
················-····~!..::?:.···71i;{(·~{2·····~1j.8·7[j·· .......................... L.t:-f···.f.Z;·N~·················.J;;;.il ........ . ....... £o..~ ..... A:;f;9!i!........................................ . . .!~.7b.·!U.M.~ ... ~ ....... ~ ............ v: ... t.1A .............. 5'. ........ !.1/.-:r..y. .. ,S.................................................. . ................................................................................................ .
Installer Address
Type of Building I / Size Lot .. 'i;:;;I.!.~£ .... Sq. feet Dwelling X No. of Bedrooms ................ 7.............. . .. Expansion Attie). Garbage Grind~r ~ Other - Type of Buiidillg .......................... No. of persons ......... 8 ........... :,howers ( ) - Cafetena ( )
Other fixtures _ .. _._ ... _____ _____ ________ .. _______ . ________________ .. ____ . _. ________ . _. _. _. _____ . _._. ___ . _._ .. _._ ............. __ .............. ____________ .... ____ _
Design Flow ..... mm .. m?2 .............. gaJlons per person per day. Total (bily flow .... mmmmmm ................ galions. Septic Tank - Liquid capaci~.':'T'1{a~ons Length ................ Width ................ Diameter.. .............. Depth ............... . Disposal Trench - ~9~ ...... 3. ......... Width .... .3."'.~ ..... Total Length .. J~.s.: .' .. Total leaching area ...... ."LO':£.sq. ft. Seepage Pit No .... .t.Jj/:L ..... Diameter .................... Depth below inleL .... 'I.a.:!. .. Total leaching area.LISPl ... sq. h.
~:~~~I~:~~i;:itO~~~~trr Performe~~;i~:.J .. I. .. ~k. .. ?:~,.,1.;«. DateM.<!, .. lr.'!?!?,'''''I .. J..' Test Pit :-lo. I j;'>':.?' .. minutes per inch Depth of Test PiL .... :5:-~~ .. Depth to ground water:.6~/O:""" ... ~61
D
~es~ PitfNSO·.12 ......... ::::::~lin.ute.s.~:.h.nn~~.~; .. ~f.;e.st .. ~t: .. :.:.~;::: .. ~~~~t~ .. t~.:.:~~~~ .. ~ai~t;~s.. escnpt10n 0 OJ ................................... • ••• ~.g,d ..... ::::id1e#I;............................... #"R08E~T"""':. ",
.............. ------ .. -----..... ------....... -............. ---................................. -- ... ----..... --.----------- --------.---.---.......................... jJ ······FRhNCtS-·--··;S : ____ ........... __ ...... ... .............. .................. __ ...................................... __ ..... __ .. _ .. _ . . ........... _____ ..... __ .... .. . ....... .......... 0 .. t.:e~-.-... -'-'.
. . I .' Nature of Repairs or Alterations - Answer when applicable .......................... _______ ......... ___ ..... .......... .. .1!.a •• 22. ~4 -0,'" ... ~
~, . . . ..
A~;~;~:~~~~e~s·i=:~··~~r~~:·:~··;~:~~·;,L~~~:g~~~i~~::~::~s~;··~:~t~:· in ·~~~6:dan~··~;;I~ the provisions of 7ITLE 5 of the State Sanitary Code - The undersigned further agrees not to place the system in
operation until a Certificate of Complia;:;n:~=~ .. l~.t~ .. m .. : .. ~ .. : ... ... ........... .\\.\ ..... \ ~ ,---'--~ Date
Application Approved By................................................. ............................................. . ................ . ............... .. Date
Application Disapproved for the following reasons: ................................................. ... ........................................................... .
[ '7- / j7 Permit No .............................. !!... .................... . Date
Issued. ...................................................... . Date
THE COMMONWEALTH OF MASSACHUSETTS
~ BOARD OF z:.~ ......... LVCA!.Il/ .... 0F .... . H/J1 ....... ...... , ....... .
Qtrrttfirutt nf mnmpliuuu THIS f! TO CERTlFYS That the Ind,vidual Sewage Disposal Sfstem constructed ( ) or Repaired ( ~
by ............... ~ ... ?~!?!.0:::r..y. ....................................................................................................................................................... . , .- ----a -; / /~ Vi ' L.c/A \ Installer
at.. ..... / .. .J ......... .(. ... "' ...................... :r.\... .................. / .......................................................................................................... . has been installed in accordance with the provisions of 'l'I'='~C 5 of t he State Sanitary ~e a~escrfeft!..· the
appli~~~n I~~~:~S:I ~:o~~I~ons~~~lt~~~:;~m:~:.a~~ .. ~~.~~~~ !~e!~~:~~~~~~~~;~.~ ~:~:~~,,;"N~2 'd;';;Y:m '~~':mmmmm ~ THE COMMONWEALTH OF MASSACHUSETTS
<::--<J -/ V' No ... !J ••• (. •••••• _.fl.. .. _
BOARD OF ZEAL TH
... ~wtr,) .. ..... OF /laJ . .. 4,£c. .............. . ~
FEE.iA ............. ..
iltnpnnul mnrkn ,Qtnuntrurttnu J~rmtt C- fo( /0.0.;2.. Permission is hereby granted._. __ ._SZ?:::~.y._.d.. __ . __ .. _._ ... __ . _____ ._._ ..... _._ .... ___ . _____ . _______ ......... _____ .................. __ ...... _ .... __
to Construct ( ) or Repair C. ~ Indivirlual Sewage Disposal System
:: ::::~~;;;=:;"~:~;7~=;;~;;~~:7N;Jt;if ;,.~~~ DATL .... :o/.~ ... ~ .......... yq............... /7i H"l,h 7~~,z;tz~ FORM 1255 HOBBS &: WA.RRI::N. INC .. PUBLISH!::RS
· .
AMHERST HEALTH DEPARTMENT
TITLE V FEfS
o,;,~er: Ko"-'If } J, Jbt )/Ir.z Site: /S-ifi,1/ tu';' W/l i Percolation Test: /QO ",o' Per Lot c I( /f-Zy
/C/d~
• Date: "
• Date: "
# Date:
" Date: ff
· # Date:
Disposal Harks Construction ' Permit
Plan Rev ie,/ Date _____ _
IV~-e.i 71J IT ~ -~"'fn.CV-- 4 / ' Final Inspection Date#. ,;tva r
CD CIl.4c f« cf ./ b ox:.. '
~ ~tr .LtrifJ-;.i~-;.-: -r-;~7';~ - - - - - I
Subsequent P1an Review
Da te ;./0 (/, c:
Date, _____ _
Date, _____ _
Reinspection of Installation
Date;;0 U 30
DateA
_____ -'
EH:
,
...
•
TOWN OF AMHERST
PERC TEST DATA SHEET
--;:::> d ,/'<70 a"
e: ?(. /5--9'1 ----DATE ffiU {G7 LOCATION /~~/!u.JJ?1 U)/I/ LOT SIZE ____ _
OWNERUdlll!l ~V/'Z ADDRESS ~~"----f-.· ~'-7"-L..><..:.....:,---"W:...::...._/l+' --:; TELE # dS-3-~;?..s-P.E./R8.1~r.J ~j FIRM OBSERVED;- ByD u,.;Iz;,..",4!
BACK HOE OPERATOR >.,~~;/ f BENCH MARK ____________ _ //' 7
PERC DEPTH5Y PRE SOAK TIME cf: v""::- PERC DEPTH PRE SOAK TIME ______ __
TEST /..:;2.. 'f;;::be) I -; '1 ;33
//// 9, 00 7 ~ f!~3 1", C. ,..-, ---
/ 0 9 ... ~)/ f· ,r:; '7 ". y: dJ
RATE __ ....J~r-'''''--'S===-~=------- RATE _ ______________ _
., TOP & TOP
SUB SUB
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• • • BOARD OF HEALTH
TOWN OF AMHERST) I1ASSACHUSETTS ,
i or s 7 -Jk/L'-'U~ wAf Important Information Regarding Your Private Sewage Disposal System
DISPLAY THIS DOCUMENT IN A PROMINENT PLA~E
lJI.mer: _]?....,;IO::"C{)IL,/A!.Lj -"L=.l.fl+-JL~J..<.(~~lIl!..!/Gfo::..c- ::..::~=--_ Address )120 5'7??14! & Ins ta 11 er _ .iJ.Jd.>.-<,/)-'---"9 ... :rrrNc..==t?-___ Address _---'mc......:._~"-'If/.~~-'-"--__ _
---' IJ -JJ-(Yh Date Installation Inspected and Approved ..i308
Description of System: Tank Capacity: !S&Q~ t:{
Seepage Pi t ( ) Squa re Feet: No leach Field ( ) Bed (J( )
Garbage Grinder Yes ( t( )
As - BUILT PLAN:
No ( ) No. Bedrooms: ~ No. PeoPl~ .~
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PROPER t'1AINTENANCE OF YOUR PRIVATE SEWAGE DISPOSAL SYSTEM
1. This system must be . inspected periodically and the tank pumped out at an i nterva 1 not to exceed ,5 years.
2. For your protection sanitary pumpers are licensed by the Amherst Board of Health.
3. Regular pumping is crucial to avoid early failure and costly repairs of the system.
4. DO NOT dispose into the system such items as rags, string, sanitary napkins, coffee grounds as they can cause it to clog and fail.
5. Further information can be obtained by contacting your Health Department at 253-7077.
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