VI

j :t

\~

?/ Q4./ 7( -«.J (~ t; a 4Q , FCf- ? No ................ _ ..... _ FEB " ... T1~ .. ,".."T.-

THE COMMONWEALTH OF MASSACHUSETTS

BOARD OF HEALTH

", 0 I" ",\.\.,\", fit, .. IIII ..... ~\.'T' __ --.. "Y.rJ'. I, ..

....... ~ ~c:'!: ......

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1\pplir~~~;1~~ mi~;~~~t;:;:~~~~;~~ii~~ JL~ i~~ \ g) ~ ~ $

Application is hereby made for a Permit to Construct 4.0 ) or Repair ( ) an Individuaf., Se e Dis ", ""4': * .....

~!ttt:! ... ~.~:: .... £{.y.!.!.f!................................................ . ...................... k:.T./~ ....................... ~~~:~:~~~~~~~~!~!.~~:"'" Location· AQ.dress 6Y.P#.iJl"Jjo. rl ...

42\\ .... ~_ .. _~~J:.!!~)J,t( ...... ?!;:!'::;!.!; ........................... __ .. J.!~l\J?~.~ ..... ~~.l' .. \? .... l:<U . ..I,1i.~ .. (je{.tE:

;:vl~il~(!t·~~!r~~ ............ ··· ... ·· ... ··.... . .. ~Q~.~.~ ... g~~~~::::~~~::::~ Dwelling - No. of Bedrooms ....... 4 ................................. Expansion Attic (~ Garbage Grinder ('\()l Other - Type of Building ........ ::-::::: ............. No. of persons ......... c::"!':: ••.••..•.... Showers (- ) - Cafeteria E- )

Other fixtures ............. ~ ................................................................................................................................. . Design Flow ........... s.:~ ......................... gallons per person per day. Total dailv fiow .. +'to.)::J. '-? ~ .. :::.~ ... gaIlons. I -r . ' - .,- y 1 Septic Tank - Liquid capacity.l;;;".Q.gallons Length..!(; . .';) ..... Width ... := .......... Diamcter...:-::= ...... Depth . .$. .. 3 .... .

. .... W· .. • " ".." . Lrr. ~ ('u' DIsposal Trench - No . ..... ,e............. ldth ..... "" ............ Total Length ... .-J..'.v. ..... Totalleachmg area. ... ~ ...... sq. ft . :;A......s Seepage Pit No ..... = ..... ;{Diameter ..... ~ ........ Depth below in1et..l~$)-....... Total leaching area .. :~.QO' ..... sq. ft . Wli;';oi' Other Distribution box (\ ) Dosing tank ~ ) , Percolation Test Results Performed by ........ "~.;;r ........ .b.!.~-"':.\'.!1L ........ f' .. ~ ......... Date. .. !j/ 2dlff? ............. .

Test Pit No. 1 .. .. .1.!;, ....... minutes per inch Depth of Test Pit ... J2.Q.~~ .... Depth to ground water .... 9.~.IASED. Test Pit No. 2 ................ minutes per inch Depth of Test Pit .................... Depth to ground water ....................... .

Description of SoiL .. 2g::tttii4+~:P.:::~:Jq;;:i::S:::::::::::::::::: : : :::::::::::: :: :: :::: ::::: ::: ........... ::::: .... :::: ............ :: ...... : .... : .. : .... : .. : ...... : ...... ::::::::::

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 71 TLE 5 of the State Sanitary Code - T he undersigned fur ther agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health.

Signed...................................................................................... . ........ ..... ............ _ ... . Date

Application Approved By ................................................................................................. . Date

Application Disapproved for the following reasons: ......................................................................................... ..................... _

C9-? Permit No ........... a. ..................................... _ ... . Date

Issuerl. ...................................................... . D . ..

~ /c)117/~1 BOARD OF HEALTH

THE COMMONWEALTH OF MASSACHUSETTS

nm ... n n::r~~n m m OFnn.n .. nnAMHff.J;:r.n .n .. nnnnnnn~.~ c

<!rrrtifttatr nf <!rnntpliaurr ~/i-r/.d THIS IS TO CERTIFY, That the Ind;vidual Sewage Disposal System constructed (-"j"Or Repaired ( )

::"jjf:£Z~T.::::2l.!..Za::::::::::~2;:~:i.~ft..;::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: has been installed in accordance with the provisions of TI~c::::;5 of TI;e _ State Sanita ry Code as described in the application for Disposal Works Construction Permit N 0 .. .. c.I-..... ~ .. r......... dated ... .. ...... ...... ...... ........................ .

THE ISSUANCE Of THIS CERTifiCATE SHALL NOT BE C~D AS A GUARANTEE THAT THE

~:~:~~~lLjlgi'F~":'~:___ '""«0, ... -- ~7~-,. . THE COMMONWEALTH OF MASSACHUSETTS

BOARD OF HEALTH

;:!:~~~. ;;;~~n=::=~~mJ~~~t FEE~~:ni V/~ to C::;;~::io~~;:t)~1di~i3~~~~~~~~'!nm ... nn.n ................. n.n ......... nn .... nn .. ___ .. at N 0 .. .. . .............................. H ........ S ..... ~cll£ ......................................................................................................................... .

No ... f.2::f:: ....

M ,,",wo 00 ili, .".;~"oo '0' D;,po", wo,~ Cooh'· ,~; .. 'fo.L D," ' .• ~

DATE. ............................................................................... \.....1'Id~:J.:.uu ~f <>lthlj'~-·,£/ . FORM 1255 HOBBS & WARREN. INC . . PUBLISHERS

P"

Ii !/. .. ~ Department of Environmental Management/Division of Water Resources

~,.~,/Ol!T 1 2 19~TER WELL COMPLI!TION RfPORT

WELL LOCATION GEOGRAPHIC DESCRIPTION

Address !I,~T HII,I,S RD. E &> of , 4,£9 N S (eirel,)

City!Town AMH ER ST E:IA'J; Hili I ,5 RD

Well owner I,EQN~RD SEE~E , .. " Address 394 flat hills ro:!. ~ IJ a N @ E W of

~MHERST M~. 0]002 mrln t~th$) fcirt:f,j

Board of Healtttperm it: yes 0 no 0 jntersect wi HIGiH ¥lOUI ,..-, . WELL USE WELL DATA

Domestlcj] Public 0 Industrial 0 Total well depth :ZOO ft,

Monitoring 0 Other Depth to bedrock 14 It,

Method drille<l\ I R HAm1ER Water -bearing rock/unconsolidated mater ial :

Date drilled 9 t..'ll89 DescriptionSOFT GR~Y RQCK

CASING Water·bearing zones:

Type STEEl. 17 lb 11 From 280 To " 00 2} From To

Length--40-- ft .DialJ. D.J--6...-in. To

\ 3) From ,

Length into bedrock 24 II, Gravel pack well : dia.

Protective well seal 'DR I VE SHO! Screen: / 1-'

dia.

Grou!JdiilO Other Slot"'" length from to

PUMP TEST

Static water level below land surface ] 3 It, Date 9,LJ a ,l8g Drawdown1Q.Q.- ft. after pumping---2-.-hr. __ min. at ~ gpm

How measureeJIn L I F'l'ecovery 41 It alterb.- hr, S min.

S1 LOG of FORMA nONS COMMENTS [

• M.teri.1I From To • 0 ,

I" 1> """'1 e: " lm I"

In"TTT n~" e: I n 1 ~4 Driller E:RI1DIilR I ell: 11 WallEY

Ie: lIT.'!' t.. Mass. Reg istration'- 499 I" '\('tr 1 <1 17M FimMOllEY WEI,!, DR II,IIIbIG INC

Add(ess BOX J 09 ] ,

Cityrrown\lIEI I SlIT ' OS:Z:Z!l .--',

4~t: J(.jkt!'--3u i 1IIIMt 0 ff} nl$in 1f~_1f

1_ print fIrmly

BOARD OF HEALTH COPY .. .' -

" " ~

LOCATION OF PROP.,

LOT NO.,

~ATE PERFORt·ln" 9' jZ00J

AMHERST ~IEALTH-DEPARTMENf BANGS CO~,!MUN1TY CENTER !V IV 130LTWOOD iVALK AMHERST, MA 01002 . ..r-

.-......

SulL EXN<INATIONS I PERCOLATION TESTS

SKETCH PLAN

Pi'RoORl !rD BY, /?b J/~,v ?,£

fl lTNESSEO BY, ,4.---&j~ /k/fJ~' y~ PERI: TEST RESULTS, (tabulation on back)

2.

3.

4.

JOB #

..-v 70 1

/ &j';' ,P;A dd' ;~:,.;

CI= "'7';".1 k.r;f /,,/~.

~---- -------

"

Percolation Test

Test No. ff / (I3) Reading Time Saturation (15 min) AJ,/{;"- /t:J.'30

)37i- ~7- 733 ;0: ~o :--~ .

/cJ'l~ .3 ' /0 3Z - -=-n=--- 3:1-,IJ. 33 ----,-,--,,.....,....,,,.­

zpz- 3 ' 71 :2<5

,!)IF5"/6"(/ £/1)'£ Perc Rate /.;;·0 Min/inch Ground Elev. Depth of Hole ~~~~~" __ _

T2st No. ---Reading Satur~rion

137z

Time (15 min)

Perc. Rate Ground Elev . Depth of Hole

77:) I Deep Test PH/s Test Pit /- Test Pit

Min/inch

~D~e~t~h~~~S70~i~l~D~e7s7c7r~i~t~i~on Depth Soil Description c>;r '/~5T C&?IY'/? 7 ~-Z;J)~7.5@/}IO

~~~~~~. ~;.v.@ts,:#I!1/L (o~t';-/l,(0 ~/- A~_ 9J ~ '/5/Lr _ . -.,L U ~/TH _'/- Q _z,i:L2 7Y.ea&R~tt'£ --,..,--::;-_-.;-:;,---="..,-lC2:>.;=:::,~:..;-:;::::-;+ \ i/ -PC? -;rcJA/ /2"/ 77 L. t..

77 c:.L.A ",(,Ie/fA;?) / Groundwater Depth~Elev. ___ _ Bedrock Depth~Elev. ___ _ Ground Elev. --------------------

Groundwater Depth LJA$Elev. __ Bedrock Depth __ Elev. ___ _ Ground Elev. _________ ~~~~~

S.C.S . Soil Description_~ ___ Seasonal High Water Table? 5E~ TE-S-T ~/z: J7{9 u.:-

Bench Mark : Elev. :2et:) Description $£.T/JT8k'c' 3//1:- -----------

Date : s-r-,o;r c:P/ /C;~8 Client: Z, IIC5 t ,

7

JOHN A.FARNSWORTH CIVIL ENSNEER,SANI"tlR1AN B34

OtSFOSAL WORKS DES;GN AND INSTALLATION 473 HARVARD ROAD, LANCASTER, MASS. OI~23

(617) 365 - 5577

SOIL AND PERCOLATION TEST RESULTS TEST RESULTS DO NOT IMPLY SITE SUITABILITY FOR

DISPOSAL WORKS UNDER TITLE V

CLJENTR1?-k worn JOB NO. ~'16 DATE 0+ 2--1. 13h SITE ~w..T HIL-L-0 J:<.d,A..b WITNESS ? D~~t:::: . (Ufl.O?h .j::-~M f-J. . .A-M{.\B'R~T ;,... F7.(7. H. ME::-J-l.T

1-1[4 H POI J.lT 1/1.2...) PERC. NO. A PERC. NO. PERC.NO. START SCAK( DEPTHJ(TlME) 1C7' 4: 00 END SOAK = 1l~ +ZO = __

~.±±1: _ ~..£U± _ ==== ~I MI*Z';v?; f

~R=Arr~ __ -2M~m~/ul~MC~HL-_ I ~~ __ ~

HOLE NO . ...1.-0- 1" fJ!:' -+ IlL I

--

-

t OBSERVED GROUNDWATER SY1rI8OL. SHEET 1 OF Z.

'. / .' / DEf..\LCO EN:i INEER I/'.G , IN: •

3f Chamberlain Parkway Worcester, ,\14 01602

(617) 798-34<56

flJD." .. :t.P.

1~

Client: 'R,I?-l-<. t--lo..;b Job No. 0"=> - 46 Date: 04"' 2.4:' Sb

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No ...... Q ............... .

s- '--) g - 0, g 3 2f MAY 1 0 1989

THE COMMONWEALTH O F MASSACHUSETTS

BOARD OF HEALTH

FEB ... ~o.., Q.Q.-pcl. .J:f-' \" 111 ".",,,

,\,,~\.,\'\ OF "'.;"" ....... ~~~.rJ'. ',,,.,

.!' .. ~~/ ~ fj-- F ~ ~~:'~~ :~ ~:

-ruw"" HH ... OF ... . H .. AMH~ ..... f$ i ti! \ ~~

Applicatiutt fur iliIipusal lIurkIi illuttstrurtiUtt I i Llts. R.S. ;;: ~ - ~ -

~APPlication is hereby made for a Perml! to Construct (V'l or Repair ( ) an Indivi~ • wage Dispo j

S steD1 at: '..... .. ......

'5'11 .. 4:M ..... m.m··· .. f~:·;:f~~~re~·~m ....................... m. ..?:.~.±m.:#.L9 .... m .. mm .. m ..... m ... ~~~~~~~, .. !.Tf!!~.~~~'" .. mm'.m.,. .. m.'''''''' ....................... b.' ....... m ............. m.... ...~U(.~ .... ~~.f?1om.~~ .. "-e..4E.

z -

.. ~ .. !/111i£S.,S"!?XC.ltf.~!.~.~ ........ uuu ... mu .. uu uu~.q.~~.~ .... ~.~.~;!~.U\.uuf.\1Jt-'-.. umumm .. Type of Building Size LOLs:..'!69 .... uu.~

Dwelling - No. of Bedrooms ........ 4. ................................ Expansion Attic (-+ Garbage Grinder iI-Id Other - Type of Building ........ =::: ............. No. of persons ......... = ........... Showers (-) - Cafeteria E-)

Other fixtures ............. :~ ............... .................................................. H ......... ·.······· ············ ............................... . Design Flow ........... .5.S ....................... .. gallons per person per day. Total daill ftowH.1:1o.,)[.! ... ?:$':"":,.$?Q .. gallons. Septic Tank - Liquid capacity.lS02gallons Length .J.Q.s. .... vVidthH.5 ...... H. Diamcter... .-::::::-...... Depth . .5 .. 3.1 .. . Disposal Trench - :-10 ...... ~ ........ .... Width ..... ?,.' ......... Total Length .... 'Z'OO.~ ... Total leaching area ..... ~ ...... sq. ft. SI~ Seepage Pit NO ...... =H ... /Diameter ...... -::::::-........ Depth below inlet .. .1 .•. «;;.' ........ Total leaching area .. .4.Da ..... sq. ft. ~ Other Distribution box (V) Dosing tank r) Percolation Test Results Performed byH ....... W.,,;r., ...... S.l~I? .. v:m:-.......... r .. F.::., ...... Date ... .9/.?d.j.fJf! ............. .

Test Pit No. 1 .... J.5H .... minutes per inch Depth of Test Pit ... .1.w.'.· .... Depth to ground water .... 9' .. u.St;[) Test Pit No. 2 ................ minutes per inch Depth of Test P iL ................. Depth to ground \Vater .... ................... .

Description of Soil ...... 2gg:::i\~p.:::~::~S::::::::::::: : ::::::::::::::::::: : ::::::::::::: ._ ............ ._._ .... ._ .... ._._ .. ._ .......... ._._._._._ .. ._ .. ._._._._._._._._._._._._._._._._._._._._._._ .. ._._ . ...... .. .. ....... ............................ .. ....... ....... .... .............. .......................................... ~ ........................................................ ....... .. ..... - ...... .

Nature of Repairs or Alterations - Answer when applicable ................................... ........ ................................................... .

Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposa1 System in accordance with

the provisions of 71 TLE 5 of the State Sanitary Code - The undersigned further agrees not to place the system in

operation until a Certificate of complia;~;n:s .. ~6=:~lt.l~:...... ..... . . . . ......... . .... ?hlf!.!t ........ . Date

Application Approved By.................................................................................................. . ...................................... . Date

Application Disapproved for the following reasons: ............................ ........ ...... .. ........ .......................................................... ..

Date C-c; - p---Permit No ............ O .......................................... . Issued. ..................................................... ..

Dato

THE COMMONWEALTH OF MASSACHUSETTS ~ rr/ ~711? t BOARD OF HEALTH ~~~rCWl.<R

.. .. ::-:niN~ ........... OF ... ... ..... ... ~ .. ......................... H •••• (f Cltl'rtifiratr uf (!J'.nmpliattrl'

THIS IS TO CfJlTIFY That th~nd:vidual Sewage Disposal Sjstem constructed ()Or Repaired ( )

::fl.:;;::::EZ~.i::~:7'?;,;:::~?2:2I!ii!:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::~ has ?eef~ in st;t1le~ in accunlance wi th the .provision.s o! 1'1Fd 0L-...Tl~tate Sanitary Code as described in the appilcatlOn for DISposal Works Construct ion Permit No ............. 7. ... .. ...... r ........ dated ... ............................................ .

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THE COMMONWEALTH OF MASSACHUSETTS

BOARD OF HEALTH

~:::~al;:r~~~::=~~ .. J~~~i;.... .. FEErPz~;;"~VI~ to C:::~~~:io(")fo~~~p~;nt)··~i~i!:;/~~~~~~~!~·········· .. · ........... .............. ... .. .................... ... at N o .................. f.'t.I:tr:': .. H.\.Ur.S ..... ~ .......................................................... ............ ................................................ .

NO ..... &...£

... • St~cet 7-r as shown on the appilcatlOn for Disposal Works constru~".~.lt ... . ~,;;;;;:2.DL.· ____ .·U~"4J DATE......... ........................................... .......................... / Board oir;;7~~'r ... ~ FO RM 1255 HOBBS &: WARREN . INC .. PUBLISHERS

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