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1f'S10No. .t01 '3il ?-.{FEB . . .THE COMMONWEALTH OF MASSACHUSETTSBOARD OF HEALTH. OF.i\ppluutiutl fur ilinpunul ifurkn QJ:utlntrudwtl JrrmitApplication is hereby made for a Permit to Construct () or Repair(-v{"anIndividual Sewage Disposal . . ::. 5.7.Q.mt.d.'d.L .vt. l7?z1.h.o.:.if:.:. . . .dl.{lt:.I.L. l:.'t::.;;:/ wl.t. /t2/.1. :."':.:. : . .!Pd.t//j.q"';' ./.2:c.Installer. . . . . . . . . . . . . . . . . . . . . . d ,,'. . . . . . . .B ::b n3Address.Type of B ildingSize Lot. . Sq. feetGarbage Grinder ( Dwellmg - No. of Bedrooms . ExpanslOn Att.c ( )Other - Type of Building . No. of persons .3. . Showers ('-) - Cafeteria ( )Other fixtures .;« . 1\' . .Design Flow. gallons per person per day. Total dajY fI,ow . .2. .t:? .'.gallons.Length .fP.'{Vidth . 5 . k.'. Diameter . Depth . .Septic Tank - Liquid capacityL l).O' . gallonsDisposal Trench - No . Width . Total Length . Total leaching area. sq. ft.Seepage Pit No . Diameter . Depth below inlet. . Total leaching area . sq. ft.Other Distribution box ( )Dosing tank ( )Percolation Test ResultsPerformed by . Date . .Test Pit No. 1. . minutes per inch Depth of Test Pit. . . Depth to ground water. . .Test Pit No. 2. . minutes per inch Depth of Test Pi!. . Depth to ground water. . .Ie.'.Description of Soi1. . . ·. ·. ·'7.1 .·.·. .Nature of Repairs or Alterations - Answer when applicable. . ,t'.t'p!tl.J:.f:,d2t1:UT.Jt:1.r. .T.t?A.k. L.l2d.1 -4,;rAgreement:The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance withthe provisions of TITLE 5 of the State Sanitary Code he undersigned further agrees not to place the system inoperation nntil aceQ; :;;:;n::s .Application Approved By .n.t . . .Z.- d1. .?"' ' .lifj . k.k. .s!. . · . Jb,· . .6/9. .nn .7/ fZ . .Application Disapproved for the following reasons: .Permit No .Issued. .DateTHE COMMONWEALTH OF MASSACHUSETTSBOARD OF HEALTH. OF . .QJ:rrtifirufr uf C!Lumpliutlrrby. . f.t7. .:.[ (U; lJ. . . i u; T : . .i :. . :. .t .:. . . .:. . . . :. .:.:. .{l1i.1.' 5f.,,- "00,.,'albat . 2 ."2 . : .:.has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in theapplication for Disposal VV-arks Construction Permit No. dated. .THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THESYSTEM WILL FUNCTION SATISFACTORY.D ATE.Z/!!:!?./1.!C. . .Inspector . .THE COMMONWEALTH OF MASSACHUSETTSBOARD OF HEALTH. . OF .1\,To . .FEE: .ilispusul Burks QJ:utlstrudwtl JrrmitPermission is hereby grante.d .: . .to Construct ( ) or Repair ( ) an Individual Sewage Disposal Systemat N 0 . . . . . .Streetas shown on the application for Disposal \\'orks Construction Permit No . Dated . .Board of HealthDATE .FORM1255HOBBS & WARREN.INC . PUBLISHERS

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No. .FEB . . . . .THE COMMONWEALTH OF MASSACHUSETTSBOARD OF HEALTH. . . OF . . . .Applitutiuu fur ili.!lpu.!lul Ifurk.!l QtUU.!ltnutwu JrrmitApplication is hereby made for a Permit to Construct () or Repair (.y--a nIndividual Sewage Disposal . 9.J2.i11.{d&.Jl: deL.2!.:.: . .dit2LI.2. .!-.:.7.7m. .'LtltC'/.t2'4. . :. . . . . . Pa l././L';BiCL. . :: . IIt:#tt:. .InstallerAddressType of B ilding-3.Size LOL. .: . Sq. feetDwelhng- No. of Bedrooms . ExpanSlOn Attic ( )Garbage Gnnder ('-'1Other - Type of Building . . No. of persons .3. Showers ( .?l. - Cafeteria ( )Other fixtures . .Design Flow.gallons per person per day. Total daily fl9w .1&1!.1. 3. Q.gallons. T ank - L'lqU1'd ' capaclty. .JLTlOL ength ItY,,"Sl",.? g all ons. . ""dV\ 1 t h . . f, D·lameter . . D cpt h .S epttcDisposal Trench - o . . Width . Total Length . Total leaching area.sq. ft.Seepage Pit No . Diameter . Depth below inlet . Total leaching area. sq. ft.Other Distribution box ( )Dosing tank ( )Percolation Test ResultsPerformed by . Date. .Test Pit No. l . minutes per inch Depth of Test Pit . Depth to ground water . .Test Pit No. 2. minutes per inch Depth of Test Pit. Depth to ground water. . .Description of SoiL. . .Agreement:The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance withthe provisions of TI TLE 5 of the State Sanitary Code - The undersigned further agrees not to place the system inoperation until a Certificate of Compliance hasbe n',s e b mO ycI of)1:a1th.SIgned. . (./. .7-,;(-'/-7.r.Date:Application Approved By.Date:Application Disapproved for the following reasons: .Oat,Permit No .Issued.DateTHE COMMONWEALTH OF MASSACHUSETTSBOARD OF HEALTH. OFo:trrttfitutr uf QtumpliuutrTHIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )by. .Installerat. . .has been installed in accordance with the provisions of TITlE5 ofThe State Sanitary Code as described in theapplication for Disposal Works Construction Permit N 0. dated . .THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THESYSTEM WILL FUNCTION SATISFACTORY.DATE.Inspector. .THE COMMONWEALTH OF MASSACHUSETTSBOARD OF HEALTH. OF . .No . .FEE . . . . ili.!lpu.!lul lIurk.!l QtUU.!ltrurtiuu JrrmitPermission is hereby granted . .to Construct ( ) or Repair ( ) an Individual Sewage Disposal Systemat N 0 . . . . . . . . . . . . . . . .Streetas shown on the application for Disposal Works Construction Permit No. Dated. .·-·------·-··----·-·-·-·-· -- ·--·--····--- -B ;d- -i-H; iili- �·--DA TK . .FORM1255HOBBS & WARREN,INC . PUBLISHERS

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COMMONWEALTHTOWN OF APPLICATION FOR CE,DateAugust 2,1995In accordance with the provisions o f the108.15, I hereby apply for Certificate of Inat the following address:Street and Number 2 8 0 W e s t S t r e e t'Name of Premises C r o c k e r F a r m E l e m e n t a r vv Purpose for which premises is used, S c h o o lLicense(s) or Permit(s ) Required fort ,preUSE GROUPCertificate to be issued to -cAddress Owner of Record of Building T o wn o f A m h e r s t ,Address Chestnut StreetAmherstMA0

JUt 1 8 1995fREf'S WASJIWATEIl REMOVALJuly 10, 1995I'I1,I:ITown of AmherstBoard of HealthBoltwood WalkAmherst, Ma.01002"Dear Board:Enclosed is the Title Five Inspection Report for propertyowned by Gwen Whelan, 590 Middle Street, Amherst, Ma.If you have any question please feel free to call.Thank you.Yours very truly,GREG'S WASTEWATER REMOVAL //ll' Gregory M. GardnerPresidentGMG:hjk,I,IP.O. BOX 197 - 239A GREENFIELD ROAD, SO. DEERFIELD. MA. 01373PHONE 413-665-3989 -- FAX 413-665-7358

.· 8SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORMPART BSYSTEM INFORMATION '"IFLOW CONDITIONSIf residential-1--1-:Les.:Les. number of bedroomsnumber of current residentsgarbage grinder, yes or no'laundry connected to system, yes or noseasonal use, yes or noIf nonresidential, calculated flow:Water meter readings, if available:Unknown61,500 ' gal.Last date of occupancyGENERAL INFORMATION· .Pumping records and source of inf9 tion:Greg's Wastewater Removal 7/15/9J. , -- -------------------------------------- . ':'. -H2-- System, pumped as part of inspection, yes or noif yes, volume pumpedReason for pumping:I - 1!\' Typeof system Septic tank/distribution box/soil absorPtion systemSingle cesspool---, Overflow cesspoolPrivy 'Shared system (yes or no)(if yes, attach previous inspectionrecords, if any) .Other (explain) Approximate age of all components. Date installed, if known. S.ource ofinformation:10 to 12 years source Gwen Whelan Sewage odors detected when arriving at the site, yes or no· ./'

.'JUl1819957SUBSURFACE SEWAGE DISPOSAL SYSTBM INSPBCTION PORMAddress of propertyOwner's nameDate of Inspection590 Middle Street, Amherst, Ma.Gwen WhelanJuly 7, 1995PART ACHBCJtLISTCheck if the following have been done:xx-IPumping information was requested of the owner, occupant, and Board ofHealth .r'i-r-INone of the system components have been pumped for at least two weeksand the system has been receiving normal flow rates during thatperiod. Large volumes of water have not been introduced into thesystem recently or as part of this inspection. As built plans have been obtained and examined.available with N/A.Note if they are l notThe facility or dwelling was inspected for signs of sewage back-up.The site was inspected for signs of breakout.All system components, excluding the SAS, have been located on thesite.The septic tank manholes were uncovered, opened, ,and the interior ofthe septic tank was inspected for condition of baffles or tees,material of construction, dimensions, depth of liquid, depth ofsludge, depth of scum.The size and location of the SAS on the site has been determined , basedon existing information or approximated by non-intrusive methods.The facility owner (and occupants, if d fferent from owner) wereprovided with information on the proper maintenance of SSOS.'",,;;).oY.J ' .-"",vjpi"Hdk' G". b,,",J. 7h·.AO' ,. . C-,,Jljo.SG.0 o',.-

.SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION PORMPART BSYSTEM INFORMATION continued .SOIL ABSORPTION SYSTEM (SAS): X(locate on site plan, if possible; excavation not required, but may beapproximated by non-intrusive methods)If not determined to be present, explain:Type its and numberchambers and numbergalleries and numbertrenche·s, number, lengthfields, number, dimensionscesspool, number3 pipes18' wide 37'longComments:(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, recommendations for maintenance or repairs,etc.)Course sand. hard pan. no hydraulic failure. no pondingvegetation normal. ran water in leachfield aprox 400 gal noproblem.CESSPOOLS (locate on site plan):number and configurationdepth-top of liquid to inlet invertdepth of solids layerdepth of scum layerdimensions of cesspoolmaterials of constructionindication of groundwaterinflow (cesspool must be pumped aspart of inspection)N/AComments:(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, recommendations for maintenance or repairs,etc.)NfAPRIVY:(locate on site plan)materials of constructiondimensionsdepth of solidsN/AComments:(note condition of soil, signs of hydraulic failure, level of ponding,condition ·of vegetation, recommendations for maintenance or repairs,etc.)

., ,'"9'JSUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION PORM,PART BSYSTEM INFORMATION continued.SEPTIC TANK:---1L(locate on site plan),.depth below grade:8"material of construction: X concrete metal FRP other(explain)dimensions: 9 ' 1 o n g 5 ' d e e p 4 ' 5 " w i d e sludge depthdistance from top of sludge to bottom of outlet tee or bafflescum thicknessdistance from top of scum to top of outlet tee or baffledistance from ' bottom of scum to bottom of outlet tee or bafflei.')Comments:(recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity,evidence of leakage, recommendations for repairs, etc.)pump ' every 3 years inlet tee in place outlet tee in place, liquid level '4 "0\:g ;O ll t;ne f f ; ;. j, pp : d t \l5e a!e:kt;tr t: r meWher e, '·belowoutlet inyert. Recommend replacement 0 tan1DISTRIBUTION BOX: X(locate on site plan)Not abovedepth of liquid level above outlet invertComments:level and distribution is equal, evidence of solids carryover,evidence of leakage ['nto or fut of box recommendation for repairs, ' etc.)Distribution is l ve & equa , no s6rl S carryover,D Box rofEed out, recommend to replace tt .- - (note ' if .PUMP CHAMBER: flocate on site plan)pumps in working order, yes or no\'comments:N/A. (note condition of pump chamber, condition of pumps and appurtenances, ' ,-- recommendations for maintenance or repairs,etc.)" .".",. . f. ' " 1"