72 Soil/Perc Test 2001 FORM I I - SOIL EVALUATOR FORM
Page I of 3
No. Date:
Commonwealth of Massachusetts
• Massachusetts
Soil Suitability Assessment for On-site Sewage Disposal
Performed By: /jC%GLIA' 97 J/it"J�Uirii �(/xIL Date: /a/10
Y� p_
Witnessed By: A1Ct ,c "tic ,t c-LA/&)
�•°�'�.` S 72.- 4-UlZ'fliI ' /0 6.12 4-10
Let
Ww Construction 0 Repair
Office Review
Published Soil Survey Available: No ❑ Yes fi-
Vine Published Publication Scale
Drainage Class Soil Limitations
Surficial Geologic Report Available. No ❑ Yes L�-
Fri— v— ef:12 •
in.. T,�l-4(//j2�.�3l 4- %lgt/KP
• ••, ee Ai eSm f /ow And
Year Published
Geologic Material (Map Unit)
Landform
Flood Insurance Rate Map:
Above 500 year flood boundary No ❑Yes
Within 500 year flood boundary No aYes ❑
Within 100 year flood boundary Na..a ❑
Wetland Area:
National Wetland Inventory Map (map unit)
Wetlands Conservancy Progreso Map(map unit)
Publication Scale
Current Water Resource Conditions (USGS): Month
Range Above Normal aNcrmal ❑Below Normal ❑
Other References Reviewed:
DIP Arnim/en'ORM•II/V/11
Soil Map Unit
FORM I I - SOIL EVALUATOR FORM
Nee 3of3
92_ / '7Z' c.ti g12-14"C
Landon Address or 1.e1 No. __ AjGe„..th ,‘"
Determination fur Seasonal Ilia Water Table
Method Used.
Epepth observed standing In observation hole
__ �spth weeping from side of observation link
5 Depth to soli rnottlea Maine
El Ground water ediuennant fnn,
7-1;I' at,_
Inches _
Inches
'enoY/
7g ,
Index Well Number flooding Onto Index well level
Adjustment teeter Adiuererl ground water level
Depth of Naturally Occulting Porylove Materiel
• Don at least four feet of naturally occurring pervious msterial exist In all •
observed throughout the area proposed for the soil absorption system?
If not, whet is the depth of naturally occurring pervious material?
Certification
I certify that on f %S" (date) I have passed tJ II evaluator ex
approved by the [leper ment of Environme al rot and that the above
was performed by me consistent with th. j�� ed jrbl nu, expertise and ex
described In 310 CMR 15.017. ®
Signature Uhl eta
Ay%22/s
PERCOLATION TEST(S)
Time: I Time: J I
Observation Hole #1 Observation Hole #2
Depth of Perc Depth of Perc
Start Pre-soak p Start Pre-soak
End Pre-soak _ End Pre-soak
Time at 12° „. Time at 12'
Time at 9” . Time at 9'
Time at 6" 7-1 Time at 6"
Time(9"-6") Time(9"-6")
Rate Min./Inch Rate Min/Inch
'minimum or 1 percolation test must be performed in both the primary area AND reserve area.
Performed by I Performed by
Witnessed by Witnessed by
Comments:
NORTHAMPTON BOARD of HEALTH- Title 5-
DEEP OBSERVATION HOLE LOG`
y.,.,._Jr.
Location Address or Lot# 7 \ /
Owner
U /l.;rr
Date Time
�,
Depth from
Surface(Inches)
Owner's
Address
Sol Texture
(USDA)
Engineer
<1-/A-Tv.' . ^
Weather
Phone#
Land Use
l,/Ji
%Slope
�o
Surface Stones
��,
Landform
Vegetation
tart me
Position on Landscape(�on the badW
Distances
Drinking Water Well
Stop Time
Open Water Body
feel
feel Property Line
feet
Possible Wet Area
—
feet
Drainage Way
feet Other
feet
DEEP OBSERVATION HOLE LOG`
y.,.,._Jr.
MINIMUM yr my nu¢sxtUUWEDATEVERYPROPOSED DISPOSALAREA
Depth from
Surface(Inches)
Sal Hommn
Sol Texture
(USDA)
Sod Color
(MunseR)
Sol
Moans
Other
(Shur/lure.94nn....Boulders,Catsntmy,%Grav2p
^)
` r
l,/Ji
�`//iii
�o
Iry
��,
/ 3
Parent Mahial{gmkgic) I
I Depth bBndmd
I
Depth to groundwater Standing Water a the Hole
I
Weeping from Pit Face
Estimated Seasonal High Ground Water
Deep Hole#:
Depth from
Sedate pndres)
1Horvon
DEEP OBSERVATION HOLE LOG*
'MINIMUM OF IWO HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA
sd
Texture Sol Color
(USDA) (Monad)
Sae
r.IStareng Warn the
waIHigh Ground Water
Other
(Sine=,Sbnes,Boolders,Consistency,%Gravel)
aemrea
.Weepip Yam Pd Farm
PERCOLATION TEST(S)
I Time: I I Time: I
Observation Hole
#1
Observation Hole
#2
Depth of Pero
_
Z
S/Li
Depth of Perc
Start Pre-soak
I 7
Start Pre-soak
End Pre-soak
; \
End Pre-soak
Time atl2'
rte- >
Time at 12'
Time at 9'
Jfl
Time at 9'
Time at 6'
4 -D (;
7
Time at 6'
Time(9"—6")
q T/�
Time(9• 6")
Rate Minilnch
3 / -
Rate Min./Inch
'minunian ot 1 percolation test must be performed in both the Primary area AND reserve area.
Performed by
Witnessed by
IPerformed by
Witnessed by
Comments:
Location Address or Lot No.
FORM 12 - PERCOLATION TEST
72- Ate"n n?it) ,(%1Zlccp
COMMONWEALTH OF MASSACHUSETTS
/4/0/70,0/0 u, Massachusetts
Percolation Test
Date: _/3/42/0 / Time: 700
Observation Hole #
Depth of Perc
`,
Start Pre-soak
907 9. 0.2_
67 y 4 0/
End Pre-soak
%y Z
Time at 12"
92 L
Time at 9"
9Z8
Time at 6"
% 3 7
Time (9"-6")
7/3 = 3' 6
Rate Min./Inch
2PS/7f io Le
is;ci
• Minimum of 1 percolation test must be performed in both the primary area AND
reserve are
Site Passed 'Q Site Failed ❑
Performed By: it)/ ci-/ /v7 v//S K!/.,r79
Witnessed By: �• 41c-X/2-G#/'f/ 90/7
Comments:
S
DEP APPROVED FORM.12/0125
Percolation fesL
Test No . /Mee / Tnnt IL .
Reeding Time 907 9.ZZ nrndlnp. Tim'
Saturation ( 15 min / Saturation ( 1.5 min
/7
/6
7
7
/P
Pere Rate
Ground Elev .
Depth of Role
,SD Mln/ inch
2 i.
g� 7-Ai/ ✓ , Deep 'l eat Pit is 7`7' .
MNItnnPit rw►a t♦ nIiPAI '' i M t tsru
Z.?,—Z? f e_ ry s�d✓o sa
zz- +4-4o //B Z9-4/ cYnil scal
zy-9/ flft'O /mod 3
rosin water Depth atiElev . (:COUwater Dept l E ev.
Bedrock Depth / Elev . Bedrock Depth Elev.
Ground Elev . on/l(�T -7 Ground Kiev. 78 ry
/ 4( -may
0/1
I'PIT . Iinte
Ground Elev .
Depth of hole
Min/inch
S .C . S . Soil Description 5,29.4,-22 Seasonal High Water Table?
Bench Mark : Elev .
— Descriptluu -
/Pt 4/0 6/
COMMENTS :
773 Pr i XP,
Date : 40/110 f
d/z!-N/1.P7/!%«c/
Engineer : Gc>.Tr5//sy�" /��Y/7
Witness : ,,v fl1G,/LC /Z/H/
Incatl.ou of Pere :
21
4/ '/bar- 4O.Iv
_ Z'°°C- leen..�Q C , Sm.ISM _._G 1S1n Se - .uCc(i_-,--
,abM Paarrary'on nail -
see Dr An G( s.re us,st arl.a.Moms -�^- ° .n�.Gr✓
wDw.eea
ram, tem.. nv/ sv ma /
sem o t
__ Mem home MAIM pMraa.W.I� Ise .
hea.ral"ha b . .f 044 . Jo 2/�/C Dear Was Mav /
DPW Vier IMO Q,QIs. praral.w.v "1 Jo Pea a.Wx*rn//////NM Astor L * .1__i�t /-Z.C.SwLC(
Pee W.1 Ana Sr Pete um .... IM FT Si cc,: Drrahr0 Wala W.I r.a pWa . •
w 6h C /12 0
//t v DEG? OBSERVATION HOLE LOG'
DEEP OBSERVATION HOLE LOG' Ds.Wan yrN * SS Taira YOM Sr aw.
Oars Ina Sal legman I Sr Tara Sr Car I Sr Ome s .a ear MOM PYY WOO, Ws .Star Ma .Crrnina.11
See wash a®.r OYei larding Dnmk SIN .arra Gant 11
lea `
a-ez /1/ /
V
o-a2 / 1 0_ zL`
va-�q 8, 1 ys 5--3 saws j
z9 9/ ! ' /o
J194/4 y? /ter /mod j ;.� s _
�i-/aa c �,� � t,p`a , .< O S e,- ( 7'-/z/I GL. I /-0 r�J, z s•
i G L.syi.P 7g 11 F A/�I,C,� I Cal ,T-L � ;1.//.tGC-�cc? S LI E.ywr J1„vG t-12 . .
Li .,wtP 76 " .., .
•rms,o w a wuS was aaaa.LL.rV. r...mews,r..arr QU Y-W/{S�f�/ " a.ara+.m Di n ..
...mss,wniar --1,(2/0'5/ O.rrlras .Q/f/Q D®s�>E n.+WWa.mMrr: /L�`. .+.....enre .(fat_l.-
;.wmaaw.ana Surma Was neat Q///y w•aawsnls /- -1-4
trwarl Sad 110 Omni War G �) T
areal Saar WO Omni War / /Z '<Zit�/ ,� F.:.=.
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