30 Septic Inspection Form 2012 Kuehner 's Inspection Services
168 County Road
Southampton, MA 01073
Phone (413) 533-3031
TITLE 5 INSPECTION
At the request of Ms. Tricia Walker, an inspection of the septic system located at 30
Brisson Drive, Northampton MA. was performed on March 23 2012. The septic system
was in normal operation at the time of the inspection. The inlet and outlet baffles were in
place and functional. The septic tank was pumped to allow for inspection. The
distribution box was located and inspected.
It is my opinion based on information available that this septic system meets the passing
requirements of Title 5 (310 CMR 15.00) at this time.
Problem Areas: 1. None:
Recommendations: I. None
This report is based on conditions existing at the time of the inspection, and is not
intended to project, guarantee, or warranty the future operation of the septic system.
For further information please refer to the attached inspection report.
Inspector: Karl M. Kuehner Inspector
Owner
information
required
every page
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When filling out
forms on the
computer,use
only the tab key
to move your
cursor-do not
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
30 Brisson Drive
Property Address
Tricia Walker&Arielle Pern
Owner's Name
Northampton
City/Town
MA 01060 3/23/12
State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way.Please see completeness checklist at the end of the form.
A. General Information
1. Inspector:
Karl M. Kuehuer _
Name of Inspector
Kuclmefs Inspection Services
Company Name
16R County Road
Company Address
Southampton
City/Town
413 533-3031
Telephone Number
MA
State
SI 124
License Number
01073
Zip Code
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 15.000).The system'.
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
a
,G 3/28/12
Inspector ature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
'""This report only describes conditions at the time of inspection and under the conditions of use
at that time This inspection does not address how the system will perform in the future under
the same or different conditions of use.
Tide 5 Official Inspection Form Subsurface Sewage Deposal System-Page 1 el
required for
page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
30 Brisson Drive
Address
Tricia Walker& Addle Pem_
Name
Northampton MA 01060 3/23/12
State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary. Check A,B,C,D or E/always complete all of Section D
A)System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 - 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass"section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health,will pass.
Check the box for"yes" , "no" , or"not determined" (Y, N, ND<) for the following statements. If
"not determined." please explain.
The septic tank is metal and over 20 years old" or the septic tank(whether metal or not) is
structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System
will pass inspection if the existing tank is replaced with a complying septic tank as approved by the
Board of Health.
*A metal septic tank pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ N ND(Explain below).
title 5 Mani Inspection Form Subsurface Sewage of
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
30 Brisson Drive
Property Address
Tricia Walker& Arielle Pen
Owner Name
information
Northampton MA 01060 3/23/12
CltylTown Slate Zip cede Dale of Inspection
B. Certification (cant.)
B) System Conditionally Passes (cont.y
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection (with approval of Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below).
❑ obstruction removed ❑ Y ❑ N ❑ ND(Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below)
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health)
❑ broken pipe(s) are replaced ❑ Y n N _ ND (Explain below).
[_ obstruction is removed ❑ Y ❑ N ❑ NO(Explain below).
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(I)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool - privy is within 50 feet of a bordering vegetated wetland or a salt marsh
Tale 5 ORUal Inspection Form Subsurface sewage Disposal system-Paa
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
30 Brisson Drive
Property Address
Tricia Walker&Ariellc Perry
Owner Owners Name
information is Northampton MA 01060 3/23/12
for
City/Town State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system(SAS) and the SAS is within
1 00 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance.-
"This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform
bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be
attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes"or"No"to each of the following for all inspections:
Yes No
❑ of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than 1/2 day flow
Title s ar¢lal inspection Form Subsurface Sewage D ,osal Sysrem-Page 4 o17
req ulred
every
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
30 Brisson Drive
Property Address
Tricia Walker&Arielle Pern
owner's Name
Northampton MA 01060 3/23/12
C ltyli own State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s) Number of times pumped_
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® portion of a cesspool or privy is within a Zone 1 of a public well
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® - portion of a cesspool or privy is less than 1 00 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
n The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303,therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
O El
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either yes or no to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area (Interim Wellhead Protection
❑ ❑ Area- IWPA)or a mapped Zone 11 of a public water supply well
If you have answered"yes" to any question in Section E the system is considered a significant threat,
or answered Vied In Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
Tses Onioal Inspection Fomr Dimosal mem-Pages
<CN
Owner
information is
required for
every page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
30 Brisson Drive
Property Address
Tricia Walker&Arielle Perry
owners Name
Northampton MA 01060 3/23/12
City/Town State Zip Code Date of Igspeclon
C. Checklist
Check if the following have been done. You must indicatd 11/45 dr Was to each of the following'.
Yes No
M ❑
❑ M
Z ❑
❑ M
® ❑
® ❑
M ❑
M ❑
M ❑
M ❑
M ❑
Z ❑
Pumping information was provided by the owner, occupant, or Board of Health
Were any of the system components pumped out in the previous two weeks?
Has the system received normal flows in the previous two week period?
Have large volumes of water been introduced to the system recently or as part of
this inspection?
Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
Was the facility or dwelling inspected for signs of sewage back up?
Was the site inspected for signs of break out?
Were all system components, excluding the SAS, located on site?
Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
Was the facility owner and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS) on the site has
been determined based on.
Existing information. For example, a plan at the Board of Health.
Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) 1310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
3 hilrooms 3 bedrooms
Number of bedrooms (design). Number of bedrooms (actual):
DESIGN flow based on 310 CMR 15.203(for example'. 1 10 gpd x#of bedrooms):
330 gal/day
Title 5 Officlal inspection Form Subsudece Sewagt OISPOS siern-Page 6 of 17
Owner
information is
required for
every page
ftlns-09/05
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
30 Brisson Drive
Properly Address
Tricia Walker&Ariellc Perry
Owner's Name
Northampton
City/Town
MA 01060 3/23/12
Stale Zip Code Dale of Inspection
D. SYSTEM INFORMATION
2residenls
Number of current residents.
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes / No
Laundry system inspected? ❑ Yes ® No
Seasonaluse? ❑ Yes /1 No
n/a
Water meter readings, if available(last 2 years usage (gpd)y
Detail:
Sump pump?
Last date of occupancy:
Commercial/industrial Flow Conditions:
Type of Establishment.
Design flow(based on 31 0 C MR 15.203)'.
Basis of design flow(seats/persons/sq.ft., etc.)'.
Grease trap present?
Industrial waste holding tank present?
Non-sanitary waste discharged to the Title 5 system?
Water meter readings, if available.
❑ Yes Or No
present
Date
Gallons per day(gpd)
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Mlle 5 DPooal Inspect Form Subsurface Sewage Disposal Systnn-Page 7 of
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
30 Bnsson Drive
Properly Address
Tricia Walker& Anelle Perry'
Owner's Name
Northampton
MA 01060 3/23/12
City/Town
Slate Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use:
Other(describe below).
Dale
General Information
Pumping Records:
owner)pumped every 2 years
Source of information:
system pumped as part of the inspection? ® Yes ❑ No
1500 gallons
If yes, volume pumped'. gallons
Determined at time of pumping
How was quantity pumped determined?
to inspect tank
Reason for pumping.
Type of System:
Septic tank, distribution box, soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no)(if yes, attach previous inspection records, if any)
Innovative/Alternative technology.Attach a copy of the current operation and
maintenance contract (to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
Title 5 Official Inspection Form Subsurface age Olsposad System•Sag"of
5C.' ft
cr
Owner
information is
required for
every page.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
30 Brisson Drive
Properly Address
Tricia Walker&Ariellc Perry
Owners Name
Northampton MA 01060 3/23/12
City/Town Stale Zip Code Dale of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known)and source of information_
1997 file at BOH
Were sewage odors detected when arriving at the site?
Building Sewer(locate on site plan):
Depth below grade:
Material of construction-
El cast iron
®40 PVC ❑other(explain)
Distance from private water supply well or suction line.
24"
feel
❑ Yes ® No
cttc water
feet
Comments (on condition of Joints, venting, evidence of leakage, etc.)-
Septic Tank(locate on site plan).
Depth below grade:
Material of construction.
[g]concrete ❑ metal
If tank is metal, list age'.
18"below grade
feel
❑fiberglass ❑ polyethylene ❑ other(explain)
years
Is age confirmed by a Certificate of Compliance?(attach a copy of certificate)
126"x 68" x 64"
Dimensions'.
Sludge depth
® Yes ❑ No
6"
Title 5 ONfcal Inspection Form Submdace Sewage nspoel System Page 9 of v
information is
required for
every page.
..
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
30 Brisson Drive
Property Address
Tricia Walker& Arielle Pem
Owner's Name
Northampton MA 01060 3/23/12
City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont-)
Distance from top of sludge to bottom of outlet tee or baffle
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
How were dimensions determined?
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, eta)'.
21"
6"
19"
measured at time of pumping
Grease Trap (locate on site plan)
Depth below grade:
Material of construction
feet
❑concrete ❑ metal ❑fiberglass U polyethylene ❑other(explain)-
Dimensions.
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping.
Lee 5 Official Inspecton Coen Subsurfam Sewage Disposal System-Page 10 o717
Commonwealth of Massachusetts
Title 5 Official Inspection Form
FT li Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
30 Brisson Drive
Properly Address
Tncia Walker&Aricllc Perry
Owner Owner's Name
information is Northampton MA Ol(1(>0 3/23/12
required for State N r„ae naio of m�oa
every page- City/Town
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank (tank must be pumped at time of inspection)(locate on site plan)'.
Depth below grade:
Material of construction
❑concrete ❑metal ❑fiberglass ❑ polyethylene ❑ other(explain)-
Dimensions.
Capacity'. gallons
Design Flow: gallons per day
Alarm present ❑ Yes ❑ No
Alarm level. -- --_ Alarm in working order: ❑ Yes ❑ No
Date of last pumping: pate ---
Comments(condition of alarm and float switches, etc.)-
•Attach copy of current pumping contract(required). Is copy attached?
❑ Yes ❑ No
Titles Official Inspection Form Subsurface Sewage Disposal SYstef-Page I l or 1-
el Commonwealth of Massachusetts
Title 5 Official Inspection Form
Owner
information is
required for
every page.
15ias-93108
y
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
30 Brisson Drive
Property Address
Tricia Walker&Aricllc Pem
Owner's Name
Northampton MA 01060 323/12
City/Town State Zip Code Date of Inspectron
D. System Information (cont.)
Distribution Box (if present must be opened) (locate on site plan):
Equal flow to all legs
Depth of liquid level above outlet invert
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.)
Chamber(locate on site plan).
Pumps in working order: ❑ Yes ❑ Na
Alarms in working order ❑ Yes ❑ No
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.)
Absorption System (SAS)(locate on site plan, excavation not required):
If SAS not located, explain why:
Title 5 Ofiiinal Inspeclion Form Subsurface Sewage Disposal System-Page 12 of17
Owner
information is
required for
every page.
owns
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
30 Brisson Drive
Properly Address
Tricia Walker& Ariclle Pen}
Owner's Name
Northampton MA 0106(1 3/23/12
City/Town
State Zip Code Date of nspection
D. System Information (cont.)
Type:
❑ leaching pits
❑ leaching chambers
❑ leaching galleries
leaching trenches
❑ leaching fields
❑ overflow cesspool
❑ innovative/alternative system
number
number:
number:
number, length'.
number, dimensions:
number
2- trenches
Type/name of technology:
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Cesspools(cesspool must be pumped as part of inspection)(locate on site plan):
Number and configuration
Depth -top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
Tile s ODAml Inspection Form Subsurface savage Deposal System-Page 13 of ir
C�
alsansr
into
required For
es s page.
.. a
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
30 Brisson Drive
Prepon>Address
Tricia Walker& Arielle Perry
O.ners Name
Northampton
Cd.r)Wf
MA 01060 3/23/I 2
State zit rode Dale of nspecuo
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
eta)_
Privy (locate on site plan)_
Materials of construction-
Dimensions
Depth of solids
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.).
rme 5 Official Inspection Form Suesrface Sewage Disposal
14 of
s II
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
30 Brisson Drive
Property Address
Tnciu Walker&Ariellc Pen
Owner owners Name
information is Northampton MA 01060 3/23/12
required for
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 1 00 feet. Locate
where public water supply enters the building. Check one of the boxes below:
'Eris 09108
iihand-sketch in the area below
drawing attached separately
see attached drawing
Title 5 Official Inspeclion Form subsurface Sewage Disposal System-Page 1501 I
Ownei
information is
required for
every page.
a a
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
30 Brisson Dose
Property Address
Tricia Walker&Adelle Perron'
Owner's Name
Northampton
City flown
D. System Information (cont.)
Site Exam:
® Check Slope flat
MA 01060 3/23/12
Slate Zip Code Date of Inspection
® Surface water None
® Check cellar dry
® Shallow wells None
Estimated depth to high ground water:
120"
feel
Please indicate all methods used to determine the high ground water elevation-
111 Obtained from system design plans on record
If checked, date of design plan reviewed: Dale
® Observed site (abutting property/observation hole within 150 feet of SAS)
• Checked with local Board of Health -explain.
information on file
▪ Checked with local excavators, installers- (attach documentation)
• Accessed USGS database-explain
You must describe how you established the high ground water elevation:
Vim ed site,
checked past reports on fit with BOB
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
Tile 5 Official Inspection Form Satan-Face Sewage Dsposal S79em-Page 16 of 17
a
..
• Commonwealth of Massachusetts
Owner
Information is
required for
every page.
thins 09708
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
00 Bnsson Drive
Properly Address
Tricia Walker&Arielle Perry
Owner's Name
Northampton MA 01060 3/23/12
Cily/Town Stare Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary'. A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
® System Information-Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
Tile 5Ofical in ion Form Srbsjda
ge Pryosal SY9en-Page IF of 17
SAS
D
distribution box
24" below grade c
1500 gallon
septic tank
1.5 below grade
patio
A
LEGEND
AB-26'
AD=44'
CB=18.9'
CD = 12.5'
30 BRISSON DRIVE
garage
KUENNER'S INSPECTION SERVICES
INSPECTOR: Karl M. Kuehner NO SCALE:
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No.
FORM 11 - SOIL EVALUATOR FORM
Page 1 of 3
Date: Aug. 14,1997
Commonwealth of Massachusetts
Northampton , Massachusetts
Soil Suitability Assessment for On-site Sewage Disposal
Performed By: Paul B. Hatch. PE
Witnessed By: Peter McErlain
Location Add,assor Brisson Drive
Lola
Date: Aue. 14, 1997
New Construction RepairXXX
ors Name Dave Dombrowski
Address,and 30 Brisson Dr. ,Northampton 01060
Telephone 413-584-2361
Office Review
Published Soil Survey Available:No
Year Published 1981
Yes XXX
Publication Scale 1:15840 Soil Map Unit Hg
Drainage Class A Soil Limitations
Surficial Geologic Report Available:No XXX Yes
Year Published Publication Scale
Geologic Material(Map Unit)
Landform Glacial outwash
Flood Insurance Rate Map:
Above 500 year flood boundary: No YesX
Within 500 year flood boundary: No Yes X
Within 100 year flood boundary: No Yes X
Wetland Area:
National Wetland Inventory Map(map unit)
Wetlands Conservancy Program Map(map unit)
Current Water Resource Conditions(USGS):Month
Range: Above Normal
Other References Reviewed
Normal Below Normal
r,
FORM 1 -SOIL EVALUATOR FORM
Page 2 of 3
30 6rt iSbc& V I1
Location Address or Lot No...V:L=ndcherir.Northampton
On-site Review
Deep Hole Number 1 Date: 8/14/97 Time: 9:00 Weather Clear
Location (identify on site plan)
Land Use home recreation Slope(%) 1 Surface Stones None observed
Vegetation Diciduous and coniferous
Landform glacial outwash
Position on landscape (sketch on the back)
Distances from:
Open Water Body > 100 feet
Possible Wet Area> 100 feet
Drinking Water Well>100 feet
Drainage way >100 feet
Property Lines feet /0"
Other
'MINIMUM OF 2 HOLES REQUIRED AT EVERY PROP
Parent Material(geo ogic)
Depth to Groundwater Standing Water in the Hole: None
Estimated Seasonal High Ground Water: Over 120 inches
Depth to Bedrock:not found
Weeping from Pit Face: None
DEEP OBSERVATION HOLE LOG*
Depth from
Surface(inches)
Soil Horizon
Soil Texture
(USDA)
Soil Color
(Munsell)
Soil
Mottling
Other
(Structure,Stones,Boulders,Consistency,%
Gravel)
0-11"
11"-28"
62"-120"+
Ap
B
C1
C2
LS
LS
S
5
10YR3/2
10YR5I6
10YR5/8
10YR6/6
no
no
no
no
10%cobbles&20%gravel
30%gravel
'MINIMUM OF 2 HOLES REQUIRED AT EVERY PROP
Parent Material(geo ogic)
Depth to Groundwater Standing Water in the Hole: None
Estimated Seasonal High Ground Water: Over 120 inches
Depth to Bedrock:not found
Weeping from Pit Face: None