Lot 5 Soil Tests 1w1 l
Massachusetts Department of Environmental Protection CArrtinal Way , No✓+havnp+ok
Bureau of Resource Protection - Wastewater Permitting Program Slte Addreu or Map/Lot Number
\ Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (minimum of two holes required at every proposed disposal area)
Deep Observation Hole: Date. 6J9104- Time: 9'• IS Weather: 51^"-y 75 ''
1. Deep Hole Number SA Location (Identify on Plan ).
2. Land Use. Node's Surface Stones Few Slope (Vey ? vegetation. M eple ,.Spr°.a
(e g.woodland, agricultural field,vacant NI,etc
Landforrn C"W^d M Position on landscape.
3. Distances from: Open Water Body zee ft. Drainage Way 100+ ft. Possible Wet Area loo+ ft.
Property Line ZO ft. Drinking Water Well Zoo ft. Other_ft.
4 Parent Material: AL1U -.T I1 Unsuitable Materials Present Yes❑ No 21/
If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s)❑ Weathered/Fractured Rock ❑ Bedrock ❑
5. Groundwater Observed Yes li No ❑
If Yes' Depth Weeping from Pit 72" Depth Standing Water in Hole lb" Estimated Depth to High Groundwater: 33
Redpximorphic Features Coarse Fragments
Soil Soil Matrix: (mottles) %by Volume
Depth Horizon/ Soil Texture Color-Moist Depth Color Percent Gravel Cobbles Soil Structure Soil Consistence
(In.) Layer (USDA) (Munsell) &Stones (Moist) Other
0 -5• A "1"5L loiRzlz crumb Lose
5 -4 B w LS Z.545/6 5% m455"ve ve.Lka.
7.5v RSfS
11‘_ Nan C L5 10 R6/2 33 ° Ilovg7/1 So% logo 5y 06a05,vc c,,abta-
l i
Additional Notes
DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 3 of 4
Lot- 5 I
Department of Environmenti Cc.v cLnal Way , Norl-kavitirn
Bureau of Resource Massachusetts Protection -Wastewater Permitting tal Protec Pron ogram Site Address or Map/Lot Number
I Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
A. Facility Information
Owner Name. W2 ercl< F Fr 54" HILLTOWN ENVIRONMENTAL CONSULTING
`� Y � P. O. BOX 226
Street Address' 1039 Map/Lot. NORTH HATFIELD, MA 01066
s
(413) 247- 5464
City: Eas Stale MA Zip Code. 01027
B. Site Information
1. (Check one) New Construction El' Upgrade ❑ Repair ❑
2. Published Soil Survey available? Yes 3' No El If yes: I 981 I 15940 AmB Amostown
Year Published Publication Scale Soil Map Unit Soil Name
Sod limitations V4efncn percs slowly
3. Sudicial Geological Report available? Yes ❑ No ❑ If yes.
Year Published Publication Scale Map Unit
Geologic Material Land form
4. Flood Rate Insurance Map:
Above the 500 year flood boundary? Yes No ❑ Within the 100 year flood boundary? Yes ❑ No Ei
Within the 500 year flood boundary? Yes ❑ No Eli Within a Velocity Zone? Yes ❑ No ❑
5. Wetland Area: National Wetland Inventory Map
Map Unit Name
Wetlands Conservancy Program Map
Map Unit Name
6. Current Water Resource Conditions(USGS) 6 04 Range'. Above Normal ❑ Normal E". Below Normal ❑
7 Other references reviewed.
DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal•Page 1 of 4
Lo+ 5
Massachusetts Department of Environmental Protection Ca-dr,,,l ,Jay) Nar4 t p{e.
Bureau of Resource Protection—Wastewater Permitting Program Sae Address or Map/Lot Number
t Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
D. Determination of High Groundwater Elevation sA SB
1. Method used: ❑ Depth observed standing water in observation hole A. B.
❑f Depth weeping from side of observation hole A. B.
L Depth to soil redoximorphic features (mottles) A. 33" e. 35
❑ Groundwater adjustment(USGS methodology) A. B.
2. Index Well Number Reading Date Index Well Level
Adjustment Factor Adjusted Groundwater Level
E. Depth of Pervious Material
1 Depth of Naturally Occurring Pervious Material
a. Does at least four feet of naturaft occurring pervious material exist in all areas observed throughout the area proposed for the
soil absorption system? Yes gad No❑
b. If yes, at what depth was it observed? Upper boundary. Z6 " Lower boundary: 108
F. Certification
I certify that I have passed the soil evaluator examination' approved by the Department of Environmental Protection and that the
above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017.
9 / 2001-
Sign ure of Soil Evaluator Date
Mark Thompson April 29, 1997 .
Typed or Printed Name of Soil Evaluator 'Date of Soil Evaluator Exam
Er re-5+ Mn+IN■cU /�c...+ �v Nuv+�.n...Y�n.._
Name of Board of Health Witness Board of Health
Note: This form must be submitted to the approving authority vnth Percolation Test Form 12
DEP Form 11 Shc Suitability Assessment for On-Site Sewage Disposal•Page 4 of 4
Lo+- 7
DMassachusetts Department of Environmental Protection Car�'�°I W01 O(4 `°'"'ff0
Bureau of Resource Protection —Wastewater Permitting Program Site Address or Map/Lot Number
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (minimum of two holes required at every proposed disposal area)
Deep Observation Hole: Date 6/9/04 Time 10',00 Weather: Sr.ary 8Or
1 Deep Hole Number 5 3 Location (Identify on Plan ):
2. Land Use: Vac aA- L°k Surface Stones: Mai Slope (%): o- 1 Vegetation. Uo^e-
(eg.woodland, agricultural field,vacant W.etc
Landform: G„.,1 Morn,n< Position on landscape.
3. Distances from Open Water Body 200+ ft. Drainage Way loo'-ft. Possible Wet Area 1°0' ft.
Property Line 35 ft. Dunking Water Well IS + ft. Other_ft.
4 Parent Material: Ain-10x—f,II Unsuitable Materials Present. Yes ❑ No[l
If Yes: Disturbed Soil!: FIR Material❑ Impetuous Layer(s)❑ Weathered/Fractured Rock ❑ Bedrock ❑
5 Groundwater Observed: Yes Q No ❑
3
It Yes: Depth Weeping from Pit 72” Depth Standing Water in Hole 92 Estimated Depth to High Groundwater: 5 I.
Redoximorphc Features Coarse Fragments
Soil Soil Matrix: (mottles) %by Volume
Depth Horizon/ Soil Texture Color-Moist Depth Color Percent Gravel Cobbles Soil Structure Soil Consistence
(In.) Layer (USDA) (Munsell) 8 Stones (Moist) Other
0-1z c11I — -
12- 18" A TsL_ IbNQZ/l Crum), 4ose r oo+S
18- 26 , B LS 2.5Y5/4 107a massi v e fv;aL(t v 0.-Ir s
/ t r. . IS•/1Z SIb
26-h2 L L-5 2/`t j> 2 .S Y G I I 5077, ' i is
1„0..‘
Additional Notes
DEP Form'II Soil Suitability Assessment for On-Ste Sewage Disposal •Page 3 of 4
t_o+ s
EMassachusetts Department of Environmental Protection �' ^°� W Y/ o` rtwm°+D1_
Bureau of Resource Protection -Wastewater Permitting Program Site Address or Map/Lot Number
l Form 12 - Percolation Test
A. Facility Information
1. Facility Information T
142-Ore IC �yr.s;/V T ust
Owner Name /
P, O ,Box 1039 Map/Lot
Sapt Addr,eers 1•-1A‘as Nna p4o 0■02.7
Cny State Zip Code
Percolation Test-
Date: 7N„e 9 , 2004-
Observation Hole # TA 53
Depth Of Perc 35” 48
Start Pre-soak z 114 Z. : n
End Pre-soak z '39 2 ;3(7
Time at 12" z 39 z 1,,345
Timeat9" 2 ; 41 zi43
Time at 6" Z'.4$ z :57
Time (9"-6") 7 MI 14 Mir--1
Rate - Min/Inch 3 ' . Jr$J S M0J/l^I
•Minimum of 1 Percolation test must be performed in both the primary area AND reserve area.
Site Passed 2 Site Failed ❑
T( = p HILLTOWN ENVIRONMENTAL
Performed By. of k s�� CONSULTING
�oAL 1eN P.O. E 2
Witnessed By: Er r�rl NORTH HATFIELD, MA 01066
Comments:
DEP Form 12 Percolation Test • Page 1 of 1