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164 Title 5 Application/Permits 2008, Report 2009 n. Massachusetts Department of Environmental Protection 164 Oitrk-k RA ) Its ..f,, Bureau of Resource Protection —Wastewater Permitting Program Nvms `�r�' "a�P "h jt Form 11 - Soil Suitability Assessment for On-Site Sewage oil S site uita40rManLOtNumber ie C. On-Site Review (minimum of two holes required at every proposed disposal area) Deep Observation Hole: Date: 9/I 1/bS Time 91 /0 Weather oil n my 1. Deep Hole Number A Location (Identify on Plan ): 2. Land Use: Ce/d Surface Stones: Few Slope(%): 5 Vegetation ./la ex t5 (e.g_woodland agricultural field,vacant lot,etc Landform. / rrr al Position on landscape. 3. Distances from: Open Water Body Z004 ft. Drainage Way /00-F ft. Possible Wet Area /00* ft. Property Line ZS ft. Drinking Water Well 150-1 ft. Other ft. 4. Parent Material: 0o441wa51, Unsuitable Materials Present: Yes ❑ No V If Yes. Disturbed SoilD Fill Material! Impervious Layer(s) ❑ Weathered/Fractured Rock [7 Bedrock ❑ 5. Groundwater Observed: Yes ❑ No El If Yes: Depth Weeping from Pit _ Depth Standing Water in Hole Estimated Depth to High Groundwater 90.f Soil Redoximorphic Features Coarse Fragments 1 Depth Soil Matrix: %by Volume (I P) Horizon/ Soil Texture Color-Moist Depth (mottles) Layer Pth Color Percent Gravel Cobbles Soil Structure Soil Consistence (USDA) (Munsell) Stones (Moist) Other 0 -Si I A s � 2 . 5Y3 3 8 3¢ 3w L5 I2,sys/µ 4✓14551Ve —GC6.1 34-901 C I 5 tbvR7/3 srvylt yra,.k l goc€ s+ra+;Vied o-114 C L- 5 Z.5ys/z 50 " sv6/I 5% — — Slny it)ra,Ix /golf ni+-126° C3 5L Z . 5 1/4/51i S/ 5% moo-A/c rfr rabLe roofs+ Additional Notes L I-/LLTOWN ENVIRONMENTAL CONSULTING P.O. SOX 314 CHESTERFIELD,MA 01012 413) 296-4490 DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal (Formcr4.1 Loo- 7MI .) N Massachusetts Department of Environmental Protection (04 Nord-� F v vis �Nor-F1.a.+o' ,r t Jam. Bureau of Resource Protection —Wastewater Permitting Program Site Address or MapiLot Number � '1i Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal A. Facility t 1 Information Owner Name: tCAl4Ct B-e-in ref,5 HILLTOWN ENVIRONMENTAL CONSULTING 1 P.O. BOX 314 Street Address. 699 PNrk {-{(1( Ron4 Map/Lot: CHESTERFIELD, MA 01012 11�� (413) 296-4499 City: 'f' lerer.Ca- State. MA Zip Code- 61062— B. Site Information 1. (Check one) New Construction El Upgrade❑ Repair ❑ /� 2. Published Soil Su9ey available? Yes V No 111 If yes: 1981 I : 15$4D Cr A 5i.i in.,/ f,� Year Published Publication Scale Soil Map Unit Soil Name Soil timitations pocr-Cr■\Vee5 We- ass 3. Surficial Geological'Report available? Yes ❑ No ❑ If yes: Year Published Publication Scale Map Unit Geologic Material Landform 4. Flood Rate Insurance Map: Above the 500 year flood boundary? Yes 211 No ❑ Within the 100 year flood boundary? Yes ❑ No Within the 500 year flood boundary? Yes ❑ No ❑ 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) B/°S Range: Above Normal 2/ Normal ❑ Below Normal ❑ Month/Year II I 7. Other references reviewed: 1Gee- add■4io r‘at o65erVCVtfo vv `1n (t cAo.ko, c.v14 pert Tes4 ras*.ks -Pro r.,.. co/Z7 /9yo (-coo -NW la y Ma.-1-kvi Sokol, nro c...... II c,a c,iraeala Aceaaamant for(m-Site Sewaoe Disposal •Pape 1 of 4 L\--\ Massachusetts Department of Environmental Protection &4 Nor{-L. Fc rvns Roa�7 No���mn,P�-ho Bureau of Resource Protection —Wastewater Permitting Program Site Address or Map/Lot Number Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal D. Determination of High Groundwater Elevation 1. Method used. ❑ Depth observed standing water in observation hole A. B. ❑ Depth weeping from side of observation hole A. B Depth to soil redoximorphic features (mottles) A. _ 90 n B. 94 n ❑ 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 naturallyyccurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Yes Il✓ No❑ b. If yes, at what depth was it observed? Upper boundary: Lower boundary: 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. / r 5e44. , � I 2006 HILL TOWN ENVIRONMENTAL CONSULTING Signs re of Soil Evaluator Date P.O. BOX 314 CHESTERFIELD, MA 01012 Mark Thompson April 29, 1997 (413) 296-4499 Typed or Printed Name of Soil Evaluator 'Date of Soil Evaluator Exam PR- - MLA L Nor4-11g n 1r C4Dev+) Name of Board of Health Witness Board of Health Massachusetts Department of Environmental Protection 164 No.4% FOWDIS Rd • Not-i-kuntlan Bureau of Resource Protection—Wastewater Permitting Program site Address or Map/Lot Number i i k 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. 9,/11/OS Time: ? % 2-5 Weather. Sunvy\/ 1. Deep Hole Number 3 Location (Identify on Plan ): / II 2. Land Use: Meld Surface Stones: rew Slope (%) 5 vegetation eeClS (e.g. woodland, agricultural field,vacant lot,etc Landform: revaart Position on landscape. 3. Distances from: Open Water Body 200+ ft. Drainage Way /oof ft. Possible Wet Area (On+ ft. Property Line _ft. Drinking Water Well 150* ft. Other ft. 4. Parent Material: 0 v,1wmsl„ Unsuitable Materials Present: Yes ❑ No(N'/ If Yes: Disturbed SoilE Fill MaterialD Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock ❑ 5. Groundwater Observed: Yes No ❑ If Yes: Depth Weeping from Pit I 1 Z" Depth Standing Water in Hole I ion Estimated Depth to High Groundwater. 24- Redoximorphic Features Coarse Fragments -__ Soil Soil Matrix: (mottles) Br by Volume Depth Horizon/ Soil Texture Color-Moist Depth Color Percent Gravel Cobbles Soil Structure Soil Consistence Layer (USDA) (Munsell) & Stones (Moist) Other CI -7 ' A -15L 2.5Y3/3 max, ftos— 7-)9 ■ 3 L5 2,515/4 ,(ASS(vt wirl. I 9¢ CI S IDIR 7J3 Ji„yejra,ti. I6OS 5+rd;FteI w -C Sol.A 94 ia6" Cz LS z$y $/ 94 z55Y/t Z% 2°g Yna g L N.IC �r vy Additional Notes HILLTOWN ENVIRONMENTAL CONSULTING P.O. BOX 314 DEP Form 11 Rnii cudmeua„n«e«...o..■s,.,n,, c.,,O.. .. n Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wastewater Permitting Program Site Address or Map/Lot Numbet Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal A. Facility Information Littletree Environmental Consulting Owner Name: Michael Behrens P.O. Box 503 Street Address: 164 North Farms Road Map/Lot: Chesterfield, MA 01012 (413) 537-0344 City' Northamoton state: MA zip code. 01080 B. Site Information 1. (Check one) New Construction 0 Upgrade ❑ Repair ❑ 2. Published Soil Survey available? Yes ❑ No ❑ If yes: 1998 1:25,000 Sr A Sudbury Fine Sandy Loam Year Published Publication Scale Soli Map link Soil Name Soil limitations severe, wetness,poor filter 3. Surficial 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 Within the 500 year flood boundary? Yes ❑ No ❑ Within a Velocity Zone? Yes ❑ No 5. Wetland Area: National Wetland Inventory Map Map Unit Name Wetlands Conservancy Program Map Map Unit Name 8. Current Water Resource Conditions(USGS) June 2009 Range: Above Normal ❑ Normal 0 Below Normal ❑ Month/Year 7. Other references reviewed: Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wastewater Permitting Program Site Addreea 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) Littletree Environmental Consulting Deep Observation Hole: Date: July 13.2009 Time: 9:00 Weather. clear P.O. Box 503 Chesterfield, MA 01012 1. Deep Hole Number C Location (Identify on Plan): (413)531-0344 2. Land Use: Building Lot Surface Stones: no Slope (%): 1-2 Vegetation: none Landform: Kame Position on landscape: 3. Distances from: Open Water Body NA ft. Drainage Way NA ft. Possible Wet Area NA ft. Property Line 40' ft. Drinking Water Well NA ft. Other NA ft. 4. Parent Material: Aeolian over Outwash Unsuitable Materials Present: Yes❑ No If Yes: Disturbed SoilO Fill Material0 Impervious Layer(s)0 Weathered/Fractured Rock 0 Bedrock 0 5. Groundwater Observed: Yes 0 No If Yes: Depth Weeping from Pit _ Standing Water in Hole no Estimated Depth to High Groundwater: > 120" Redoximorphic 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 0-4 A Is 2.6Y 3/3 0 weak friable granular 4-20 Bw Is 10YR 5/6 0 single loose grain 20-41 ' C Is 10YR 4/4 0 single loose grain 41-128+ 2C s• 5Y4/3 0 single loose grain Additional Notes *layered sands 1 Massachusetts Department of Environmental Protection Bureau of Resource Protection—Wastewater Permitting Program Site Addressor 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) Littletree Environmental Consulting Deep Observation Hole: Date: July 13.2009 Time: 9:00 Weather. clear P.O. Box 503 Chesterfield, MA 01012 1. Deep Hole Number D Location (Identify on Plan): (413)537-0344 2. Land Use: Building Lot Surface Stones: no Slope (%): 1-2 Vegetation none Landform: Kame Position on landscape: — _ 3. Distances from: Open Water Body INA ft. Drainage Way NA ft. Possible Wet Area NA ft. Property Line 40' ft. Dunking Water Well t1 ft. Other NA ft. 4. Parent Materiel: Aeolian over Outwash Unsuitable Materials Present: Yes❑ No If Yes: Disturbed Soil❑ Fill Material❑ Impervious Leyer(s)❑ Weathered/Fractured Rock ❑ Bedrock ❑ 5. Groundwater Observed: Yes El No If Yes: Depth Weeping from Pit _ Standing Water In Hole no Estimated Depth to High Groundwater: > 120" Redoximorphlc Features Coarse Fragments Depth Soil Soil Matrix: p (mottles) ^%by Volume Horizon/ Soil Texture Color-Moist Depth Color Percent Gravel Cobbles Soil Structure Soil Consistence (In.) Layer (USDA) (Munson) 8 Stones (Moist) Other 0-18 C Is 10YR 4/4 0 single loose grain 18– 2C s" BY 4/3 0 single loose 120+" grain Additional Notes •layered sands `f Massachusetts Department of Environmental Protection Bureau of Resource Protection-Wastewater Permitting Program Site Address or Map/Lot Number Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal D. Determination of High Groundwater Elevation 1. Method used: ❑ Depth observed standing water in observation hole A. B. C. D. ❑ Depth weeping from side of observation hole A. B. C. D. O Depth to soil redoximorphic features (mottles) A. B. C. >120" D. >120" ❑ Groundwater adjustment(USGS methodology) A. B. C. D. 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 naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Yes ® No❑ b. If yes, at what depth was It observed? Upper boundary: 4" Lower boundary: 120+" F. Certification I certify that I have assed the soil evaluator examination*approved by the Department of Environmental Protection and that the above analysis wa p form=d by a consistent with the required training, expertise and experience described in 310 CMR 15.017. I ` ✓ / � , �`01(% -G (1 Littletree Environmental Consulting :Igneture of Soil E .lu?r Date P.O. Box 503 Lesley A"Mickey"Spokas SE2310 April 27. 1997 Chesterfield, MA 01012 Typed or Printed Name of Soil Evaluator Date of Soil Evaluator Exam (413) 537-0344 E. Bokina Northampton Board of Health Anent Name of Board of Health Witness Board of Health Note:This form must be submitted to the approving authority with Percolation Test Form 12 itMassachusetts Department of Environmental Protection Bureau of Resource Protection—Wastewater Permitting Program 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: July 13 2008 Time: 9:00 LIttletCe Environmental Consulting Weather clear P.O. Box 503 C Chesterfield, MA 01012 1. Deep Hole Number Location (Identify on Plan): 2. Land Use: Buildino Lot (413) 537-0344 Surface Stones: no Slope (%): 1-2 Vegetation: none Landform: to _ Position on landscape: 3. Distances from: Open Water Body NA ft. Drainage Way NA ft. Possible NA ft. Property Line _}Q_fl. Drinking Water Well NA ft. Other NA fl. 4. Parent Material:Aeolian over O_ i - _ash Unsuitable Materials Present: Yes D No El If Yes: Disturbed Soilj Fill Materialo Impervious Layer(s)❑ Weathered/Fractured Rock D Bedrock 0 5. Groundwater Observed: Yes o No If Yes: Depth Weeping from Pit Standing Water In Hole no Estimated Depth to High Groundwater: > 120" Redoximor Soil hic Features Depth Sall Matrix: P Coarse Fragments (mottles) Horizon/ (In.) Layer Soil Texture Color-Moist Depth Color ) Percent Gravel by Volume bbles Soil Structure Soil Consistence 0-4 Ma. 2.6Y 3/3 0) 2.5Y 7/ &Stones (Moist) Other 4-20 NM® 10YR 6I6 0 weak friable granular 2041 single loose �� 16V 4/74 0 grain 0 single loose ® grain single loose grain Additional Notes • a e ed s- •s • Massachusetts Department of Environmental Protection Site Address or n Bureau of Resource Protection—Wastewater Permitting Program . ,.... . , IForm 11 - Soil Suitability Assessment for On-Site Sewage Disposal A. Facility information LRtletree Environmental Consulting P.O. Box 503 Owner Name: Michael Behrens Chesterfield, MA 01012 Street address: 164 NorthFarm!Road Map/Lot: (413)537-0344 city: Northampton stet Me_ Zip Code: 0160 B. Site Information Upgrade 1. (Check one) New Construction ® U P9 ❑ Repair ❑ ¢ dbAry Fine Santiv Loam No ❑ If yes: jig_ 1:25.000 SA 2. Published Soil Survey available? Yes ❑ Year Published Publication Scale Son Map link Soil Name Soil limitations severe wetness.poor filter 3. SNK No ❑ If yes:CI81 Geological Report available? Yes ❑ Year Published Publication Scale Map Unit Geologic Material Landform 4. Flood Rate Insurance Map: Above the 500 year flood boundary? Yes ❑ No ❑ Within the 100 year flood boundary? Yes ❑ No Within the 500 year flood boundary? Yes ❑ No ❑ Within a Velocity Zone? Yes ❑ No • • 5, Wetland Area: National Wetland Inventory Map unit Name Wetlands Conservancy Program Map . --- -- Map Unit Name 6. Current Water Resource Conditions(USGS) 009 Range: Above Normal ❑ Normal Below Normal ❑ MonttW 7. Other references reviewed: ._____—_-.....nn_¢ae Fawaoe Disposal•Page 1 of 6 Massachusetts Department of Environmental Protection ' Bureau of Resource Protection—Wastewater Permitting Program s he seeress or Map tat Number Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal D. Determination of High Groundwater Elevation 1. Method used: ❑ Depth observed standing water in observation hole A. B. C. D. ❑ Depth weeping from side of observation hole A. _ B. C. D. El Depth to soil redoximorphic features (mottles) A. B. C.>120' D. >120' ❑ Groundwater adjustment(USGS methodology) A. B. C. D. 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 naturally occurring pervious material exist In all areas observed throughout the area proposed for the soil absorption system? Yes El No❑ b. If yes, at what depth was It observed? Upper boundary: _s2 Lower boundary: 120+" F. Certification I certify that I have passed the soil evaluator examination*approved by the Department of Environmental Protection and that the above analysis wa;performed b$me consistent with the required training, expertise and experience described in 310 CMR 15.017. �1 ^� �� 1 - , �� , U ( \ Littletree Environmental Consulting 1\ , I !1 ,J Il Signature of Soll EJeluaiaf \, Date P.O. Box 503 Chesterfield, MA 01012 Lesley A"Mickey"Hookas 8E2310 Aoril 27. 1997 (413)537-0344 Typed or Printed Named Soil Evaluator Deta of Soil Evaluator Exam E.Bokina Northamoton Board of Health Aslant Name of Board of Health Witness Board of Health Note:This form must be submitted to the approving authority with Percolation Test Form 12 • DEP Form 11 Soil Suaabllity Assessment for On-Site Sewage Disposal •Page 4 of 8 Massachusetts Department of Environmental Protection Bureau of Resource protection-Wastewater Permitting Program _ �� Form 11 - Soil Suitability Assessment for OnSite Sewage Disposal or e p C. On-Site Review (minimum of two holes required at every proposed disposal area) Lltlletree Environmental Consulting Deep Observation Hole: Date: 13 Time: 0 Weather. clear P.O. Box 503 o s:0 1. Deep Hole Number Q Location (Identify on Plan): Chesterfield, MA 01012 2. Land Use: uildine t (413) 537-0344 —.- Surface Stones:A.2 Slope(%): 1-2 Vegetation: none Landform: Kam. Position on landscape: 3. Distances from: Open Water Body Jilt. Drainage Way NA ft. Possible Wet Area NA ft. Property Line Sift. Drinking Water Well NL1 t. Other NA ft. 4. Parent Material:BpsitTaLshittaps Unsuitable Materials Present: Yes❑ No Ej If Yes: Disturbed Sail0 Fill Materialfj Impervious s La er Y ( )❑ Weathered/Fractured Rock ❑ Bedrock ❑ 5. Groundwater Observed: Yes 9 No If Yes: Depth Weeping from Pit __ Standing Water In Hole _DA_ Estimated Depth to High Groundwater: > 120^ Depth Soil Soll Matrix: Redoximorphic Features Coarse Fragments (In.) Horizon/ Soil Texture Color-Moist Depth Colones) Percent Gravel Volume Soil Structure Soil Consistence (USDA) (Munseli) 111111.011 10Th 4/4 0 8 Stones (Moist) Other is- single loose 113-' �— 6Y 4/3 0 single loose grain _ Additional Notes_ *levered ends • DEP Form 11 Soil Suitability Assessment for On-Sit.5.,.,.,..ro I _ PAY TO THE ORDER OF MICHAEL J BEHRENS DBA CONSTRUCTION PLANNING & MANAGEMENT 164 NORTH FARMS ROAD NORTHAMPTON,MA 01060 PH(913)559-1812 C', r Or iti �✓9 Oaa C'- 2n_.1->(--?.{./C) 0 DATE 785 53-7166/1112 $ FOR FLORENCE SAVINGS BANK es w15155+6.066065 NR 1 --ec dais .4d 11'000785u• R. 21 LB ? 16881: L9 8l DOLLARS 8 '„. Deep Hole Number: # Location(identify on site plan): Land Use: Landform. Distance from Date: Vegetation: Position of Landscape: Open Water Body Possible Wet Area Drinldne Water Well Time Weather: Slope(%): Surface Stones: Feet Draivaeaway Feet Property Line Feet Other Feet Feet Feet TP -i DEEP OBSERVATION HOLE LOG Depth from Surface (Inches) Soil Horizon Soil Texture (USDA) Soil Color (Mansell) Soil Mottling Other(Structure,Stones,Boulders, Consistency,%Gravel) I i , 7.� / : /S /6 A r CI y / <K �� F, s. Parent Material(geologic) Depth to Groundwater: Standing Water in the Hole: Depth to Bedrock: High Ground Water: Weeping from Pit Face: Estimated Seasonal TP I DEEP OBSERVATION HOLE LOG Depth from Surface (Inches) Soil Honzon Soil Texture (USDA) Soil Color (Monsen) Soil Mottling Other(Structure,Stones,Boulders, Consistency,e Gravel) t t �.� �) fy L" r 2 � - ��t� = . < //-7 {' '� 4 i/, 9g,, 1 / per _ �'' Parent Material(geologic) Depth to Groundwater. Standing Water in the Hole: n Depth to Bedrock Estimated Seasonal High Ground Water: 7J Weeping from Pit Face: Certification: I certify that in November 1994. I 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. Macs Soil Eval.Approval No.SE1543 'gnature: Peter S. MeErlain Date: NORTHAMPTON BOARD OF HEALTH 212 MAIN ST. , NORTHAMPTON, MA 01060 TEL; 413-587-1213 Site Suitability for On-Site Sewage Disposal Project Number. Performed by: Health Invenir Site Address I Nib t I IL(11A-- ) C"- New Co r Date: Equipment Operator Client Na 2" 4 Repair x T.P.1, & dress w !' ' Office Review Yes it Soil Map Unit Yes ,t CeoIc is Material(Map Unit) Ladd{otm Within 500 year flood boundary It Within 100 year flood boundary it Wetlands Conservacy Program Map(Map Unit) Month Below Normal x Published Soil Survey Available: No a Year Published Publication Scale Surficial Geologic Report Available: No a Year Published Publication Scale Flood Insurance Rate Map: Above 500 year flood boundary rt Wetland Area: National Wetland Invetory Map{Map Unit) Current Water Resource Conditions(USGS): Range: Above Normal x Normal x Other References Reviewed: Drainage Class Soil Limitations Percolation Test Results ,7/// I Time I Measurement I Time Measurement Begin Saturation Begin Sanitation j End Saturation End Saturation 9"depth Measurement 9"depth Measurement 6"depth Measurement 6"depth Measurement Elapsed Time 9"to 6" I Elapsed Time 9"to 6" Bottom of Percolation Test Hole: Method Used ❑ Depth observed standing on observation hole inches ❑ Depth weeping from side of observation hole inches ❑ Depth to soil mottles—inches ❑ Ground water adjustment inches. Index Well Number Reading Date Index well level Adjustment factor Adjusted ground water level Percolation Rate: Bottom of Percolation Test Hole: Determination for Seasonal Dinh Water Table Depth of Naturally Ocuuring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? [fyes, what is the depth of naturally occurring pervious material? TP _ TEN If not,what is the depth of tataally occurring pervious material' FP= , TIM _ On-Site Review Ti'. 4 On-Site Review T.P. # t`C +-j5 Deep Hole Number: i4 ice Date: 7--1 3 -O q Time-7:y c Weather: S., v, ,, Pk)Rr Location(identify on site plan): (-- Land Use- -&.", Oh,d Lot Vegetation: Na n m e- Landfo : Position of landscape: Distance from: Slope(%): Surface Stones: IC(7II 5 Open Water Body N(Pr Feet Dnvnageway NI PI- Possible Wet Area N I, Feet Property Line Drinking Water Well iHiji Feet Other Feet >a.b Feet Feet TP(k ) (, DEEP OBSERVATION HOLE LOG J Depth from Surface (Inches) Sod Horizon Sod Texture (USDA) Soil Color (Monsen) Sod Mottting Other(Structure,Stones, Boulders, Consistency, % Gravel) 0 —ti `f - ao )0 -4i HI a i� 4 C. a c l. 5 t. 5 5 _a ,S v 3/3 ( o'YK 57b 15Y(C 4J,LI 5 y 4/ D 0 0 U.iet vi 7rnr✓iav 5 ;„ty n i ¥va,ble 1JU=e Parent Material(geologic) Depth to Groundwater. Standing Water in the Hole: NO Estimated Seasonal High Ground Water:> I01 Weeping from Pit Face: N la teve,� s Rvt1 S Depth to Bedrock UAkra...), ycY TP DEEP OBSERVATION HOLE LOG Depth from Surface (Inches) Sod Horizon Sod Texture (USDA) Sod Color (Monsen) Sod Mottling Other(Structure,Stones,Boulders, Consistency, I Gravel) 0 - 1 I� IS S�* b 0 U 5;„ � r:4. 0 . Parent Material(geologic) Depth to Groundwater. Standing Water in the Hole: N � Estimated Seasonal High Ground Water. >ID� Depth to Bedrock: (%,+ICnow✓t >)b� Weeping from Pit Face: NO Certification: I certify that in I 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. SE Certification# Signature: Date: 7 -13 -07 NORTHAMPTON BOARD OF HEALTH 212 MAIN ST., NORTHAMPTON, MA 01060 TEL; 413-587-1213 Site Suitability for On-Site Sewaoe Disposal Date: -7-- J3 -o7 Equipment Operator. I>, 10( Client w ) LU1 �Ia✓d � OEent Name&&Address &la`ll 1j11 b c:1L�N> l 1n4 N. Favw`s ?d, Noatka w,,C Von tit/1 o,ouC Repair n V Project Number. �.y� ka5 Performed by:%sou✓k-TFo,m(25c VA.A.i ro Health Inspector: 13oki\.0 Site Address �q 159 varfi) For vion S TRA 1`Vov't4nawtroi .MA 010 Lo0 New Constructio T.P.M Office Review Published Soil Survey Available: No a Year Published Publication Scale Surficial Geologic Report Available: No r Year Published Publication Scale Flood Insurance Rate Map: Above 500 year flood boundary it Wetland Area: National Wetland Invetory Map(Map Unit) Current Water Resource Conditions(USGS): Range: Above Normal tt Normal ,t Other References Reviewed: Yes it Soil Map Unit Yes n Geologic Material(Map Unit) Drainage Class Soil Limitations Within 500 year flood boundary it Landform Within 100 year flood boundary 7t Wetlands Conservacy Program Map(Map Unit) Month Below Normal it Percolation Rate Bottom of Percolation Test Hole: Bottom of Percolation Test Hole: Determination for Seasonal Risk Water Table Method Used y_ inches ❑ Depth observed standing on observation hole,inches ❑ Depth weeping from side of observation hole ❑ Depth to soil mottles inches ❑ Ground water adjustment inches. Index Well Number Reading Date Index well level Adjustment factor Adjusted ground water level D,_pe th of Naturally Daunting Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If yes, what is the depth of naturally occurring pervious material? 1?# iP# If not,what is the depth of naturally occurring pervious material? TP#_ TP# : a - Time Time Measurement N0 &'f5 Time Measurement f Begin Saturation Begin Saturation End Saturation End Saturation 9"depth Measurement 9"depth Measurement C'depth Measurement 6" depth Measurement Elapsed Time - 9" 6' Elapsed Time 9"to 6" to Percolation Rate Bottom of Percolation Test Hole: Bottom of Percolation Test Hole: Determination for Seasonal Risk Water Table Method Used y_ inches ❑ Depth observed standing on observation hole,inches ❑ Depth weeping from side of observation hole ❑ Depth to soil mottles inches ❑ Ground water adjustment inches. Index Well Number Reading Date Index well level Adjustment factor Adjusted ground water level D,_pe th of Naturally Daunting Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If yes, what is the depth of naturally occurring pervious material? 1?# iP# If not,what is the depth of naturally occurring pervious material? TP#_ TP# : BOARD OF HEALTH MEMBERS JAY FLEITMAN,M.D.,Chair SUZANNE SMITH,M.D. DONNA C.SALLOOM XANTHI SCRIMGEOUR,MHEd,CHES DIRECTOR (413)587-1214 FAX(413)587-1221 To: Michael Behrens 699 Park Hill Rd Florence, MA 01062 CITY OF NORTHAMPtThN MASSACHUSETTS 01060 OFFICE OF THE BOARD OF HEALTH PERCOLATION TEST FEES 212 MAIN STREET NORTHAMPTON,MA 01060 Date: July 28, 2009 Perc Test requested by: The Northampton Board of Health charges a fee for the witnessing of percolation tests: $50.00/hr - (minimum fee-$50.00). No. Date 1. 7-13-09 2. 3. Location 164 North Farms Road Lot # 2. 3. Start Time am Stop Time am Hour 2.00 Total Hours: 2.0 (R?$50.00/Hr. (Repaid Amount due: $100 .00 Witnessed by Ellen Bokina ,/Nft � nev s v<H F 'DIDb& 11ji11 Sew @ 50x00 (('' n h1' cof Soil CJ/aLvei Y1.5 W i I-n essivb ,12tvltoam Site ({.rte 4'tIBlti�l :,AM-tiDf✓?. Please make checks payable to: The City of Northampton and mail to the Board of Health Office, 212 Main St., Northampton,MA 01060 Thank you. Ellen Bokina, Title 5 Inspector No.a, __/ (J THE COMMONWEALTH OF MASSACHUSETTS Fee BOARD OF HEALTH Cl+y OF N014-Lk r” t APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct (yj Repair ( ) Upgrade ( ) Ahandon I ) - 3tleomplete System X64 Norfk Fc.enns R°ad Michael Bel,rer,5 4(f�) N vV ao„t,a„ Park ,an Nema 699 rkµ(It 2 . V� ranee MA OtO62 Map.Pami: AJtlav 413 - 559- 1812 kiictith/et, i-��l1+owr. �r.virorew��.r.�a..1 t�(a[Ier;N !tle 3i4 Ck�:-. �<<- mMA otolz Address Address 413 -2% 4499 IJUpeonor Tatepnonen Type of Building: StyJle fLw., Iy IDWe I 1 j Lot Size Sq.feet Dwelling—No.of Bedrooms 4 Garbage Grinder (eel Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min. required) 440 gpd Calculated design flow 660 gpd Design Ho Plan: Date 9 4 O8 Numbef of she@[s t Revision Date Title �woy _ t3p=saI Sys �+w. .L%s)r. Description of Soil(s) sec Furrs. II -raw, 4 /24494 £■ i It 08 Soil Evaluator Form No. Name of Soil Evaluator P4 rflose,psma Date of Evaluation L/27/9b £� DESCRIPTION OF REPAIRS OR ALTERATIONS M•S kop 9�11/oE provided 666 gpd The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees not to place the system in operation until a Certificate of Compliance has been issued by fig urd of Health. Signed Date /r GZ� Inspections / FORM I - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 Description of Work: The undersigned hereby 'certify[h bv: of _ Net re..-.. has been installed in accordance with the provision plans relating to application No. dated Installer THE COMMONWEALTH OF MASSACHUSETTS �'- FEE +ABOARD OF HEALTH CERTIFICATE OF COMPLIANCE ❑ Individual Component(s) ZComple[e System at the Sewage Disposal System;Constructed(.-J'Repaired( ), Designer Upgraded( ),Abandoned( ) of 310 CMR 15.00 (Title0 (Tide 5�roved design plans/as-built . Approved Design Flow (gpd) The issuance of this certificate shall not be construed as Date_ FORM 3 - CERTIFICATE OF COMPLIANCE guarantee that the system will function as designed, DEP APPROVED FORM 5/96 No THE COMMONWEALTH OF MASSACHUSETTS i .la/%t`=s BOARD OF HEALTH DISPOSAL SYSTEM CONSTRUCTION PERMIT FEe disposal system at eby Net t o Permission is hereby granted to C nstr uct ( v-f Repair ( ) Upgrade ( ) Abandon in the application for Disposal System Construction Permit No. _-,-.^YS-_ j �, ( ) an individual sewage as described,dated Provided: Construction shall be coed within three sears of the date ofpermit.Igii i Date _-- Board of Health FORM 2 - DSCP DEP APPROVED FORM 5/96 FORM 1255 {REV 5/9W He W.) Hoses fl WARREN'"