244 Soil Eval Form 2004 No.
FORM 11 - SOIL EVALUATOR FORM
Page 1 of 3
Date: Rf a,;/
Commonwealth of Massachusetts
/Uorthamp-MA) , Massachusetts
Soil Suitability Assessment for On-site Sewage Disposal
Performed By: .in i ChOJJ !( 11.I frit-
�1, Date: ?PION
Witnessed By: &rUC,St _ lr!/eU_.. .. .
o yy west F-any s Rd
Vew Construction ❑ Repair in
one. George a 1/45f ot{S
.�.-,...ro 8bx 48
Teirpore
WrhampIC.v IYIA oioa7
Office Review
Published Soil Survey Available: No ❑ Yes
Year Published
Drainage Class
Igl
Publication Scale
Soil Limitations
Surtiicial Geologic Report Available: No Yes ❑
Year Published .._..._.. Publication Scale
Geologic Material (Map Unit)
Landform
Flood Insurance Rate Map: IIc�77rr
Above 500 year flood boundary No ❑Yes ip,i
Within 500 year flood boundary No [Yes ❑
Within 100 year flood boundary No l Yes ❑
Wetland Area:
National Wetland Inventory Map (map unit)
Wetlands Conservancy Program Map (map unit)
Soil Map Unit
Current Water Resource Conditions(USGS): Month
Range :Above Nominal ❑Normal ¥Below Normal ❑
Other References Reviewed:
DEP APPROVED FORM-12/07/95
ENVIRONMENTAL DESIGN INC.
101 OLD FERRY ROAD
NORTHAMPTON, MA 01060
at a_sRCamh
.ocation Address or Lot No.
FORM 11 - SOIL EVALUATOR FORM
Page 2 of 3
Deep Hole Number l d-al
Location (identify on site plan)
Land Use
Vegetation __Gl' r
Landform ...... . ......
Position on landscape (sketch on the back) -S-
Distances from:
Open Water Body 7/p0 feet
Possible Wet Area >loo. feet
Drinking Water Well ?/CO. feet
On-site Review
Date: S y/OV
Slope (%)C / Surface Stones
Time:. tOD- Weather
r
I1 t9t
,i
SC e*
Drainage way >'SD
Property Line >4240
Other _. ..
h.o�L
feet
feet
•
T
P
F For 4S 'do-
DEEP OBSERVATION HOLE LOG'
Depth from
Surface(Inches)
Soil Horizon
Soil Texture Soil Color
(USDA) (Munsell)
Soil
Mottling
DM
(Structure.Stones, 3oulders. Consistency. %Grayed
8
C
SL
5L
5
/oVRjJa
bYKy/e
/oyas13
4op& l
5U b59111
Course_
o-ii"
is_ At 111
c9,Qs- 114
A
8
G
5L
5L
5
dAg- 74)u
10\jab
io'R d/b
/oY ggly
dr ctrl/
ucA)2
CousrS2
63"_ 7H th.wia
s _/eie.,-
Coin,e_ Reef
• MINIMUM OFTHISLEh HETIUII(EU.6.t E' HF P13EPUb U dlSRMAL kAO,. -
Parent Material(geologic) Gl A1"lh)a Sh DepthtoSedrock: — /OR
I 14 Q.
Depth to Groundwater: Standing Water in the Hole:
Weeping from Pit Face: lDr-y
Estimated Seasonal High Ground Water:r /og a .=. .= //v/1
DEP APPROVED FORM-12/pt/95
ENVIRONMENTAL DESIGN INC.
101 OLD FERRY ROAD
NORTHAMPTON,MA 01060
413-585-5020
•
FORM 11 - SOIL EVALUATOR FORM
Page 3 of 3
Location Address or Lot No. o294 W-e Far yrS cnd
Determination for Seasonal High Water Table
Method Used:
❑ Depth observed standing in observation hole.. inches
❑ Depth weeping from side of observation hole inches
• Depth to soil mottles-7- 1°8"' inches 2 114"
❑ Ground water adjustment feet
Reading Date _. Index well level
Index Well Number
Adjustment factor
Adjusted ground water level
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally observed throughout the area proposed occurring
the pervious� exist in all areas
soil absorption system? _
If not, what is the depth of naturally occurring pervious material? \IL�•CJ
Certification
I certify that on /WO, 97 (date) 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.
n j
Signature ate 81�o
DEP APPROVED FORM 12/07/9
ENVIRONMENTAL DESIGN INC.
101 OLD FERRY ROAD
NORTHAMPTON,MA 01060
413-585-5020
FORM 12 - PERCOLATION TEST
Location Address or Lot No. d iL1 LK% -f SaCYY1\ 2nctd
COMMONWEALTH OF MASSACHUSETTS
, Massachusetts
Percolation Test'
Date: 3)40 q Time:,.QC-iet..Limo
Observation Hole #
Depth of Pert
' t� '/
Start Pre-soak
oi,Z)
End Pre-soak
2:05
Time at 12"
umu big
Time at 9"
Time at 6" 0/
al.'�1�111—4 I .J %h:,&U
Time (9"-6")
Rate Min./inch
4a
Minimum of 1 pe colation test must be performed in both the primary area AND
reserve area.
Site Passed E Site Failed ❑.
Performed By: I r I I vl cu X A��t�/."t71c..�v1
Witnessed By: £roeSL CYlaath)e u
Comments: . . ..... .J_ __/.... 2c7:.O.(
DDP APPROV®FORM.1147195
ENVIRONMENTAL DESIGN INC.
101 OLD FERRY ROAD
NORTHAMPTON,MA 01060
413-5R5-Sn,n
•
not to scale = PERCOLATION REPORT
•
�r \ye sS ow F` k AND SITE EVALUATION
1' 'gyp /l Sy
`Vn sk� ' S� / _ �? ` DATE: Ph Y//WITNESS: 0,,(�f IA,�} W (rte' ,G zyr Dill /�f�2
b n Test Pit # Test Pit #
Z a�4 S + _ 3 miet p rz tete /19� re-
v/g� cc is/a C)
d `9 991erm7 c
�y �XY
(` 1 ,,s__ /��1 � _ i }�Nu DRY :�d�n.,�
II 7„ LS.`i ~ ?I _ L I Q.. c.:nrl- S lel'tLi )) Qu-};,J(LCL
1/ 1 1 Perc. Hole rain .•/n, H -,-
C ,T: S-6
X 1 h, v�_i Perc. Rate
r J 4/1„:r`ii ; _ .e3 nti /I �a-
mint in.
t,
jr U• ' 0.' "` ENVIRONMENTAL SANITATION...
3 �Nz ii ' AND ENGINEERING ASSOCIATES INC .
P I • LOT LOCATION/&'NO.
Eli �� —,3 P��7 fr[iti OWNER: Qe i, c -? / r-Anc. 9f/