91 On Site Review 2000 NORTHAMPTON BOARD of HEALTH- Title 5 - Site Review yti
ation Address or Lot# m' 1 I r (,' i / Owner /
N,f rl,j,l�-{loxyf._9+„ Uio ' �,EQ -rvl_
e - Time (I Owner's I
Address / J,i ----0—‘...-__ '
lineer I Weather Phone#
Land Use %Slope Surface Stones
Landform Ve•etation Start Time
Positron on Landscape(sketch on the back) Distances Stop Time
pen Water Body feet Drinking Water Well feet Property Line feet
issible Wet Area feet Drainage Way feel Other feet
DEEP OBSERVATION HOLE LOG*
]Hole#: 'MINIMUM OF TWO HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA
epth from Soil Horzon Sol Texture Soil Color Soil Other
ice(Inches) A (USDA) (Munse9) Mottling (Structure,Stones,Boulders,Consistency.%Gravel)
> ,... d 71 I
G /: S i, I 6 (I/
d <�„ C L 5 0- >"I 6 it 1 y6
,
i -- � � � `�t— Dtc /q f 'fi r, SJc ,
lent Mama;(geologic) Depth to Bedrock 1 57 a—r) _
Dem to groundwa ter Standing Water in the Hole Weeping from Pit Face I / (p
Estimated Seasonal High Ground Water I 7 L/c
DEEP OBSERVATION HOLE LOG'
t Hole#: 'MINIMUM OF TWO HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA
pth from Soil Horizon Soil Texture Soil Color Soil Other
ce(Inches) (USDA) (Munsell) Mottling (Sbacture,Stones.Boulders.Consistency %Gravel)
(
I I /
i '
� -cam
( r R-i' AL
/' / ' /J6CGJ
t .:,, .. r /' &y / /
CSI V i �, 71--a n olry lc} Japty to B a. �
Depth
—A
Depho dSasralH Ground W terHole Weeping from Pi Face
Es dad Seasonal HpM1 Ground Plater
9/ �+ - � a2
PERCOLATION TEST(S)
Time:
Time:
Observation Hole
#1
Observation Hole
#2
Depth of Perc
''
of Perc
Start Pre-soak
3)--
Start Pre-soak
End Pre-soak
tl -1
End Pre-soak
Time at 12"
4
Time at 12'
Time at 9'
3. s1
lime at 9'
Time at 6'
Ll
1 0
Time at 6"
Time(9"-6')
I0/
Time(9"-6')
Rate Min./Inch
JJ
Rate Min./Inch
'minimum of 1 percolation test must be performed in both the primary area AND reserve area.
rr ? ;....__■ ,' r ■._ ti -.■ _._I
Performed by
Performed by
Witnessed by
I
Witnessed by
Comments: