167 On Site Review 2001 NORTHAMPTON BOARD of HEALTH- Title 5-Site Review
•cation Address or I
Lot# Owner
e Time
Owner's
Address -
Weather Phone 1 -
Land Use %Slope Surface Stones
Landform V-!etation
P on Landscape(sketch on the bad) Start Time Time Ois[ances Stop Tire
fen Water Body feet Drinking Water Well
ssible Wet Area feet Property Line feet
feet Drainage Way feet Other
yeti_
DEEP OBSERVATION HOLE LOG*
Hole e: -.. *MINIMUM OF TWO HOLES REQUIRED AT EVERY PROPOSED DISPOSAL Ana
Xh from Sal Horizon Soil Texture Soil Color
2(Indies) (USDA) (MUnsell) MothinQ Otlrs,
(Store,Stones,Boulders,Consistency,%Gravel)
i
C T
/ ,
I Mahal(geobgle)
Sept])to groundwater. Standing Water in the Hole I I Depth to Bedrock //�--
Estimated Seasonal High Ground Water I Weeping from Pt Eke
DEEP OBSERVATION HOLE LOG*
Dle a: I •MINIMUM OF?WO HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA
from Soil Horizon Soil Texture -
Indles) (USDA) (MuCO1I) Soil Other
Unselq Mottling (Sbudure.Stales,Boulders,Consistency.%Gravel)
•
labial(geologic) I I Depth to Bedrock I
to groundwater Standing Water in the Hole I :.-mtu - -
I
Estimated Seasonal HghGround Water Weeping from PA Face
PERCOLATION TEST(S)
Time:
Time:
Observation Hole
#1
Observation Hole #2
Depth of Perc
Depth of Perc
4 `I
Start Pre-soak
Start Pre-soak
:": i 2 v
End Pre-soak
, ;�
End Pre-soak
Time at 12"
Time at 12"
r ."
Time at 9"
Time at 9"
In
Time at 6"
- /
Time at 6"
Time (9"-6")
Time(9"-6")
Rate Min./Inch
_.
Rate Min/Inch
"minimum of 1 percolation test must be performed in both the primary area AND reserve area.
Performed by
Performed by
Witnessed by
I Witnessed by
Comments: