9 Soil Assessments Lot-
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Massachusetts Department of Environmental Protection Curl:�.,� way . Na.+�Aw,P{-ov
Bureau of Resource Protection—Wastewater Permitting Program Site Address or Map/Lot Number
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
A. Facility Information �
Owner Name: WZore i< Fa n-1,17 —I ✓os� HILLTOWN ENVIRONMENTAL CONSULTING
'at SIXCX110—
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Street Address'. P.0.a ox 1039 Map/Lot:
m - •rJT--war.
Cr; City. Eas4-knnn4ei, Slate: MA Zip Code 01027 (113) 2% -4+99
B. Site Information
1. (Check one) New Construction
( ) [v]c Upgrade Repair 0.
2. Published Soil Survey available? Yes [El No If yes: 1981 I . 15940 AmB Amos alwan
Year Published Publication Scale Sal Map Unit Soil Name
Soil limitations V.1 ef.wcc peccs slow 17
N 3. Surticial Geological Report available? Yes ❑ No ❑ If yes.
N
Year Published Publication Scale Map Unit
N
Geologic Material LanINarm
° 4. Flood Rate Insurance Map:
Above the 500 year flood boundary? Yes [El No ❑ Within the 100 year flood boundary? Yes ❑ No [v]
Within the 500 year flood boundary? Yes ❑ No 0/ Within a Velocity Zone? Yes ❑ No ❑
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5. Wetland Area: National Wetland Inventory Map
Map Unit Name
Wetlands Conservancy Program Map
Map Unit Name
N
6. Current Water Resource Conditions(USGS) (,/0¢ Range: Above Normal ❑ Normal [V Below Normal ❑
w Mo th/Year
1 Other references reviewed:
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DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal•Page I of 4
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Massachusetts Department of Environmental Protection Carolina, Way r N or -In ohm )}et,
Bureau of Resource Protection—Wastewater Permitting Program Site Address orMShcd Number
ia ) Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
a.
C. On-Site Review (minimum of two holes required at every proposed disposal area)
Deep Observation Hole: Date: 619/04 Time: 1;15 Weather: 5.)-y ?O
10
I. Deep Hole Number 2A Location(Identify on Plan ):
p' 2 Land Use: C l.-c-J Woods Sunace Stones: F a Slope(Fish z=3 Vegetation: Weeds
% (e.g.woodland,agricultural fee,vacant Id,etc
c Landfonrt Gr, M..a„w Position on landscape.
V
0 3 Distances from: Open Water Body Zoo re- ft. Drainage Way WA- ft. Possible Wet Area tw. ft.
Property Line ft. Drinking Water Well ft. Other_ft.
4. Parent Matenal: AbInin,nti 11 Unsuitable Materials Present: Yes 0 No Er
co If Yes: Disturbed SoilD Fill MaterialO Impervious Layer(s)❑ Weathered/Fractured Rock ❑ Bedrock ❑
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5. Groundwater Observed: Yes l/ No ❑
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If Yes'. Depth Weeping from Pit 71„ Depth Standing Water in Hole 1°2 Estimated Depth to High Groundwater: 38”
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Redozimorphic 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 (In.) Layer (USDA) (Munsell) &Stones (Moist) Other
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.y 0-$° 4 ;SL i o'R3/2 cr,,,,.,lu Iowa
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E 5{-IS" 3 LS IDyR5/6 5% we„i�e -,. .tile_
o it-l�6 C- LS lot/R6/7 3S° IDYRS'8 )0% 1o% 1070 w,asSWe tnala'e-
Ie VR 7/1
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y, Additional Notes
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DEP Form 11 Sail Suitability Assessment for On-Site Sewage Disposal•Page 3 of 4
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Massachusetts Department of Environmental Protection Cc' a Al Way/ Nb'}I""""°4 N
m �- Bureau of Resource Protection-Wastewater Permitting Program
Site Address or Mw/Lot Numbs 1.
a t\ 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-D4 Time: I;3O Weather: <sinAy 90
2.3 Location(Identify on Plan p:
m 1. Deep Hole Number `' I r,
N.
d We I y�e¢d'S
2. Land Use: Muds+ ods Surface Stones few Slope(%): 2-3 Vegetation.
o (e g.woodland,agriculuraltield.vacant I .etc
c Landform. Cr . Mora•Ike Position on landscape.
o 3. Distances from: Open Water Body WO 4 ft. Drainage Way loop ft. Possible Wet Area toot ft.
Property Line ft. Drinking Water Well 150 ft Other ft.
4. Parent Material: tatOn4t'm�{I\ Unsuitable Materials Present. Yes El No D
nr If Yes: Disturbed SLID Fill MaterialO Impervious Layers)0 Weathered/Fractured Rock ❑ Bedrock ❑
LE
n 5. Groundwater Observed: Yes R- No D
N
CO 11 Yes'. Depth Weeping from Pit 80 Depth Standing Water in Role 110'1 Estimated Depth to High Groundwater:
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RedoximorPhic Features Coarse Fragments
Sal Soil Matnx: (mottles) %by Volume
Depth Color Percent Gravel Cobbles Soil Structure Soil Consistence
Depth HLayerl Soil Texture Color-Mast CStones (Moist)o o (In.) Layer (USDA) (MUnselq -
r cr,.w.b (Dos e
03 0-5° 4 Ts � IbMR3�1
LS oYtis/6 5% 1s,�e ;allt
= 5 IS'I �N
z [ I p r¢aCe
\5'170" G t--5 oYRb 4-0I Io1R7/1 10% I )113 la/ hnasslvc cv
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a. Additional Notes
14 DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal•Page 3 of 4
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Massachusetts Department of Environmental Protection Ca„ol■,,,- W. orHna,„, • a,., ,
c, ci.: •Li Bureau of Resource Protection—Wastewater Permitting Program Site Addrea or Map/Lot Number
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
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C. On-Site Review (minimum of two holes required at every proposed disposal area)
Deep Observation Hole: Date: 12-/41D7 Time: 1145 Weather: _(, I o„dy ZO3 -
m 1. Deep Hole Number Z C. Location(Identify on Plan ):
in
at 2. Land Use: Cle.,.e,d W"ck5 Surface Stones: FevJ Slope(%): Z-3 Vegetation. Spr...ce-
(e.g.woodland.agricultural field,vacant lot,etc
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67v- ,t M..a,,,e
Landform. Position on landscape-.
v 3. Distances from: Open Water Body /a°+ ft. Drainage Way toe+ ft. Possible Wet Area lo°-I ft.
0
5 t 1e_ Property Line jft. Drinking Water Well ISO-I- ft. Other ft.
4. Parent Material: /46 -fien7;11 Unsuitable Materials Present: Yes 0 No Er
co If Yes: Disturbed SoilD Fill MaterialD Impervious Layer(s)0 Weathered/Fractured Rock ❑ Bedrock D
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5. Groundwater Observed: Yes El No ❑ ,}
m If Yes: Depth Weeping from Pit /06„ Depth Standing Water in Hole _ Estimated Depth to High Groundwater: 42 N
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0
Redoximorphic Features Coarse Fragments 1
Depth Soil Soil Matrix: (mottles) %by Volume
p Horizon/ Soil Texture Color-Moist Depth Color Percent Gravel Cobbles - Soil Structure Soil Consistence
(In.) Layer (USDA) (MUnsell)
A &Stones (Moist) Other
0-511 A SL Io?R3/1 !Yvmb Bost
5-22 n Bw LS oYR 5/6 5/0 lo% mats ya {r,61.
27.711C C L5 is & 'Ii 42" IDNR she 5% /0% S% massive
Additional Notes
m HILLTOWN ENVIRONMENTAL CONSULTING
c P.O.BOX 314 DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal•Page 3 of 4
CHESTERFIELD,MA 0101E
o (413)296-4499
L04 2 � I _o
L. Massachusetts Department of Environmental Protection CArcbinAI WAy / 'ver}�SCa.,p+oh
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 Iwo holes required at every proposed disposal area)
Deep Observation Hole: Date: 12-k/07 Time: 2'. IQ Weather: CI obi dy 20S
1. Deep Hole Number 2D Location(Identify on Plan):
2. Land Use: C l< •'.d Woo.L5 Surface Stones: CY-) Slope(%): 22=3 Vegetatian:S rac4-
(e.g.woodland, agricultural field.vacant lot,etc
Landfalm:C'.o„ael Moraine-Position on landscape-
3. Distances from: Open Water Pliably 1184- ft. Drainage Way Ins4- ft. Possible Wet Area lore ft
Free-r Property Line 5 ft. Drinking Water Well ft. Other ft.
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4. Parent Material: Ab la+;e r r; I I Unsuitable Materials Present: Yes O No Ly ?
A,
If Yes: Disturbed SoilD Fill MaterialD Impervious Layer(s)❑ Weathered/Fractured Rock ❑ Bedrock ❑
a
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5. Groundwater Observed: Yes Ly No ❑ a
A
If Yes: Depth Weeping from Fit t 14 Depth Standing Water in Hole I?T" Estimated Depth to High Groundwater 45_
A
Redoximorphic Lures Coarse Fragments
Depth Soil Soil Matrix'. (mottles) vet Volume
Cob
Horizon) Soil(USDA) Color-Moist Depth Color Percent Gravel Cobbles Soil Structure Soil Consistence 0
(In.) Layer Munsell
A (USDA) ( 1 &Stones (Moist) Other o
6-7" -(!y1 SL Io YR 3/Z crr.rn(s loose_ o
7-22 �IMI Ls ho viz,S/L I S°4 10% wsnst;ve- -1r;>610 m
o
/o YR -r/f J ZZ- 7$ C L.5 to YRG/Z 45 II YR 5/8 5% JO / SC�
v✓\wss iv's- -c-iota l<. _.
Additional Notes m
HILLTOWN ENVIRONMENTAL CONSULTING a
P.O.BOX 314 DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal-Page 3 of 4
CHESTERFIELD,MA 01012
(413)296-4499
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Cavdcnal tilay, Nmi+l,a, .rib..
Massachusetts Department of Environmental Protection Slte Address or Map/Lot Number
Bureau of Resource Protection—Wastewater Permitting Program
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Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
D. Determination of High Groundwater Elevation 7 P 2B 2C- 2..7
1. Method used: ❑ Depth observed standing water in observation hole A. __
B.
Po
❑ Depth weeping from side of observation hole A._ B. -
n w Depth to soil redoximorphic features (mottles) A. 3B� B- 40"
42" 45"
e ❑ Groundwater adjustment(USGS methodology) A. EL° N Reading Date Index Well Level
2, Index Well Number 9
Adjustment Factor Adjusted Groundwater Level
S E. Depth of Pervious Material
n t Depth of Naturally Occurring Pervious Material
N
CO a. Does at least four feet of naturallllypiumng pervious material exist in all areas observed throughout the area proposed for the
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soil absorption system? Yes ' No❑
b. If yes, at what depth was it observed? Upper boundary:
IS M Lower boundary: r ZO'
in
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F. Certification
°
m 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 15017.
o
o Sgn ure of Soil Evaluator
D� 2004/�ac. 4 Z°D7
iu April 29, 1997
Mark Thompson
'Data of Soil Evaluator Exam
Typed or Printed Name Soil Evaluator
Er„erA- M>+i katn Naarrrrir+er,(A5ank)
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Marne of Board of Health Witness Board of Health
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Note:This forth must be submitted to the approving authority with Percolation Test Form 12
DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal•Page 4 of 4
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Massachusetts Department of Environmental Protection C"'O('nolni rko4aw,p�a�` 4
L Bureau of Resource Protection-Wastewater Permitting Program s e Addreaa or MaplLot Number f
t Form 12 - Percolation Test
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A. Facility Information
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1. Facility Information
\rJzartk Fa,vv.% ( 7 ct
Owner Name
P.O . •o)C 1039 Map/Lot
Street Address
as-I-M..V..1,fc v. IA,Ar Olo2.-7
City State Zip Code
Percolation Test '
Date: S..e- 9 , 2004 o
Observation Hole# P-2.A P-273 o
Depth Of Perc , 4t" 4 " a
Start Pre-soak 3:24 3:40 m
End Pre-soak 3:39 3',55
Time at12" 3 :41 3i 55
Time at 9" 3 t 41 4'.03
Time at 6" _ 4•.ot 4-us
Time (9"-6") _ I3 MIN IZ M1rs) o
Rate - Min/Inch S M1P/1 hi 41-1IN/10
0
�,'Minimum or 1 Percolation lest must be performed in both tae primary area AND reserve area. J
Site Passed ly Site Failed ❑
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Performed By: Mark--lihow.rse P. v
Witnessed By: t.v,ask Ma�l,i ey
Comments.
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DEP Form 12 Percolation Test•Page 1 of 1
Important:
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t5form3.doc•06/03
Commonwealth of Massachusetts
City/Town of NORTHAMPTON
Certificate of Compliance
Form 3
DEP has provided this form for use by local Boards of Health. Other forms maybe used, but the
information must be substantially the same as that provided here. Before using this form, check with
the local Board of Health to determine the form they use.
This is to Certify that the following work on an On-Site Sewage Disposal System
® Construction of a new system
❑ Repair or replacement of an existing system
❑ Repair or replacement of an existing system component
Has been done in accordance with Title 5 and the Disposal System Construction Permit(DSCP):
DSCP Number DSCP Date
Theodore Towne _
Facility Owner
9 Cardinal Way
Street Address or Lot ii
Northampton MA
City/Town State
Designer Information:
Ja s A Gracia
mx / V P
agnature
Installer Information:
Mark Lavalley
Name
James A. Gracia, PE
Name of Company
2- -Z7-Dr
01060
Zip Code
Date
Lavalley&Sons Trucking
Name of Company
Z- 27- o8
Date
Use of this syste • is conditioned on compliance with the provisions set forth below:
The issuance of this cert icate shall not be construed as a guarantee that the system will function as
d-s es. / it _ L�o• � �7y�.�"`�—�`
Appro
Sig ',s /adds', IJ/0 U
Sig'ature / Date
Certificate of Compliance•Page 1 of 1
JAMES A. GRACIA, PE
99 Glendale Street, Easthampton, MA 01027
AVM 1VNIWIVD
WESTHAMPTON ROAD - RTE 66
THEODORE TOWNE
9 CARDINAL WAY
NORTHAMPTON, MA
SEPTIC SYSTEM "AS BUILT"
SCALE: 1" = 30 2/27/08
Pe::Test
Date'/
Cash: Check it:
Property Owner,r9/tr
New Construction
R Ot
lowly g Sei
PAY TO THE
ORDER OF
1423 TRUST
JII ELWZOREK OR WILLIAMTWZOREK, SR x s
F R P Ot CATE-4�- 14_p
—F DN,MA 01027
$ 3_-
DOLLARS
Eranknorth 371)
4; 4401-kS
-_tMassachusetts
1 4 1 3 328588't' 7.42-3-
nedayr-uo4aMSnoJ "°N
s1. — A;m old
riatmo dpadord
GK 297 $ luowV tyl'r.alto
p w adlas g
op nag
EXPLANATION AMOUNTTh
EVELYN M. OR THEODORE D. TOWNE _ 5370932/18
2T AMTON, ROAD
LOUPVI L R 01027 EAST 2583
J
� CHECK II
t PAY 0 _ � DOLLARS CHECK LJ
1/i DATE TO THE PDERI DESCRIPTION CHECK NO /e
ESEASTHAMPTON
SAVINGS BANK "Z vm"'l%— - _
11•00 2 513 30 I: 2 L L8 ?OR 3 51: L 200E10 586e
�+GD?-t$
COMMONWEALTH OI MASSACHUSETTS
Board of Health, A.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
PA
C AL 26-43
Permission is hereby granted to;to; C/onstruct(�Repair( ) Upgrade( ) Abandon( )an individual sewage disposal system
at 9 X ) 1.0.-, 'Z)- Zi oW as described in the application for
Disposal System Construction Permit No.anon-i3 dated /2/45/01.
Provided: Construction shall be completed within-thfee years of the date of this ermitt.5. All localnditions must be met.
Form 1255 �.5, AM SO:mo Co Boston MA Date/ 07/07 Board of Health 'J; -v.-k �A•Sr C.H.O.
ROMP OF HFALIII