Lot 1 Soil Tests Massachusetts Department of Environmental Protection 383 ��s4t.,�ph �J ,No.}�q„ f{ r
Bureau of Resource Protection -Wastewater Permitting Program site Address w 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)
Deep Observation Hole: Date: 6-9-04 Time: 43o Weather: 50✓1A)1 90s'
1 Deep Hole Number I Location (Identify on Plan )
I
2. Land Use. I�awb% Surface Stones Nom,- Slope(%): I-2- Vegetation. Law)-,
(e.g.woodland, agricultural field,vacant la,etc
Landforrn TA ro..nq Position on landscape.
3. Distances from. Open Water Body lm+ ft. Drainage Way Ion+ ft. Possible Wet Area loo+ ft.
Property Line _ft. Drinking Water Well _ft. Other ft.
4. Parent Material- AL la}„h�(l Unsuitable Materials Present: Yes 0 No Q
If Yes: Disturbed Soil° Fill MaateriialD Impervious Layer(s)❑ Weathered/Fractured Rock ❑ Bedrock ❑
5 Groundwater Observed: Yes [1 No ❑ p
If Yes Depth Weeping from Pit 99 " Depth Standing Water in Hole IOU's Estimated Depth to High Groundwater. `K) '
Redoximorphic Features Coarse Fragments
Depth Soil Soil Matrix: (mottles) %by Volume
Depth Horizon/ Soil Texture Color-Moist Depth Color Percent Gravel Cobbles Soil Structure Soil Consistence
Layer (USDA) (Munsell) S Stones (Moist) Other
"-°" Flt —
' zo-3or A 5L IoYR31L
30 -4$' -S v.l LS z -Cy 5/(o 57 massive_ -Ri„10 Ls- Roc45
r
i „ Z Y /A-
4S (Z6` L J 5wizb2 .. oiR7I1 5/ • iDl ;9 �. a.�l
Additional Notes
DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 4
Massachusetts Department of Environmental Protection
393 Wes+ha,..p},„ Rd. r lo�+h=,^�p4b v.
L
Bureau of Resource Protection—Wastewater Permitting Program Sile Addressor MaplLot Number
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
A. Facility Information
Owner Name. V\ 2 orr lc Fn.,iI 1 ✓Q5+ HILL TOWN ENVIRONMENTAL CONSULTING
P. O. BOX 226
Street Address' P. 3o30/4 1039 Map/Lot
HATFIELD, MA 01066
E (413) 247— 5464
city. Eus+6.anph, . State. NIA Zip Code 0(027
B. Site Information
1. (Check one) New Construction ❑ Upgrade❑ Repair 2
2. Published Soil Survey available? Yes 13 No ❑ If yes'. 1981 I 15640 A 1B Anlosfo,.an
Year Published Publication Scale Soil Map Unit Soil Name
Soil limitations Welness Peres slowly
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 IJy No ❑-s Within the 100 year flood boundary? Yes ❑ No
Within the 500 year flood boundary? Yes ❑ No (2 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) ( 04 Range: Above Normal ❑ Normal Ln Below Normal ❑
7. Other references reviewed.
DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal•Page 1 of 4
LMassachusetts Department of Environmental Protection 383 Wes#i.arhplen R.I Na}L"..r+..
rai
Bureau of Resource Protection —Wastewater Permitting Program See Address or Map/Lot Number
Form 12 - Percolation Test
A. Facility Information
1. Facility Information
I, L
V ,zorL —ctn.;ly ✓05'I
Owner Name /
PO 1039 Map/Lot
Str ddre s
I irma ssap4anra MA e1O2.7
City State Zip Code
Percolation Test-
Date:
Observation Hole # P- l
Depth Of Perc 43"
Start Pre-soak 4, IS
End Pre-soak 4 :30
Time at 12" 4 : 30
Time at 9" 438
Time at 6" 4 ',4-7
Time (9"-6") 9 mt 1 rJ
Rate — Min/Inch 3 Merl/NJ
'Minimum of 1 Percolation test must be pedormed in both the primary area AND reserve area.
Site Passed Ni' Site Failed ❑
Performed By: V a,k I Inbw,lO5or
HILLTOWN ENVIRONMENTAL
Witnessed By E✓n \n QS+ V,gkLiei CONSULTING
P.O. BOX 226
Comments. NORTH HATFIELD, MA 01066
DEP Form 12 Percolation Test• Page 1 of 1
Massachusetts Department of Environmental Protection 383 V' es}1,,,„t ' RcI , N,r+h�,�,Pt-�
kBureau 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 hde A. B.
❑ Depth weeping from side of observation hole A. B.
,
Depth to soil redoximorphic features (mottles) A. 415B.
❑ 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 naturallyyoccurring pervious material exist in all areas observed throughout the area proposed for the
soil absorption system? Yes a No❑
1,
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— 9i '7-004
Sign um of Soil Evaluator D°1O n
Maria Thompson ADM.29..t99d.
Typed or Printed Name of Soil Evaluator 'Date of Soil Evaluator Exam
Firra-k Mo Lit N 0 r 4-/ACI WV 401" (61ye")+)
Nailed Board of Health Witness Board of Health
Note: This form must be submitted to the approving authority with Percolation Test Form 12
DEP Fonn 11 Soil Suitability Assessment for On-Site Sewage Disposal•Page 4 of 4