Lot 3 Soil Tests L o+ 3 II'' II
Massachusetts Department of Environmental Protection Cardirul Vey NOY44 MfIu.
Bureau of Resource Protection -Wastewater Permitting Program Site Address or Map/Lot Number
\ Form 12 - Percolation Test
A. Facility Information
1, Facility Information
/Vil/Zo reL. FY , I,, /✓✓S-1--
0 e,l]NNa.11ee JJ( 03,
Map/Lot
Strr I Addr ss
7A}1- n.enp}pt" • {4 o l0 2_7
City State Zip Code
Percolation Test
Date: 5,,„
Observation Hole # 3-A 3B
Depth Of Perc 39" 39 '
Start Pre-soak 3',oL 3 o4
End Pre-soak 3: 11 3 %19
Time at12" 3•o-1 3:19
Time at 9" 3 27 312"1
Timeat6" 3 41 3,39
Time (9"-6") zo Mt,J 12 min/
Rate - Min/Inch _ 7 MIrJ)pJ 4 ntN�/3
•Minimum d 1 Percolation test must be pedormed in both the primary area AND reserve area.
ly/
Site Passed ,Si�tee Failed El J
Performed By: / "/a✓{� J Iho,1M/95I-o✓t
......esseef P..:
Comments:
DEP Form 12 Percolation Test• Page 1 of 1
Lo+ 3
Cw✓d,v�al
Massachusetts Department of Environmental Protection SaoAddressor 4 '0\ NNUmbx
Bureau of Resource Protection—Wastewater Permitting Program
1 Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal •
D. Determination of High Groundwater Elevation 3 A a B
1. Method used: ❑ Depth observed standing water in observation hole A. B.
❑—/Depth weeping from side of observation hole A. B.
L/ Depth to soil redoximorphic features (mottles) A. 34" B. 36"
❑ Groundwater adjustment(USGS methodology) A. _ B.
Reading Index Well Number 9 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 naturally,,occurring pervious material exist in all areas observed throughout the area proposed for the
soil absorption system? Yes 9' No❑
b. If yes, at what depth was it observed? Upper boundary: 1511 Lower boundary: i ZO "
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 perfumed by me consistent oath the regrruuiireddttraining, expertise and experience described in 310 CMR 15 017.
Sqo um of Soil Evaluator "" b
riI 29 1 7
used
Typed or Printed Name dSal Evaluator A16,4414011 {� / y I
EVVI'e31 / IQf✓IIGN (1-/eN I.G en+J
Name of Board ci Health Witness Board or Heahh ✓ /
Note: This form 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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I---
Massachusetts Department of Environmental Protection C°..d•vr.l W..y N°'+1 `"""°far,
• Bureau of Resource Protection -Wastewater Permitting Program Sae Address or MapiLot 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: 17 '. 5-0 Weather: 3-'-'‘'-'-i 700 •
1. Deep Hole Number 33 Location (Identify on Plan )'
1
2. Land Use: WIooA3 Surface Stones: few Slope(%): 1" 2 Vegetation. Slav t./cc
(e g woodland. agricultural field,vacant lot etc
Landfonn. ( -v• Moarttne, Position on landscape.
3. Distances from. Open Water Body Zoo ft. Drainage Wayro+ ft Possible Wet Area 100+ ft.
Property Line 30 ft. Drinking Water Well 60-1" ft. Other_ft.
4. Parent Material. 461,6„1";11 Unsuitable Materials Present Yes 21 No❑
If Yes: Disturbed SollD Fill Material❑ Impervious Layer(s)❑ Weathered/Fractured Rock ❑ Bedrock 0 S0.- c(e.r °C (06"
5, Groundwater Observed: Yes [3r No ❑
If Yes'. Depth Weeping from Pit 7+" Depth Standing Water in Hole 94 Estimated Depth to High Groundwater'.
36 "
Redoximorphic 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.) Layer (USDA) (Munsell) 8 Stones (Moist) Other
0_6" A -P3(_ Ioy)23/2 c„ex.t, I„oyr<
6-15 1`I 3,4 LS tbyt.s�b 5� vn+ssiv< �(;�:al,(sL
\S '� / 1oYR 6/i 36” IDvRS/ll tb% IU% S% v�ass;ve -4Cc∎t, 1¢.
L LS IoyR 7
R4-r
Additional Notes O R 1n5rit o A 1Bovl aer5
DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 4
IS+ 7
iMassachusetts Department of Environmental Protection CAvd:nak Way t NariNAmthi,,
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 two holes required at every proposed disposal area)
Deep Observation Hole: Date: 6-9-04 Time: 12:30 Weather Synny 9D°
1. Deep Hole Number 3A Location (Identify on Plan ).
2. Land Use: \J.Io0Js Surface Stones: RW Slope (%): z=3 Vegetation. Spruce-
(e.g.woodland.agrioukural field,vacant Id,etc
Landforrn. C-c Mara{n2 Position on landscape.
3 Distances from: Open Water Body Ix f ft. Drainage Way Imr ft. Possible Wet Area Im+ ft.
Property Line 30 ft. Drinking Water Well IS)4- ft. Other ft.
4. Parent Material: 4 1.:66-1-;1\ Unsuitable Materials Present: Yes❑ Nog"
If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s)❑ Weathered/Fractured Rock ❑ Bedrock ❑
5. Groundwater Observed: Yes d No ❑
If Yes: Depth Weeping from Pit 772 Depth Standing Water in Hole I04" Esbmated Depth to High Groundwater. 34
Redoximorphic 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.) Layer (USDA) (Munsell) &Stones (Moist) Other
0 -5 A csL IoYR3/2_ cru,L, lv.„
5-IL" 3w I-5 Io1R5/6 57. Wtnssive r ;o,LI
IOVR62 34-"
toy a.-in 1o', (0e0 NtrsSive . -1v;q‘,IC
Additional Notes
DEP Form 11 Sod Suitability Assessment for On-Site Sewage Disposal •Page 3 of 4
L of- 3
Massachusetts Department of Environmen P CoLali tat WWok/ Nor 411avry+ylo
Bureau of Resource Protection—Wastewater tal Permitting Progrotection ram Site Address or Map/Lot Number
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
A. Facility Information —�
Owner Name. W1 orck Foot y "Tr orb' HILLTOWN ENVIRONMENTAL CONSULTING
P. 0. BOX 226
Street Address. pa.�0g 103 9 Map/Lot: NORTH HATFIELD,MA 01066
(413)247- 5464
City. Ec45 -L. State. MA Zip Code 01027
B. Site Information
1. (Check one) New Construction [" Upgrade ❑ Repair ❑
2. Published Soil Survey available? Yes Er No ❑ If yes: 1981 1 : 1584o A.nB Arn 0s}0..n
Year Published Publication Scale Soil Map Unit Soil Name
Soil limitations WeFac£f; pen's 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 g No ❑ Within the 100 year flood boundary? Yes ❑ No El
Within the 500 year flood boundary? Yes ❑ No d 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) G 04 Range: Above Normal ❑ Normal [' Below Norma ❑
7 Other references reviewed
DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal•Page I of 4