Lot 4 Soil Tests Lok4
�a a;r�� wajy N ,+�aw �+�
L Massachusetts Department of Environmental Protection Site Ptltlress or Map/Lot Number
Bureau of Resource Protection - Wastewater Permitting Program
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: Data 6 /9lop. Time: lltoa weather: 5 n,"Y Bos
1. Deep Hole Number 4 Pt Location (Identify on Plan ).
2. Land Use C■r"`el L°+ Surface Stones
Few Slope (%). z-3 Vegetation. V\site I P,nt
(e.g.woodland.agncueural fieS,vacant I .etc
Landform. (ra°4 Mor°`"°- Position on landscape.
3 Distances from: Open Water Body a°o=ft. Drainage Way lo +- ft. Possible Wet Area (DO ft.
Property Line _ft. Dnnking Water Well 150` ft. Other ft.
4 Parent Matenal.. k.,1;o„-(\I1 Unsuitable Materials Present Yes D No El/
If Yes'. Disturbed SoilD Fill Material0 Impervious Layer(s)0 Weathered/Fractured Rock 0 Bedrock 0
5. Groundwater Observed: Yes [21 No 0
If Yes. Depth Weeping from Pit 70" Depth Standing Water in Hole 96 n Estimated Depth to High Groundwater. Z 9 "
Redoximorphic Features Coarse Fragments
Soil Matrix: (mottles) %by Volume
Soil Soil Structure Soil Consistence
Depth Horizon/ Soil Texture Color-Mast Depth Color Percent Gravel Cobbles (Moist) Other
(In.) Layer (USDA) (Munselp 8 Stones
o-I>'' A
4.51- IOYR3/z cr,,..,ty loose
5 i-loss,ve �.,OLL
� ZO' $t„1 L I°YR tile
�.SYRS loyR 5/6 SbI la% Ip% w.o-sslve �y-raLle
20-Ilb Ci L5 /4 /V z.5v4/l
Additional Notes
DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 4
. Lo,- 4 1••
Massachusetts Department of Environmental Protection Curd,nai W°y Nor4l\a s+nPhr
Bureau of Resource Protection—Wastewater Permitting Program Site Address or MaplLot Number
\ Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
A. Facility Information
--r' HILL 701/2/N. ENVIRONMENTAL CONSULTING
Owner Name: w L Z=rdc f e4y I ✓usF P. O. BOX 226
NORTH HATFIELD, MA 01066
Street Address. F.O.Los 1039 //�� Map/Lot. (413) 247- 5464
CAy: Eus+'l.A F.n�h State: -4A Zip Code. 01027
B. Site Information
1. (Check one) New Construction Er Upgrade ❑ Repair ❑ /L,t�' B
2. Published Soil Survey available? Yes [/ No ❑ If yes:ar Punished Publication t 158Sale Soil Map Unit Al Name u^
Soil limitations Vle k. . pees do w17
3. Surficial Geological Report available? Yes ❑ No ❑ If yes'.
Yew Published Publication Scale Map Unit
Geologic Material Landfam
4 Flood Rate Insurance Map:
Above the 500 year flood boundary? Yes Ei No ❑/ Within the 100 year flood boundary? Yes ID No El
Within the 500 year flood boundary? Yes ❑ No E Within a Velocity Zone? Yes ❑ No ❑
•
5. Wetland Area: National Wetland Inventory Map Map UM Name
Wetlands Conservancy Program Map Name
Map Unit
6. Current Water Resource Condlhons(USGS) G Ou Range. Above Normal 11 L_y Normal Below Normal ❑
7 Other references reviewed
DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal•Page 1 of 4
Lo+ 4
a. i al Way, NoviLa- fo� ,
Massachusetts
of DResource epartment Protection of Environmental Protection n
—Wastewater Permitting Program
site Address or Map'Lot Number
(1 Bureau Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
D. Determination of High Groundwater Elevation s& 4
1 Method used: ❑ Depth observed standing water in observation hole A. B.
❑ Depth weeping from side of observation hole A. B.
Ly Depth to soil redoximorphic features (mottles) A. 2.9 " B. 2S"
❑ 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 naturalurring pervious material exist In all areas observed throughout the area proposed for the
soil absorption system? Yes No❑
b. If yes, at what depth was it observed? Upper boundary: 20 " Lower boundary:116
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.
*I- 9 2004
Sign ere of Soil Evaluator DS
Mark Thompson April 29. 1997
Typed or Printed Name of Soil Evaluator 'Date of Soil Evaluator Exam
E.r.es+ M • +lmie�. Nj0.+L , a ( A,ao4)
Name of Board of Health Witness Board of Health
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
Lo+ 4
CA.Ji al Way , Nor U� P+a
Massachusetts Department of Environmental Protection sae Aadressor MaWLONUmbx
Bureau of Resource Protection —Wastewater Permitting Program
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 X4/04 Time: II 15 Weather: 5....-y 803
1 Deep Hole Number 4B Location (Identify on Plan ).
2. Land Use. VPcc _ - Lo4 Surface Stones: Cr)+1 Slope(%): 2-3 Vegetation Pi.w vplc
(e g woodland,agricullural field,vacant Id,etc
Landfonn. Gvaa,J M.,-ms. Position on landscape.
3. Distances from: Open Water Body (o_+ ft. Drainage Way loo+ ft. Possible Wet Area 100 ft.
Property Line 30 ft. Drinking Water Well I so' ft. Other_ft.
4. Parent Material: 41.0r6‘•TI1. Unsuitable Materials Present: Yes ❑ No['
If Yes'. Disturbed Soil): FIR Maa_terriialD Impervious Layer(s)❑ Weathered/Fractured Rock ❑ Bedrock ❑
Lv
5. Groundwater Observed: Yes No ❑
If Yes. Depth Weeping from Pit 67" Depth Standing Water in Hole 94 Estimated Depth to High Groundwater. 28
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
el—G' A cSL- 10,03/7_ c...,L Ieese_
-7A" Bv, LS 1olk4/6 57 5/ n,a:s;VC cY;4104
5/* IoYRSib 50% o/ G/ �assiVe �n.6le
7D- II6 G LS 7.5YR /4 28" 2.5Y7if
.
I
Additional Notes
DEP Fonn 11 Soli Suitability Assessment for On-Site Sewage Disposal • Page 3 of 4
!o44
Massachusetts n
Carl Ina W py)N0<I�Qw
Atp+oV.
Bureau of Resource Department Protection of Environme-Wastewater Permitting Program Sde Address or MadLot Number
R Form 12 — Percolation Test
A. Facility Information
1. Facility Information —��
More k / ;/y //✓1+
Owner Name
P.o. BDX 1x32 Map/Lot
Street Addres
J+ 01 b,sd— df M A o 107-7
City State Zip Code
Percolation Test-
Date: c/7/04-
Observation Hole # 4A 4E3
Depth Of Perc 50" 41'
Start Pre-soak z 15 z
End Pre-soak 2 :3¢ z :3L
Time at 12" 2:34 Z .32-
Time at 9" z '.S7 2:31
Time at 6" z : 33 z 44
Time (9"-6") Zro MIN 7 MINI _
Rate - Min/Inch 9 r�w(IN 3 MIN/t�l
'Minimum of I Percolation test must be performed in both the primary area AND reserve area.
Site Passed Site Failed—f
Performed By. V A.k le tn0■"^Ps=N.
Witnessed By E, - tc4 Ao —'✓tie'
Comments
DEP Fonn 12 Percolation Test • Page 1 of 1