275 Septic Soil & Perc Test •
• FORM II -SOIL EVALUATOR FORM
Page 3 or3
� FORM 12-PERCOLATION FFST
Location Address or tot ate. Z ,g i7S Nenen.0 SP Location Address or Lot No. 07f /' i i7dta 5l
Determination for Seasonal High Water Table COMMONWEALTH OF MASSACHUSETTS
/tag T7-js.,,o P'D// r Massachusetts
-
Method Used;
El Depth observed standing in observation hole KreChes Percolation Testa
❑ Depth weeping from side of observation hole inches
•
❑ Depth to son mod y�,
es o—•incnez Date: 9 .. r Z Time:
❑ Ground water adjustment fee: Obser:anon Ho!e I
Index Well Number Reading Date Index well level
N
epth M Parc
Adjustment factor Adjusted ground waver lave: 7/ D SS II
Start Presoak
Den of Naturally Dc .ring Pervious MaTerial End Presoak w O'/J/r
/
Does at least four feet of naturally occurring pervious material exist in �t areas Tme at 11' C/7 G,1t
observed throughout the area proposed for the soil absorption system7 yi n
If not, what is the depth of naturally oCcurr n / Time at 9
9 p<wipuz ma:erlaP / 0
Time at 6- /`
r.rtif�rehon L✓oLO A:fT /, , t//F7LYL-
Time 19'.6'1
I certify that on)1pnE 9r4"ldate) I have passed the sort evaluator e ves nat on Rate Min./Inch
approved by the Department of Environmental Protection and that the above analysis
was performed by me consistent with the required training.expertise and e•perrence
described in 310 CMR 15.017.
Q • Minimum of 1 percolation test must be performed in both Na primary am AND
/ /// Date %-/L/ Q Z reserve are
Signature DOG
Site Passed Site Failed ❑
Performed By: 7?-_. C 4c{r'/j[._L(
witnessed BY: ,°crfl f /1^c(3X Cy4, et)
Comments:
lit?.rrvoru r viol i.e,oi ® DIP.e.+o.mrw.is.r,.r
•
•
. S
FORM II -SOIL EVALUATOR FORK FORM 11-SOD.EVALUATOR FORM
•
Page l of . Patel of
Location Address or Lm No. Z75 Al eerFrct ri 5r, wcine se.,,„rJ„i
No. Dater -1L—o7.-
Commonwealth of Massachusetts
Ort-site Review
ld27 kJinM/l rot— ; Massachusetts Deep Nola Rome., Cate: 9-/tw Z r: w..m., 9.i”'^j
,Soil Suitability Assessment for On-sire Sewage Disposal Loe.eon b,.mmtygt wane _ . _ -_
Land Use sieo.IXI Z Surf AC*smnea !U°
PMamrd By Pt b¢c+ ,Cri n •Lei Defeo 9„ye'_vZ Lwlorm CQ7taS
Vansa%d By: 4 at n'. `-eIZ.LA.i_&) . . Lancform a✓vw asy ..
Position on bna.cape(swrn on ma back)
a.: .a from:
•-• �.-_- �= (./ /� tie Open Water doar7(to tel oramw•war 7Sat feat
:—r• �y I—v T1••'1 I Possible Wet Area rat feet P,aa.nu Let. 7i'O f.
VRW OdOtruRlOn []Rebair pp - beaming Water Wea /op leer- Omer ten
Se�/-�JL/Uy1 7
Omit Rnkm P6tp a 0- ZCo -760 DEEP OBSERVATION HOLE LOG.
Published 5.:l Survey Mailable'No ❑ Yes i !!
Year Publifke! Publication Scale . . ...._ Soil Ma U
Map o.......
s«.�... wrn.. eek). sr
mDrainer mu. Sell Lamiwiws - s....u. .x 'vacs., wxs u..uea. n..v..iy . .x om•Mn.u u .
Sum i i Guleaic Repen Aabla te:No ❑ Yes O /�5 ®s'.�ad ' t I , IL
Year Pblled _ Publication Sale _ I `2 `II 44 (� �7j o/'et(, - uo La LL
timran54aW(Map Unlp /'` Z� i S Z S GILL
IyY
need Ingram Rue May ---. C. S/9 nD^Q I - S'R ND
Above SW ya flood boundary No QY LII{
Wien SO0 test good Wintry No ,l.YYW ❑
wieie 100>d flood baue4ry No IJYn [.1
Wow As: d4-Q�^D d ' 7bl rill 'gw� (': 1Ci// i//A
Noises!YmWd la' yMT gasp weal
- �p ��
w.Rwd.a....aar grogram Map twat Rio . G 170-fly/1 S �pw Sam'
on,Wake Rise,,Caoditiou(USSGSS• each ._r....nw„ sees,. ..
Mge:Abeea Hn.I Oita! L4&Iaw Normal 0 ___ .. k..use OLh'..+raSw y1Df
enner Law my.own wer 2.0"
•Gee Retie Re.k.ad: Non•.o...m x.. swr.s we.• ww .2 w.,ne..rer6 h
r® ( ® s ear oAr . n Pa.nmY,en .„a", t Z S
■
-- 7 FILL.
11 F
O � S i5 _ S- o 7ally 6s q
I'Location AddressprLot,*4l 075- Flu
Date ..
PERCOLATION TEST(S)
Time: I Time:
Observation Hole #1 Observation Hole #2
Depth of Perc Depth of Perc
Start Pre-soak \ ' Start Pre-soak
\` End Pre-soak End Pre-soak
GTime at 12" Time at 12"
Time at 9" Time at 9"
N / Time at 6" Time at 6"
Time (9"-6") Time(9"-6")
Rate Min./Inch Li'Ati° A Rate Min./Inch
'minimum of 1 percolation test must be performed in both the primary area AND reserve area
SITE SITE I SITE SITE
PASSED _ FAILED I PASSED _ FAILED
Performed by I Performed by
Witnessed by Witnessed by
Comments:
L—_
NORTHAMPTON BOARD of HEALTH— Title 5— Site Review
arias.
I ,phone#..:1
S!
Start Time;.
Endi/me:
r✓
Deep Hole#: -4
DEEP OBSERVATION HOLE LOG*
rd OF TVJO HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA
Depth from
Surface(Inches)
Soil Horizon
Soil Texture
(USDA)
Soil Color
(Munsell)
Soil Mottling
Other
(Structure,Stones.Boulders,Consistency.%Gravel)
3
r r /
I
V
Parent Material(geologic) I 0-1/1s A JJyi—( ---.
Depth to Bedrock 1 ottS1 c,
Depth'to groundwater..Standing Walerin the Hole
„� . I Weeping from Pit Face
Estimated Seasonal High Ground Water
% / 2) 7 -
Parent Material(geologic) I
Deep Hole#:
DEEP OBSERVATION HOLE LOG*
'MINIMUM OF TWO HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA
Depth from
Surface(Inches)
Soil Horizon
Soil Texture
(USDA)
Soil Color
(Munsell)
Soil Mottling
Other
(Structure.Stones, Boulders,Consistency,%Gravel)
41
i
I6 ,
1 1-/�
_._ 1.
X 1
l)
) I d(
Parent Material(geologic) I
Depth to Backed( I -
Depth to groundwater ttaand'ingMY rid ttiWide
I Weeping froth Pit Face I
Estimated Sea swtal rngl Grouts