28 Title 5 Soil Evaluation 2013 Commonwealth of Massachusetts
g-- City/Town of
a Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
A. Facility Information
Richard 8 Camilla Humphreys
Owner Name
28 Morningside Drive #46
Street Address Map/Lot#
Florence MA 01062
City State Zip Code
B. Site Information
t. (Check one) ❑ New Construction ❑ Upgrade ® Repair
2. Soil Survey Available? ® Yes ❑ No If yes: Hampshire Co. MA. -Central part Cm8
Source Soil Map Unit
Charlton Huh seasonal watertable-slow permeability
Soil Name Soil Limitations
3. Surficial Geological Report Available?❑ Yes ❑ No If yes: Dec. 1981 1:15840
Year Published/Source Map Unit
Glacial Till
Geologic/Parent Material Landfomi
4. Flood Rate Insurance Map
Above the 500-year flood boundary? ® Yes ❑ No Within the 100-year flood boundary? ❑ Yes ® No
Within the 500-year flood boundary? ❑ Yes ® No Within a velocity zone? ❑ Yes ® No
5. Wetland Area: Wetlands Conservancy Program Map Map Unit Name
6. Current Water Resource Conditions(USGS): Monthnear Range: 111 Above Normal ® Normal ❑ Below Normal
7. Other references reviewed ------- - - ----- --
Florence-28 Momingside Drive-Soil Evaluation Form 11-Sept.24, Form 11 —Soil Suitability Assessment for On-Sae Sewage Disposal •Page 1 of 8
2013•rev.3/13
Commonwealth of Massachusetts
I:,-- City/Town of
'�' Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (minimum of two holes required at every proposed primary and reserved disposal area)
Deep Observation Hole Number: # 1  _Sept 12, 2013 10:00 AM Clear, cool
Date Time Weather
1. Location
Ground Elevation at Surface of Hole: 9763 - Location (identify on plan): North of garage -see plan
2. Land Use Side yard None 3% -5%
(e g.,woodland,agricultural field,vacant lot,etc.) Surface Stones Slope CA)
Lawn Glacial till _ _ North of garage _
Vegetation Landform Position on Landscape(attach sheet)
>100' 25" 100'
3. Distances from: Open Water Body feet Drainage Way feet Possible Wet Area feet
Property Line eet Drinking Water Well hetA Other feel
4. Parent Material: Sandy silt laom._grayish Unsuitable Materials Present: ® Yes ❑ No
If Yes: ❑ Disturbed Soil ® Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock
5. Groundwater Observed: ® Yes ❑ No If yes: 96" Depth
Depth Weeping from Pit Depth Standing Water in Hole
Estimated Depth to High Groundwater:
inche s 94.63
s elevation
Florence-28 Morningside Drive-Soil Evaluation Form 11-Sept.24, Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 2 of 8
2013•rev.3/13
Commonwealth of Massachusetts
131 City/Town of
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
_
C. On-Site Review (continued)
Deep Observation Hole Number: # 1 8#2
Redoximorphic Features Coarse Fragments
Soil Horizon/Soll Matrix:Color- (mottles) Soil Texture %by Volume Soil Soil
Depth in Layer Moist(Munsell) (USDA) Structure Consistence Other
Depth Color Percent Gravel Cobbles& (Moist)
Stones
0-24" Fill
24"-35" B 7.5YR 4/3 36" orange >5% Loamy N/A N/A fine friable It. brown
sand
35"- 108" C 7.5YR 4/1 sandy silt � 1% N/A crumbles firm in grayish
loam in hand place
Additional Notes:
Florence-28 Morningside Drive-Soil Evaluation Form 11-Sept.24, Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 8
2013•rev.3/13
Commonwealth of Massachusetts
fig . City/Town of
L hl 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 hole A. 108" B. 106"
inches inches
❑ Depth weeping from side of observation hole A. 96" _ _ B. 96"
inches inches
® Depth to soil redoximorphic features (mottles) A. 36" B. 36"
inches inches
❑ Groundwater adjustment(USGS methodology) A. 36" B. 36"
inches inches
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 naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil
absorption system?
El Yes 0 N
b. If yes, at what depth was it observed? Upper boundary: 36 Lower boundary: 106 -------
inches inches
Florence-28 Morningside Drive-Soil Evaluation Form 11-Sept.24, Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 6 of 8
2013•rev.3/13
Commonwealth of Massachusetts
•Fm AI City/Town of
H,:
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
F. Certification
I certify that I am currently approved by the Department of Environmental Protection pursuant to 310 CMR 15.017 to conduct soil
evaluations and that the above analysis has been performed by me consistent with the required training, expertise and experience
described in 310 CMR 15.017. I further certify that the results of my soil evaluation, as indicated in the attached Soil Evaluation Form,
are accurate and in accordance with 310 CMR 15.100 through 15.107.
—I— f 4, 2013 September 2
Signatur J Ev Date
Timothy . _ag_ s-SE1454 September 12, 2013
Typed or Printed Name of Soil Evaluator/License R Date of Sail Evaluator Exam
Daniel Wasiuk Northampton, Mk
Name of Board of Health Witness Board of Health
Note: In accordance with 310 CMR 15.018(2)this form must be submitted to the approving authority within 60 days of the date of field testing, and
to the designer and the property owner with Percolation Test Form 12.
Florence-28 Morningside Drive-Soil Evaluation Form 11-Sept.24, Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 7 of 8
2013•rev.3/13
K
Its
Depth of Naturally Occurme Pervious Material
Does at least four feet of naturally occurring pervious ruierial exist in all areas observed throughout the area proposed for the soil
absorption system?
If yes,what is the depth of naturally occurring pervious r uterial?
If not,what is the depth of naturally occurring pervious r raterial?
Deep Hole Number: Date:
Location(identify on site plan):
Land Use/Vegetation,Lawnigrass
Landform:
Position of Landscape
Distance from:
Open Water Body
Possible Wet Area
Drinking Water Well
On-Site Review
Tine.
Slope(%):
Fee.
Fec
Fett
Weather:Cool&Overcast
Surface Stones: none
Drainageway
Property Line
Other
T.P.# 1-1
Feet
Feet
Feet
DEEP OE,SERVATION HOLE LOG
Depth from
Surface
Soil
Horizon
Soft Texture
(USDA)
Soil Color
(Mansell)
Soil
Mottling
Other(Structure,Stones,Boulders,
Consistency, %Gravel)
•
1.'5/ ,Seto"
%6-y/1/
z�r 3/4/)
8
> o
GS
5411s://-
6WT 36 "
Clay
I
aei-35"
sc--
N
, ea
/yes
02,4
-
it
Parent Material(geologic)
P Dth tlt-Groundwater:3 Standing Water in the Hole:
Estimated Seasonal tgh Ground Water: >
@g ,
Depth to Bedrock >
Weeping from Pit Face:
BOARD OF HEALTH
MEMBERS
JAY FLEITMAN,M.D.,ACTING CHAIR
SUZANNE SMrsH,M.D.
DONNA C.SALLOOM
CITY OF NORTHAMPTON
MASSACHUSETTS 01060
DIRECTOR OF PUBLIC HEALTH OFFICE OF THE
XANTHI SCRIMGEOUR,MHEd,CHES, BOARD OF HEALTH
a /rJ 4 `� per°
Site Suitability for On-Site Sewage Disposal
(413)587-1214
FAX(413)587-1221
Nt)/t4�,/JPS
Project Number / /•
Performed by /. 'y/''M'/.
Health Inspector 9 Ay,,./
Site Address /
pl0 EDr,„.7rie- P�'
New Construction 0
Date: 90/T
Equipment rater:
212 MAIN STREET
NORTHAMPTON MA 01080
■
Client Name&Address
Office Review
Published Soil Survey Available: No 0
Year Published Publication Scale
Surfrcial Geologic Report Available: No 0
Year Published Publication Scale
Flood Insurance Rate Map:
Above 500 year flood boundary 0
Wetland Area:
National Wetland Invetory Map(Map Unit)
Current Water Resource Conditions(USGS):
Range: Above Normal ❑
Other References Reviewed:
Yes
Soil ap Unit Drainage Class Soil Limitations
Yes ICJ
Geologic Maknal(Map Unit) Landfonn
Within 500 year flood boundary 7
Month
Normal ❑
Within 100 year flood boundary 0
Wetlands Conservacy Program Map(Map Unit)
Below Normal ❑
rer Ca aa...a .a.. a........_
Pere I-1
Time
Me�aas$uurreemment
Time
Measurement
Begin Saturation
ti1h9 o
st 9i 4fr 2 i
Begin Saturation
End Saturation
• End
d Saturation
9"-4apd a.
Measurement
r0
/0 airrl
„
9"depth
Measurement
6"depth
Measurement
-/
? /d' 4q
5./ 1015(k
6"depth
Measurement -
_ . .
Elapsed Time
`013d e
9'
Elapsed Time
Percolation Rate <E minim ��Jp�/w pe�� rq, ervolanonttatc.
Bottom of Percolation Test Tole: (/ onom P rcohttionn
pert�__6 tt T ..
st Hole:
Method Used
Depth observed standing on observation hole> ❑ Depth weeping from side of observation hole _inches
❑ Depth to soil mottles_inches ❑ Ground water adjustment inches.
Index Well Number Reading Date
Index well level
wvra
J, � ,
/,� r Cri
Lt iI r�M\
Florence, MA-1 Markers, Length=0 feet 28 Mornings/de D ive- 042°21'06.9"N, 072°
Copyright(C)1996,EaMVlsions,Inc.