710 Title 5 Application/Permits, Soil Survey 1997, Well Documents 1997 FORM 11 - SOIL EVALCAIUR FUR\I
Page 1 of 3
No. 4 I � \ Date: 6,-Pit-77
Commonwealth of\Rlassachusetts
AJokilikMplarJ , Massachusetts
Soil Suitability Assessment for On-siteSewage Disposal
Performed By: %7M S , I IUA1t.S Date: (o-i 2- 97
Witnessed By: PereR M RL& ) - /+erve.T rl ha-&J)
—on„m..,- LOT
-. No271f FARMS RoAA
New construction L!1 Repair ❑
aavess and
L.;b
Ro/3ERT 13 ATE 5
cos S - &F(i C-D-Q LN
NGY+ntRws( DEv W ✓1
5aY- 7 Y37
Office Review
Published Soil Survey Available: No ❑ Yes
Year Published 14 8 I... . . Publication Scale is 15840. Soil Map Unit cu C
Drainage Class 4./0-2- DRAiA1EQSoil Limitations MVP& Mjt S(-cp , 5EE)2/6E-
Surficial Geologic Report Available:No ❑ Yes ❑
Year Published - Publication Scale-
Geologic Material (Map Unit)
Landform- betiri">
Flood Insurance Rate Map:
Above 500 year flood boundary No Yes ❑�
Within 500 year flood boundary No LJYes ❑
Within 100.year flood boundary No SC/es ❑
Wetland Area: -
National Wetland Inventory Map (map unit)
Wetlands Conservancy Program Map (map unit)
Current Water Resource Conditions (USGS): Month
Range :Above Normal ❑Normal ❑Belc'v Normal ❑
Other References Reviewed:
DEP APPROVED FORM•12,07/95
Orr-sire Review
Deep Hole Number . /. Date: (�—/ 2-qq Time. Q.�00 /t,4} "Weather
Location )identify on site plan)
Land Use 6pc.AuD fc4t3I Slope l%) ° .5/t Surface Stones S°.LIE
Vegetation OAK.-._Cut-Jilt Prub — /3r P.c,N As;}_.
Landform TU Rt06-E
Position on landscape (sketch on the back)
Distances from: /
Open Water Body /° d feet Drainage way feet
Possible Wet Area± /50/ feet Property Line .jr WO 'feet
Drinking Water Well N/p feet Other r 3ocid {R..,,.t,) P4 p
•
DEEP OBSERVATION HOLE LOG
C CAR
rage
cooL
Depth horn Surlace
(Inches)
Son Houcon
Spa Testure
IU50A)
Sod Color
.IMunselll
Son Monhng
a - 9
r,- (20 ,
ay
C
L0gM
Sraa.ay
LOAM
LrLU y
•
5A. o
/u R. 3lµ
16Yrz 4/6
N/A
N/A
DIMv
ISvueture. Stones, aoNdere.
Conuuency. % Gravel'.
Rcc75 - 5ToLc S
�R A(3LE
FR-1 Pied*/
/ .e 5 id
(stave
Parent Material (geologic) GLACIAL TU., - Depth to Bedrock: µ/A
pawn to Groundwater: Standing Water in the Hole
N/A
WeePinq from Pit face: ATi
Estimated Seasonal H,gn Ground Water: A//A
•
On-site Review
Page 2
Deep Hole Numbers... Date: (o'!Z- 47 Time: Q •
Location (identify on site plan) ? 30 p Weather C�t:y1h/�0/
Lend Use LP LAwP Fr✓e51 Slope (%) ` .5 yh Surface Stones So,anb
Vegetation QAC._- 1.4-°}f,7L PI 1 - R'iat - AS y_
Landform %ILL QIOGE
Position on landscape (sketch on the back)
Distances from:
/
Open Water Body )/00 feet Drainage way feet
Possible Wet Arent /SO y feet Property Line?.(oO' feet
Drinking Water Well N/A feet Other Y 3o0 fp &M
imp
DEEP OBSERVATION HOLE LOG
Depth nom Swing I Sod Horizon
(Inched
5c1 ienwa Sol Color
IUSOAI ,IMuneee)
•
Sod Mottling-
Qtr
0
9r1- 3411
3 '- 12011
4
A SAwO/
1.60“44
t3 sa.,7y
t
Loion
Other
(Structure. Stones. Booklets.
Consauncy. % Grove
' s y 3/9 I N/,q I FUT — /to
siA
(0w4pr
1.0� y sy 4/ NJA
5 PIA,
SiL.T7
cc/0 AV0L
Parent Materiel (geologic' GLIALCIAL. '11 LL
Depth to Groundwater: Standing Water NIA
star in the Hole:
Depth to Bedrock
Weeping from Pit Face:
Estimated Seasonal High Ground Water:
FORM 11 - 5011. LVALCAl Olt FORM
Page 3 of 3
Location Address or Lot No. icrnii - NoR j) FItg.M5 RD — /yjo Aires;,, A
Determination for Seasonal High Water Table
Used:
❑ Depth observed standing in observation hole /4/ inches
❑ Depth weeping from sid
❑ Depth to soil mottles N f of observation hole A) H inches
A inches
❑ Ground water adjustment ._ feet
Index Well Number
Adjustment factor
Reading Date Index well level
Adjusted ground water level tfO•E O/35t-RVEP
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas
observed throughout the area proposed for the soil absorption-system? e.2
If not, what is the depth of naturally occurring pervious material?
Certification
a
certify that on !I RV' (date) I have passed the soil evaluator examination
approved by the Dep rtment 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.
Signature % Date 6-1µ--q17
DEP APPROVED FORM•12/07/95
FORM 12 - PERCOLATION TEST
COMMONWEALTH OF MASSACHUSETTS
ldoRTNAmp-70 /, Massachusetts
Percolation Test
Date: ,TUNE Ili 199 (7 Time: q t:"A"
Observation Hole #
-0 I
Depth of Perc
i1
rr
53
Start Pre-soak
End Pre-soak
9; is AA
q 3a-AlM1
Time at 12"
_I
-I � t SA-„vi
9� 3a ANA
Time at 9"
t P-ia ALAA
YI44- AM
Time at 6"
,1 : kAiki
(0: a1 Afrk
Time 19"-6")
12r pjP 5
19Wtiu.i)T65
Rate Min./Inch
4- MPS
S.6 L APL
Site Passed lJ Site Failed ❑
Performed By: T VI
lb
Witnessed By: (i)€a2 , C�L - j — %fegc 66-B11/4.7—
Comments:
',MN VW'uo18uiuum) pvoj 119DN
NOILIVI\po3 Ab1SJY03 UM67911/3 1431/ I JD?' 'i_taw
og/rr/b ,ooc=„7 :3rdos rugd £'ossa%' •
' ca»h C.0 15e. h JOQ J€0a9Nfo i1'° :a»ooSdbti. ,r
g..1.1147 "3 1d3DOB C
,4 pa2Jar 'ozpbssrid' 'ttidizerry h. /padoud •
, i \ •
1 an 00.E o
1 1 1 1 1 1
1 •
\ 3ai8 N
\ � ,a,oi C? \ t1. ° J o v rot.....
-. - - (\
NM /
\ _ 92'OBSh'b'iT7iM
G J
" - jH 185 ^ ) •
i 1 NolI6007 'Cn?lddy
ii a ,r Lmf
,II/4
.al C 1 .'.,.i
-- -.... rowdu PEICOCATION Tar
_ - .._,EOMMONW F
attranfAB"SACNWth-S . . ..
.MassKm.em
_ I/
lime as•
Mnmh ilWritel
- . . MOW urb ea.mn teiu must M i«ramed b both u..
_ a�.w...AND
Site Passed Ss.Fas 0
Perlanertf By:
Wmwsed Br
Comments:
pounces.Rae.wens
- _.e.. G
. . . _...
•
•
a4;th."
On-site Review
lion Address or Lot! 1 W 1-a-4 -C 1---7, 1 _]4-k 0
Hole Number [ 1 Date 1,2 1 1l— [(/ 1 1 Time 1 IHi NJ 1 Weather 1 C-ed-er___
Dcation(identify on site plan)
Land Use
L hi 71) �}-rA---- 1 Slope(%) 1 1 Surface stones 1
Vegetation
)---.„_.--A--./
Landform
1117
on on Landscape(sketch on the back) 1
Distances from:
en Water Body
%/To feel
()Uniting Water Wei
feet
Property Line
feet
ssible Wet Area
71 in; feet
Drainage Way
feet
Other
feel
DEEP OBSERVATION HOLE LOG'
Hole!: ) • DIVIUM OF TWO HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA
db tom
(Inoas)
Soi Malmn-
Sol Texture
NSDA)
Sot CCW
(A el)
Sol
Mdam
Other
(Shinn sbnes.Balers.Canssbny%Greg
1117
c `
"�;-.._7
lc L/h YI,
qi l
-- fr �. . v
I
l-
ent Marta loecb*
1
mo••' ....
I Depth b BNmok -t.J._�_.
Depth',groundwater.Stincrirg WaWb to Hde
na-rti- 1 Yam Ware 1 it
Es&mtd Seasonal Kgb Gras Water 1.
Hole
Pik mm
is(Indies)
(l
Sot
DEEP-OBSERVATION HOLE LOG'
MINIMUM 0 TWO HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA
SolTesbae"',. Sol 0*
(USDA) pAmo)
Soi
Mo16G
Ober
(Stodge,Sbnes.Badders.Cois'stency.%Gravel)
ertMabtt
Esfiiakad Seasonal/fish G.nS Water
HOWARD LABORATORIES, INC
750 North Pleasant Street
Amherst, MA 01002
MA Lab LiC# M-00851
WATER ANALYSIS REPORT
Lyzed For:Robert Bates
:ess: 68 Shelfield Lane
Florence, MA 01060
a phone: (413) 584 8439
Sample #4862
Sample Location:710 North Farms Road
Northampton, MA 01060
Sampled By: HENSHAW WELL DRILLING
Date Sampled: 10/14/97
Date Received:1O/14/97
Parameter
Results
Limits
Comments
Total Coliform
Bacteria
0
colonies/100mt
0 colony/tooml
OK
pH
7 .98
pH Units
6.5-8.5 pN Units
OK
Manganese
*
0.76
ma
0.05 mg/t
Hardness
94.0
mg/l
No Standard
<50 soft, >100 hard
Conductivity
0. 27
m5/cm
No Standard
Chloride
89. 2
ma
nowt
OK
Iron
*
2 .39
mg/t
0.3mg/t
Sodium
9.0
mg/t
28mg/L
OK
Nitrate
0. 1
ma
7Omg/t
OK
Nitrite
0.001
mg/t
l mg/t
OK
Color
*
78
Ptco Color Units
15 Pt Co Color Units
Turbidity
*
13 . 1
Nru
5 NTU
ommendations: Iron, manganese, color and turbidity are normally elevated
newly drilled wells. Use water for 30 days then retest the parameters that
e elevated levels.
s sample does meet acceptable standards of potability for public water
plies except for the parameters marked with an asterisk (*) , however,
re are no state or federal standards for individual use of well water.
lyst: JB
oked By: Jonathan S. Be, • ,A I6 1s.`
Laboratory Superviq or /4
Date: 10/14/97
' Department of Envirgnmental Management/Division of Water Resources
WELL COMPLETION REPORT
Board of Health -may
permit obtained: yes
WELL USE
Domestic[p Public❑ Industrial❑
Monitoring Other_
Method drilled
Date
Date tlrill ed_
CASING
Type l I
Length tt Dla(I.D)�_in.
Length into bedrock ---___
h.
Protective well seal:
Grout ❑ Others
STATIC WATER LEVEL(all wells)
Static water level below land surface_ ft
WELL TEST(production wells)
WELL DATA
Total well depth
Depth to bedrock `]r n,
Water-bearing rock/unconsolidated material:
Description rT _
Water-bearing zones:
1)From ICC .-
2) Fram TO—�� 9
3) From
mem
•(mi.�c mcmm N T E W of
(cite)
intersect w/Ch_j_141_114.
Drawdown L RO ry otter pumping hr. <-r;
How measured L ,. G min. at fir gpm
Recovery ft. alter hr.
min.
Driller
Firm
Address 7 (
CItYROwn��_
Supervising Driller Reg.#
BOARD OF HEALTH COPY
COMMONWEALTH OF MASSACHUSETTS
Board of Heath, HORN MA.
TION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
to Conaruct(4epair( 1 Upgrade( ) Abandon( 1 - O Complete System J Individual Components
Location NORM'tM FF,zfiyj go
Owner's Name goea r /O47 C1
Map/Parcel# ld....-P,Ab£ '- 2o3`}-/i3. i b — /IN—
Address GV SNEFf/ELQQ
Lot# r
7l�nit/E
TeIcphoneV4/) 5CgLj - 0731
Installer's Name avvi5i 6
Designer's Name T tiTidy m/i6
Address
/1NNts��t�,,,,RntS
Address 96 mo -funfG Ro— W'�
Telephone# _
Telephone# @-v ) 527 -524/
ype of Building
5/Moir rPfella y
welling-No.of Bedrooms 2
Lot Size f4'-1 ¢ft
Garbage grinder(.r
¢her-Type of Building No.of persons 6 Showers 6 r 1.i= ( )
!they Fixtures
esign Flow(min.required) -a 3Q gpd Calculated design Fl 41(i ow }/ Design Flow provided 6p13
'3 gp
Ian: Date AS -as- 9y
(tle PLAN ap 02(oos61O 5005 a aP/4 ewa& I/ /OSL. S�/51 E)Yl
J
esciption of Soil(sO L o- i "3 8 S Z. 10 L 4 C /LL• S
ail Evaluator Form Na Name of Soil Evaluator p Rlla asf Mk/&3 Date of Evaluation
Number of sheets /
Revision Date
ESCRIPTION OF REPAIRS OR ALTERATIONS
he undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
ether agrees to not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health.
!gncd
Date
tspccuons
iTOMMONWLAI.TA OF MASSACII[JSEITS
FEE
Bond of Health, MA.
CERTIFICATE OF COMPLIANCE
Iescription of Work: J Individual Component(s) J Complete System
lie undersigned hereby ccrde) that the Sewage Disposal System: Constructed ( ),Repaired ( ),Upgraded O.Abandoned ( )
as been iusmlled in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
pplication No _ dared Approved Design Flow (gpd)
nstallcr
tesignen Inspector: Date:
he issuance of this permit shall not be construed as a guarantee that the system will function as designed.
C J
1 t/.v�7 FEE
� _
COMMONWEALTH OI'F MASSACIIUSLTTS
y��
Board of Health, /i/1,y t f 'etsYa )jr"ALA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
u35' 5
3 N •0 ej
G.
,il) in 0 L
0
? ( � 0
. os: o
�tb�Tl is hereby me ro; Construct( Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system
M. �(
O y O W(}r o -as de c)ibed in the application for In
saal stem Construction Permit No. �—f %,dated /I/)o/_
�
5rwitkof Construction shall be completed within three scars of the date of this welmt All local condm9m»st be met.
d as
mlzss rt€a sass aysri�i co.Bolton ton Date /'%/ /�oard of Health �