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22 Soil & Perc Tests 2014 Commonwealth of Massachusetts `_. City/Town of NDaTUAKe opp 7,---,�'� Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) /Deep Observation Hole Number: /°/2. F/Z°I¢ /o:no /oudf Date Time Weather 1. Location Ground Elevation at Surface of Hole: Location (identify on plan): — - 2. Land Use Law v■ hooves. 7 (e.g.,woodland,agricultural field, vacant lot, eto) Surface Stones Slope(%) 6vc\S5 _ VOVNrt yNO VQ\y\Q Vegetation Candtorm Position on Landscape(attach sheet) 3. Distances from: Open Water Body zO°±_ Drainage Way — Possible Wet Area ) °O--I- feet feet feet EAs ern Property Line 40 — Drinking Water Well e -1" Other feet feet feet 4. Parent Material: /60bl°-kor Ti 11 Unsuitable Materials Present: ❑ Yes V] No If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock 5. Groundwater Observed: ❑ Yes Ly No If yes: Depth Weeping from Pit Depth Standing Water In Hole Estimated Depth to High Groundwater: > ( On inches elevation Redoximorphic Features Coarse Fragments De th in. Soil Horizon/Soil Matrix:Color- (mottles) % b Volume Soil P ( ) Layer Moist(Munsell) Soil Texture_ Y Soil (USDA) Structure Consistence Other Depth Color Percent Gravel Cobbles& (Moist) Stones U - (c) A IDyR3/2_ - SL crv.,.b ==se & - zo 3,,, 15111+ — L S Ars,ve ( abo .aofz Zo —I(6 C 5Y5/3 5 IO% o% ,r,,c5;Ve -11r,,,. Additional Notes: ' Commonwealth of Massachusetts ASSESSMENT PERFORMED BY HILLTOWN P.O.BOX ENVIRONMENTAL City/Town of Not-r{,{kplPTar�1 . FeoD au J CHESTERFIELD,MA 01012 L Form 11 _ Soil Suitability Assessment for On-Site Sewage Disposal (413)296-499 '\',,. - HILLTOWNENVIRONMENTAL @GMail.corn-r, A. Facility Information Owner Name zz old w',lsoes Read Street Address /� Map/Lot# \or+vsgv'f+a v. MA 010 Coo City State Zip Code B. Site Information 1. (Check one) n New Construction l.� Upgrade H Repair 2. Soil Survey Available? I` Yes I No If yes: USDA 5-011 Survey - 1931 x-i5 Source Soil Map Unit Glo c. uSACY F -Y� - (n�� leer __ — Soil Name Soil Limitations 3. Surficial Geological Report Available? ❑ Yes ❑ No If yes: Year Published/Source Publication Scale Map Unit Geologic/Parent Material Landform 4. Flood Rate Insurance Map 2/Yes Above the 500-year flood boundary? L✓ Yes iii No Within the 100-year flood boundary? 11 Yes i No Within the 500-year flood boundary? ❑ Yes ❑ No Within a velocity zone? ❑ Yes J No 5. Wetland Area: Wetlands Conservancy Program Map Map Unit Name 6. Current Water Resource Conditions (USGS): 10/ 14h Range: E. Above Normal ❑") /Normal ❑ Below Normal Month/Year 7. Other references reviewed. ASSESSMENT PERFORMED BY Commonwealth of Massachusetts HILLTO P. .BO OX 314 NTAL CHESTERFIELD.MA 01012 City/Town of NoRTHAMPI—Mt3 (413)296<499 toForm 11 - Soil Suitability Assessment for On-Site Sewage Disposal HIfLT°WNENVIRONMENTAL@GMailc°m h D. Determination of High Groundwater Elevation ■ 1. Method Used: ❑ Depth observed standing water in observation hole -- - inches inches inches inches 'Depth weeping from side of observation hole > II‘ > log " ,....( inches inches inches inches LJ Depth to soil redoximorphic features (mottles) 116 ? lob inches inches inches inches ❑ Groundwater adjustment (USGS methodology) Inches Inches 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 jraturally occur pervious material exist in all areas observed throughout the area proposed for the soil Z absorption system? Yes No b. If yes, at what depth was it observed? Upper boundary: Inches Lower boundary: inches/6 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 acc... with 310 CMR 15.100 through 15.107. Oct illr ,/- C/ Z/i Signature .f Soil Evaluator a Date Mark? I Aovnpscn SE 2436 April Z9, 1997 Typ¢d or Printed Lamy of coil Evaluator/License# Date oof Soil Evaluator Exam \ cf n.¢ W Sru � A.A.-14a v.-irk r. (Aced) 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 l ).e I i . . ,,� Commonwealth of Massachusetts ' City/Town of /V02-THAMPThK, Form 11 - Soil Suitability Assessment for On-site Sewage Disposal kw,,,./ C. On-Site Review (continued) Deep Observation Hole Number: Z /o /24/2,014 _ It .30 D rlly coo(sic'Y__ Date Time Weather 1. Location Ground Elevation at Surface of Hole: -. Location (identify on plan): 2. Land Use L-440 r% n 0>Me- 7 (e.g.,woodland,agricultural field,vacant lot,etc) Surface Stones Slope(%) tre55 _ _ _ _ _ jro..rad Pp orain 2 Vegetation Landform Position on Landscape(attach sheet) 3. Distances from: Open Water Body ZOO# Drainage Way Possible Wet Area 100 + feet feet feet bn54-er t-. Property Line 35 — Drinking Water Well ISo i Other feet feet feet 4. Parent Material: Ab iaf'oro—n if _ Unsuitable Materials Present: ❑ Yes ❑ No If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock El Bedrock Ly 5, Groundwater Observed: ❑ Yes 'eNo if yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: > I08 inches elevation _ Redoximorphic Features Coarse Fragments Depth (in.) Soil Horizon/Soil Matrix:Color. (mottles) Soil Texture % by Volume Soil Soil Consistence Other Layer Moist(Munsell) (USDA) Cobbles& Structure Moist Depth Color Percent Gravel Stones (Moist) - 0 -7 A I D yl2 3/Z - SL crvwtL Ioo52_ 7- Ll�I��� I3w 2.5VY 4/y- - LC5 wt45S'Ve -T,4IL._ voo45 2l -IVe% C _ 5 ) 5/3 ✓ /0 % 1o0/ ✓✓lAfstve -};rw.• Additional Notes: Commonwealth of Massachusetts _r City/Town of 1\10E-IHAP‘e-TDO .- Percolation Test Form 12 Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with the local Board of Health to determine the form they use. nortant: A. Site Information ten filling out (� ff ns on nputertuse qCr J0.✓)P. LevtZLC1 y the tab key OwnerName ---- -- _-- -- - nove your la Ol of V) ;Ise, Roac1 sar-do not Street Address or Lot# _.-_- /lam/ the return Ns-.'.L1 dt�110 7"'✓� / 1 4 01060 City/Town State Zip Code D Contact Person(if different from Owner) Telephone Number B. Test Results lo'z1/ 14 Date Time Date Time Observation Hole# - ��' I - -- -------- - ----- Depth of Perc ---- i - ---- Start Pre-Soak S5 -- End Pre-Soak - IC Time at 12" }0 . 16 Time I 0 ',ZS ime at 9" _ ___ 10 . 46 Time at 6" --- ----- — - Time (9"-6") if -- Rate (Min/Inch) 7 MJ0(It-1 Test Passed: © Test Passed: ❑ //,,�� �-,_�. Test Failed: ❑ Test Failed: ❑ j°ta rk �. J �orl Test Performed1By/ _ -- -Pao i2l WAS,Nk_-___ Witnessed By: Comments: nm12.doc•06/03 Perc Test Page 1 of 1 Depth of Natural's Occunnw Pcrvigus Matenal Does at least four fat of naturally occurring pervious rm venal exist in all areas observed throughout the area proposed for the soil absorption system? i/ �. t 1 Litt, If yes,what is the depth of naturally occurring pervious i taterial'? 7//G If not, what!sidle depth of naturally occurring pervious material?- 4/d_ 1 x Flo/Ps Deep Hole Number:kL c ''iC Date: /4 4/ Location(identify Land Use/Vegeta taf Lau es Landform: n / Ty Position of Landscape:$14-41/av/d /au.at) Distance from: Open Water Body >/& Possible Wet Area tt,fjn.0 Drinking Water Well 61/0'WA 6aa/J) On-Site Review Time.yAM Weath Slope(%): t J•'- Fet. Fete Fect Drainageway Property Line Other Swfa. c T.P.# 1-1 Feet Feet Feet DEEP OBSERVATION HOLE LOG Depth from Surface (Inches) Soil Horizon SvttPeatone (USDA) r,a/e>r lall:lelar (Mansell) Soil Mottling 7ZgiVRc Other(Structure,Stones,Houk Consistency, %Gravel) h G— " / A "7Oyr '/ "7' 1411 J -ci.) SL 10 f (> h• 'hrp5 r sS t ;.< fljP 'SW•'Pnas .•t . m C u 7 - 21 I-/0&- 1? RI C k.5 Alf LS s S r^ EA Parent Material(geologic) Depth to Groundwater: Standing Water in the Hole:/Jove Estimated Seasonal High Ground Water: >//6 " Depth to Bedrock: > Weeping from Pit Face4/p/to OARD OF HEALTH MEMBERS LEITMAN,M.D.,ACTING CHAIR SUZANNE SMITH,M.O. DONNA C.SALLOOM IECTOR OF PUBUC HEALTH 1I SCRIMGEOUR,MHEd,CHES, (413)587-1214 FAX(413)587-1221 CITY OF NORTHAMPTON MASSACHUSETTS 01060 OFFICE OF THE BOARD OF HEALTH 212 MAIN STREET NORTHAMPTON,MA 01060 I pa Site Suitabilitti for On-Site Sewage Disposal Lf/ �e ft Number 74(A 71,0,150•J -/T- Date: &[/ rmed by. p Egwpment Op razor. D Inspector aG� - 4N? I Fu✓,roan:•rvir t U,5., Site Ad ress New Construction O / cZb'..`•.. Client Name&A dress '{(/i��/att oC fD feyekz Office Review !bed Soil Survey Available: No 0 Yes tar Published Publication Scale So' Map Unit dal Geologic Report Available: No 0 Yes O far Published Publication Scale Geologic Material(Map Unit) Landform Insurance Rate Map: Dove 500 year fl boundary 0 Within 500 year flood boundary 0 Within 100 year flood boundary 0 ind Area Al 4 ational Wetland vetory Map(Map Unit) sit Water Resource Conditions(USGS): mge: Above Normal 0 References Reviewed: Drainage Class Soil Limitatious Month Normal Wetlands Conservacy Program Map(Map Unit) Below Normal O X5%/ai /Y O,UC per C. iorrraa/Cercotarav_nac.a ..o.,aa.- I-I (aid 1 Time !vitasurement Time Measurement k'" Begin Saturation !Saturation ituntion f m !O%/(JR r /t' /Z a•rtN,50h End Saturation 7th. /G;/On'^ _ 9"depth deptement cement /0?2 ,rt l� M r"1 6"depth 6" Measurement - \ cement ure ed Time 6" l'y6e r" / • • r i t mid:3'7 Elapsed Time 9"to 6. C' Rate . 3 . anon to < tutu.:- - ' m ofPerfolation Test Hole: 021 ne I rJ = -7 M',N Bottom o Percolation Test Hole: .,r/, tic ,t,j �?�/ _. # --ts. +e 'ontorSeaoaetHt� /,ri/ry 1e�thoh observed standing on observation hole> 'vPN m te 0 Depth weeping from tdeo p f observation hole_inches epth to soil mottles inches 4,YJ..e ?//6 0 ❑ Ground water adjustment inches. Well Number Reading Date Index well level