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101 Soil Eval Form 2003 y� ,,m... Ic t i "- 4 'eek,r g cl b Oxbow /V\0-r"`°- O1011/4 tta_ oo-d. w Construction ❑ Repair El FORM 11 - SOIL EVALUATOR FORM Page 1 of 3 Date: /7/9103 Commonwealth of Massachusetts ,&/ ,- Jar,tp�1.-, Massachusetts Soil Suitability Assessment for On-site Sewage Dispoaal formed By: W' Jae- Messed By: tt,'c-r— /Y/cc`�.— c ;ti.. . .... Date: /a%/AS °":"-^4. : nkgm, 0 K ac W %'&C)`--v-i,%.o, S8� AJ,-e „P>4ti,rnA en lir lice Review unshed Soil Survey Available: No ❑ Yes 0 ar Published singe Class Publication Scale Soil Limitations rficial Geologic Report Available: No to Yes ❑ Publication Scale ar Published ologic Material (Map Unit) ndform rod Insurance Rate Map: rove 500 year flood boundary No NI Yes ❑ ithin 500 year flood boundary No ❑Yes ithin 100 year flood boundary No ❑Yes etland Area: itional Wetland Inventory Map (map unit) 'elands Conservancy Program Map (map unit) Soil Map Unit urrent Water Resource Conditions(USGS): Month ange :Above Normal ❑Normal egiBelow Normal ❑ ther References Reviewed: a DEP APPROVED FOAM-12/07/95 ENVIRONMENTAL DESIGN INC. 101 OLD FERRY ROAD NORTHAMPTON, MA 01060 413-585-5020 FOR111 11 - SOIL EVALUATOR FORM Page 2 of 3 ation Address or Lot No. ()xbpw-nw rnA� )AVd`ilRMp7ia.._ On-site Review :p Hole Number I )02_ Date: /0421/o3 Time:/' o,-A-"', ation (identify on site plan) id Use t 0.W n.- Slope 1%) C - letation C -e,S3 Idform _ :ition on landscape (sketch on the back) Lances from: Open Water Body •) 70 feet Possible Wet Area v 70 feet Drinking Water Well>/00 feet Weather R-ai^- Surface Stones Drainage way>SO feet Property Line )'pl-t feet Other Depth from ',urface(Inches) © Iy 4& _c 50 - 120 o —14 14026 46 0 Soil Horizon 4 DEEP OBSERVATION HOLE LOG' Soil Texture (USDA) Soil Color (Munaell) /OYP-3/2 Arne/2 �.SYy/f S'L 16Y3/2 L ,1.syy/i tS �•s°ryl2 S% -;_s'yy1 • MINIMUM OF 2 HOLES F EQOIREO AT L■EHY PRUPDS Brent Material(geologic) 4 lepth to Groundwater: Standing Water in the Hole'. / O A1—r p Soil Mottling Other (Structure,Stones,G uls % Boulders. Consistency. S'r -brti A/0 A-4._ ry[r�TV 17 N f r��ye EUUISPUrraRfa ? 7 Err % %�O° DepfMoBedrock: �Y. Weeping from Pit Face: / )+—j! stimated Seasonal High Ground Water: 1 DEP APPROVED FORtt- 12/07/95 ENVIRONMENTAL DESIGN INC. 101 OLD FERRY ROAD NORTHAMPTON,MA 01060 413-585-5020 FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No. Cbacu'"aluINS C-1v,.'fj - o Determination for Seasonal High Water Table Method Used: U Depth observed standing in observation hole inches ❑ Depth weeping from side of observation hole inches ® Depth to soil mottles 9O inches ❑ Ground water adjustment feet Index Well Number _ Reading Date Index well level Adjustment factor Adjusted ground water level Depth of Naturally Occurring Pervious Material Does at least four feet of observed throughout the area tproposedcfor lthe pervious material system?in areas oil bsorption ye C If not, what is the depth of naturally occurring pervious material? Certification ,, I certify that on /VOv 9 / (date) I have passed the soil evaluator examination approved by the Departr4ent 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 ����r�r� ate ///y/10.3 PEP APPROVED FORM• 13107195 ENVIRONMENTAL DESIGN INC. 101 OLD FERRY ROAD NORTHAMPTON,MA 01060 413-585-5020 .ocation Address or Lot No FORM 12 - PERCOLATION TEST OK-t.oaa r z,t_t COMMONWEALTH OF MASSACHUSETTS ■_4-LLU,t,0-ems, Massachusetts Percolation Test' Date: Observation Hole # Depth of Perc Start Pre-soak End Pre-soak Time at 12" Time at 9" Time at 6" Time 19"-6") Rate Min./Inch ,0 / /103 7='• I 196 " /I: o3 Time:, i 7or-AJ nf� ' Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed Site Failed ❑ Performed By: Witnessed By: Comments: I r1&e-, Lour( t� DPP APPROVED PO 12/07/95 ENVIRONMENTAL DESIGN INC. 101 OLD FERRY ROAD NORTHAMPTON,MA 01060 413-585-5020 Soil Horizon Location Address or Lot# Date Engineer Land Use Vegetation... PosiUOnOnland* (Sketch 'be NORTHAMPTON BOARD of HEALTH- Title 5- Site Review Deep Hole#: Depth from Surtace(Inches) 1 Soil Horizon DEEP OBSERVATION HOLE LOG* 'MINIMUM OF TWO HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA Soil Texture (USDA) Sal Color (Munsell) Soil Mottling Parent Material(geologic) I /�_,{ cJ 9-c Depth to groundwate Standing later in the Hole Estimated Seasonal High Ground Water Other (Stru cture,Stones,Boulders,Consistency,go GI 41 90 ° Depth to Bed Weeping from Pit Face %o. — Deep Hole#: Depth from Surtace(Inches) DEEP OBSERVATION HOLE LOG* 'MINIMUM OF NVO HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Parent Material(geologic) 1 O -W[n q Depth to groundwater. Standing Depth to Bedrock / MirG Water in the Hole I Estimated Seasonal Nigh Ground Water �lU r�t� I.Wing from Pit Face ��N__y Other (Structure,Stones,Boulders,Consistency,%Gray �' � t v re}^...� Locatigna or Li ,Data,„„, PERCOLATION TEST(S) Time: Time: Observation Hole #1 Observation Hole #2 Depth of Perc / l `1 Depth of Perc SITE PASSED. Start Pre-soak O Start Pre-soak End Pre-soak / 1 P� End Pre-soak Time at 12" l Time at 12" Time at 9" -� Time at 9" Time at 6" / 3 Y Time at 6" Time (9"-6") S Time(9"-6") Rate Min./Inch I ' �,„D_W I s� Rate Min./Inch 0,d SITE PASSED \/ /\ SITE FAILED -. SITE PASSED. — --- SITE FAILED Performed by {/i1, 1 / Performed by Witnessed by I 4} r C Witnessed by Comments: 0,d