41 Site Review 2003 Location Address-Or Lot#
Date
PERCOLATION TEST(S)
Time:
Time:
Observation Hole
#1
Observation Hole
#2
Depth of Perc
3 "
Depth of Perc
Start Pre-soak
) ;12
Start Pre-soak
End Pre-soak
End Pre-soak
Time at 12"
). 11 ; 7
Time at 12"
Time at 9"
)- ' -, (//
/ e . cr L
Time at 9"
Time at 6"
;
Time at 6"
Time (9"-6")
Time(9"-6")
Rate Min./Inch ....„._"„
)AA /
"I
Rate Min./Inch
F *minimum nf 1 nn-n •.n., —f— ...6-___._ .
SITE
PASSED
SITE
FAILED
pnmary area AND reserve area
Performed by
Witnessed by
SITE
PASSED
( Performed by
Witnessed by
SITE
FAILED
Comments:
it
L
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NORTHAMPTON BOARD of HEALTH— Title 5— Site Review
n
Lot#
er
d Uses.:+.
Nation"
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yl � .,ti
Owner's
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Address
-
Owner
e.'!'n.J—�
weather„
I:.Phone#
I Surface tones
ater Body
Wet Area
feet
DT¢
rDrinkIng Water ell".
feet
Pro
n
feet
feet
Drainage Way.ri•:
feet
feet
le#:
DEEP OBSERVATION HOLE LOG*
MINIMUM OF TWO HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA
im
tries)
Soil Horizon
Soil Texture
(USDA)
Soil Color
(Munsell)
Soil Mottling
Other
(Structure,Stones,Boulders,Consistency,%Gavel)
J
". JIJ
LA
-At 3
(
-) /
J.,.#4_,TV 44,12224
erial(geologic)
I Depth to Bedrock I j✓a
roundwater. Standing Water in the Hole
/up/� ' I Weeping from Pit Face I Vi
paled Seasonal High Ground Water
%y1
Ile#:
I DEEP OBSERVATION HOLE LOG*
'MINIMUM OF TWO HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA
om
fiches)
Soil Horizon
Soil Texture
(USDA)
Soil Color
(Munsell)
Soil Mottling
Other
(Structure,Stones,Boulders,Consistency.%Gravel)
derial(geologic) I
Depth b Bedrock I
groundwater, Standing Water in the Hole
I Weeping from Pit Face
Hated Seasonal High Ground Water