38 Site Suitability 2016 Depth of Ns'n,-aflc U
Does at least four feet ofna.arali
absorption system? I, z 5 -
Ifyes.what is the depth of rarer h--
If not. what is the depth cloaca ai]
Deep Hole Nurnbm:
Location (identify on she plant.
J.and U-^'Vega•-bnn(l.av,m/L,eus
Jandform:j pc-fe et,‘-(
E .
Position of Landscape:
Distance from:
Open Water Body
Possible Wet Area
Drthkino Water Well i
e Asti 11 It aeobse
Llr,'ItIc; Per rIEICC]nr! (0 el
p.n-0w ,arrnal? -
On-Site Review
Dale: l c%t-th‘ Time:
Slrpe(°b)'. ( `)/e
Fes'. (co'4
cost
Weather Coal S Dv ast
Drainageuay
Property Line
Other
T.P.
Sun n/. brre
Surface Stones: "o%
Lhr
FcctCec
It
Feet zed+
Feet
DEEP OB ERVATSON HOLE LOG
Depth from I Soil
Surface Horizon
Soil Texture I Soil Color
(USDA) (Munsell)
S
P51
I
Soil Other(Structure, Stones,Boulder:
MottIine, I Consistency, % Gravel)
Parent Material (geoloer) h Hit t.a a k
Depth to-Groundwater. Standing Water in the Hole
Estimated Seasonal High Ground Water: es rec,.,
'✓`°.s4 Depth to Bedrock: > (C {
Weeping from Pit Face: l� e,1 c
BOARD OF HEALTH
• MEMBERS
J4-Y FLEITMAN,M.D.,ACTING CHAIR
SUZANNE SMITH,M.D-
DONNA C.SALLOOM
DIRECTOR OF PUBLIC HEALTH
:ANTHI SCRIMGEOUR, MHEd,CHES,
(413)587-1214
FAX(413)567-1221
CITY OF NORTHAMPTON
MASSACHUSETTS 01060
OFFICE OF THE
BOARD OF HEALTH
Site Suitability for On-Site Sewage Disposal
Data /0/Z M720/di
Equipment Operator: Q U ( y/dp C ty K
?roject Number:
'erformed by:A(c.ul Isle,5
4=alth Inspector: Ckr, x(3,5 "O
Site Addres
fl L C'_1��Ctile/(tr r 4 to %kr1C
-35S A):(tt, 110-
f ore e, AAA New Construction
212'1(AIN STREET
NORTHAMPTON,MA 01060
Client Name& Address
7)) /Uort-1, ftano,s Ro.«b
R
Office Review
'ublished Soil Survey Available: No 3 Yes O
Year Published Publication Scale Soil Map Unit Drainage Class Soil Limitations
lurticial Geologic Report Available: No O Yes 9
Year Published Publication Scale Geologic Material(Map Unit) Landform
lood Insurance Rare Map:
Above 500 year flood boundary 0 Within 500 year flood boundary 9 Within 100 year flood boundary ❑
Vetland Area:
National Wetland Invetory Map (Map Unit) Wetlands Conservacy Program Map(Map Unit)
foment Water Resource Conditions(USGS): Month
Range: Above Normal 3 Normal 9
)ther References Reviewed:
Below Normal O
Percolation Lest eeCau.La
Time
Measurement
Time
Measurement
erc 1-I
°
Begin Saturation
\
/
S
1
:�n
,y
"
End Satrration
9"depth.
Measurement
6"dept
Measurement
Elapsed Time
9" to 6"
Saturation
nd Saturation
nd
•
leassure
i
( �
men
suret
"depth
{/
l Gi I
leasurement
lapsed Time
"
rvt�
2. S
to 6"
o...,.,,. inn
ate
/
2
ercolation Rate <2 nun. ma Zy
onom of Percolation Test dole: Fii5
Bottom of Percolation Test Role, i
-- - ---- Deter'minationforSessonal$i_h«•rtei Tebh
ACt-
lethod Used
Depth observed stnndin on observation hole>NC Ile 0 Depth Gr undnwater acts side
ntobsers inch ole inches
I Depth to soil mottle inches
dex Well Number Reading Date Index well level
ALAN E.WEISS,M.S.,I2_S,L.S.P.
Licensed Sim Professional
Registered Sanitarian
Hydrngeolocisi -Weiland Consults
President •Soil and Wain Testing
nfield Rd. -21E She lnvesugations
nn.ldRd. •Percolation Tests and
5957&323-49I6 FAX title-Septic Designs
TitleSLry2uons
azweisc @chaner.na
Commonwealth of Massachusetts
IViassachusetts
Soil Suitabili Assessment or On-site Sewa
Performed By: t\\c? Wt.`s ? S.) Si, SE
Witnessed By: !:`,5 o{/fet --P-o
tci\AC
L mAaeve>
Lot I
new Construction 0 Repair �✓j
Oilice Review
Soil Survey Available:
Year Published
Drainage Class ..
Sut vial Geologic Reoont Av_Iab
C-eo!CCIC MP=e al (Map Unit)
Flood _?mince Rae Map:
y
dot!! es
Publication Scale
Soil Limitations
n
e: No ?77 Yes
TV
Publication Scale
Above 500 yea; flood boundary No Dyes
Within 500 year flood boilndary No 114
Within 100 year flood boundary No
s
Wetland Area:
National Wetland inventory Map (map unit)
Wetlands Conservancy Program Map (map unit)
Currem Water Resource Conditions(USGS): Month
Range :Above Nom:al LNormal _Bekw Normal
Other References Reviewed:
DEP APPROVED FORM. 1 no7/95
Date:
Page 1 of 3
�e Disposal
Date: IONIi6
GtIi . tau,
3S5 tit ._- r-. S e2i
rtlia.L.eitho, AA.
Map d er._. v- :
On-site Review
Hole Number.._/_ z Date:._ /")./ Time:.L'$_�.... Weather ‘,.5..2.."2----_—
ation (identify on site plan)
Id Use Slope (%) 1... Surface Stones .._✓°—}__--..-
;station 5265 .,..,...__,., _.
Idform eFT-4
:ition on landscape (sketch on the back) ___.____...__
tances from:
Lg.
Open Water Body . feet Drainageway.— .°. feet
Possible Wet Area .._(°° f feet Property Line _zc + feet
Drinking Water Well -t qp�... feet Other
DEEP OBSERVATION HOLE LOG
>spte from SuHace
(Inches)
Soil Horizon
Soil Texture
(USDA)
Soil Color
(Munsell
Soil Movdino
Den
lSuuowre,Stones.boulders,
Co/ins:onry bGrevelf
c_ ae4
-. Sc.-Sy,
O —S°
t
1�
A
A
C
-Gs c
S
-CS
-
y
vrc-1/4-
o y/
w.s)spy
0;t4
rr
1 - l�
/ �u l U
4
6
{-5(_
r
Fs
/6 ytcV3
167,
z ys/Y
9b„
— En4Lots
- p s .J%.
cs�A ,
(r �t'�V��/�C ent Material (goo ogle) !„L = 5 Depth to Bedrock:
.oth to Groundwater: Standing Water in the Hole• Ato t Weeping from Pit Face: -- dfr
Estimated Seasonal High Ground Water: IC=
/vb t._
U ..'
?d Used'
Depth observed standing in observation hole ______ inches
❑,Depth weeping from side of observation hole—.-.– inches
d,is Depth to soil mottles i inches
❑ Ground water adjustment feet
c Well Number ______
Reading Date —.—.- Index well level
stment factor ._.__. Adjusted ground water level
Percolation Test
Date: f//6
Time:
)bservation Hole #
)epth of Pero 35.
>tart Pre-soak
/; 3S-
End Pre-soak
rime at 12" _
l; S�
Time at 9"
5
Time at 6"
•
S Y
Time (9"-6")
e– Z
Rate Min./Inch
4-- Z
1:30
:e Suitability Assessment: Site Passed lte Failed
Additional Testing Needed:
irformed By afritt Wyss SC, if 5
itnessed By:
Gin S�i _ > . 3r5 ap
omments:
Certification Numbe
DH
Location Address or Lot No. y1 S (2y
Determination or Seasonal Hi_h Water Table
Method Used:
nn Depth observed standing in observaion hale._...... . inches
pth weeping from siderof observation hole... .. inches
Depth to soil mottles. inches
I Ground water adjustment __
feet •
Index Weil Number
Readtho Date _.._
1ndEx well level
Adjustment factor ._. ._
Adjured around water :eve) .. . __.. .-
Desa. of "laterally Occurring Pervious Lateral
Does at least four feet of naturally OLCUF pn pervious material exist in aU areas
observed ;a :
Ea proposed for Me se:: absorption syszem?::. NCC
If not, what is the depth of natura3v ocOur:`;ng pervious material?
—err:fir-atlas
I certify that on ✓i1.{ °° c (date)by the Depa _c ) E have passed the and atth a examination
s
-mththerequiredtriiin exp&�eaboexa;i nce
was performed 3by 10 f consistent with the requires training:expertise and experience
described in 3i0 CMR 75.C77
Signature �
Date (017416
COLD SPRING
ENVIRONMENTAL, INC.
$50 OLD ENFIELD RD.
DELCHERTOWN. MA 01007
171 7 AYP AOl'p mpJ$•12/07)95