7 Perc Reports 2017 Page 1 of 3
ALAN E.WEISS,MS.,R.S.,L.S.P. .
Licensed Site Professional
Reetcr,d Sanitarizn -Welland Consults
Hydre^eeiceist
-Soil and Water Testing
President •21E Sire Investigations Date:
350 Old Enfield Rd. -Per oIaiior.Testsand 1 Itd��
Bcichcnown.MA 01007 -Sep'.ic DStcns
(413)323-5957&323.4916(FAX) -Tale 5 Irspec;ions
aewciss@c`ianer.net Commonwealth of Massachusetts
No/1k....,,i)/\--) Massachusetts
Soil Suitability Assessment for On-site Sewage Disposal
• Performed By: t�-%r�a.,. W-e--`f, c -S. s� ., 5 Date: 76010-
,
Witnessed By: ✓c.,v �..�7--�'r, e.,F( - .
L.=.......6..1“.1 J V
aw..1l.:c+a
Cr-•./41...z,/41...z, pe c�1 l/N 4-"..E
;y f -..1.
aC 111����<
Y'..) 'Wis . 7.--el. ?Z. c t r 5 �.u�sr lt�,i ai�.
(t s$ Ct-o,,f�-'F(`l 41
!d?.v cD lSt rLC.3Cr1 real' i L P '.0 5 . N;-r'-Kc •, k. l
Office Review c toss
7,biic Ned Soil Survey Available: No 0 ys
Year- ?ujt_s__d (,-.)...,.� F-Lb!icL'__On Scale G i 5. Sci' Map tin l i
D2i?age Cass E*` -�''{t Soi: Limi_tior!s
-?
S: sial Geologic Rexri.Avzzlabe. No' i l `:'es
\.'- ?_71li5:h....^_ C.,N-it- . ?m!ication Scat
Ceoic2ic Mme-21 (V-?:��ti) 5... . .. •
Flood I arse Rate Map:
;,hove 500 yeaflood bou:�da-y. No Yes
•
Within 500 yea; flood boundary No DIes Li
Within 100 year flood 'aoundzy No les u
Wetland Area:
National Wetland Inventor; Map (map unit)
Wetlands Conservancy Program Map{map unit)
Current Water Resource Conditions (USGS): Month -,
Range :Above Norval ❑Normal Rtick'v Normal -_
Other References Reviewed:
efter
M.
. ot:r APPao'v,1-oxm•12mt9s
Location Address or Loi No. -� 51-e t-ej s Ft, -i �b ,
On-site Review .
Deep Hole Number (A? - Date: .71.44 Tsrne: Z'e.o Weather Si• J. 5`1-.
Location (identify on site plan) ....-_,- . _
Land Use ,.. rz`_g' — Slope(%) Surface Stones• _-- ----
Veceta_ion 1 44 SS jw•ee9.0
Landiorrn ..'..1'tN :"' :..
Position on landscape (sketch on the back) . ... — —
Distances from:
Open Water Body /goof sem; Drainage way ZSR} sect
• Possible Wet Area t04 4 feet Properry Line feet
Drinkino Water Well 1O" I' ;e=t Other . .. _
i DEEP OBSERVATION HOLE 1 OG'
•• Dept:from Se@ Ho'=^ I .sem i e.-re soa co)c
Soil Gomer
5'.z={L^.�.ts) I {t A7 1 {'�"ssz) !. ? :r i -acre.st,�rs. .ares.c3.rSis. CY,-7.
'
i ( ) &a++r.
) o - � 2 " a tet iO. 3 —�'n�b�•
i' ) 3 =' a
. -i ' i
I . 1 F_ S. I e•sy3I3= 7�5-4'
Liii--- 12411 ,y '/, 7, �
S-4-t,,e 1..11-41,--',J
� l 1 a
s o - 1Z " 4 I 1 C- 160 , v-N 1
1
^4�.—Z3 o I Fr? ; Z'1'
ti ,
IN
2. j �S i
11
77—i76" C . in S, sr�) y(c
i
• l
- M tgimir • • 1 • !'121 A t I'?'• • •u• • •L • c./., •
Par ern Maleriai tgeologic) () A%>2 "- 1-2G k`f-
DeotrnoBedlocfc v.
Depth to Groundwater. Standing Weirs in thr Hole: l34) W e=;ng from Pa face: T
Emirnatr:d season!) High Ground Water.
Asia t
1
Du APPROVED FORM-22/07t9S
14.d (ckr sr1
COLD SPRING
Commonwealth of Massachusetts ENVIRONMENTAL. INC.
City/Town of 350 OLD ENFIELD RD.
• / BELCHERTOWN. MA 01007
Percolation Test /I
F., �.�UP( L (o �r��f.1 r,M��le( (vh
Form 12
57S-(5I51
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.
Important:When A. Site Information
filling out forms
on the computer, Q. C b�jMG(1
use only the tab _.
key to move your Owner Name ((f / r Q ! ��
cursor-do not 51.,01 S +(aI 4�� 1� GI,. Sd+-�(c cl '- `.
use the return Street Address or Lot
key.
Leeds s I e1/4).) Ata,,, ` 4 BI 0'7
City/Town State Zip Code
Contact Person(if different from Owner) Telephone Number
B. Test Results
7—(o "17 -2 - a4
Date P lime Date Time
Observation Hole# j
Depth of Perc — ----
ZkIO
Start Pre-Soak -
End Pre Soak 2 c 2 c.-
27��
Time at 12' -.
Time at 9,. Z'
Time at 6"
Z ` s-o
1 C
Time(9"-6") -- _
Rate(Min./Inch) ---- —/
•
• OF VAS,9' Test Passed. [[� Test Passed.
et f 'te S S C est Failed: ❑ Test Failed ❑
n t Test Perfo By: ) /
. 1 `6 /
71/4";:;•.e'' C SZ K 1 T
4 • Board of Health Witness
• `'4; Comments:
t5form12.doc•08/15 Perc Test•Page 1 of