21 Perc 2016 BOARD OF
HEALTH CITY OF NORTHAMPTON t°"-'"""�,.1
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MASSACHUSETTS 01060 SITS
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SUZANNE SMITH,M.D.
DONNA C.BALLOON + !i;
DIRECTOR OF PUBLIC HEALTH
OFFICE OF THE P'-
XANTHISCRIMGEOUR,MHEd,CHES, BOARD OF HEALTH
212 MAIN STREET
(413)587-1214 NORTHAMPTON,MA 01060
FAX(413)587-1221
if� 1
Site Suitability for On-Site Sewage Disposal D4i/
Project Number. (A 1 Date: 6/jir //(p /!
Performed b}t� /v' Equipm t OpefytSr: , /p Titifer
Health e Inspector: //N, /
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s7v
Site Address Client Name&Address
a i 1 #z ISP sz -C.,=(,()
/,t /p,,, (��// Vwllet Spec" otos$
6o10 5.2° - Am f/ m 54)onstmctiJnY Repair, �c--iTCeA 4
Office Revie C1-- c �?CC, !(.a
Published Soil Survey Available: No O Yes �
O
Year Published Publication Scale So p Unit ' Orainage Clas) Soil Limitations
Surficial Geologic Report Available: No 0 Yes 0
Year Published Publication Scale Geologic Material(Map Unit) Landform
Flood Insurance Rate Map:
Above 500 year flood boundary 0 Within 500 year flood boundary 0 Within 100 year flood boundary 0
Wetland Area:
National Wetland Invetory Map(Map Unit) Wetlands Conservacy Program Map (Map Unit)
Current Water Resource Conditions(USGS): Month
Range: Above Normal ❑ Normal 0 Below Normal 0
Other References Reviewed:
Percolation Test Results
Pere 1-1 Time Measurement Time Measurement
Begin Saturation 99�,1 //,,.,� Begin Saturation
End Saturation ✓t / tly�/'"% End Saturation
9"lepth. / --. - ,r depth._
Measurement Measurement
6"depth 6"depth
Measurement - - Measurement --- - ----
Elapsed Time Elapsed Time
9"to 6" 9"to 6"
-
Percolation Rate <2 nun.rm -- - --——" Pr<LoTaTion lOfi:
Bottom of Percolation nest Hole: Bottom of Percolation Test Hole:
___"' _-- - --' er " ----- Determination farScasonattdieh-Wates Tel&
Method Used
y( Depth observed standing on observation hole> 0 Depth weeping from side of observation hole inches
0 Depth to soil mottles_inches 0 Ground water adjustment inches.
Index Well Number Reading Date Index well level
Depth of Naturally Occur-mg Pervious Material
Does at least four feet of naturally occurring pervious me.tenal exist in all areas observed throughout the area proposed for the soil
absorption system?
If yes, what is the depth of naturally occurring pervious material? .
If not,what is the depth of naturally occurring pervious material?
T.P.X 1-1
'/ On-,Site Review
Deep Hole Number/? Date: 4.A /Mime: yWeather:£evi-&(vercast//,s,t...rrc
Location(identify on st
Land UseNegetati . wo/gra t Slope(%): O% Surface Stones: none
Landform:
Position of Landscape:
Distance from:
Open Water Body 7t' t9 C-74-F„, Drainageway Feet
Possible Wet Area /f Feel Property Line Feet
Drinking Water Well r Feet Other Feet
DEEP OBSERVATION HOLE LOG
Depth from. Soil Soil Texture Soil Color Soil Other(Structure,Stones,Boulders,
Surface Horizon (USDA) (Munsell) Mottling Consistency, %Gravel)
f1 (Inchh/es) /
ll j/
g-a / g
tfr
7,5 r3/ e ef-17/••
aN' Un Gt
50 -00 Ci_ yH/
Parent Material(geologic) 674644 j )6J sfc .✓ftt-''N�
Demi,to-Groundwater: handing ater in the Hole: Depth to Bedrock: >
Estimated Seasonal High Ground Water: > Weeping from Pit Face:/00tiC
atu