254 Lot 2 Perc 2019 J0
Commonwealth of Massachusetts
City/Town of Northampton
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
A. Facility Information
Pine Grove Golf Course Toward Club house second Site 10.8.2019 -
Owner Name .
254 Old Wilson Road Site 2 Lot 1 See Map.
Street Address Map/Lot#
Northampton MA 01060
City State - Zip Code - - —
B. Site Information
1. (Check one) ® New Construction ❑ Upgrade ® Repair
2. Soil Survey Available? ® Yes ❑ No If yes: Cal web USDA 311 c
Source Soil Map Unit
Woodbridge Fine Sandy Loam moderatey well Drained
Soil Name Soil Limitations
3. Surliicial Geological Report Available? Yes ❑ NO If yes: USGS current gis
Year Published/Source Publication Scale Map Unit
Lodgement Till, Kame Terrace Moraines, Drumlins Terraces
Geologic/Parent Material Landform
4. Flood Rate Insurance Map
Above the 500-year flood boundary? ® Yes ❑ No Within the 100-year flood boundary? ❑ Yes ® No
Within the 500-year flood boundary? ❑ Yes ® No Within a velocity zone? ❑ Yes ® No
5. Wetland Area: Wetlands Conservancy Program Map Map Unit Name
6. Current Water Resource Conditions(USGS): Month/Year Range: ®Above Normal ❑ Normal ❑ Below Normal
7. Other references reviewed:
Pine Grave Lot 1 soil evaluation by club house and Old Wilson, Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 1 of 8
10.08.2019.doc•rev.3/13
Commonwealth of Massachusetts
City/Town of Northampton
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (minimum of two holes required at every proposed primary and reserved disposal area)
Deep Observation Hole Number: 1 &2 10.08.2019 1600 -
Date Time Weather
1. Location
- _ -Ground Elevation at Surface of Hole: - shown Location (identifyonplan):
2. Land Use Golf/.field Edge of woodland no 2
(e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones Slope(%)
Grasses terrace shown
Vegetation Landform Position on Landscape(attach sheet)
3. Distances from: Open Water Body feet 100'+ Drainage Way e0t+ Possible Wet Area e0t+
Property Line 10'+ Drinking Water Well 50'+ Other
feet feet feet
4. Parent Material: Kame Terrace Unsuitable Materials Present:
❑ Yes ® No
If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock
5. Groundwater Observed: ❑ Yes ® No If yes: Depth Weeping from Pit Depth Standing Water in Hole
Estimated Depth to High Groundwater: 50
inches elevation
r
Pine Grave Lot 1 soil evaluation by club house and Old Wilson, Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 2 of 8
10.08.2019.doc•rev.3/13
Commonwealth of Massachusetts
UluCity/Town of Northampton
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (continued)
Deep Observation.Hole Number: 1 and 2(Lot 1, Site 2
Redoximorphic Features Coarse Fragments
Soil Horizon)Soil Matrix:Color- (mottles) Soil Texture %by Volume Soil Soil
Depth(in.) Consistence Other
Layer Moist(Munsell) (USDA) Cobbles& Structure
-- - -- - --- Depth Color--- Percent Gravel_ Stones - (Moist)- - -
0-60" A 10 YR 3.2 FILL Mix Friable
60-112" C1 2.5 y 5.3 112" 7.5 yr 5.8 10% CS 10 s grain Granular
0-56" A 10 yr3.2 FSL Friable
56-112" C1 2.5 y 5.3 112" 7.5 yr 5.8 10% LS 10 s grain Granular
Additional Notes:
Pine Grave Lot 1 soil evaluation by club house and Old Wilson, Form 11-Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 8
10.08.2019.doc•rev.3/13
Commonwealth of Massachusetts
City/Town of Northampton
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
D. Determination of High Groundwater Elevation
1. Method Used: ,
® Depth observed standing water in observation hole A. B.
inches inches
-- - - Depth weeping from side of observation hole _ A. -- - B. - -
inches -inches
® Depth to soil redoximorphic features (mottles) A. 112" B. 112"
inches inches
❑ Groundwater adjustment(USGS methodology) A. B.
inches inches
2.
Index Well Number Reading Date Index Well Level
Adjustment Factor Adjusted Groundwater Level
E. Depth of Pervious Material
1. Depth of Naturally Occurring Pervious Material
a. Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil
absorption system?
® Yes ❑ No
"
b. If yes, at what depth was it observed? Upper boundary: inches Lower boundary: inches
Pine Grave Lot 1 soil evaluation by club house and Old Wilson, Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 6 of 8
10.08.2019.doc•rev.3/13
Commonwealth of Massachusetts
City/Town of Northampton
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal -
F. Certification
I certify that I am currently approved by the Department of Environmental Protection pursuant to 310 CMR 15.017 to conduct soil
` evaluations and that the above analysishas been performed by me consistent with the required training, expertise and experience
described in 310 CMR 15.017. I further certify that the results of my soil evaluation, as indicated in the attached Soil Evaluation Form,
are accurate and in accordance with 310 CMR 15.100 through 15.107.
- - - - -10/8/2019 - - - - --- - --
Signature of Soil Evaluator - Date
ALAN WEISS, RS#933, SE#2568, Cold Spring Env. Inc. 6/1995
Typed or Printed Name of Soil Evaluator/License# Date of Soil Evaluator Exam
B, Eichstaed Northampton
Name of Board of Health Witness Board of Health
Note: in accordance with 310 CMR 15.018(2)this form must be submitted to the approving authority within 60 day's of the date of field testing,and
to the designer and the property owner with Percolation Test Form 12.
c
Pine Grave Lot 1 soil evaluation by club house and Old Wilson, Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 7 of 8
10.08.2019.doc•rev.3/13
< Commonwealth.of Massachusetts
City/Town of Northampton
H Percolation Test
Form 12
1M
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
filling out forms A. Site Information
r
on the computer,
use only the tab Pine Grove Golf Course: Location 2 on 10.8.2019
key to move your Owner Name
cursor-do not 254 Old Wilson Road
use the return Street Address or Lot#
key.
Northampton MA 01060
r� City/Town State Zip Code
C/O Jeff Squires , BDG.
Contact Person(if different from Owner) Telephone Number
B. Test Results
10.08.2019 1700 10.08.2019 1700
Date Time Date Time
Observation Hole# P1 P2
Depth of Perc
78" 69"
Start Pre-Soak 1706 1513
End Pre-Soak 1709 1515
Time at 12" Can't 'Can't
Time at 9" Hold Hold
Time at 6" Soak Soak
Time(9"-6")
<2 <2
Rate(Min:/Inch)
<2 <2
Test Passed: ® Test Passed:
Test Failed: ❑ Test Failed: ❑
A WEISS, RS , SE, Cold Spring Environmental Consultants, Inc.
Test Performed By:
B Eichstaed, BOH
Witnessed By:
Comments:
t5form 1 2.doc-06/03 Perc Test•Page 1 of 1
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