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415 Perc Application & Soil Suitability Report 2020City of Northampton Board of Health 212 Main Street Northampton, MA 01060 413-587-1214 Fee Collected: Pere Test Date: APPLICATION MUST BE SUBMITTED 10 BUSINESS DAYS PRIOR TO THE SCHEDULING OF A PERC TEST Application for Percolation ("Pere") Test Date of Home Owner Name: City/Town/State/Zip Code: U 3 MV,)-- 0 10 CP 'Z PLEASE MAKE ALL CHECKS PAYABLE TO THE CITY OF NORTHAMPTON CHECK LIST EfNew Construction ❑ Repair/Upgrade ***Number of Lots to be Pere Tested New Construction only- Give Lot Numbers*** ❑ Dig Safe Sign -Off: Gas/Electrical ❑ Trench Permit/Info Sign Off from DPW (413) 587-1570 ror Board of Health Use Only CITY of NORTHAMPTON PUBLIC HEALTH DEPARTMENT Public Health Director Merridith O'Leary Municipal Building — 212 Main Street — Northampton, MA 01060 Phone (413)587-1215 — Fax (413)587-1221 hitp:llwww, i?orthamptonma.gov/245/Health v tv `// Pere Test/Soil Evaluation Form Property Address: 5 //,..,,¢ ;}fie , P y ti �ti t' eQ7 t�r`4Yirh�s i k � �1?�s;$g�7hmiphr y�i�, ��z° Owners Name: `,JL5 l— 1'�stW "�'iL l��� — x cr �ri r e � Date: 4 i 1'xir Performed by: r 11 VERA x e y: �x c., (y d ua Rw ae tt a Witnessed b `,�I �1� �"' a tR� Judi No. of Bedrooms'` -Tl .u�. t Y Garbage Grinder? �R e"s"I�lo a°`�` Fee Paid? !/ Yes U60 ni nrnnar y.a"n irinrafin of deep PereHole# 2�'� tl 1.� 3 4 '. Gf Elev: tR�Yt t{� t �, r �xc4 t ev Elev: Elev: ssI Start pre-soak End pre-soak ,.xg,.-,- yime,�@ 12pp Y Z;ft �d x1 �° 7 J i s icyt,] AM, � Rv xyy s k, �1 pied 44, Yt`G n �ti'.. X311 Ri��� uAs dime @ YRR11yF �gxiy ) �k��.��l�ixy"�6Q.if.t �r rRSY J S .iJtit\*T�'')V p ry rlA;Y 9)e{i^:tl Fr, ix3F'yti ,V� 1� )?R��u'I "'tet i" y yYti:?{4e"R� m..'! �Shv� Time @ 6" �f on" ' // �L'o-" (,.e 3 7? 7 ell, r"`6F .Y "� .,. Elapsed timd �A, " Y. I 1a., _f2_ _1 1114j_;1_ _L -_ �..p lm t _1 _4! 9"-6" Rate (min/in) t� Deep Hole Observation Log Depth From Surface (inches) Soil Horizon Soil Texture Soil Color Mottling (inches) ® lP /,k y� /—C3D I� ZIP erre /dvc , Cl r' s� xt L - C-/ 16 rP cr /rz�� Commonwealth of Massachusetts Cityrrown of Northampton Form 11 - Soil Suitability Assessment for On -Site Sewage Disposal Site Address: 415 North Farms Road, Northampton 01062 Homestead Inc. #: 850 DEP has provided this form for use by on-site professionals and local Boards of Health. Other forms may be used, but the information must be substantially the same as provided here. Before using this form, check with your local Board of Health to determine the form they use. A. Facility Information 1. Facility Information Jeff Mackler OwnerName 415 North Farms Road 07-014-001 Street Address Map/Lot Northamiton MA 01062 B. Site Information 1. (Check one) New Construction ® Upgrade F1 Repair 2. Published Soil Survey available? X Yes ® No If yes: 1980 15840 9 - Year Year Published Publication Scale Soil Map Unit AA C Agawam fine sandy loam Severe limitations: poor filter Soil Name Soil limitations Comment 3. Superficial Geological Report available? X Yes _No If yes: 190080 190080 Year Published Publication Scale Map Unit glacial outwash kame terrace Geologic Material Landform 4. Flood Rate Insurance Map: Above the 500 year flood boundary? X Yes _No Within the 100 year flood boundary? _Yes X No Within the 500 year flood boundary? _ Yes X No Within a Velocity Zone? 5. Wetland Area: National Wetland Inventory Map Wetlands Conservancy Program Map 6. Current Water Resource Conditions (USGS) 7. Other references reviewed: Map Unit Name _ Yes X No Map Unit Name Range: Above Normal —Normal _ Month/Year Below Normal 2 DEP Form 11 Soil Suitability Assessment for On -Site Sewage Disposal • Page 1 of 6 Commonwealth of Massachusetts City/Town of Northampton Form 11 - Soil Suitability Assessment for On -Site Sewage Disposal Site Address: 415 North Farms Road Northampton 01062 Homestead Inc. #: 850 C. On -Site Review (minimum of two holes required at every proposed primary and reserved disposal area) 1 Deep Observation Hole Numbet 1 10/6/20 Perc date 9:00 ari Time cloudy, light rain Weather 2 Land Use: Mowingt (e.g. woodland, agricultural field, vacant lot, etc.) _4 Surface Stones Slope (%) Vegetation ,grasses Landform kame terrace Latitude: 3 Longitude: Distances from: Open Water Body >200 Drainage Way >150 Position on landscape (attach sketch) Possible Wet Area 100+ Property Line 3. Drinking Water Well >200 Other: feet feet feet 4 Parent Material: Glacial outwash If Yes: Disturbed Soil Fill Material Unsuitable Impervious Layer(s) Materials Present: 1Q Weathered/Fractured Roc4 Bedrock 5 Groundwater Observed: N0 If Yes: Depth Weeping from Pit inches Depth Standing Water in Hole inches Estimated De th to Hi h Groundwater: 3-2 inches _ Depth (In.) Soil Horizon / Laye it Matrix Color -Moist Munsell Redoximorphic Features mottles Soil Texture (USDA) Coarse Fraqments Soil Structure Soil Consistency Moist Other Gravel Cobbles & Stones Depth Color Percent fine sandy 0 - 12 AP_1OYR 4/3 loam 0% 0% none 12-- 29 Bw 10YR 6/4 sand loam 0% 0% bedded I friable 10YR 7/1 29- 49C 1 10YR 7/3 32 10YR 5/6 >5% loam sand 2% 2% bedded friable 49 - 1 Z _C� 10YR loamy sdand 2% 2% bedded friable DEP Form 11 Soil Suitability Assessment for On -Site Sewage Disposal - Page 2 of 6 { i ommonwealth of Massachusetts Cityrrown of Northampton Form 11 - Soil Suitability Assessment for On -Site Sewage Disposal 811e Address: 415 North Farms Road Northampton 01062 Homestead Inc. #: 850 C. On -Site Review (minimum of two holes required at every proposed primary and reserved disposal area) 1 Deep Observation Hole Number 2 10/6/20 9:30art iC oudy Perc date Time Weather 2 Land Use: mowing _NQ (e.g. woodland, agricultural field, vacant lot, etc.) Surface Stones Slope (%) Vegetation .grasses Landform kame terrace Latitude: Longitude: Position on landscape (attach sketch) 3 Distances from: Open Water Body >200 Drainage Way >150 Possible Wet Area 100+ Property Line 25 Drinking Water Well >200 Other: feet feet feet 4 Parent Material: Glacial out !i Unsuitable Materials Present: M If Yes: Disturbed Soil Fill Material Impervious Layer(s) Weathered/Fractured Rock Bedrock 5 Groundwater Observed: No If Yes: Depth Weeping from Pit inches Depth Standing Water in Hole inches Estimated De th to Hi h Groundwater: 32 inches Depth Soil Soil Matrix Redoximorphic Features Soil Texture Coarse Fragments Soil Soil Other (In.) Horizon Color -Moist mottles (USDA) Cobbles Structure Consistency Depth Color Percent / Laye Munsell Gravel & Stones Moist fine sandy 0 - 12 Ap 10YR 4/3 loam 0% 0% none 12- 29 B 1OYR 6/4 sandy loam 0% 0% bedded friable 10YR 7/1 29- 124 C 10YR 7/3 32 10YR 5/6 >5% loamy sand 2% 2% bedded friable DEP Form 71 Soil Suitability Assessment for On -Site Sewage Disposal • Page 3 of 6 Commonwealth of Massachusetts Cityl-rown of Northampton Form 11 - Soil Suitability Assessment for On -Site Sewage Disposal Site Address: 415 North Farms Road Northampton 01062 Homestead Inc. #: 850 C. On -Site Review (minimum of two holes required at every proposed primary and reserved disposal area) 1 Deep Observation Hole Number 3 10/6/20 10:00 art Cloudy Perc date Time Weather 2 Land Use: Mowing No 3 Vo (e.g. woodland, agricultural field, vacant lot, etc.) Surface Stones Slope (%) Vegetation grasses Landform kame terrace Latitude: Longitude: Position on landscape (attach sketch) 3 Distances from: Open Water Body >200 Drainage Way >150 Possible Wet Area 100+ Property Line 31 Drinking Water Well >200 Other: feet feet feet 4 Parent Material: Glacial outwash Unsuitable Materials Present: NO If Yes: Disturbed Soil Fill Material Impervious Layer(s) Weathered/Fractured Rob Bedrock 5 Groundwater Observed: If Yes: Depth Weeping from Pit inches Depth Standing Water in Hole inches Estimated De th to Hi h Groundwater: 31 inches Depth Soil Soil Matrix Redoximorphic Features Soil Texture Coarse Fra ments Soil Soil Other (In.) Horizon Color -Moist mottles (USDA) Cobbles Structure Consistency / Layer Munsell Depth Color Percent Gravel & Stones Moist fine sandy 0 - 12 AP 10YR 4/3 loam 0% 0% none 12 - Z� , , B W 10YR 6/4 - sandy loam 0% 0% bedded friable - t OYR 7/1 29't 12,E G„_ 10YR 7/3 30 10YR 5/6 >5% loamy sand 2% 2% bedded friable DEP Form 11 Soil Suitability Assessment for On -Site Sewage Disposal -Page 4 of 6 Oommonweaith of Massachusetts City/Town of Northampton Form 11 - Soil Suitability Assessment for On -Site Sewage Disposal >a Sufte Address: 415 North Farms Road Northampton 01062 Homestead Inc. #: 850 C. On -Site Review (minimum of two holes required at every proposed primary and reserved disposal area) 1 Deep Observation Hole Number 4 2 Land Use: Mowin (e.g. woodland, agricultural field, vacant lot, etc.) Vegetation grasses Latitude: Longitude: 3 Distances from: Open Water Body >z 00 Property Line _U feet 4 Parent Material: Glacial outwash If Yes: Disturbed Soil Fill Material 5 Groundwater Observed: NO If Yes: Depth Weeping from Pit 10/6/20 10.30 AM Cloudy Perc date Time Weather Ng Surface Stones Slope (%) Landform kame terrace Position on landscape (attach sketch) Drainage Way >150 Possible Wet Area 100+ Drinking Water Well >200 Other: feet feet Unsuitable Materials Present: NO Impervious Layer(s) Weathered/Fractured Rock Bedrock inches Depth Standing Water in Hole inches Depth (In.) Estimated Soil Horizon De th to Hi Soil Matrix Color -Moist h Groundwater: Redoximorphic Features mottles j21L Mouns Soil Texture (USDA) Coarse Fragments Soil Structure Soil Consistency Other Cobbles De th Color Percent / La er Munsell Gravel & Stones Moist fine sandy 0 - 12 A 10YR 4/3 loam 0% 0% none 12- 29 BW 10YR 6/4 sand loam 0% 0% bedded friable 10YR 7/1 29- 44 C 1 10YR 7/3 30 10YR 5/6 >5% loamy sand 2% 2% bedded friable 44- 135 C2 1OYR 7/2 loamy sand 2% 2% bedded friable DEP Form 11 Soil Suitability Assessment for On -Site Sewage Disposal - Page 5 of 6 Commonwealth of Massachusetts Cityrrown of Northampton Form 11 - Soil Suitability Assessment for On -Site Sewage Disposal Site Address: 435 North Farms Road Northampton 01062 Homestead Inc. #: 850 D. Determination of High Groundwater Elevation 1. Method used: 2. Index Well Number Adjustment Factor Depth observed standing water in observation hole A. inches B. _inches Depth weeping from side of observation hole X Depth to soil redoximorphic features (mottles) Groundwater adjustment (USGS methodology) Reading Date E. Depth of Pervious Material 1. Depth of Naturally Occurring Pervious Material Adjusted Groundwater Level A._inches B. inches A. _29_ inches B. _729 inches A. inches B. ®inches Index Well Level _ 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 b. If yes, at what depth was it observed? Upper boundary: a12 Min. inches Lower boundary: _109 Max. inches 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 analysis has been performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. 1 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. r«g.10/6/20 Signa�of Soil Evaluator Date ThnmaC c ieue SE 1368 June 1995 Typed or Printed Name of Soil EvaluatodLicense Numbs Date of Soil Evaluator Exam Dennis Lacourse City of 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 days of the date of field testing, and to the designer and the property owner with Percolation Test Form 12. DEP Form 11 Soil Suitability Assessment for On -Site Sewage Disposal •Page 6 of 6 B. Test Results 10/6/2.0 10/6/20 Date Date 9:00 AM 10:00 AM Time Time /Observation Hole # 1 2 Depth of Perc Start Pre-soak Pre-soak at 12' at 9" at 6" (9" - 6") Test Performed By: Witnessed By: Comments: 43 inches 51 inches 9:58 AM 10:39 AM 10:16 AM 10:54 AM I 10:13 AM 10:54 AM 10:17 AM 11:05 AM Test Passed:KA Test Failed: El Test Passed: X Test Failed: D Dennis Lacourse Northampton t5fonn12.doco 06/03 Perc Test 0 Page 1 of 1 Commonwealth of Massachusetts City/Town of Northampton - — Percolation Test a 4 Form 12 Important: when filling Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage out forms on the Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, computer, use only the but the information must be substantially the same as that provided here. Before using this form, tab key to move your check with the local Board of Health to determine the form they use. cursor - do not use the return key. A. Site Information Owner Name: Jeff Mackler Street Address or Lot#: 415 North Farms Road 07-014-001 City/Town: Northampton State: D% Zip Code: 01062 Contact person (if different from owner) Telephone Numbers1 —222— 102 Homestead Inc.#:850 B. Test Results 10/6/2.0 10/6/20 Date Date 9:00 AM 10:00 AM Time Time /Observation Hole # 1 2 Depth of Perc Start Pre-soak Pre-soak at 12' at 9" at 6" (9" - 6") Test Performed By: Witnessed By: Comments: 43 inches 51 inches 9:58 AM 10:39 AM 10:16 AM 10:54 AM I 10:13 AM 10:54 AM 10:17 AM 11:05 AM Test Passed:KA Test Failed: El Test Passed: X Test Failed: D Dennis Lacourse Northampton t5fonn12.doco 06/03 Perc Test 0 Page 1 of 1