SITE CHARACTERISATION FORM

Name & Address of Applicant: ______
______
______
Site Location & Townland: ______
Telephone No:______Fax No: ______E-Mail: ______
No. of Double Bedrooms: ______No. of Single Bedrooms: ______
Proposed Capacity of Septic Tank: ______No. of Chambers: ______
(LITRES IF APPLICABLE)

Proposed Water Supply:Public Mains Private Well Group Well
/Borehole /Borehole

GROUNDWATER PROTECTION SCHEME

Soil Type: Bedrock Type:
Subsoil Type: Aquifer Type:
Vulnerability Class: Groundwater Protection Response:

Layout Drawing

A Layout Drawing (Scale 1:500) showing measurement to trial hole location and percolation test hole locations, wells, direction of groundwater flow, proposed house, water courses, significant sites, roads and other features. The North Point is to be shown.

The drawing is also to show houses in the vicinity as appropriate (including associated wells, waste-water treatment systems and percolation areas).

Note: Discharges to groundwater of more than 5m3/day require a licence under the Water Pollution Acts. It is recommended that a licence application is lodged at the same time as the planning application.

Note: Trial holes are to be left open pending determination of the application.

TRIAL HOLE

Hole should be approximately 1m x 0.75m in plan and a minimum of 2.1m deep

Dept of Trial Hole (m): / Date & Time of Excavation: / Date & Time of Examination:
Depth from ground surface to bedrock (m):
Depth of ground surface to water table (m):
Soil Type: Sub-soil Type:
Additional Sub-Soil Information
Texture / Structure / Bulk Density / Colour* / Preferential
Flowpaths
0.1m
0.2m
0.3m
0.4m
0.5m
0.6m
0.7m
0.8m
0.9m
1.0m
1.1m
1.2m
1.3m
1.4m
1.5m
1.6m
1.7m
1.8m
1.9m
2.0m
2.1m
2.2m
2.3m
2.4m
2.5m
Other information (e.g. depth of water ingress)

*All signs of mottling should be recorded

PERCOLATION TEST

Type of Test: T-Test or P-Test

Percolation Test Hole / 1 / 2
Depth from ground surface to top of hole (mm) (A)
Depth from ground surface to base of hole (mm) (B)
Depth of hole (mm) [B-A]
Dimensions of hole [length x breadth (mm)]
Each hole must be pre-soaked twice before the test is carried out (from 10.00a.m. to 5.00 p.m. and from 5.00 p.m. to the next morning)
Date of test
Date pre-soaking started
Time filled to 400mm
Time water level at 300mm
Percolation Test Hole No. / 1 / 2
Fill No. / Start Time
(at 300mm) / Finish Time
(at 200mm) / Δt (min) / Start Time
(at 300mm) / Finish Time
(at 200mm) / Δt (min)
1
2
3
Average Δt / Average Δt
Average Δt/4 = [Hole No. 1] _____ (tֽ) Average Δt/4 = [Hole No. 1] _____ (t2)
T-Value = (tֽ + t2)/2 = ______(min/25mm)
Result of Test: T=
Comments:

On-Site Assessment/Visual Assessment

Topography: / Slope:
Steep (>1:5) Shallow: (1:5 – 1:20)
Relatively Flat: (<1:20)
Surface Features:
Outcrops
Houses
Ditches*
Wells*
Springs
Roads
Watercourse*
Site Boundaries
Existing Land Use
*Note water level
Type of Vegetation: ______
Ground Condition: ______
Comments/observations: ______
______
______

Recommendation

Propose to install: ………………………………………………………………………………..
and discharge to surface water/groundwater (delete as appropriate)
Signed: ……………………………………………………………………………………………
Address: …………………………………………………………………………………………
………………………………………………………………………………………...
Qualifications: ……………………………………………………………………………………
Date of Report: ……………………………..
Phone: ………………………. Fax: ………………………
E-Mail: ……………………………………………………………….
To be accompanied by a current certificate of professional indemnity insurance

1