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Lot 4 & 5 Soil Assessments t-o4 4 C'PJ i A W 0. y \ 0( �aPSe*ON Massachusetts Department of Environmental Protection y Bureau of Resource Protection -Wastewater Permitting Program Site Address or Map/Lot Number Form 12 - Percolation Test A. Facility Information 1. Facility Information 1 -�' Wjorco I�fm l[y 20.rf Owner Name R0, BO)( /D32 Map/Lot Street Address EaJ4-49 u,p F > ■ M A 0 ,0-0 City State Zip Code Percolation Test Date: c/9/o4 Observation Hole# 4A 4B Depth Of Perc So" 4V' Start Pre-soak z : IS Z :16 End Pre-soak 7 :34- z :3 L Time at 12" 2'. 4- z :32 Time at 9" z :57 2:37 Time at 6" z :33 z'.44 Time (9"-6") 2ra MW 7 rvrJ Rate - Min/Inch 9 Mir-qtr-1 3 MiN/In1 •Minimum of 1 Percolation test must be performed in both the primary area AND reserve area. Site Passed /Site Failed fl Performed By: Mayk il I hor^^Psor i. Witnessed By: Erra-s+ My--tomrev Comments: DEP Form 12 Percolation Test • Page 1 of 1 n Commonwealth of Massachusetts City/Town of NDR(fHArAel-CJ , s++' Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal D. Determination of High Groundwater Elevation 1. Method Used: 4C 4D ❑ Depth observed standing water in observation hole inches inches inches inches ❑ Depth weeping from side of observation hole inches inches inches inches 0 Depth to soil redoximorphic features (mottles) 3�{-" 36'. inches inches inches inches ❑ Groundwater adjustment (USGS methodology) • Inches inches 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 occurdn999 pervious material exist in all areas observed throughout the area proposed for the soil absorption system? IZ Yes No b. If yes, at what depth was it observed? Upper boundary: inches Z Lower boundary: 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. I further certify that the results of my soil evaluation, as indicated in the attached Soil Evaluation Form, are accurate and in ac ordance with 310 CMR 15.100 through 15.107. ,_ __ `Sir 24 , 2o14- Signa re of Soil Evaluator . Date Mark-T. / ho»,p,con SE 2436 April a9, 1997 T or Printed Name of Soil Evaluator/License# Date of Soil Evaluator Exam A�tel Waslnk N0f4Tina1r r (A9e—„a-) 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 Pe,cclaeen Tes. Got m12. Form 11 •rev. 1/10 Form 11 -soil Suitability Assessment for On-site Sewage Disposal -Pag 7 p of O I g Jo g -acv V \ F 4E U t� a a5 NF#ADZA wFgn1a . , , NF AC5 Or O. POND 2500' � \ yA`7< — V #ACJ � � bb 150. i°00100'E i 1� M, �q,� 6 10°00'00 E i wrger0 -NFaA MkgAti d°410c ” 6 fir§.auc' - _ _ _ \ � xss � -- ANF/FFA.a -(j7,'7 %INERT WF#.AA 1 —v 10;4,9.33' —A . ,aE -. \ wrfAA3 ' A/Ed AB= rFgPc ,�'��� Nc AA, ffie ' ----_,{ WF�HA 1 2, LP co 47 k 01 oN 113 � N - N: 2937965.59 592.41' E: 334344-39 i ,.; S09°32 48"E NI. _ Massachusetts Department of Environmental Protection LOT 4 CARDINAL W Ay Noa it t.-yp7orJ 1 \ Bureau of Resource Protection -Wastewater Permitting Program Site Address or Map/Lot Number Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (minimum of two holes required at every proposed disposal area) Deep Observation Hole: Date: 7/24/2014 Time: 9; 56 Weather: St,,rny 1. Deep Hole Number 4C Location (Identify on Plan ): 2. Land Use: vacate-- lo+ Surface Stones: < I % Slope (%): 3 -4 Vegetation. W 2.ed51 -ee-S (e g.woodland,agricultural field,vacant lot,etc Landform5i unJ wwraire. Position on landscape: 3. Distances from: Open Water Body 109.1- ft. Drainage Way — ft. Possible Wet Area '¶BD ft Property Line 45 ft. Drinking Water Well 150 t ft. Other_ft. 4. Parent Material:Ablgkioo T:I I Unsuitable Materials Present: Yes © No❑ If Yes: Disturbed Soil0 Fill Materials Impervious Layer(s)❑ Weathered/Fractured Rock ❑ Bedrock ❑ 5. Groundwater Observed: Yes IZ No ❑ If Yes: Depth Weeping from Pit �iO" Depth Standing Water in Hole Estimated Depth to High Groundwater: 34 Soil Redoximorphic Features Coarse Fragments Depth Soil Matdx: (mottles) %by Volume ept Horizon/ Soil Texture Color-Moist Depth Color Percent Gravel Cobbles Soil Structure Soil Consistence Layer (USDA) (Munson) 8 Stones (Moist) Other !/0 - ICI Vii (! — 16-22 A S L II>Y12.3/Z r•lass'we- -G,aL1,— roci-5 ZZ-34 Zvi LS i0YR 416 eimaisb iVe- cr;4b\e_ fe0-{3 3+-11A C L5 7.51R5/4- 341-,1 7,SYR5./s > 5% 10% 00°4 rna55tvC -cflALC SY 6/1 Additional Notes HILL TOWN ENVIRONMENTAL CONSULTING P.O. BOX 314 CHESTERFIELD, MA 01 012 DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal •Page5 of.5 (413) 296-4499 Lic Massachusetts Department of Environmental Protection Lo+ 4 Cc rdina( Way2 Nnr wttl}er Bureau of Resource Protection -Wastewater Permitting Program Site Addressor Map/Lot Number Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (minimum of two holes required at every proposed disposal area) Deep Observation Hole: Date: 7I7.A-/ 14- Time: ID : 30 Weather: 4(Anny 1. Deep Hole Number 4D Location (Identify on Plan ): / 2. Land Use: VA cara4- lot- Surface Stones: < I% Slope (%): 3-41- Vegetation: YhiXed 11arc1/40q'w0045 (e.g woodland, agricultural field, vacant lot,etc Landform yroLA mbrairt Position on landscape: 3. Distances from: Open Water Body 100+ ft. Drainage Way_- ft. Possible Wet Area TB'D ft. Property Line 45 ft. Drinking Water Well ISD+ ft. Other ft. 4. Parent Material: P16[CrilDYCn tl Unsuitable Materials Present: Yes❑ No Ei If Yes: Disturbed Soil(] Fill MaterialD Impervious Layer(s)U Weathered/Fractured Rock ❑ Bedrock U 5, Groundwater Observed: Yes gi No ❑ If Yes: Depth Weeping from Pit 56" Depth Standing Water in Hole 100" Estimated Depth to High Groundwater: 36 r Redoximorphic Features Coarse Fragments Depth Soil Soil Matrix: (mottles) %by Volume Dh ept Horizon/ Soil Texture Color-Moist Depth Color Percent Gravel Cobbles Soil Structure Soil Consistence On) Layer (USDA) (Munsell) &Stones (Moist) Other c-IC A 5L IbYRZ/z cr„Mb looms roo+s 16'34 BW LS IoYR4/(0 rnassive- -dal,le, r6045 34-120 7.5YR5 3(01. 75 R F 6 1070 vnass,ve Additional Notes HILLTOWN ENVIRONMENTAL CONSULTING P.O. BOX 314 DEP Form 11 Soil Suitability Assessment for On-Site Sewage'Dis Disposal • Page Cr of$ CHESTERFIELD, MA 01012 y P (413) 296-4499 LD4 4 r t I Massachusetts Department of Environmental Protection Cow Jivia\ Wrry , NOY 4-kavntA-Dn Bureau of Resource Protection —Wastewater Permitting Program site Address or Map/Lot Number Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (minimum of two holes required at every proposed disposal area) Deep Observation Hole: Date: (019tog- Time: II . 15 Weather: 51..-y 805 1. Deep Hole Number 4B Location (Identify on Plan ): 2. Land Use va.Atn4- Lo} Surface Stones: re_✓ Slope WO: 2=3 vegetation. Pi nit MA n12 (e.g.woodland,agricultural field, vacant lot,etc Landform: Ground Mbva iwx- Position on landscape. 3. Distances from. Open Water Body loo+ ft. Drainage Way loot ft. Possible Wet Area '113D ft. Property Line 30 ft. Drinking Water Well 15°` ft. Other_ft. 4. Parent Material: Al5lorb∎n Trll Unsuitable Materials Present: Yes❑ No Eli If Yes: Disturbed Soil❑ Fill Material❑ Impervious Layer(s)❑ Weathered/Fractured Rock ❑ Bedrock ❑ 5. Groundwater Observed: Yes 0 ri No ❑ If Yes. Depth Weeping from Pit 67 Depth Standing Water in Hole 94 Estimated Depth to High Groundwater: 26 Redoximorphic Features Coarse Fragments Soil Soil Matrix: (mottles) %by Volume Soil Structure Soil Consistence Depth Horizon/ soli Texture Color-Moist Depth Color Percent Gravel Cobbles (In.) Layer (USDA) (Munsell) &Stones (Moist) Other 0-6.° A fSL Io'R3/2 G,,..1 loose 6-70" B. LS )0/k 4./L, 5/ 5% nmAs51vc c,.,A tt 12D- 116 G LS 75YR5/ ?b lo`I 50% 10% 10%, r^‘ASSive Gig,lote Additional Notes DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 3 of 8 L.+ 4 L Massachusetts Department of Environmental Protection Ca.dc^"� WaYr Or ll4"'F'+b" NT Bureau of Resource Protection-Wastewater Permitting Program SRe Address or Map/Lot Number Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal , D. Determination of High Groundwater Elevation 49_ 4 B 1. Method used: ❑ Depth observed standing water in observation hole A. B. ❑ Depth weeping from side of observation hole A. B. 2 Depth to soil redoximorphic features (mottles) A. 2.9 II B. Za" ❑ Groundwater adjustment(USGS methodology) A. B. 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/ccurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Yes 0 No❑ b. If yes, at what depth was it observed? Upper boundary: Zd r r Lower boundary: I 1611 F. Certification I certify that I have passed the soil evaluator examination' approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017, s,, L - 1-: ¢, 2004 Sign ure of Soil Evaluator Oatl _ Mark Thompson April 29, 1997 Typed or Printed�Natme of(Soil Evaluator ttalle of Soil Evaluator Exam 1 Cv r.cs4 /`x l..�h i e tx I` ill-Inuw.y}n.. (l Ai 7nH4) • Name of Board of Health Witness Board of Health Note: This form must be submitted to the approving authority with Percolation Test Form 12 DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal•Page 4 of 8 �,\ Commonwealth of Massachusetts ASSESSMENT PERFORMED BY y City/Town/Town of %_ y NoRTHAMP'fonl HILLTOWN ENVIRONMENTAL q q Suitability /, On-Site �+ !S P.O.BOX 314 r -L - Form I 1 - Soil Suitability Assessment for On-Site Sewage Disposal CHESTERFIELD, 1012 L =" y t` (4131296.4499 HILLTOWNENVIRONMENTAL @GMail com A. Facility Information vnZoREK Owner Name - - - — - - - - - --- --- LOT 4 CARDIYJAL )A;Av Street Address - - - {' Map/Lot# f'L- RENGE MA otoc 2_ City - State Zip Code B. Site Information 1. (Check one) XI New Construction Upgrade I I Repair 2. Soil Survey Available? X Yes I I No If yes: (AS-DA Spilt S�rvev__1981 _ A � ASource - / Soil Map Unit H 1MO5'I'owh Zv-c_s Stow LY W�VYZss Soil Name .—_. ---._ --. S II Limitations / J 3. Surficial Geological Report Available? ❑ Yes ❑ No If yes: Year Published/Source Publication Scale Map Unit 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 El No Within a velocity zone? El Yes ❑ No 5. Wetland Area: Wetlands Conservancy Program Map Map Untt Name 6. Current Water Resource Conditions (USGS): 6/Z014 Range: ❑ Above Normal g Normal U Below Normal Month/Year 7. Other references reviewed: 'orm 11 rev. Via Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal • Page 1 of 8 n1�k 4 L Massachusetts Department of Environmental Protection l.Ardi`'"`I WY `dr+k^"''�+"I^ Bureau of Resource Protection -Wastewater Permitting Program Site Address or Map/Lot Number Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (minimum of two holes required at every proposed disposal area) Deep Observation Hole: Date: 617104- Time: 11/00 Weather: SvnnY SO4 1. Deep Hole Number 4 Ps Location (Identify on Plan ): 2. Land Use: Cl a.J L.+ Surface Stones: Fe.. Slope(V0): zz=3 Vegetation. M4fla Pi vie_ (e.g.woodland,agricultural Saki vacant Id,etc Landforrn: {xrao..a Nlormioo- Position on landscape. 3. Distances from: Open Water Body book ft. Drainage Way — ft. Possible Wet Area -('BD ft. Property Line 314 ft. Drinking Water Well 150* ft. Other_ft. 4. Parent Material: Atilo-l;o,T,1I Unsuitable Materials Present: Yes❑ No a/ If Yes: Disturbed Soil❑ Fill MaterialD Impervious Layer(s)❑ Weathered/Fractured Rock ❑ Bedrock ❑ 5. Groundwater Observed: Yes d No ❑ If Yes: Depth Weeping from Pit 70“ Depth Standing Water in Hole 96" Estimated Depth to High Groundwater: 29 ,E Redoximorphic Features Coarse Fragments Soil Soil Matrix: (mottles) %by Volume Depth Horizon/ Soil Texture Color-Moist Depth Color Percent Gravel Cobbles Soil Structure Soil Consistence (In.) Layer (USDA) (Munsell) &Stones (Moist) Other - 0-0° A 1•51... IovRS/z c.. , looses • $-2D" 3s,4 LS Ioy24/& , vn n,5ive. -Er.atdc I oyR SA/ 00 vr55ive iw�)a- io-II6 & L5 isvRS/4 29 ' 2,5y61 50% 10% I -ao. 1 Additional Notes DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal •Page of 8 Lo+ 5 Massachusetts Department of Environmental Protection �r��ra� Way, Nibrk�q,;,�O{-o� L---1 Bureau of Resource Protection-Wastewater Permitting Program Stte Addressor Map/Lot Number Form 12 - Percolation Test . A. Facility Information 1. Facility Information T 1 Wzo✓eIc jrrl/1/ / ✓us.- Owner Name /'�-"• P,0 ,Box 1035 Map/Lot Street ddes eg -1-�q14-Np TI°N M o1oz7 City State Zip Code Percolation Test- Date: 7„„e. 9 , 2004- Observation Hole# SA 5 8 Depth Of Perc 38” 48" Start Pre-soak z :14 z : n End Pre-soak z '35 2 ,36 Time at 12" z'Y39 Z 36 Timeat9" 7.141 z :43 Time at 6" 2',A9, 2 157 Time (9"-6") 7 Mta 14 Mt"-1 Rate - Min/Inch 3 r'tt,a Irr3 5 w,iNiNJ •Minimum of 1 Percolation test must be performed in both the primary area AND reserve area. Site Passed Mar Failed ❑ Performed e I- `o..k. ��or., s=� HILLTOWN ENVIRONMENTAL Y Q CONSULTING Witnessed By: evvesk \ADALte„• graraosztaasalstes Comments. (4/3) 296 —44.99 DEP Form 12 Percolation Test • Page 1 of 1 Commonwealth of Massachusetts City/Town of N D IC-I-(PAN P l 0 0 fi tie" Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal D. Determination of High Groundwater Elevation 1. Method Used: S C 5> ❑ Depth observed standing water in observation hole inches inches inches inches ❑ Depth weeping from side of observation hole inches inches inches inches 7 Depth to soil redoximorphic features (mottles) 34" f inches inches inches inches ❑ Groundwater adjustment (USGS methodology) Inches inches 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 occur�d-ng pervious material exist in all areas observed throughout the area proposed for the soil u absorption system? 0 Yes No b. If yes, at what depth was it observed? Upper boundary: inches 30 Lower boundary: Inches/20 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. I further certify that the results of my soil evaluation, as indicated in the attached Soil Evaluation Form, are accurate and in acco nce with 310 CMR 15.100 through 15.107. a0Iy 24-, 2-0 r4- Signal a o� - f Soil Evaluator Date Mark ! Thompson SE ?4-36 April Z9 1997 Ty ed or Printed Name of Sroil Evaluator I License# Date of Soil Evaluator Exam of vli� l Witness No✓earth npTOnl A3Z-0 tT Name of Boartl of Health Witness Board of Health \ J 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 Ipy_ie n le _fomnr_. Form 11 rev. iRO Form 1I —Soil Suitability Assessment for On-Site Sewage Disposal - Pag 7 of 8 1 _. p}[ ,C£ 19.20' TeEl VE CO ■ rn O W N W O Cn bd x'05"W k; , 98 TOTAL- 0.15 69.63;),F,1F74) ,n,rjp I FS I x'00'05"W 58 88' L=21 .44' CO'J O _ O cP E=97G 0G "I L=173.78 15234 WF#AC73 ,01 52 150.0 d6-doi < ' o£ ) S10.00'00"E aE I ar-4 fi In a Z N J O N O J O F$A. f rvr#A:II POND L �1 4 Massachusetts Department of Environmental Protection Le+5 Can D.oal Way Hof+komrire„ Bureau of Resource Protection —Wastewater Permitting Program Site Address or Map/Lot Number \ Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (minimum of two ho/es required at every proposed disposal area) Deep Observation Hole: Date. 7/24/1¢ Time: e'•4o Weather: S(401 fly 1. Deep Hole Number S C Location (Identify on Plan ): 2 Land Use: Vgc.Gi} (0+ Surface Stones < I% Slope (%): I-2- Vegetation: r.- eent5 (e g.woodland, agricultural field, vacant lot,etc Landform gfour rl vneralm& Position on landscape: 3 Distances from: Open Water Body IDDt ft. Drainage Way - ft. Possible Wet Area'FBD ft. Property Line 30 ft. Drinking Water Well 150+ ft. Other ft. 4. Parent Material: g61g4-tor�I II Unsuitable Materials Present: Yes® No❑ If Yes: Disturbed SoilD Fill Material® Impervious Layer(s)❑ Weathered/Fractured Rock ❑ Bedrock ❑ 5. Groundwater Observed: Yes I 1 No ❑ z^ If Yes: Depth Weeping from Pit 50° Depth Standing Water in Hole l06` Estimated Depth to High Groundwater: /`f Soil Redoximorphic Features Coarse Fragments Depth Soil Matrix: (mottles) %by Volume apt Horizon) Soil Texture Color-Moist Depth Color Percent Gravel Cobbles Soil Structure Soil Consistence Layer (USDA) (Munsell) &Stones (Moist) Other o -lo 1;11 ID "18 A SL IoYR3/1 1n0,53;Ve. -CrfaloL (oo{r 146 -31- $ q L5 S'14/3 wwsstve rooks 34- 120 C L 5 7,S1R+ a 34, 7,SYR S/6 > 5 o I D% l Svv/t S% vnassNe -Piral,le_ Additional Notes HILL TOWN ENVIRONMENTAL CONSULTING P.O. BOX 314 DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal •PageSof r CHESTERFI ELD, MA 01012 Y (413) 296-4499 L Massachusetts Department of Environmental Protection X0-1- 5` LarL. cx W0, NortLcn n rim-N Bureau of Resource Protection—Wastewater Permitting Program Site Address or Map/Lot Number Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (minimum of two holes required at every proposed disposal area) Deep Observation Hole: Date: 7//241N+ Time: 9:05 Weather: Sunny 1. Deep Hole Number 5 Y Location (identify on Plan ): 2. Land Use: VAcan* o1 Surface Stones: < 1= Slope (%): 1-2- Vegetation: weeds (e.g.woodland,agricultural field,vacant lot,etc Landform:jot/Ad Mora i rte- Position on landscape: 3. Distances from: Open Water Body Of ft. Drainage Way ft. Possible Wet Area MD ft. Property Line 30 ft. Drinking Water Well 150+ ft. Other ft. 4. Parent Material: Ablairio T I l Unsuitable Materials Present: Yes IZ No❑ If Yes: Disturbed Soils Fill Material Impervious Layer(s)❑ Weathered/Fractured Rock ❑ Bedrock ❑ 5. Groundwater Observed: Yes Q No ❑ If Yes: Depth Weeping from Pit G‘11 Depth Standing Water in Hole 106 r Estimated Depth to High Groundwater: 4`+- Redoximorphic Features Coarse Fragments Depth Soil Soil Matrix: (mottles) A by Volume Depth Soil Texture Color-Moist Depth Color Percent Gravel Cobbles Soil Structure Soil Consistence Layer (USDA) (Munsell) 8 Stones (Moist) Other 0 -24 I I — 2 --3D A SL 10YR3/1 crassly _;,-,L.1.9._. rcls 3o -44 Bv/ LS 5Y4/3 r^-w,ssi`/c —;-6,112_ rood 44-120 C L5 7,5YR4 z 44' 7,5-Y14 5/6 >5% i0% 5% w,asswe -GitMe- sybb Additional Notes HILLTOWN ENVIRONMENTAL CONSULTING P.O. BOX 314 DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • 6 of S CHESTERFIELD, MA 01012 Y g p Page (413) 296-4499 Lo+ 5 • Massachusetts Department of Environmental Protection CardW V11 �ox+t1ar"'pfbv Bureau of Resource Protection -Wastewater Permitting Program srte Address or Map/lot Number Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (minimum of two holes required at every proposed disposal area) Deep Observation Hole: Date: b(9/0µ Time: lo;DO Weather: 5„r,,y B0s 1 Deep Hole Number S E Location (Identify on Plan): 2. Land Use. vac r,,4\- L=}- Surface Stones: Mary Slope (%): a- 1 Vegetation. None. (e g.woodland,agncuftural field,vacant lot,etc Landform: Crtt„hc, Mot nine Position on landscape. . 3. Distances from: Open Water Body 100+ ft. Drainage Way loot-ft. Possible Wet Area -rsD ft. Property Line 30 Drinking Water Well ISO+ ft. Other_ft. 4. Parent Material: Qbl.,{0,e1-,11 Unsuitable Materials Present Yes❑ No tic If Yes: Disturbed SolID Fill Material(] Impervious Layer(s)0 Weathered/Fractured Rock D Bedrock 0 5. Groundwater Observed. Yes E No ❑ If Yes: Depth Weeping from Pit 72„ Depth Standing Water in Hole 96,n Estimated Depth to High Groundwater: 35 Redoximorphic Features Coarse Fragments Soil Soil Matrix: (mottles) 0/0 by Volume Depth Horizon/ Soil Texture Color-Moist Depth Color Percent Gravel Cobbles Soil Structure Soil Consistence (In.) Layer (USDA) (Munsell) _ Stones (Moist) Other D-IZ' PI — - 17- (8" A .c5L I IbYRz/Z crurv,t, lb opr. r or 18 - 26" 3 LS 25Y5/4 10% vho55we 4;°1,l. ✓tdrs Ibvg516 la 26,-112° C L5 7-s1k 514 35 " zsYoh sbt vl I5/ 5°/ a1s,Vr {rl°b 1 Additional Notes DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal • Page 3 of 8 Lo+ 5 Massachusetts Department of Environmental Protection Cv-d,X41 W ay r '). # 4 n,L- ( Bureau of Resource Protection —Wastewater Permitting Program Site Address or Map/Lot Number \ Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal D. Determination of High Groundwater Elevation SA SB 1. Method used: ❑ Depth observed standing water in observation hole A. B. ❑ Depth weeping from side of observation hole A. B. El/ Depth to soil redoximorphic features (mottles) A. 23" e. 35 ❑ Groundwater adjustment(USGS methodology) A. B. 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: Z6 " Lower boundary: _ /OS F. Certification I certify that I have passed the soil evaluator examination' approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. TL 9 2o04 Sign ure of Soil Evaluator Date , Mark Thompson April 29, 1997 Typed or Printed Name of Soil Evaluator 'Date of Soil Evaluator Exam F,v,air M,4-1,„rzu. /qty + i•I.,4-1,..-p-I," Name of Board of Health Witness Board of Health Note: This form must be submitted to the approving authority with Percolation Test Form 12 DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal •Page 4 of 8 Commonwealth of Massachusetts ASSESSMENT PERFORMED BY \ City/Town of N 02-11-1/4.A IAPTON\ HILLTO P.O.BOX 314 RONMENTAL Q6 P.O.BO Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal CHESTERFIELD,MA 61612 Disposal . HILLTOWNENVIRONMENTAL©GMail corn t " v A. Facility Information WI !Hawn Wzor,{c Owner Name -_.-- - - -- Lo+ 5 Cocci ; of Way Street Address Map/Lot# El orev‘ce -- _MA OLO(oZ City State Zip Code - - -- B. Site Information 1. (Check one) bZ New Construction I Upgrade ❑ Repair n 2. Soil Survey Available? ® Yes n No If yes: USDA. S0�\ Survey \ 9SI) /-+r— D Source Soil Map Unit Ain^oS'it-ow■,-, ✓cs S low I/, web-&ss Soil Name "- - - - Sol limitations 3. Surficial Geological Report Available? ❑ Yes ❑ No If yes: Year Published/Source Publication Scale Map Unit 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): 6/14 Range: ❑ Above Normal ® Normal ❑ Below Normal Monlh/Year 7. Other references reviewed: _ am 11 •rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal • Page 1 of 8 Lo Jr 5 • I Massachusetts Department of Environmental Protection Cu.d;rcl Way No✓4-6,,"•`I°+°`- Bureau of Resource Protection —Wastewater Permitting Program sne Address or Mapam Number \ Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (minimum of two holes required at every proposed disposal area) Deep Observation Hole: Date. ( /1 /04 Time: 9', 15 Weather: Sin nY 75 ° 1. Deep Hole Number 5A Location (Identify on Plan ). 2. Land Use. Moods Surface Stones: Few Slope N. Z Vegetation-. M LA plc , 1pru°°- (e.g.woodland, agricultural field,vacant lot,etc Landfonm. 6 ra Jl M>.,.,n4- Position on landscape. 3 Distances from. Open Water Body Ioaf- ft. Drainage Way loo+ ft. Possible Wet Area at) ft. Property Line 20 ft. Drinking Water Well 150+ ft. Other_ft. 4. Parent Material: ALt1 en T l l Unsuitable Materials Present: Yes❑ No R If Yes: Disturbed Spill] Fill MaterialD Impervious Layer(s)❑ Weathered/Fractured Rock ❑ Bedroll ❑ 5 Groundwater Observed. Yes E{ No ❑ It Yes: Depth Weeping from Pit 7Z IF Depth Standing Water in Hole 58" Estimated Depth to High Groundwater: 33 " Redoximorphic Features Coarse Fragments Soil Soil Matrix'. (mottles) %by Volume Depth Horizon/ Soil Texture Color-Moist Depth Color I Percent Gravel Cobbles Soil Structure Soil Consistence (In.) Layer (USDA) (Munsell) j & Stones (Moist) Other o -s, pA - 5L IoYRZ/z cant l =ose S-Ico" llw LS 2515/6 s% ma5sloe. cviaLla- 7.5N R sue 14,' 108„ C L5 ' Huh, 331 IoYR7/l 5070 ID/ 57 NI4ss0/c cr;.,6k I I Additional Notes DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal •Page2 of 8