888 Septic Soil & Perc Test 1997 FORM 11 - SOIL EVALUATOR FORM
OWNER ' S NAME: 4-1c lr&inex C
LOCATION ADDRESS: Ghee ( r{ZcdbA Yd 444,P ,,LOT #
JOB NUMBER: 97-044 DATE: 6/(7/97
COMMONWEALTH OF MASSACHUSETTS
f-.)0(Eni- MQTaUJ Massachusetts
) 11 Suitability Assessment for On-Site Sewage Disposal
Performed By:—.1%)oe,G,L4$ Mac Lein
Witnessed By: p cs-r fl\c, Fr)c c
Location Address or CHEST Q.FIL`L2) £o4a
Lot •
Owner's Name C u.J C Ltt P P
Address and�C
Teleoadne 1 V L
62-5"-- QI-1-1
New Construction 7 Repair 1 Number of Bedrooms
. Office Review
Published Soil Survey Available: No ❑ Yes
d
�SL
Year. Published P921 Publication Scale: / = (32OSoi1 Map Unitrhad �
Drainage Class Soil Limitations
Surficial Geologic Report Available: No ❑ Yes ❑
Year Published Publication Scale
Geologic Material (Map Unit)
Landform
Flood Insurance Rate Map:
Above 500 year Flood boundary NO ❑ YES
Within 500 year Flood boundary NO ® YES ❑
Within 100 year Flood boundary NO ® YES ❑
Wetland Area:
National Wetland Inventory Map (map unit)
Wetlands Conservancy Program Map (map unit)
Current Water Resource Conditions (USGS) : Month
Range: Above Normal 1 Normal Below Normall ryi
n+k+nrn nnhrrnnrnr nnvinwnrl
FORM ii — SOIL EVALUATOR FORM
l OWNER' S NAME:
LOCATION ADDRESS: LOT #
JOB NUMBER: 97-044 DATE: Chi/97
Determination for Seasonal High Water Table
Method Used:
Depth observed standing in observation hole inches .
Depth weeping from side of observation hole inches .
Depth to soil mottles 7= 45T inches .2= S`jwihcjcs
❑ Ground water adjustment feet .
Index Well Number Reading Date index well level
Adjustment factor Adjusted ground water level
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in .all areas
Y1^observed throughout the area proposed for the soil absorbtion system? "i y
If not, what is the depth of naturally occurring pervious material?
Certification
I certify that on /O 5 (date) I have passed the examination approved by the
Department of Enviro mental Protection and that the above analysis was
performed by me cosistent with . equire. raining. expertise and experience
described in 310 CMR 15.017
FORM ii - SOIL EVALUATOR FORM
IER ' S NAME: I Page 2
rOCATION ADDRESS: LOT #
JOB NUMBER: 97-o44
On -Site Review
Deep. Hole Number ) Date: 6/x7/97 Time: c? SO441 Weather: PTLY C.Lb'y'
Location (identify on site plan)
Land Use: /JIY,CiE)_i7 Slope (%) Z Surface Stones SEW
Vegetation: G2q Cfc r
_and form:
'osition on Landscape (sketch on the back)
iistances from:
Open Water Body Zoo-% feet
Possible Wet Area 2oo-V feet
Drinking Water Well h/0Na feet
Drainage way ace—r
Property Line N021
Other:
feet
feet
DEEP
OBSERVATION HOLE LOG
lepth from Sur ace
(inches)
Soil Horizon
Soil Texture
(USDA'
Soil Calor
(Bunsen'
Soil Mottling
0 her
(Structure, tones. Boulders.
Cons tats
0 : 5"
94 Z/ "
z/° Sr
o,
37k - IC,"
fl
13w
C.
�aqm
SAkIS
sir
rINC
t5 A e.rb\
7cnie
3i«
I°YR`-
Icy ` /
Io' sic
2. CI
¢
'a
SS /
SYSit
1590
4.5.1
S/%
cy. I Gravel)
�a(A� ,r
&ftW Sr°NHS
�RIABLIS
Fn.),a,;L(r
ZSZ CyC-
Pelt
Fl P-M
f�W- S['oNLr
rent Material (geologic) 154S4L T7tC__
Depth to Bedrock: 4e/'f
pth to Groundwater: Standing Water in the Hole: A./40/.../12- Weeping from Pit Face: ,C/arar
FORM 11 - SOIL EVALUATOR FORM
JWNER ' S NAME:
LOCATION ADDRESS: LOT #
JOB NUMBER: 9-7-a 44
Page 2
On -Site Review
Deep Hole Number Z Date: G in /91 Time: II : I4 AM
Weather:CLb'' Sr'
_ocation (identify on site plan)
_and Use: //QYLAFTo Slope (%) 2-
Vegetation:f/2.455c:f
_andform:
Surface Stones 'FEW
'osition on Landscape (sketch on the back)
listances from:
Open Water Body Zaa-! feet
Possible Wet Area Lao-,1 feet
Drinking Water We11 ,vo.v4 feet
Drainage way 200 '
Property Line W/p
Other:
feet
feet
DEEP OBSERVATION HOLE LOG
Depth from Surface
finches)
Soil Hort on
S it Texture
(USDA)
So 1 Color
(M nse11)
Soil Hot ling
Other
fat ucture. Stones. Boulders.
Consistency. % Gravel)
°—/Z "
I2M - 2- I
ZI - 36"
R
L- j
c ,
L34kLrY
LoAnn
SA Inf.)/
L
4
Ofit.ra
IoY24/3
I(SYR q,
To)"
L
sera
e P
2,cirk 54
2,g‘ri2 S4
2o%
FRiAaL�r
FIXW STCriC
FCzmt3L-
2c CS, c
C12 IaBLLr
r ,si"or`'1.:[-
a rent Material (geologic) aacts- %L
Depth to Bedrock: 91e
?pth to Groundwater: Standing Water in the Hole: A104/4r Weeping from Pit Face: R/0h/r
FORM i2 — PERCOLATION TEST
WNER ' S NAME:
LOCATION ADDRESS: LOT # I
JOB NUMBER: 7/-044-
COMMONWEALTH OF MASSACHUSETTS
/.IDRTN AIIIPTON, Massachusetts
Percolation Test
Date: - 4,0-7/91 Time. Id AM
Observation Hole -#
I
Z
Depth of Perc .
- - S
SQ N
Start Pre-soak
I O : C.
End Pre-soak
- p ! IF
Time at 12"
WIT
,,,s(
Time at 9" -
Jo Z-3
Time at 6"
10r30
Time (9'-6")
Rate Min/Inch
3
Site Passed
Site Failed n
Performed By:DouG Lac tccc_ Lea
Witnessed By: c.41s✓ iMC _v(a . e
Comments:
Ge Fraca 0Aa
KG
0 — _
oct
SawMiL(-
s rrE
i ' N