380 Septic Soil & Perc Test 1997 No.
FORM 11 - SOIL EVALUATOR FORM
Page 1 of 3
Date: Li2L.222_
Commonwealth of Massachusetts
Nnaittrorme1250, Massachusetts
Soil Suitability Assessment for On-site Sewaze Disposal
Performed By: TEA.)hi. - 1,4 C.4,c)/z.
Witnessed By: Amt-t, int Fre_L s,a
Date:
to-0, -e>
Lanl'°"mdit's y2t& C/f z.(2
La
NO-r2 # 07/7 ?CO "Vis
New Construction D Repair 21
Ownis
Address.ant 3 a ea ewe er-"Tea
TeLeprove/
e 4:7 P-47-
0 a_a"
Office Review
Published Soil Survey Available: No 0 Yes
.1211.Q.1Publication Scale /.1/.515.44.1 Soil Map Unit
VII btattr.111 Soil Limitations 3t-a tc' t
7?ALA ea,'"
Surficial Geologic Report Available: No D Yes 0 bitt tFeettaje-D 'Pc)
Year Published Publication Scale
Geologic Material (Map Unit)
Landform
Flood Insurance Rate Map:
Above 500 year flood boundary No 0 Yes ig
Within 500 year flood boundary No M-Yes
Within 100 year flood boundary No SYes 0
Wetland Area:
National Wetland Inventory Map (map unit)
Wetlands Conservancy Program Map (map unit)
Year Published
Drainage Class
Current Water Resource Conditions (USGS): Month
Range :Above Normal 0Nonnal Below Normal
Other References Reviewed:
13 /Ca•
1).ilt 1"b
/1
DEP APPROVED FORS,-12/07195
Location Address or Lot Igo.
FORM 11 - SOIL EVALUATr1 FORp1
Page 2 of 3
3so c»Es75 ,,a=lr& (-QD
On-site Review
Deep Hole Number Dare: Time:.£I0 an Weather 9 rfwu�
Location (identify an site plan) ..
Land Use Sc Sl b'u.7-4t, Slope (%) -C. Surface Stones A/4.1)2C ,
Vegetation L.41r1 .✓ ..
Landform ..tcR.A? cc ._. ._.. , ,. .
Position on landscape (sketch on the back)
Distances `ram:
Htf-
Open Water Body / ce, feet Drainage way 60r feet
Possible Wet Areaa,6' _ feet Property LinetO.a 2or feet
Drinking Water Well /a"'. feet Other ..._..
DEEP OBSERVATION HOLE LOG.
Depth from
Surface (Inches)
Soil Horizon
Sail Tenure
(USDA'
Soil Color
(Munson)
Sail
Mottling
o to 1,1i
le Tv
.i cz totals"
A
)
C
lPy<)12
51/
IbyeYJ
pJD
Other
(Swcure,Stones, Boulders, Consistency, %
Gravel)
4.-4wr•a • Law.."
f7 eane , A-r.i] 4TaaeE,-
As is o 'r
C•<raeec� Fr[.n(cv90bc> yr..>
Vroa. 5. 73-t'v ao 9p Gi?JtL
MINIMUM CH-1 HOLCa RtQUIHCD AT EVERY PRDPOScUDIapcgALARcA
Parent Material(geologic) Sec c #V aLItwgg 5 DepettoBedrack:
Depth to Groundwater Standing Water in the Hole: ,V b A..t;
Estimated Seasonal High Ground Water: 52 "
/O�
Weeping from Pit Face: Nau<
DEP APPROVED FORM-12/07/95
FORM 31 - SOIL EVALUATOR FORM
?age 2
On-site Review
Deep Hale Number - Date: (6.r.217
Location (identify on site plan) _.
Land Use (CSt7]c• t• L
Vegetation 'A"9/0 -
Landform ._i$429.FE_.
Position on landscape (sketc i on fiat bas
Distances from:
Open `Haler Scaly 2/9"A" feet
Possible Wet Area a.BO .. feet
Drinking Water Wer/ 2't./feer
Slope (361
Time: ..L6B62.-•
Weather l-Mr.ersr
_. Surface Stones
I
Urci.tage way..99,_ fee;
Property Line in*f feet
Cther _ _.__ ..
� P OBSERV'A'ITON TIOLE LOG
Depth from Surface
Onched
rr
6^ to if
Sod Texture
(USDA)
5lL
5 'I Calur
(Munn'',
lo y4.
Sol MaCling
Other
(Structure. Stones. ?oulGers.
C rsrs:!1cv. % GreveM
ibt j4✓s n T Lon?”,
my°
7.5 ra
F-t,,nf& Feseel
CC3i%lE Y- c
nvrr sei vs at
a.4d✓!L
Parent Material (ge plogicl ._.Ter...f✓..YSs.7.../_tree- 1<4.4
Ceat,h to Groundwater:
Standing We ar in the Hola:,9flE
Death to Bedrock: 929
Weeping from Pit Face:Mew
_a ti.na.ed Seasonal i'lun Grout„pater: yO
r
Location Address or Lot No.
FORDI 11 - SOIL EVALUATOR FOF
Page 3 o
Determination or Seasonal Hi.h Water Table
Method Used
0❑ Depth observed standing in observation hole inches
0 Depth weeping from side of observation hole... .. , inches
0 Depth to soil mottles5a"•yo inches
Ground water adjustment ...... .. .
feet
Index Well Number
-- Reading Date Index well level factor _.__..._.. Adjusted ground water level
_......._._.
Depth of Naturally Occurrin
Pervious Material
Does at least four feet of naturally occurring
observed throughout the area proposed for the
If not, what is the depth of naturally occurring
Certification
pervious material exist in all areas
soil absorption system?V�
pervious material? T`�
I certify that on (date) I have passed the soil evaluator examination
approved by the Depa m nt of Environmental Protection and that the above analysis
described in 310yCMR 1 tent with 017. eq, red training, expertise and experience
Signatu.,, ,.
Date fl-1')
DEP APPROVED FORM•12107!95
n yvQ ciypb 3 +..ns &n$
• -ffdL
6r 14` 1 - -
td1
1b 701 341 01.
—r�3M stest nfiV �1+a0 1-1
113(1
eeovc3s
' g - FORM 12 - PERCOLATION TEST
Location Address or Lot No. 7 2 C t-6/cz F ai EQ
COMMONWEALTH OF MASSACHUSETTS
�b4 rH?„rptp»Massachusetts
Percolation Test`
Date: . ./0 • Z- '77 Time:.
Observation Hole #
Depth of Pero
Start Pre-soak
End Pre-soak
Time at 12"
Time at 9"
Time at 6"
Time (9"-6")
Rate Min./Inch
_.L
to, i
I 3
� o : 33
ll .- ot
Minimum of 1 percolation test must be performed in both the primary area AND
reserve area.
Site Passed j Site Failed ❑
Performed By: ,friev -/-r e�
Witnessed By:
Comments: ..__
PEP APPROVED PORM-12,07115