192 Septic Soil & Perc Test 2010 FORM 11 -SOIL EVALUATOR FORM
Page 1 of 3
Performed By:
Witnessed By:
Commonwealth of Massachusetts
Massachusetts
,Snit Suit4ility Assessment for On-site ewage Disposal
70- - L Date: i°
/n, cU ,v lz�vsf t
La, /9a co/as
Vow consttucUon C Repair , !it
1 4
Date•/6/7 /o?Op
1124 L///EA(J )',
' /9e Gabs. ,/ 'boo # , /2,0
NatrAllouja t) Ai/4_75
Office Review
Published Soil Survey Available: No ❑ Yes tl�'
Year Published Publication Scale Soil Map Unit _.. .
Drainage Class
Surficial Geologic Repo
Year Published
Geologic Material (Map
Landform
Flood Insurance Rate
Soil Limitations t
Available: No ❑ Yes vO '" �� �
Publication Scale _Lr _, p/
Above 500 year flood bt undary No • Yes a—
Within 500 year floodb4undary No es ❑
Within 100 year flood boundary No PYes m.❑
Wetland Area:
National Wetland inven ry Map(map unit).
Wetlands Conservancy gam Map(map.unit)
Cunt Water Resource onditions.(USGS):Month
Range:Above Normal fNorinal ❑Below Normal
Other References Revie
S63 523t .?8
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n site Rei etv
•
Or{sue Review f
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,k'ynrw.Y / twl .ODw GYIWq wW�N.J.•...j_J.I..t// O.t�'iy_
' .. - .:. : '. DEEP 9BSERVATION HOLE-LOO. • - • • • • ' : . - DEEP OBSERVATION HOLE LAG' •
..ar°:t:..p.: bsbut e...c"(+ r.`�,.,. ' •'tl.::..i.«.....a:.r..r wt�trw.t - twos tr.,w u..,... .
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/6 awaa.4 U /751f T w,nw,...dta /U� • warvaDSL[tuwbbAt tv[nx rwnua .au �- t
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test No,
PIPC /Q .
Reading • 'Cline yL ._ n „
%
Saturation (15 mil) % /_
g'el1olatien 'Test
/O0
7
Co
Pere Rate
Ground Elev.
Depth of Pole
Test Pit rt"/
Depth Soil Deacri,p tion
F/
cO //
/CO9
Tegt No . y% Z TP--L
Rending{ Time
Salur loll (.15 min)
id' cal
Hilt/inch Pere . Rote
„y,.:.. Ground Elev .
._...._. hopth of Iloeelt,
Ueep Teat t Teat 'loll
Depth Soil
1tl/9/
tAer
° L a 0 N-stij
Ors 4-
Eta -S W s �rr/ JAW°
5 f—/O l0 P a A—i66/stig
49 re "cat
Groundwater Depth /ofp—Eiev
Bedrock Depth
Les inh (
y
.6e,el
Description
Croup water Depth . ev.
Ground Elev, Elev.— Bedrock Depth Elev.—'—
._ Ground nevi..
S.C.S. Soil Peecription 77G1, Seasonal Iligh Water Tablet /f
Bench Hark: Elev. ✓ - S
' Description
WPC
pnlli-e 61
■
S
t
&OTOO itt
av/Ado :0/f/2a
6/)
T
Date: /0 40/0
C.11 eat .
nR ne = r:
uitnee :
Loco tin o Pere :
ate
20/2 .2k77.Theall CC to
6 ,
FORM 12 PERCOLATION TEST
/92- c-o%S /Ke%douw /24
Location -Address or Lot No. NO�LJ71 4(����C/ �(�ts
COMMONWEALTH OF MASSACHUSETTS
No1--fl6miofO Massachusetts
Percolation Test'
Date: _/_0.,�_1 97U/d Time: _.9" 517_,—
Observation Hole #
Depth of Pero
0-:-3 °'
Start Pre-soak
912/ L .— 9r7
End Pre-soak
9 C7
Time at 12"
7
X14
Time at 9"
/0 O
X8/3
Time at 6"
jO a 7
Time (9"-6")
16/3 = to s h
Bate Min./Inch
/,Z.P6/9#-)
Minimum of 1 pe colation tot must be per ro med ini"botht a primary
reserve area.
area AND
Site:Passed , Site Failed ❑
Performed By: ,adif/v! s _._. Y7f /42/E.--i=
Witnessed By: 1T. Ni£%/ZOS7G aO/,'
Comments:
FORM 11 - SOffi EVALUATOR FOR
• Page3 of
Location Address or. Lot iNo. . ./ roc caters % ,,g a tc' /c0
✓ a¢aa% GUT
. Determination for Seasonal !sigh. Water .Table
Method Used: •
U De ob rued standing in observation hole inches pytrt
ep weeping from side of observatiorthole . inches . er
epth to soil. mottles _ inches •a/yvwi
❑ Ground water adjustment :• feet . . . /06
Index Well Nu 'm'ber . , • Reading Date Index well level
Adjustment factor - • Adjusted groundwater level .
Depth of Natural:'/Occurring Pervious Material
Does at least four feet of naturally occurring
•observed throuoout the area proposed for the
ff not, what is the,.depth of naturally occurring
Certification
I certify that on • sf9.r • tdat
approved by the Departmentdf Eri
was performed by me consistent
described in 310 CMR 15.r 17
pervibus material exist in alt arm
soil absorption system? j//
pervious material? •
is soil evaluator examination
Hon and that the above analysis
trafhing, expertise and experience
Date _//4,,�Po/d
160.46 00
1 . 7.31
n 180
515.00 26.84
113. 1
471 .31