255 Septic Soil & Perc Test 1997 FORM 11 - SOIL EVALUATOR FORM
Page 2 of 3
Location Address or Lot No 0 a U—S- iA/-C cy10-3 A.. .
d �f+ On-site Review
Deep Hole Number i? 7X7`Date: G,)2/9k? Time: MACr-tn.
Location (identify on site plan)Land Use Use t 3Oe 00.-ems_ Slope (%)0 -- S— Surface Stones
Vegetation "el--c-A_S
Landform
Position on landscape (sketch on the back) — -_ S'E'k-a_
Distances from:
Open Water Body 5./GO feet
Possible Wet Area >S-c, feet
Drinking Water Well >(CC feet
"k Weather C) C o —
t-0
Drainage way >,2S feet
Property Line •>/6 feet
Other
DEEP OBSERVATION HOLE LOG.
Depth from
Surface finches/
Soil Horizon
Soil Texture
(USDA(
Soil Color
IMunsell)
Soil
Mottling
Other
(Structure,Stones, Boulders, Consistency, %
Gravel)
o - /:) "
1 "-.2 cf
P4"-80t
/-)
S
C-
S. L-
S'. L.
Sc>�d` Sl�`IIV
Ions-1LI
lo 2410
YJo:,_.r_
/\1oL2._
IL,
CGron
To-per : t
S v, 't,S ctil
)C4 �vc-
o -f,.)"
13'-)cl"
C2‘-!ii S. 4
s-H"-90'
//
E
C ,
Cs
S-.2...
S;. L_
S o ck
S' OK-
I.VC'3(9
)OV29%G
7,Sv[6t
S irit
?loL
KOLA
/V O.--2-
)o`4
SyaLti6
t-o-se) I
'':>`4CSs-(3iI
Parent Material (geologic) l LA-* JOS'L_ -LO\ Dep htoBedrock: >C.c.i y = /c rk >�o
Depth to Groundwater: Standing Water in the Hole: A4g`-4/O'L? 'AYv Weeping from Pit Face: (4.."10 ra h-oi. &Ll
la '2.43 Estimated Seasonal High Ground Water (f/ G) / %,Z zrl 60 "
DEP APPROVED FORM-11/07195
Environmental Field Services, Inc.
P.O. Box 518 Leeds, MA 01053
(413) 586-7200
No.
FORM 11 - SOIL EVALUATOR FORM
Page 1 of 3
Date: i"J/f;J9'7
Commonwealth of Massachusetts
, Massachusetts
Soil Suitability Assessment for On-site Sewage Disposal
Performed By:
Witnessed By:
Er—U ar-Uk,
LAN jij\ C n kS ft% CLC1,0k.
, r3
aye.1
New Construction ® Repair C
o,.R,s Name.
Address,and
Telephone I
Date: 62):3 q 7
T0. v is
(-Jo() c
,;e
SL a l L'Halh rvtl9
01.770
Office Review
Published Soil Survey Available: No ❑
Year Published
Drainage Class
Yes ❑
Publication Scale
Soil Limitations
Surtiicial Geologic Report Available: No
Year Published
Geologic Material (Map Unit)
Land form
Flood Insurance Rate Map:
Above 500 year flood boundary No ❑Yes ❑
Within 500 year flood boundary No III Yes ❑
Within 100 year flood boundary No El Yes ❑
Wetland Area:
National Wetland Inventory Map (map unit)
Wetlands Conservancy Program Map (map unit)
Yes LJ
Publication Scale
Soil Map Unit
Current Water Resource Conditions (USGS): Month
Range Above Normal ❑Normal (Below Normal ❑
Other References Reviewed:
DEP APPROVED FORM•13/07195
Environmental Field Services, Inc.
P.O. Box 518 Leeds, MA 01053
1413) 586-7200
FORM I1 - SOIL EVALUATOR FORM
Page 3 of 3
Location Address or Lot No. Co Its i en. cr..li � ..
Determination for Seasonal High Water Table
Method Used:
❑ Depth observed standing in observation hole..... ... . inches
❑ Depth weeping from side of observation hole .. .. . inches
g Depth to soil mottles60,7-,60inches
n 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
observed throughout the area proposed for the soil absorption system? yPS
If not, what is the depth of naturally occurring pervious material?
Certification
I certify that on t✓ 9Y (date) I have passed the soil evaluator examination
approved by the apartment 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.
DEP APPROVED FORM-12/07/95
Date
Environmental Field Services, Inc.
P.O. Box 518 Leeds, MA 07053
(413) 586-7200
FORM 12 - PERCOLATION TEST
Location Address or Lot No. Cie l s ]tiLQA , � 1E k , e g
COMMONWEALTH OF MASSACHUSETTS
)4)— >y'40,.., Massachusetts
Percolation Test`
Date: Cs fS/97 Time:, marn,. +hn
Observation Hole #
Depth of Perc
St "
If
Start Pre-soak
/0 '2U
/a -'33
End Pre-soak
/6 f,3y,
Time at 12"
/0 .' s—
/o/
Time at 9"
28; E r
Time at 6"
/0 "//
//-' OS-'
Time (9"-6")
-7
p
Rate Min./Inch
rV
Minimum of 1 percolation test must be performed in both the primary area AND
reserve area.
Site Passed NI Site Failed ❑
Performed By:
Witnessed By:
Comments:
777 L 9k25?Z -E
r S•—/cti A_
DEP APPROVED FORM-12/07/95
Environmental Field Services, Inc.
P.O. Box 518 Leeds, MA 01053
(413) 586-7200
-_.._. ._ FORM 13 PERCOLATION�tr-
e rl ...sas.'-•Su c, e�.r,'.._". tocstim ... "-'.` _...
{ ) �
. _ q ltp 1 Y
I COMMOSMEALTITIOF 14TASSACHCTSETT§
' 1. •Massachusetts
/
Percolation Test'
Observation H
D.p.of .re • S T 67 4 5
_
Icy Stan Pro-soak
•
. End Pre-soak
3 -
re:,.Ir
t /
rum at s•
trne at 6'
i;
_ rem 0'-6.1
•
•
"'.I��YtsnM/y,irob�.tsit mrtG /WStam.dP bwh.Nyrkbyy nsi AND...
ifsw.vw
.nom. Sbe pssp; � SNe F,i3O ❑
Witnessed By:
comment::
_. _ .:\—
•
wry ,
'V .
1oAA
On- i,f`e Ifrview -
Location Address or Lot# L.,.(y. fYV-/f , J "CJ C ' kJ4-I--._ '_ ' /rz.P r -0- ••• j :,•
Deep Hole Number Date
r6° �/ 4 7 Time /d - eather
Sal Texture
(USDA)
Location(identify on site plan)
-. Seri tax
(Must)
Sot -
Moiling
Land use
'� t r _ <.� I Sitibe(%) I I Surface Stones
I/
Vegetation
n)11,
/
/J
Landform
Position on landscape(sketch on the back)
Distances from:
( // y
Open Water Body
feet
Drinking Water WS
feet
Property line
.---4/' '
feet
Possible Wet Area
//y-0 / feet
Drainage Way
feet
Other
feet
DEEP OBSERVATION HOLE LOG'
Deep Hole is IMIRWUM OF TWO HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA
Depth from
Snare Sates)
Sol Hodson
Sol Tease
(USDA)
SOP Cda
(Mosel)
Sd
Modng
Other
(Shaw%Stones.Boulders.Consistency,%Gravel)
i1 c/�)e
i
L
,) . i
z--
c>9),A))
'r-• /
■
i
f
1
f.��A-°✓✓ S .
L
PPM MMtlbesba) I r•
J Deal Beloot I
DrgtbyawasMer. St nag Weevil the Hob I Weal.boat Plisse I
aimed Samosa!WO Ground wabr . ... . • /4e
DEEP OBSERVATION HOLE LOG'
Deep Hole k 'MINIMUM OF IWO HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA
Depbboa
Surface Orates)
Sol Haimn
Sal Texture
(USDA)
-.
-. Seri tax
(Must)
Sot -
Moiling
Other
(Stebe.Stones,Boaters.Consistency.%Graw)
I/
l
f_„
—
_
/
/J
/c
S
� "
/A A
/1-.4 //
( // y
Abut •emu
• Depth Is groundwater
'-
SMndng Water the Hole
" -.; ....�... .
Matto YOn Pt Fare
,.,/-1. —
EtsteJSeasasl • Ground Was