11 perc test c-vNSULTANTS, INC.
ALAN E. N'ELSS,M.S.,L.S.P.
Licensed She Professional
Rcgisiered Sanitarian
Hydrogcologisl
President -Subsurface Investigations
IOId Enfield Rd -21 E Sim Investigations
cbenown.MA 01007 -Pallutlun Remedimion
3)323-595]@323-4916(34%) Septic laDesignssm and
Commonwealth of Massachusetts
Noti%aitofW , Massachusetts
Soil Suitability Assessment for Ora-site Sewage Disposal
AAL
FORM 11 - SOIL EVALUATOR FORM
Page I of 3
Dale: _l—g-O/
Performed By:
Witnessed By:
ALA.) ui ts_s
tEu E MPC11(1Ell■.
Date: 7- 8- -cc'
Lcca m
Ley 1k COL, 1Tt UJGA
%(ofe1/45z2 ,,J/
dew Construction L Repair L'7
yrd
r..,hn
J - 5oct 'iYRS
(1 Cc, W
Office Review
Published Soil Survey Available: No
Year Published 115 f Publication Scale
Drainage Class 0A1)1D Soil Limitations
Sudicial Geologic Report Available: No LJ Yes `I
Year Published Publication Scale
Geologic Material (Map Unit)
Landformr
Flood Insurance Rate Map:
Above 500 year flood boundary No LJYes LJ
Within 500 year flood boundary No LJYes ❑
Within 100 year flood boundary No EY s l
Wetland Area:
National Wetland Inventory Map (map unit)
Wetlands Conservancy Program Map (map unit)
Current Water Resource Conditions (USGS): Month
Range :Above Normal LNormal Ll Belt w Normal
Other References Reviewed:
Li Yes C5v
ZS,c e
DEP APPROVED)FORM-I//07/95
Soi! Map Lini! .� C
Location Address or Lot No.
FOR:1i 11 -SOIL EVALUATOR FORM
Page 2 of 3
On-site Review
Deep Hole Number 1+1
Date: poi Time: i11 qr‘ Weather RA ns spec
Location (identify on site plan)
Land Use flI( 'I Qty
Vegetation
2
Landform 1.(. kC-C (5,.,.e-
Position on landscape (sketch on the back)
Distances from:
Open Water Body 10o feet
Possible Wet Area 0 4 Drainage way So 4- feet
—Let Otheerty Line Sc -feet
Drinking Water Well (Co Cp feet Other
Slope ) — _Surface Stones 5a ne_•
DEEP OBSERVATION HOLE LOG
Soil Horizon
Soil Texture
(USDA)
Soil Color Soil Other
(Monsen) Mottling /Strucure.Stones.Boulders, Consistency, %
Graven
v- 57 " 6 �
32r=rzo'r C-
/20 rr-2C2° c-
Z• tits¢ I2c F'M . SA,uo` . (cos &
drab _. o i c.y
�+r
1112.Sy `ft 2
• l•.• . •II • •
Parent Material (geologic( b(i 5h
Depth to Groundwater Standing Water in the Hole: (Ve(-
Estimated Seasonal High Ground Waxer: /Zp'l
Depditoaedrock
Weeping from Ph Face: it"iGI-
DEP APPROVED FORM.120]!95
Location Address or Lot No. 1( [o
FORM 12 - PERCOLATION TEST
COMMONWEALTH OF MASSACHUSETTS
N� act �s1 oaj , Massachusetts
Percolation Test*
Start Pre-soak
Time at 12"
Time at 9"
awn
w ric
Entaispam
Minimum of 1 percolation test must be performed in both the primary area AND
reserve area.
Site Passed
Performed By:
Witnessed By:
Comments:
S'te Failed ❑
DPP APPROVED PORM.12/07/95
Location Address or Lol No.
RORM 11 - SOIL EVALUATOR FORM
Page 3 of 3
L I Ccau5 03.±i
Determination for Seasonal High Water Table
Method Used:
Depth observed standing in observation hole
L-1
,-,�D h weeping from side of observation hole
H"-Depth Depth to soil mottles /z(1.rr inches
iJ Ground water adjustment feet
Index Well Number .... Reading Date
inches
inches
Index well level
Adjustment factor _. Adjusted ground water level
Depth of Naturally Occurring 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 p
I certify that on (P 7 (date) I have passed the soil evaluator examination
approved by the Dep ment of Environmental Protection and that the above analysis
was performed by me consistent wii the required training, expertise and experience
described in 310 CMR 15.017.
pervious material exist in'al! areas
soli absorption system?
pervious material?
Signature
DEP APPROVED FORM- 12/07/95
ate 7%1 v
me te.oe g13Stlbbld7
6 J SOLDATIS PACE B?
-NOTE-
THIS PLAT IS+COyPREp FROM DEEDS, PLANS NC OTHER SOURCES MD IS FAITut
TO BE AN ACCURATE ACCURACY IS AND I$ NOT TO BE RECORDED.
BODING LOCATION ACCIRtACY IS NOT 6UARANIEFD
TO: PROPLfl SAVINGS BANA &
CONNOWEALTR LAND TITLE INSURNACE CDHRANY
10 THE BEST OF MY INFORINTRIN. KNOWLEDGE AND BELIEF
I IEREBY REPORT THAT I HAVE DAMNED TIE PRISMS AND BASED ON EXISTING
MOM MDITATION ALL V6UIE EMBLEMS. AND BUILDINGS ARE LOCATED ON
THE GROUND AS SIOIN AND THAT THE IRO.Y WITHIN THE LOT ONES,
OWCEPT AS NOTED. I FURTHER REPORT THAT THE PROP 6 NOT LOCATED WIT/in
ASP ONE NRA AS SOWN ON FEDERAL FLOOD NSURANOE MAPS FOR
r�
2501�6�7 J
SUpyEnOIRE F\A.) -5. Its -NOM-
THIS LMAT FO�IIpRT-NOMLOAI
AND DOES NOT CONSTITUTE A _
WORTHATtON. xASCADWUWrns
PREBARFD FOR
C1 I$TY s. c JEFFRRY J. SOLDATIS
SCALE: 'ea(OOI SEPTEMBER 26, 2001
12 EEApTFONNyAND A T$EVS},,WIG
235 RUSSELL SYREEt itti iY IIII�ApR Errs