244 Soil Suitability Assessment & Plans 1999 No.
FORM 11 - SOIL EVALUATOR FORM
Page 1 of 3
Date: A/9 -9?
Commonwealth of Massachusetts
Nt,zi.e,wrhs_ , Massachusetts
Soil Suitability Assessment for On-site Sewage Disposal
Performed By: Y✓1 i c ha e./ ,(a U,9 ti Z
Date: 3 -3o-9q
Witnessed By: Pe +Qt- m t e.r/a i sO
a.w
AM...a & J Hay-demolieRd
New construction ❑ Repair
oh,&) ill IgetiUa
p7 iSCut-beryl LM e
( aidefP, Vn oi372
978-.5 yt/- x,393
Office Review
Published Soil Survey Available: No ❑ Yes ❑
Year Published
Drainage Class
Publication Scale
Soil Limitations
Surficial Geologic Report Available: No ❑ Yes ❑
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 ❑yes ❑
Within 100 year flood boundary No El Yes ❑
Wetland Area:
National Wetland Inventory Map (map unit)
Wetlands Conservancy Program Map (map unit)
Publication Scale
Soil Map Unit
Current Water Resource Conditions (USGS): Month
Range :Above Normal ❑Normal El Below Normal ❑
Other References Reviewed:
DEr APPROVED FmUI•I1(07/95
Environmental Field Services, Inc.
P.O. Box 518 Leeds, MA 01053
(4131 586-7200
CORM 11 - SOIL EVALUATOR FORM
Page 2 or 3 •
Location Address or Lot IJo. ay(' /kid L(l tt41 I%1 ite Rd
On-site Review
Deep Hole Number ti.t.Q. Date33P-LIq Time:mOrn-LA119 Weather
Location (identify on site plan) 'SB-e Pad . ...
Land Use l asp^... Slope 110.2-S— Surface Stones tiatw
Vegetation 9`?Sr.e-r 1 L.)1_ILL p /t--r-- ._.
Landform .. _.._ _..
Position on landscape (sketch on the back) S4X wit Ch A141,-__
Distances from:
Open Water Body >100 feet Drainage way >/oe feet
Possible Wet Area >/00 feet Property Line 7'/Q feet
Drinking Water Well -7/00 feet Other
DEEP OBSERVATION HOLE LOG'
Depth from
Surface (Inches)
Soil Horizon
Soil Texture
(USDA)
Soil Calor
(Munson)
Soil
Mottling
Other
(Structure,Stones. Boulders, Consistency, %
Gravel)
6- 10"
l0/'A1o"
dO"- 36'
3," l 08'
F
fi
413
C
Z
SL
5L
LS
L
icy e 3Ia
/ove.y/G
lovey/a
Z.
/voice
/V(iil.F
,O -M
eV-v"
-fDpst)i /
Sub3o1I
b- 10"
lb"-3O"
30"- ic3'
q
(j
C
SL
SL
S
io1 3J3
foMRLII,
lows
l
time
°/o
mY/5/6
62 IN"
ioyso; l
sub`t))1
DepthtoBedmck:= /C-A53 ri = I0�
Parent Material (geologic)CA iQ `\
Depth to Groundwater: Standing Water in the Hole: /Oar / 96" Weeping from Pit Face::5241 qv,/
Estimated Seasonal High Ground Water: 5 44 " £
DEP APPROVED FORM- 11/07195
Environmental Field Services, inc.
P.O. Box 518 Leeds, MA 01053
(413) 586-7200
FORM 11 - SOIL EVALUATOR FORM
Page 3 of 3
Location Address or Lot No. J /(? /10.0 (I r'A ) U kni
Determination for Seasonal High Water Table
Method Used:
El Depth observed standing in observation hole _. inches
❑ Depth weeping from side of observation hole _ inches
® Depth to soil mottles?-yigyi% mches
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 tour feet of naturally occurring pervious material exist in all areas
observed throughout the area proposed for the soil absorption system? \1_ft
If not, what is the depth of naturally occurring pervious material?
Certification //
I certify that on 11 ' 97 (date) I have passed the soil evaluator examination
approved by the Department 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•1210'195
Date -7199
Environmental Field Services, Inc.
P.O. Box 518 Leeds, MA 01053
0131 586-7200
FORM 12 - PERCOLATION TEST
Location Address or Lot No.di-go Way A) t/1 ' /f Rd
COMMONWEALTH OF MASSACHUSETTS
z1hanp anti , Massachusetts
Percolation Test"
Date:3-30 -Q 9 Time:.mC7rNly q
V
Observation Hnle ft
p '
Depth of Perc
SD ('
Start Pre-soak
11 ;18
End Pre-soak
) l 1 35
`2J
at 12"
1f' Z`JV
•
Time at 9"
1it 39
Time at 6"
HIV?
Time (9"-6")
Rate Min./Inch
Minimum of 1 percolation test must be performed in both the primary area AND
reserve area.
Site Passed ® Site Failed ❑
Performed By: rn 't C hci f /
Witnessed By: U�*Ff C (MC Pr la I Jv
Comments:
DFP APPROVED FORM.Ii/E7/95
Environmental Field Services, Inc.
P.O. Box 518 Leeds, MA 01053
1413) 586-7200
Rpr 30 02 05: 24p Barbara Demerski
413-584-2e08 p. 2
No. % I THE cam OMWSALTH OF MASSACHUSETTS Fe[ A.IC
/BOARD OF HEALTH ir
CERTIFI ATE OF COMPLIANCE. Abide: au/ stO °,n
, (Indirideel Convent-00s) 0 Complete System fir „Pt.
The oedern tray arlity t'beSewage Disposal System:Constructed( ).Repaired ).Upgraded g).Abandcucd(
p c.et Wotic
by:
TfJ Xlirri�gy{IIJ
' . with- si.. Jlt 71,1
A n w.4sn
has been caste .N actor
plans telattng)wppit_4
Installer
Designerrl.-
&'.4 Indped
(I121c 5)and the applSoved des rg3UC1 n pians/as-built
A*goapd Dedign Flow' i(pad)
The b4.4....of Ma.warm..Oa ea b.mead e.a W.rads*ghat ewten N('steam ea ghaa9nd
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