46 Soil Eval Form 1999 •UKJI I I - SOIL I \ Al Al OR I.OR\I
Paec I of 3
No. Dale: 5-4 -9 q
Commonwealth of Massachusetts
NO PriAMe i�N , Massachusetts
Soil Suitability Assessment for On-site Sewage Disposal
Performed By: '�'.�,c" A.7; U\9..A Cs—) k3*%`S Date: ,j C - ?g.
Witntsaed By: 17C=9,_ )-i2Al -CStlV"j
5ov EElGki PAC POLLIS - ' h QE L6 to Solt-OSolt-OE-217-5�, .- Lit la ScSoL-14gq`�(��a� Rl�
Iew construction Q�Repair ❑ w P � ' �' CL
fart C17 Boo/
Once Review 7
Published Soil Survey Available: No ❑ Yes •
Year Published In/ Publication Scale 11' / 7° 076 S it Map Uni
Drainage Class Mad."' / OA/ Soil Limitations sl VR°e1��^-oD�Aj
Surficial Geologic Report Available:'No ❑ Yes ❑
Year Published
Geologic Material (Map Unit)
Land form
Flood Insurance Rate Map:
Above 500 year flood boundary No ❑YYe/es
D� IJ
Within 500 year flood boundary No Yes ❑
Within 100 year flood boundary No ❑Yes ❑
Wetland Area:
National Wetland Inventory Map (map unit)
Wetlands Conservancy Program Map (map unit)
Publication Scale
Curreer Water Resource Conditions (USGS): Month
Range :Above Normal ❑Normal ❑Belc Normal LJ
Other References Reviewed:
DES y'YkOvtn oa.1 07:9$
Deep Hole Number
41
Location (identlly on site plan)
Land Use V AC-RN
Vegetation _.G(ZSS
Land form
Position on landscape (sketch on the back)
Distance: from: r
Open Water Body 7/Od feet
Possible Wet Area < /eo feet
Drinking Water Well A)lp feet
Date.
tUKII It - BULL t■ ALUAIUR FOF
Fag(
On-site Review
5"-&—q9 rime:
Slope
%)
Rv�
5-7 Surface Stones
Drainage way 72o0 feet
Property Line /J. feet
Other
Weather eLn1/4..
DEEP OBSERVATION HOLE LOG
0e0m (torn Surface son moon San Tenure
pncnev IUSDAI
•
0 — / 2" A /.
12 - 24 B !
Son Cab,
IMunselll
Sad Morteng
tAix
Q611 0 .� c0/+2,56
Srt.litsgV ,
J'YR
t`OyR 1„
Otha
ISvucture.Scan,. ewkers,
Canssiener. % Graves
lccX€_ — S0-ok
v la+a
Parent Material (geologic) 5.Pa,-)`1-"
pepth to Groundwater:
Depth to Bedrock: /O<
Standing Water in the Hole: NC eeping from Pit face: )W J-E
Estimated Seasonal High Ground Water:JVGeUC
rul< 1 11 • Duu- Ltru.4A1UK ru.
Pag
On-site Review
Deep.Hole Number ° Date: s-(.p-gy Time: FM Weather CLc.= e
Location (identify on site plan)
Land Use UC/�CA� I Slope l%1 C9e Surface Stones NatS
Vegetation _6',o_-
Landform
Position on landscape (sketch on the back)
Distances from: • / .
Open Water Body -710c) feet Drainage way 'ZD feet
Possible Wet Area't oo I feet Property Line 2 ) —feet
Drinking Water Well ill/itor feet Other
DEEP OBSERVATION HOLE LOG
Deotn from$wbc• I $011 Horan
Poems)
Sari Texture
IU$DAl
•
5041 Calor I $01 Movenp
.[Munson)
On.
IStructura. Stones. Boo k.rs.
Consistency. % Onvei'
- ter A ( 5/t
a-.24- )- a 5/L
.x
a� n.
-�;y C FGPcSE
4431 &Of
/6yR ' +$. �odse
Q `r-/G NAP. (asp a_bio
2,S y 4/3 /JIB k St
�Jocis-r `
Parent Material (geologic] SA..L Depth to Bedrock:'d\k�,,er
Depth to Groundwater Standing Water in the Hole: ij0'L'4"—Weeping from Pit Face:Ai-A-'--
Estimated Seasonal Hrgn Ground Water: /UOVG
Location Address or Lot No.
FORM I t - SOII. LA MA A IOR FORM
Page 3 of 3
Determination for Seasonal High Water Table
Method Used:
❑ Depth observed standing in observation hole ,N1 /°' inches
❑ Depth weeping from side of observation hole N` inches
❑ Depth to soil mottles ti/fr inches
❑ Ground water adjustment ._ . ..... feet
Index Well Number
Adjustment factor
Reading Date Index well level
Adjusted ground water level .
Depth of Naturally Occurrina Pervious Material
Does at least four feet of naturally occurring pervious material exist in a I areas
observed throughout the area proposed for the soil absorption system?
If not, what is the depth of naturally occurring pervious material?
Certification
a
I certify that on /l (date) I have passed the soil evaluator examination
approved by the Dep rtment 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.
Signature �� {r_�4- -pate St)0—` 7
OEP APPROVED FORM. 12/07/95