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361 Soil Eval Form 1999 � N I FORM I1 - SOIL EVALUATOR FO Page 2 Location Address or Lot No. _3 / Sy )h*C0t41l. kjui On-site Review Deep Hole Number /"(rod. Date: (c/D/QQ Time: moo iu lyL Location (identify on site plan) n Land Use lA.) 6B-S O Slope 1%)a1-4" Surface Stones ?£�, Vegetation Cfrhc-tx Land form Position on landscape (sketch on the back) SO SO Ch Weather f)CLUL. Distances from: Open Water Body >/C Possible Wet Area >/Ca feet feet Drainage way >'S Property Line >20 feet feet Drinking Water Well >/06 feet Other W 1111 i SY lvcrl<. _ k... DEEP OBSERVATION HOLE LOG. Depth from Surface(Inches) Soil Horizon Soil Texture (USDA) Soil Color (Munselll Soil Mottling Other (Structure, Stones, Boulders, Consistency, X Graven 0 — I.9 '' I3"- 3o " 30"- Lao" A a C 5L SL LS iovae„a)aL),Jue loVRyfy asvgl3 bone >S90 6 YR3/y x'84" top So) l 5c(bso7 I O_ ).)^ J671/- jU" aU°- IaO" P 13 a 5L. SL L,S /oYe 33 lovey/y d.5Y 4/t/ AJcJKQ tocnk_e 75 o /DYQ .5/l a-YR aly @Sy 1r fopsoi I sub5oi I ' MINIMUM U7• t HOLEb REQUIRED A I EVENT PRUpuSNt LlspnSel Rcn Parent Material (geologic) ()t A41 t 7 n ch Dept toBedrock>I a 0" ''—I 4011 Depth to Groundwater: Standing Water in th e,Hole: 1::)r Weeping from Pit Face: Estimated Seasonal High Ground Water: y "3 C.€141 DEP APPROVED FORM, 11fO f95 Environmental Field Services, Inc. P.O. Box 518 Leeds, MA 01053 (413) 586-7200 No. FORM II - SOIL EVALUATOR FORM Page 1 or 3 Date: Commonwealth of Massachusetts /Oorin m p1O9Massachusetts Soil Suitability Assessment for On-site Sewage Disposal Performed By: YVl`I'C.hC..Q / _Loll1 c'AJC _... . Date: 61/9/9 9 Witnessed By: Pe. r nr) °E1l0.LfU m,aAma.a. 3(0 / Sy /ue3tfr Ad Lotd New Construction ® Repair ❑ a-„Marne. 1-71IV Geary Aden,.•^d c S' Mr SSU So+t St • Tei.Pbel /rate Pleasant, my o13,/9 Office Review Published Soil Survey Available: No LI Yes ❑ Year Published Drainage Class Publication Scale Soil Limitations Surficial Geologic Report Available: No ❑ Yes ❑ Year Published Geologic Material (Map Unit) Landform Flood Insurance Rate Map: Above 500 year flood boundary No ❑Yes ❑ 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 Soil Map Unit Current Water Resource Conditions (USGS): Month Range :Above Normal ❑Normal ❑Below Normal ❑ Other References Reviewed: DEP APPROVED PORN-12/0719S Environmental Field Services, Inc. P.O. Box 518 Leeds, MA 01053 (413) 586-7200 FORM 12 - PERCOLATION TEST /7 Location Address or Lot No. 3 (o I S lu-w In Rd. COMMONWEALTH OF MASSACHUSETTS Icuillict/nhI ix), Massachusetts Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed Site Failed ❑ Performed By: t C h n i I (AQ(Sic 'lA Witnessed By: Ix_'i--P r I r l e FA \ G uyU Comments: DEP APPROVED FORM-12/07/95 Environmental Field Services, Inc. P.O. Box 518 Leeds, MA 01053 01131 586-7200 Percolation Test' Date: (a// 7/99 Time:,MOVY) 7n J Observation Hole # P_ / NN P- 3 Depth of Pere o_ rr Go„ Start Pre-soak / ' . C>C End Pre-soak I I , I ) 1,. 33 Time at 12" II - 15 I1 - 3 .. Time at 9" lI ' a I • J/i 37 Time at 6" Time (9"-6") /7 / Rate Min./Inch 3 3 . Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed Site Failed ❑ Performed By: t C h n i I (AQ(Sic 'lA Witnessed By: Ix_'i--P r I r l e FA \ G uyU Comments: DEP APPROVED FORM-12/07/95 Environmental Field Services, Inc. P.O. Box 518 Leeds, MA 01053 01131 586-7200 ■ FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No. 3(. ' j ) 3 btc Ry a Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole inches ❑ Depth weeping from side of observation hole _ inches © Depth to soil mottles `5qii .1$// inches ❑ 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 observedlthroughouttheoareatproposed occurring forthe pervious oil absorption lsystem?In_ all_areas If not, what is the depth of naturally occurring pervious material? � Certification > // I certify that on I C/ `r (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•1110995 Date 7/.20? Environmental Field Services, Inc. P.O. Box 518 Leeds, MA 01053 (413) 586-7200