95 Soil Eval Form 2005 3.
FORM 11 - SOIL EVALUATOR FORM
Page ! of 3
Date:
Commonwealth of Massachusetts
, Massachusetts
Soil Suitability Assessment for On-site Sewage Disposal
r i m m e d B y 40/901 S;492-efr7/ lizyfriCe ,y Date: IS/75—
itnessed By: ---a.--/€14427-7??.,zzw-1,2 a.a.xY •
ion Stenz
.95" _,Tiives 4 neeme
NO2 4,-.7,0 tasti
ConstructOn 0 Repair 0
0—I Na 4/-)/cc- nrn
to--, ?r c5/cti-e>-- /,
A/02)1,1/21-rifi
fflcSmvi
a:dished Soil Survey Available: No El Yes a"---
ear Published Publication Scale
ainage Class Soil Limitations
irficial Geologic Report Available: No 0 'Yes
ear Published --
cologic Material (Map Unit)
inclform
Publication Scale
Y/a3t
Soil Map Unit
ood Insurance Rate Map:
bove 500 year flood boundary No
0Th
rithin 500 year4lood boundary No EN; 0
"thin 100 year flood boundary No Ell; 0
retland Area
ational Wetland Inventory Map(map unit)
retlands Consavancy Prop= Map(map unit)
urrent Water Resource Con9ions(USGS): Month
ange :Above Normal Normal 0Below Normal
ther References Reviewed:
DC AITROVICO FORM•MOOS
Percolation
015/7a-PS
.3sa _ 4'°8
feat No. (
leading Time
saturatiiyyon( 15 min) 0,/f/ %R S
z/3 - , ce6
Strri
'ere Rate ;o .5 1/
:round Elev. !
Iepth of Hole ,? 2
Teat
Test No.
Rending Dine
Saturation ( 15 min)
131 /0 (1.
Pere . Rate,
Ground Blev.
Depth of Role
Cc4/55I5cJlce
yy� ��. D/P ep Teat Plt/s
'set Pit /� �-/ f{i 4 L.—._ Teat Pit
;e th Soil Description Depth
—e • ton e_mo"t l
0—/O 9r dte gY,^wtf,SCE r 1-49
d-/„7n Gtcn// Y9 acted rt
Min/inch
Soil Description
;roundwater Depth tt//%Elev.
;edrook Depth Elev.
;round Elev. p/ iu/T
;.0.S. Soil Descriptionfr
Groundwater Depth.
Bedrock Depth
I /crcJ/n�°1G Ground Elev.
` -�/
Seasonal High .Water Table?/' ti° 60d"
Elev.
Elev.
tench Hark: Elev. Description
'AMHENTS :
Pu
c /
(late :
Client :
44//y/or-
40
L
CO is
4 7725 ✓ 1
Engineer: to ni
Witness: / /x7.7-)71/F4[.1
Location of Pere :
reyd/14 y 424)4(
D,E
FORM 12 - PERCOLATION TEST
ocation Address or Lot No. 9S c ////,ES/`ZA-Le
COMMONWEALTH OF MASSACHUSETTS
Nth/A- "k._, Massachusetts
Percolation Test'
Date:
41/41.4
Observation Hole #
rt/`/
Depth of Perc
6_,,, //
Start Pre-soak
99 y
End Pre-soak
3s0 -_ 4108
Time at 12"
!/[pry
W/1/ WD
Time at 9"
4/0
Timeat6"
it / a.
O 0 /-/
time (9"-6")
Z-/ o
3 , 6
Rate Min./Inch
6-2 O
C//1-5S C 5o/L (cc ".Se%cra '/o V Ito/,
• Minimum o percolation test must be per armed in both the primary area AND
reserve area.
its Passed
erformed By:
Vitnessed By:
Iommenta•
S
Site Failed ❑
P-M7 3io cititt./s7-2/
Ai✓llmh/ 4,1/2-v77/ y'.E £ t 1/6‘..&
4T in/47x1/ 4Azt.� 111
bQ APPaoVi FORM-i21715
nation Address or Lot NO. . ,
(%).. - " y
On-site Review
/�/ / 0r
5-)07
oep Hole Number ._. O t l .— ikne //9/ j�O ,
W5 i _ an M _— C-00C
0C
*tenon(Identify an on.Olan r /PG " lnnp / Ory n G p (((
land use ' / slope %1
Unlace stones
.nd We_i. "• 1 slap.Ixt.. , surlsa sto •
' ornl /T(s.T _ . vxeu
don / n441/41 esalnlon _ ! G ej l/ �. . - . Unarm Or J ne
i)Q
S f Ferro"
°Son on landscape(sketch on the bed) j • , Mahlon on landscape HkHGex the bvH
/ tL
.news.horn: / Distances
Open'Water sady/''nn�� feet Unitas wW ='a•`
Open Water Body Lr lest- Dtetxyi w _. lest Passible Wet Arsel -1x1. Prep.ny ux'._� bal
Possible WeTAre�G0 : Ibt Property Line. -..__ lxt , Drinking Water Wall— lest Other
DrinkinY W•tp WON _ / et Othw .:_-_�_: / /6A C
/242/0/ �— I . .
0 . pEEW 08SEpVATION HOLE LOG' ,•
DEEP.QSEBVATION I10LE LOGI
' B• oew One,
a.IMob aJ Varlet Sall Taxon macaw aaa screw C..w..a.t
py..e M1pn IN Mwnm IN leilue Soli GW ' •ea avlwalNJ.e1. IOWA WMa•N Mn.tll laa"nn.'a'wla.drvM
an=tt..4 WapAll rM4eW 22nd Iaewuw mina.RM„y C..n..V.Y.
-/o '✓ °' 6'it .. .1,440/0 /'
Conelo
�. 66 Cop es C, ' jo0 /�
i° 4�G C / 3 i:cw i gar lso c4Er
m cpJ 'ri s t i-c--P
rxwaq o /C / .le cv
•wwuw aaa IU. F Al kWRY OPOb O � d/(/1+� ......., tawpd elontl/'Iv// "tee 0./k/./.r , , ��fl�//i�y•newwYtvena J �% ii s Ws.* P Sn anal, ' voter
ywtedn�HwaVe LarbgWwea.Nel. �ib'y WMN"meanlM1a.z ///C,�' Pre. .Mw.1.1 aWt1 W1tIbNlYw
Wwea Sown.Iris ow+wwn, Sind 4.w tarn amw widen -
~ e> E iwr Ae/G r-k! Yd o
y /�°
• eW urx.xxe.r;wren .meow.oars ,
•
Location Address or Lot No.
yj
FORM 11 - SOIL EVALUATOR FORM
Page-3 of 3
cJ/L c•cef tnz9
/VP iCflr 71 ' 2 M
Determination for Seasonal High. Water Table
Method Used:
pth observed standing in observation hole
Li P : •th weeping from side of observation hole
Depth to soil mottles inches
❑ Ground water adjustment feet
Index Well Number
Adjustment factor
inches
inches .
iztr ID cc -
iPC
Reading Date Index well level
Adjusted ground water level
Death of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all. araas
observed throughout the area proposed for the soil absorption system?
If not, what is the depth of naturally occurring pervious material?
Certification
I certify that on - J 9 (date) i -ve passed a soil evaluator examination
approved by the epa mentof Enviro %ental rot titan and that the above analysis
was performed by me consistent with)t� rep ired raining, expertise and experience
described in 310 CMR 15. 17
Signature
ate 11/03-
ars.u'rxev®IepM-itnrnf