41 Soil Eval Form 2003 COLD SPRING ENVIRONMENTAL
CONSULTANTS, INC.
ALAN E.WEISS,M.S.,L.S.P.
Licensed Site Professional
legislated Sanitarian
iyydrogeologist
r sident
•Subsurface Investigations
.21E Site Investigations
Rd. -Pollution Rcmediation
\01007 •Percolation Tests and
4 323-4916(FAX) Septic Designs
Commonwealth of Massachusetts
j,-)c-g-rt e,p-te„ , Massachusetts
Soil Suitability Assessment for On-site Sewage Disposal
FORM 11 - SOIL EVALUATOR FORM
Page 1 of
Date: ,z/z/c?
Performed By
Witnessed By
7,
Date ,z /t- I c'>
LoTacion.tidal a
UN I
• / $fNt2 Cant
Z
New Construction I I Repair Q
nwo,.and
T kgom I
J AE, FL aim I !Li C
v ( 5 IZFJCe LA .
t-Gccc. C O /CC,
Office Review
Published Soil Survey Available
Year Published 19 $(
Drainage Class RAPID
Sudicial Geologic Report Av
Year Published
Geologic Material (Map Unit)
Landform
Flood Insurance Rate Map:
Above 500 year flood boundary No
No n Yes
Publication Scale I;ISgya
Soil Limitations /./IA
lable: No E Yes
Publication Scale
Yes H
Within 500 year flood boundary No es
Within 100 year flood boundary No I'r`es
Wetland Area:
National Wetland Inventory Map (map unit)
Wetlands Conservancy Program Map (map unit)
Current Water Resource Conditions (USGS). Month
Range :Above Normal Normal Bel(•v Normal
Other References Reviewed:
ner APPROVE])ftRM-t L07r95
Sod Map Unit Hi A
tion Address or Lot No.
;r;,,., La
FORM 12 - PERCOLATION TEST
COMMONWEALTH OF MASSACHUSETTS
ly,; (7,, h , Massachusetts
Percolation Test*
Date: . Mb763 Time:,
bservation Hole #
i
__pth of Perc
/r
lit
Lit ,/
art Pre-soak
/ Zn
„
P� `
id Pre-soak
CAJ
ne at lz"
/ Z
C4 1/
ne at 9"
ne at 6"
ne (9„-6.,)
Z
to Min./Inch
Ca
Minimum of 1 percolation test must be performed in both the primary area AND
reserve area.
assed [Site Failed
med By: ,g. ��,S S
ssed By: ,P. r"4 e [ 47t,5..v
cents: _ S.. Lk..
DEP APPROVED FORM-12107195
FORM 11 - SOIL EVALUATOR FORM
Page 2 of 3
[ion Address or Lot No t1(.
(.Q
On-sit e Review'
C—{ n
`
Hole Number zDate: ! 2
a-i 2. t3 Time: i - 3c,
on (identify on site plan) Weather
Slope Surface Stones Afe
_... _.
anon �s
Irm
c
et on landscape (sketch on the back)
ces from:
Open Water Body IK .L feet Drainage way j feet
Possible Wet Area ice' - feet Property Line 3C
Drinking Water Well rdrt "t feet
feet Other
DEEP OBSERVATION HOLE LOG'
3. "f
1 from
;Inches)
v
oil or on
Soil Texture I Soil Color
(USDA? iI IMunseill
(0Y41
25 �3
Soil
Mooing
Oner
I (Structure.Stones.Boulders. Cansimeney. %
Grave„
ft\ ,b4 , Io( r
00-11,x5to Lcc jjf then-(e‘
Sr}N>.
1-7. S.,1ct 4-stews (+ft/)
NIHIMUM U} 1 HOLto HEUUIHEO A 1 EVEdY PHOPOSdj DISHOSAt Aq
etntaL+4
rial (geologic)
undwaren Standing Water in the Hole:
asonal High Ground Water:
DEP APPROVED FORM•12'0:195
/ Ir
DeptrtoBedrock: JJZ '1J
Weeping from Piz Face:
01 a
Location Address or Lol No. y/
Determination
Vlethod Used:
FORM 11 - SOIL EVALUATOR FORM
Page 3 of 3
or Seasonal Hi-h Water Table
Depth observed standing in observation hole....
r��Depth weeping from side of observation hole_ inches
'f Depth to soil mottles S i inches
ruches
Ground water adjustment feet -
idex Well Number
.djustment factor . Adjusted ground water level _. _.._...
Reading Date Index well level
th of Naturally Occurrin. Pervious Material
Does at least four feet of naturally occurring pervious material exist in al)
observed throughout the area proposed for the soil absorption system? ,� areas
If not, what is the depth of naturally occurring pervious material?system?
rtification
certify that on-1rS (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• 12/07/95
Date