538 Soil Eval Form 2001 Location Address or Lot IJo
FORM 11 - SOIL EVALUATOR
Page
508 SgIuejb Rcxx_d
CNe�ec�� do G-e-fed
O/1-site Review
Deep Hole Number 1) 2 Date: Cf , p2//- I Time:MCLI/ULni Weather w, t Yh
Location (identi/n((�y on site plan) SL2-e- fLILCc-cl
Land Use t.�C�l� Slope (%1 /— L/ Surface Stones h-pa•->_ I
cj v-uSS
Vegetation
Land form
Position on landscape (sketch on the back) 4 e ‘k-
Distances from:
Open Water Body >1°() feet Drainage way >VC)
Possible Wet Area >,00. feet Property Line ?,..La
Drinking Water Well >(C)0 feet Other
Ste',ea`
feet
feet
meal
DEEP OBSERVATION HOLE LOG'
ry/Ye-)'CI zon-c
Depth Itom
Surface(Inches)
Soil Horizon
Soil Texture
(USDA)
Son Color
(Munson(
Soli
Mottling
A
b
ft
C ,
SL
S0
SL
SL
SC--)
S
CF-m)
ADOkle
Avon e
AJo not
Leo-ted
uo
$Jou-C
/untie
)(Do1 d
Other
(Structure,Stones, Boulders, Consletency
Gravel)
t XJ I 1
Subsoil 1
inp3o° 1
Si &?
cx3�
UM OF 2 HOLES HELIUM ED AT EVFHY I•HOPUSRU UISVUSAL AN EA
Parent Material (geologic) Ot / ` A nl`h p-
p
Depth to Groundwater: Standing Water in the Hole. ar), /'j
Estimated Seasonal High Ground Water plp '/ 6
DEP APPROVED FORM•12/07/95
3nc_)
z, t- r tab(x
DepthtoBedrock: ? 11 / '' 7 1,30/1
/
Weeping Irom Pit Face: 11 90
Environmental Field Services, Inc,
P.O. Box 518 Leeds, MA 0105
14131 586-7200
No.
FORM 11. - SOIL EVALUATOR FORM
Page 1 of 3
Date:
Commonwealth of Massachusetts
lOor '{1ro ij Massachusetts
Soil Suitability Assessment for On-site Sewage Disposal
Performed By: 01°1 C hex.e 1 L cx-V) c tit�-
Witnessed By: 1P e + P°— Plc el\c
Date:
�I-aN-o i
308 °3jive t,ti t?crd
(Nea Lo'z sc 0, 1e.00
New Construction ki Repair ❑
O"'"`"Name. Si-C.0 cRuuCaliCt
Am.....M
1e,vnw.r Pa P,O I Ill
LeCCh mA
ssr'- cl3v9
otoS 3
Office Review
Published Soil Survey Available: No ❑ Yes ❑
Year Published
Drainage Class
Publication Scale
Soil Lint italions
Surficial Geologic Report Available: No ❑ Yes ❑
Year Published
Geologic Material (Map Unit)
Land Conn
Flood Insurance Rate Map:
Above 500 year flood boundary No ❑Yes n
Within 500 year flood boundary No ❑Yes LI
Within 100 year flood boundary No n Yes 1
Wetland Area:
National Wetland Inventory Map (map unit)
Wetlands Conservancy Program Map (map unit)
Publication Scale
Soil Map Unit
Current Wafer Resource Conditions (USGS): Month
Range :Above Normal. DNormal El Below Normal ❑
Other References Reviewed:
nEP nVVROVED FORM• 12107/
Environmental Field Services, Inc.
P.O. fax 518 Leeds, MA 01053
(413) 586-7200
FORM 12 - PERCOLATIO.
Location Address or Lot No. Mt. /672 a2 S—a8
COMMONWEALTH OF MASSACHUSETTS
A1orTho. W1pIv Massachusetts
Percolation Test'
Date: //a WO /
Observation Hole // P
Depth of Pere 'Jr 6-(3 "
Start Pre-soak
(7J' l0 Jeg
.End Pre-soak .5
to : 13
Time at 12"
953 i0 ,ig
Time at 9"
q' -5 (9 _ 10 ; ) 9
Time at 6"
16 , DO
Time (9"-s")
Rate Min./Inch A
Minimum of I percolation test must be performed in both the primary area
reserve area.
Site Passed ® Site Failed [11 Performed By: f 1 C,7 C/P I (Qt i gti Q
Witnessed By: - k--)42-tRA._
Comments:
DEP MPRO V80 rORM-1110795
•
Environmental Field Services, I
P.O. Box 518 Leeds, MA 01
(4131 586-7200
FORM 11 - S011, EVALUATOR FORM
Page 3 of 3
Location Address or Lot No. /(few //La ls7od /i"errjei-, 1 -
Determination for Seasonal High Water Table
Method Used:
M Depth observed .standing in observation hole eh, '1' inches
reg Depth weeping from side of observation hole 861`20 inches
1 1 Depth to soil mottles inches
LI 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 four feet of naturally occurring
observed throughout the area proposed for the
If not, what is the depth of naturally occurring
pervious material exist in all a eas
soil absorption system?
pervious material?
Certification
1 certify that on ID ), C/ (date) I have passed the soil evaluator examination
approved by the apartment 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
REV ArrnoV'rn FORM•.1110119f
Date ,S / O /
Environmental Field Services, Inc.
P.O. Box 518 Leeds, MA 01053
1413) 586-7200
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