41 Soil Eval & Site Review Location Address or Lot rlo.
FOFL■1 11 - SOIL EVALUATO
P,
/V LT
On-site Review
Deep Hole Number __L ... Date:7-4'fl Time: 3,73. Weather GLeyec
Location (identify on site plan)
Land Use 42Ek,3.'e attL._. .. Slope (%) . Surface Stones Q_>p. .
Vegetation L.4Lu,,'
Landform [-jac-R
Position on landscape (sketch on the back)
Distances from:
Open Water Body t 40 feet Drainage way NC feet
Possible Wet Area _./'D. feet Property Line I3 feet
Drinking Water Well -/ feet Other
DEEP OBSERVATION HOLE LOG'
C eptn fro,—
Surface (Inches)
Soil Horizon
Soil Tenure
(USDA(
Soil Color
(MunnIII
Soil
Marling
Other
(Structure. Scnes, Boulders, Consia
Graved
D To 1�
�%p �� '
h,,?_T.4D b
1r "
ye 7D
/17
{�
r
3v
9/
C
C ,
2%
��
�j
L
it
F-'e-
�!>
x y�
• v o•
a.>
y
'7•11 t1/3
Z.Y y //y
No
s +tS
a
5.A-17,
gryD1'
p
% •
I V _
9�E
6...fa.�.a v r carq-,-r
weary tIr€ . .4••• 1 1.54
F",oz N.•Py coR/Y 2ri
Las 4E
6,.E, s.r.epy ✓O i 34..00
/T¢.ry
Mf=t� 59•e 7f I,ea SLf S
b'-svz I.•
MINIMUM Oh 2 hOLca n-AtantD Ai c vtnt rn3Pvacu OEarC, ALnncA .
Parent Material (geologic'
C1 6111H}5
(Depth to Groundwater: Standing Y ater in the Hole: Cht4 V
Estimated Seasonal High Ground Water: t#D//
Oeothta Bedrock:
//7
Weeping from PIT=ace:
DEP APPROVED FORM-32:01195
FORM 11 - SOIL EVALUATOR FORM
Page 1 of 3
Date: --akt
Commonwealth of Massachusetts
POoaikapvdpA) , Massachusetts
Soil Suitability Assessment for On-site Sewage Disposal
grmed By: I1elcit_•^-,...? /2- Al Cies -e se
tessed By: a. nit 5/14,iiai•
Date: .
....euess
construction E Repair
onff et 't
mktal'an3 I l l 0 I-a
Te.leMprz/
. 61anti -1),)077•.•-•1 "14 0 704t
e Review
shed Soil Survey Available: No E Yes ;E. •
Published Si__ Publication Scale ici/12 /0 Soil Mao Unit Ygibus
age Class watch. Ana,— Soil Limitations
kia FintaLtaci:c5 ............-
:fa! Geologic Report Available: No E Yes 7
Published Publication Scale
eic Material (Map Unit)
b= ..0.0714cie ..1.17kelt/4
Insurance Rate Map:
500 year flood boundary No Syes
500 year flood boundary No OYes Z
100 year flood boundary No CI Yes
ad Area:
tal Wetland Inventory Map (map unit)
Ids Conservancy Procam Map (map unit)
it Water Resource Conditions (USGS): Month
:Above Normal EINormal Sn Below Normal El
References Review :
DEP APPROVS)FORM- V07:95
,6'21 i"vt/?j a.-7 C;)
.6'z/ hvyN
d'o ( h
rd.1
18 tAipik O
. .y
a _
s � .?/b7 S o1 1ofy
Y d
"O
. \
tar•nav"J
uIb.I -c.a.)
r.al(na1'-b
ation Address or Lot No. y/ CC 7
FORM 11 - SOIL EVALUATOR FORNI
Page 2 of 3
1'Eaev lZ�
On-site Review
p Hale Number 27._. Date: 7-4-..14 Time:. J: id Weather ec.C9t-
ation (identify on site plan) - ..,__..,__ _....-.,,.___..._...,;,�,. ..
d Use e�cs aSZEtiZr! ... -. Slope (%) / . Surface Stones v......_
etation
form 3R,.
Rion on landscape (sketch on the back) . .
ances Yom-
Open Water Body //D feet Drainage way AA D feet
Possible Wet Area ...1/1). feet Property Line /a feet
Drinking Water Well C-1 ly feet Other . . _
DEEP OBSERVATION HOLE LOG'
:epth fr::.
face(Inches)
-.Soil Horizon
Soil'recurs
(USDA)
Sail Color
(Munselll
Soil
Mottling
Other
(Structure,Stones,Boulders.Consistency. %
Grave
Te 12
- TD ,),
Z... tl' yd
re z�
T6 Nei
AP
I'4)
/
(<
C
C
d.5 r y-L
2•Sy
3
a �y /
07.57 �?
7•s7 7y
Alt)
St )n
n7 4b r1
7Jye52
" / /
(J
is .
'r•,fr
F
Dtt-cq. rcy / Les'"?
3007y 1 f-IUE c4./.'fry LeT.01
Lao>L
Lee>E h+ E c.vPI Legq
A tEit, Rawly•
Fla.•,r )3t.oc4y FivE S.r...Dy
Gat in
IlNcy Low asap to nwrE i4e1.4
J 707 Lreit.a I-
/`
5 k..
Si
L( 5
• iNIM Lca ncLLUln W A I cV
crt PnUrU c Jb rUaAL e,
- •
Material(geologic( &/D t• PL.}s
to Groundwa ter: Standing Water in the Hole:
Ted Seasonal High Ground Water:
I
DepdrtnBedrock:
Weeping from Pit Face:
DEP APPROVED FORM-12:07:95
FORM 12 - PERCOLATION TEST
Location Address or Lot No. /( °Lc> FM.e-y /7 P.
COMMONWEALTH OF MASSACHUSETTS
ti.lealTh4vyTer-.+, Massachusetts
Percolation Test'
Date: 7- L- YG_. Time: t_ao r.2
Observation Hole #
_1-
Depth of Perc
44. 0
Start Pre-soak
3.t./73—.
End Pre-soak
31)
Time at 12"
j : .D
Time at 9"
S. 3.
Time at 6"
3: ,Y
Time (9"-6")
Rate Min./Inch
* Minimum of 1 percolation test must be performed in both the primary area AND
reserve area.
to Passed ,� e Failed ❑
,rformed By:
'itnessed By:
)mments:
a
DEP APPRO VED FORM-Il/01ns
FORA) 11 - SOIL L VALUATOR FORM
Page 3 of
Location Address or Lot No. _ILL_ ry t
Determination for Seasonal Hi 17 . Tabl_v_
1ethod Use :
❑❑ Depth observed standing in observation hole inches
Depth weeping from side of observation hole inches
Depth to soil mottles Yo"vr.° inches
❑ Ground water adjustment feet
.ex Well Number ...... Reading Date Index well level .
Ijustment factor __..__. Adjusted ground water level
oth of Naturally Occurrino Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas
observed throuchout the area proposed for the soil absorption system? t/t- 5
If not, what is the depth of naturally occurring pervious material?
•tification
I certify that on (date) I have passed the soil evaluator examination
approved.by the D ment of Environmental Protection and that the above analysis
was performed by m consistent with the re wired training, expertise and experience
described in 310 CMR 5 a 1 7.
signatur/#i'n S)i
ALP
DEP APPROVED FORM• U?07'95
Date 7 `55(
� � On-Site Review
ss or Lol ill 0Icf icv.B I Owner n / Address 7< -
It f /l�( � lime Weather
g Pro Engineer or Sanitariani D 2 2.}w._4
Me Plan - -
Ise -- t. Slope%1 r Su Aace Stones 1 I
lion
rm
idscape
.r5, •t^• +> r 'y�`T. Distances from. '" -
hBody feet Drinking Water Well _ I feet Property Line feet
et Area -- feet Drainage Way - feet Other feel
1: 'MINIMUM OF TWO HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA
..ru Horizon I Soil Texture Soil Color I Sail Mottling ' - Other
(USUAL (Munselll 'Strode-0 Stones Boulders. COnsJs ency %Graveh
5 `//
1) t c /
/a .
C s' / ty
��i
/.S I
/ �/ .y h
--
(geologic) Depth to Bedrock r
iwater. Standing Water in the Hole - 7 --'
g [/. 1 Weeping from PA Face I
Seasonal High Ground Water i - -- " - f -�
DEEP OBSERVATION HOLE LOG*
'MINIMUM OF TWO HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA
Sod Honzpn Soil Texture Sorl Color ! Sod Mottling Other
(USDA, Munselh ! Struclu.-e Stone Boulders Consistency ', .Laren
l(/ I c , I , ,_ ✓,/2/
I '
L 53 ar ii 51)
(geologic) 1 1 Depth to Bedrock I —
Mater Standin Waterrn the Hale l"� Face c r"
gl We/e�p�rnq from Pit Face % �
Seaso al High Ground Water - Ag y - / "
PERCOLATION TEST(S)
Time:
D J rC,rr/.s Ate` Performed by
Time:
Witnessed by
I Witnessed by
Observation Hole
#1
Observation Hole
#2
Depth of Perc
�09 y
Depth of Perc
Start Pre=soak
�hI 7
Start Pre-soak
End Pre-soak
'', 3D
End Pre-soak
Time at 12'
'
Time at IT
Time ht r
Tic TAW,
Time at 6'
� � 1 J;
Time at 6'
Time(9--6')
Time(9'-67
Rate Min/Inch
G 9,9/
Rate MinJlnch
'minimum of 1 percolation test must be performed in both the primary area AND reserve area.
Performed by
D J rC,rr/.s Ate` Performed by
Witnessed by
I Witnessed by
Comments:
r