521 Soil Test 2005 tr. /20g n arAte-aa
Sfa .00 04 A 1•0
4-77/fr-fv7, 7b4J /'14
NO.
FORM 11- SOIL EVALUATOR FORM
Page 1 of 3
Date: b/flos-
Commonwealth of Massachusetts
Massachusetts
Soil Suitability Assessment for On-site Sewage Disposal
Performed By: ...ahe_Ld AW7 c_5;a49r4 1,4 c Date:
PS
Witnessed By „fra--.220-4trW-4S412-L fri
1°"4""' /2-0se 44AYA-40 0
tag SW 4149/0 4A0 449
frOnfl'#in4I
Mew Construction 0 Repair' C..or
Office Review
Published Soil Survey Available: No 0 Yes
Year Published Publication Scale
Drainage Class Soil Limitations
Surficial Geologic Report Available: No 0 Yes
Year Published Publication Scale
Geologic Material (Map Unit)
Landform
Flood Insurance Rate Map:
Above 500 year flood boundary No 0Yes
Within 500 year flood boundary No. fEbte
Within 100 year flood Poubdary No IEWrs 0
`lliestland Ant
National Wetland Inventory Map(map unit)
Wetlands Conservancy Program Map(napt.mit) ,
Current Water Resource Conditions (USGS): Month
Range:Above Normal 111P OBelow Normal 0
Other References Review
Se97- os-V5z
Soil Map Unit
r AMOVED FORM•/WM
• YOI II•SUl;EVALUATOR FORM - Pace.2.
• .
/� �1 /� 11 ,yyPat�e 2 of .-
mic*Adbm>Lq Na. . ~/ . •/7; op d 04/ v'-¢./ Location AEdrs ar ld NO.
fin-site Review
•y� f ,�O ' r -
I / P .� ocu^ ' 7141”:—
win w
.N Hole Nubs Ma- Time - WaIW Co 2o/
Loc.& U.ntlry on site plant •
*union Man0IY'°Anis W�.N — `�^—._
n ue µ/L!Y+.,slam ou fiR. suc stein*.' „�4/SLA1 /(.G Gnf Load UN P°1%I_ suet.stone. -
wake
Position on landscape Ketch on Na back)wake w . bldn the back! I ' '
4:aaa.lrom:. o S/.tp Distances llaic
ONO:Wow as tt? 1 OtJoao.NN f`— M, ONn'WnM MEY� Nat MWUpa w.Y SW
Mends W.INN/w Dm Oth.t INa. _. tat PNilhM Wee ,W —y Wet RNfpy Una �� loot
OrY:kM QYanW W.II Ixn Onlir w Drinking Water Wee_ Wet (1St
.
`pr._�
../200011.QBSEBGVA I1ON HOLE LOG' DEER.OBSERVATION HOLE LOG'
IW IMm�I fflYax (•*116441 $a._ Q.,,sw.fay. r.0 Ywnr4t iq-1 - u � Nwa MINIM. Iaa n.l4✓.Y1.s Sn. w.,.♦
p i.3. /4 3fc 3 L� '
•
/3-i; 8,0 5/, /ore �oy� ' <�
87s A'
Cobs ,
af0a •c, /� 0y4 �'$ 5 s
- ' '3Ov6a s . .•
`0 (/ og, e0 `f c
netnews Inelesol 14
.Wa •
n n ...... .., Pe-ye WM.In./alr sl eJ /
RICE .O:..w.x. {•+vnWS**1•
Say Seward MW:rare WA's:. A/. L.i..a Sawa'w•awe w..r. ,
��! r a5t. •
a . ,aerworaxlOme.wrms: • 1
•
O immNm, •
1 .
.
w
Test No. Ant/
Reading Time
Saturation ( 15 Rhin)
Pet .olatiun Teet
it `<S- /o 00
Pere Rate
Ground Elev .
Depth of Hole
Test Plt
0e th .Soil Description
*/-'7
7?-7-Z-47-757L-4-1/7. =fl-r3i_ry 9fl rVa.
Croup water pep--Tt l--`g[ev,
Bedrock DeptliJ00 Elev .--
Ground Elev
S .C. S . Soil reecription Seasonal Ill•gh Water Tablet
Bench Mark: Elev.
Description
457 HiiiBiinch
Teel u ,4t4rC a
Rending Time
Saint-hi n ( 15 min)
/7/. '66
2.94 _ 9.44,
co
Pere . Rate
Ground Elev.
no ur Ilu le
Deep 'Test sit s
Tent Pit
Depth Soil Description
«r-O Go
/S
/5--Min/inch
TO
4
Group voter Depth
Bedrock Depth
Ground Elev;.
cOMHENT9: !l
)(An- criz
77-') -/
80
tut 11
Dote : y%
G11 hut :
Gs'
Elev.
Elev .
Engineer:
Witness :
born t ion of Pe
Cns.r J`aet_
FORM 12 - PERCOLATION TEST
location Address or Lot No.
COMMONWEALTH OF MASSACHUSETTS
, Massachusetts
Percolation Test'
Dale: 4,79U/Oj
Obaerveilun Hole N y—p
Depth of Pero
Start Pre-soak
End Pre-soak
Time at 12"
Time:
47.7-2 /et)
995-- /o co
/G a(,
/0 D9 A
29/3 z v
/
Time at 9"
Time at 6"
Time l9"-6")
Rate Min./Inch
/G f
• Minimum of 1 percolation test must be performed in both the primary area AND
reserve
j�area.
Site Passed X� Site Failed 0
Performed Ely /:GC_ /�'%TJ l . . ........./.J.Jo'
on..Vr*o Vm roam.nlrrfr!
Location Address or Lot No,
FORM 11 - SQL EVALUATOR FORM
Page 3 of 3
Determination for Seasonal High Water Table
Method Used•
0 Depth observed standing In observation hole Inches
❑ Depth weeping from side of observation hole inches
❑ Depth to soil mottles ........ .. Inches
❑ Ground water adjustment feet
Index Well Number
Adjustment factor
Reading Date ,. , Index well level
Adjusted ground water level
Depth of Naturally Occurrina PervluutMleterlel
Does et least four feet of naturally occurring pervious material exist in a l r s
observed throughout the area proposed for the soil absorption system?
If not, what Is the depth of naturally occurring pervious material?
Certification
1 certify that on 9`f(date) I have passed the soil evaluator examination
approved by the apartment of Environment 1 Pfotec a that the above analysts
was performed by me consistent with the lred t inm expertise and experience
described In 310 OMR 15.017.
Signature
Del APPROVED FORM•I3/07/IS
ate
/�v 6s