8 Septic Soil & Perc Tests 1996 FORM 11 - SOIL EVALUATOR FORM
Page 1
Commonwealth of Massachusetts•AbRi—dnY /OAI , Massachusetts
Soil Suitability Assessment for On-site Sewaee Disposal
�--- /2
. ✓ O61tiniis '
Performed By:`_.l irYt01 iL}// r
Witnessed B} PETS m ctp, 6 pa — „ L
T'r-1 Pro-L�./T
Date
5-/6 yb
Ls, Arldrets or
La 0
& C:LAiPtj4 °RtoL
tJ oRfiitin-())7t3, sr,/3
New construction ❑
Office Review
Repair LIB
a..,Name- R4)u Ce1RioVc.N
la)/Whill RZlu&
Sa 8i,
Published Soil Survey Available: No ❑ Yes ❑
Year Published Publication Scale
Drainage Class Soil Limitations
Surficial Geologic Report Available: No ❑ Yes ❑
Year Published Publication Scale
Geologic Material (Map Unit)
Landform
Flood Insurance Rate Map:
Above 500 year flood boundary No ❑ Yes
Within 500 year flood boundary No Er-
Wetland E"
Within 100 year flood boundary No
Area:
National Wetland Inventory Map (map unit)
Wetlands Conservancy Program Map (map unit)
Soil Map Unit ..._
V
Yes ❑
Yes ❑
Current Water Resource Conditions (USGS): Month
Range : Above Normal ❑ Normal ❑
Other References Reviewed:
Below Normal ❑
FORM 11 - SOIL EVALEATOR FORM
Page 2
On-site
T
-site Review
Deep Hoie Number / Date: `� /� r� Time: `V"1 0O M
Location (identify on site plan) __..
Land Use h T9L_.. Slope (;ol 7'5 / Surface Stones
Vegetation 6PCMA,O f ,ga.Oc.iKJO ISoFk✓,AV
Landform .
Position on landscape (sketch on the back)
Distances from:
�/
Open Water Body PR; feet Drainage way 7` feet
Possible Wet Area 7 Z,�'r feet Property Line" /5.�. feet
Drinking Water Well Al A feet Other
GZovp//coo L,
Weather /coo
DEEP OBSERVATION HOLE LOG
Depth from Surface S
Soil Hor¢on S
Soil Texture S
Soil Color S
Soil Mottling O
Other
NO l ur( r
r
int70 $r-C a
a.y V 514- M
MARC W
WQia iryNP
Parent Material (geologic)
Depth to Groundwater: Standing Water in the Hole
/4R
to Bedrock: Mk)
Weeping from Pit Face: it//A
Estimated Seasonal High Ground Water: /)j d/f- 0/3`&2Q
FORM 11 - SOIL EVALUATOR FORM
Page 3
Determination or Seasonal Hi!h Water Table
Method Used: A c) 5669:Wnr. R/6/1 ira eBSEe1%J
Depth observed standing in observation hole inches
Depth weeping from side of observation hole inches
Depth to soil mottles _ inches
jGround water adjustment feet
Index Well Number Reading Date Index well level
Adjustment factor Adjusted ground water level
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas
observed throughout the area proposed for the soil absorption system? yYs
If not, what is the depth of naturally occurring pervious material?
Certification
I certify that on/AA f91$ (date) I have passed the 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.