902 Septic Soil Tests & Plans FORM 11 - SOIL EVALUATOR FORM
Page 2 of 3
Location Address or Lot No. 90a /r%or-enca 7'd-
1
On-site Review
Deep Hole Number 62R $ Date: /2%/S/4ly Time:/ br? 1'1-7
Location (identify on site plan) S'ee--
Land Use i4-tJ rho Slope (%)g -/0 Surface Stones t n
ttJ
Vegetation 9 1-0-Sr _. .
Landform _
Position on landscape (sketch on the back)
Distances from:
Open Water Body >/00 feet
Possible Wet Area >100 feet
Drinking Water Well 1/00 feet
Weather C/fie-..
Cee-
Drainage way >as feet
Property Line > /d feet
Other
DEEP OBSERVATION HOLE LOG.
Depth From
Surface finches)
Soil Horizon
Soil Texture
(USDA)
Soil Color
(Munaell)
Soil
Mottling
Other
(Structure,Stones,Boulders, Consistency, %
Gravel)
0 — /8"
/6"02t1n
aye-36"
36"-/,o''
F
/9
B
C
r
S-L.
r.L .
Se
2•_.
/ovals
/oyzs-,t
Iov?s1Y
L.
/VoAC
Kane
S"%
/oyes/.mac
/0VR-t'/A
Top ro;/
Citisr;/
/o8 "
0- So"
sat 7/a"
198"-d/8"
2/84.-A2‘#
F
A
,8
C
L
r.L .
P.L.
S'o-f--d
L
/o04V;
/oYal‘
Io11trA'
,L
MAJ.-
/t/oAe
/a7/.e J/-ye.
/0 sesta
T7,rv;/
c:._iro •/
Apo "
Parent Material(geologic) 0LLd4Jo.s-/_r' DethtoBedrock: APO/1
Depth to Groundwater: Standing Water in the Hole:
Estimated Seasonal High Ground Water /Op " / /aO"
DEP APPROVED FORM-12/07/95
Weeping from Pit Face: /NQ r„L
OD NA
13® •F21 1-
an-
9 rt"U
1
/r,r GnCC.
No.
FORM 11 - SOIL EVALUATOR FORM
Page I of 3
Commonwealth of Massachusetts
A/o + lot._ , Massachusetts
•
Performed By: M- k G.-. LAv t
Witnessed By: Pc1'e_t— mca.-14:1
Date: /a4Ol9(e
Date: 143)967
9oa Flo.—erce_ 124- .
u,
Vew construction ❑ Repair
Meas..b
r.. .Ea4-d- Sit.
9n-7937 '9'"i"-r4 owl O/002
Office Review
Published Soil Survey Available: No ❑ Yes ❑
Year Published
Drainage Class
Publication Scale
Soil Limitations
Soil Map Unit
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 Oyes ❑
Within 100 year flood boundary No ❑Yes ❑
Wetland Area:
National Wetland Inventory Map (map unit)
Wetlands Conservancy Program Map (map unit)
Current Water Resource Conditions(USGS): Month
Range :Above Normal ❑Normal ❑Below Normal ❑
Other References Reviewed:
DEP APPROVED FORK•13.07/95
Location Address or Lot No.
FORM 12 - PERCOLATION TEST
902 rior-exc eta
COMMONWEALTH OF MASSACHUSETTS
kh -i- .p-mL, Massachusetts
CF7Th
Minimum of 1 percolation test must be performed in both the primary area AND
reserve area.
Site Passed ® Site Failed ❑
Performed By:
Witnessed By:
Comments: .....
/7%/ Ic
Taus- /7%eht-/aii,-.
DEP APPROVED FORM-WORM
Percolation Test"
Date:
/aJ3%96
Time:. /rfor„.,;,,,
Observation Hole #
-p
T _/
Depth of Parc
G y 4
Start Pre-soak
/a .'/ 9
End Pre-soak
Time at 12" .
/a : 3Y
Time at 9"
/o: H/
Time at 6"
>o : h/8
Time 19"-6"l
Rate Min./Inch
3
CF7Th
Minimum of 1 percolation test must be performed in both the primary area AND
reserve area.
Site Passed ® Site Failed ❑
Performed By:
Witnessed By:
Comments: .....
/7%/ Ic
Taus- /7%eht-/aii,-.
DEP APPROVED FORM-WORM
FORM 11 - SOIL EVALUATOR FORM
Page 3 of 3
Location Address or Lot No. %0cZ Fbb -e5�cc F-�
Determination for Seasonal High Water Table
Method Used:
❑ Depth observed standing in observation hole inches
❑ Depth weeping from side of observation hole inches
® Depth to soil mottles /Q8,f20 inches
❑ Ground water adjustment feet
Index Well Number Reeding Date Index well level
Adjustment factor Adjusted ground water level
Death 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? yes'
If not, what is the depth of naturally occurring pervious material?
Certification
I certify that on No✓ 9y (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.
Signature`, G�
DEP APPROVED FORM-13/0'!195
Date 7a/4/4/9G
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