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132 Soil Eval Form 2001 Mitun 11 -SOILEVALUATOR FORM t 6 Pace 1 0! 1 FORM 11 . PERCOLATION TEST u sms„os nedre or Lo: No. l tJ V l�( ��"' i h Location Address or Lot No. /3� 2°nD kG=STr-t+,e-ntJ .ems 1 On-si! R vi w COMMONWEALTH OF o„ ,,Numb., MASSACHUSETTS taui,o�ea.mi4,,, o...: y�a7/i7/ ran,.: /cd Q, «.n.e Svu/vy . Massacnusevs 1 l.ne Live g j.d r_vn Ac ��°o.I,<� 7o°A" -0.1.— I tity I Q-Z�SUeb<s Sion.. �'�( oo. ,o,, da.,QAS�, PIA,N - y' Percolation Test" a.o .•mn.°m.e.ai on.m,Poi t.bi — �� con w.,.•B�.>MO;oat 'l7 oe.in.v.w.. >o,..,�.w.: ,..>am/, Prawn/ f..r ommma Wa er w.e C.I T}7 ..t other un. ry...' lo, Ilialialanillr laillialeallL®® - I 8 INIMMINIEtniervall cic t6 G aq 610 LS [ Q F2�"4iz, ct74)a s _� a°!-Yb CI .Fay /or• b /M,„-, LvaSFC,P/nv . , �� shfA s ,, , I=R/A&� 9G-Ug G 3 Se LT. : .,,e r„E M)(A4 . q1E$ •,Minimum of t percolation test must be yb_ ( 2 3- /O$' ,� � i �G�-u �L asarve era performed in both the primary eraa AND /� $/rJ}9 Sr (0 GM2 �nn Site Passed 0 �•�% ... . ... .n' / /� fr.-y Site Failed ...,..��.ro.w..i_— •o+n•wn /� Perform NAT Performed Br. .� J !/J //f/�� /'� Comments: ._ 'L f'`J ii `vt�"(3ChC ® NO%E((%/S9F1/vy 2oc/ wit,/al &too/viva ia.,44•Rovez S d �mooE CZ 4t1 Dn.) 1M AfCER o .m w.�M OP-SAS /w_D tehm W 17-44 71722 -v sotAto FORM II - SOIL EVALUATOR FORM FORM II -SOIL EVALUATOR FOR Page 3 Page I of ,/ Determination for Seasonal High Water Table No. Date: '/ Qi Method Used' A 6 a_Coommon a ith of Massachusetts Er/Depth �( t=/N I✓ . Massachusetts observed standing in observation hole }" inches Soil Suitability/2 -siie Sewage Disposal aml a-pth weeping from side of observation hole f/f inches Performed By L RLI✓ej� ✓ �•rA-77r/62i sGDepth to soil mottles 110 inches wttncescd By _ 1 Date: 1,9,��O/ L / I 7E�x AVc E,�v v ICs C 1960' rv` Ground water adjustment 7 ] feet =,..“-...., C/4/ �- �` Index Well Number Reading Date Index well level . /.7d. WL s M�ryrrf « S '� 00 Adjustment factor Adjusted ground water level \ / 0 New conswalon ❑ Repair t W/Pr°teRa J Orrice Review L/ 2Q- rigs Depth of Naturally Occurring Pervious Material Published Soil Survey Available: No ❑ Yes � 6y� Year Published 3 p Does at least four feet of naturally occurring pervious material exist in all areas Publication Sole �1/e}rp� ap O /s��r observed throughout the area proposed for the soil absorption system? Drainage Class Soil Limitations yy // Gt Surfcial Geologic Report Available:No ❑ Yes L.W 07 416/N 6 4h/)i.ZS Year Published Publication Scale Tq � bU -Ten. S0."-AP II not, what is the depth of naturally occurring pervious material, Geologic Material(Map Unit) 4np.�1. et L 607 L`f Ref.f-F Laedforen L'UT-NJASFh- PCM/ �/ t Cacti/iratioR Flood bov Insurance Rate Map: / /j�� G / Above 500 year flood boundary No 0Y/es L,_�/ I certify that on el D (date) I have passed the examination approved by the within 500 y.., flood boundary No t�I�G V//ci ❑ Department of Environmental Protection and that the above analysis was Within 100 year flood boundary No It ea ❑ performed by me consistent with the required training, expertise and experience Wetland Area: q,,/�/'�y�O described in 310 CMR 15.017. National Wetland Inventory Map(map unit) /1//� C_ WS r11—TEP , //�/t/ wetlands Continency Program Map(map i0 Signature Date lj:(/ Current Water Resource C onditions NSG cut Mont t Range•Above Normal ❑Normal v Normal ❑ Other References Reviewed. 1.