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91 Soil Eval Form 2000 1ppewu 4 ran I No. 00 --2 0a, refit 2r FORM 1E. PERCOLATION TEST Commonwealth of Massachusetts 2000 Location Address or Lot No. g/ Inc 77/411/70/./ /?k, /I4 t77fgp"iprd.✓ , Massachusetts Site Suitabilio Assessment for On-site Sewage Disposal COMMONWEALTH OF MASSACHUSETTS /✓Q/PIJ/AMP7U/✓. Massachusetts Performed By: 1/i 't'Y •SE71R4 O Certification Number: Wimessed By: Perak, MrECtt/4;m q— JOyAts.-o7✓ 5 ,i-eax-< Percolation Test' L ..a im..• ae. •. o•t•:1 //t � r; 2000 Time:. .2:0" /M 9/ G vfrHARt orN AD S7'*"7i/Ay:<- /ra Observation Hole a Q/41RT//AA7/9n4, //M Sl6-77361 '7f4-.24W w) Od/E Depth of Parc New COea,rueeon ❑ Rani, LAS 3�°75a1100/./S 3¢ • • 111495s/t`r P/Y: 70 $E'Raryarir y Start Pre-soak 3 : 32 Office Review Hew Derr TE-'fiyarrON End Pre-soak As P * LW*. 3dy /.1eriery/ti 3 : 97 , Published Soil Survey Available: No ❑ Yes 1$--- Time at 12' 3 : 1r Year Published . Publication Stale. _. Soil Map Unit . . • Time at 9' 3 S Drainage Class Soil Limitations Surficlal Geologic Report Available: No ❑ Yes �,/ Time at 6' J ¢: 0 / Year Published Publication Scale Time(9'.61 /0 41/y Geologic Material (Map Unit) _. . Landform _ • Rate Min./Inch ¢42/4///y,// Flood Insurance Rate Map: ,_.,/ Above 500 year flood boundary No ❑ Yes L7 • Minim m of 1 percolation test must be performed in both the primary area ANC reserve area. Within 500 year flood boundary No ❑ Yes ❑ Within 100 year flood boundary No ❑ Yes ❑ ' Site Passed LN- Bite Failed ❑ Wetland Area: National Wetland Inventory Map (map unit) . .... _..... _. _.._.. Performed By: , /tRB f/ ,iG7,u�Lr� Wetlands Conservancy Program Map (map unit) Witnessed By: PL737 //le 0421/4/ /i, 7-671y,ay 5,,Fr<ye- Current Water Resource Conditions (USGS): Monism Comments: Range : Above Normal ❑ Normal 2. Below Normal ❑ Other References Reviewed: dm /turn :/.r0,(/req.- W/ rte Pepr 7O eP(177- 2. (wars- cONCOMq, FOR PA'OX/N//y 70 War Ant* /NA,%s /Pc,I) 3. 6A rSt7NF 7SO-jn/. 525we z r,f- n . ac PP,yeero e 4vcg4 MP, F/Le V /i'cYLA re- de/r// Np"G- /Sc'0 Y( rTH,f I Ole 5:Draft Printed September J0, 7993 Appendix el Page 2 J Nor 70 9 /C : On-site Review i vm07: Dew Hole Number end" wre. r/41 °a tenor 2:C0 weather CL 04 Y n$1` r---- a.{//MM/N6 Location la nation nl SN( ✓( -p .. �� Land U ICS/O L slop.MI 0 'j�smeu smnu� POOL15i44a vegetation LA/t/, T – . — I 0c S<pe .antltorm —,¢AlE ,pR/j1'F a Position on landscape(sketch on the backl ._ 5 Distances tom: .Yp i'�ra'C %ass/Y! Open water Body . tees oralnagewav W k I... t0 sM. Passible Wet Area 80 igee Propene Line.10. loo IC J7Rer`T t��_ /'Alto fngR 7AMt Drinking Water Well CI TV'JIe.t Other DEEP OBSERVATION HOLE LOG N' D a ,'tic oe ,. ,.w.nt awl ea Tee.. seatHl Sea',Mitten one, II NAM r „ lew.N,•.ILen...k_a.,.. if 3�,�- 90,CL l,. is a.... 0 -t0 /f *z /Ofr/4 3/2 — I'R/2r14r i /0 -20 go '14 toYR 0- — Mfite er ss� ��t N I S �r �� 2O -SZ c, 5e /0 HR f�y( t°LO' /%R/fiXE90 e :' j C;t 4pu - >ror. j'%Va I'/ - l t�eJ10) 3-2 - $t _ CZ 4 S S-`/'yz 2.>Ys/3 LopSr,f/RSfiv� L ,tens I W rp YR s l/.OYf—KDrM A 76 - /70 c7 Coerp/er 2,sYR�r �oa/grTR� ? DH sr' a • Parent material loeologicl Cc/U'r/(T ?7 L Cloth so Bedrock:>r 0/ I _ __— ____ Peon to Groundwater Standing Water in the Nine:/2C • weeping from Pit Pace: / Estimated Seasonal High Ground wate,:110'(PronGf� V6.... //E S)-��fr/eay�A/ /p�l'D 1747P Oar foie- / /ro/le .ten 1 __-----_.__ _� t:'?/eel �/4sc : 2. flianp,d 9t zotmr/ov cc ,4 o L/.Lr FORM 1I - SOIL EVALUATOR FORM Page 3 Determination or Seasonal Hi!Ii Water Table Lo citr>aW; 9/ ,V8�flM 'fVY /Pal) Method Used: n Depth observed standing in observation hole ❑/D .pth weeping from side of observation hole L Depth to soil mottles inches ❑ Ground water adjustment feet Index Well Number inches inches 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? ,r%//Z If not, what is the depth of naturally occurring pervious material? Certification I certify that on.) 4C/999-Idatel 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. Signature Date / 200