195 Soil Eval Form 2004 No.
175 lc% sYLTA-0-At
E (15) -J
r
-IL FORM 11 - SOIL EVALUATOR FORM
Page 1 of 3
L, JUN - 8 2005
nrr,r 3 7" .S
Date: r/e50
Commonwealth of Massach etts
Munch setts
Soil Suitability Assessment for On-sit Sewage Disposal
,40/ „
Performed By: c.);%-iturn -4,,cDatt WO/0
Witnessed By:
1774-1S(
g-,91 Al 0 ViS
z
/95" ace Ailigai1/4%.-,••••-• / tZA-ta /cm) oti
Ati/teri/n,n,a/DA/. I
New Construction 0 Repair U An4/951) A-4:1-47771/19"77,0 1/471C/ 04-611.5.1
Office Od/citr CII/Q
/95 irit5 /—)r
Year Published Publication Scale Soil Map Unit
Drainage Class Soil Limitations 6/.//C17-4./C,/c9fir
Suffield Geologic Report Available: No 0 Yes pi%)7-1_.)
Year Published Publication Scale
Geologic Material (Map Unit)
Published Soil Survey Available: No 0 Yes
Landfomi
Flood Insurame Rate Map: Y/5 52703
Above 500 year flood boundary No 0 Yes
Within 500 year flood boundary No Dicrs
Within 100 year flood boundary No IZYirs 0
Wetland Aran
National Wetland Inventory Map(map unit)
Wetlands Conservancy Program Map(map unit)
Current Water Resource Conditl SOS): Month
Rapp:Above Manna! ormal 011ebw Normal
Other References Reviewed:
IMP AMMO/VW FORM IMM1S
FORM 11•SOIL EVALUATOR FORM rage 3 u
• Poke 3 of
/ /./'. .5 Limn Address or Lot No.4 9 3- . -.1 A •5 r/ ,V j l t nation Address or Lqt Ne G rite / p ,/04_./
4-10/27-.402/7/141/0.c.
oaltlan o b.Mac p:� 4kew/M1' on tM1 bacckk)) +:._ .I Cr-1 7� W etM1er .._...
0 i
'l On-sfle Review �✓/i,2 y • r L /G 9 UC Weedier fU�/ '
pH l Nu Ear Del l f/9e trim,: 9 Coo C Deep Hole Number Date* —
°cation litl ml((Yy or:si pay a Su . _ Location OdenDl on Wypian J 40 �v O
G
e nd U 'fW l CDet i Slope %1 Surface Stones U4u �GK, -e-4/ Land Me 'le". Don l%I ' Surface Stone SG r d [✓e
u
Gestation 1.'_ CCe 4kL . / vegetation 440004 0
▪ al m n 6 u r 44.i- R5/ . Land'our
Position o n
lending*(sketch on the b¢kl •
dstance.Nom: A ryuA ... ... Distances from: D h��
Open Water Body Paint OrainagN YEW �/ lent Open Water Bndv— let DNnagel wry!/— ten �1/ // T
P aeable Wet Atar..- bet Preyerty WeJV feet 'C/T CJ -'/e Possible Wet Are _Net Properly Line'._ fat LIZ'
• W er Well _. feet, OtM1Er �."-C Drinking Water W 1 e Other '
flcJbf L. /fl CA , o0°TNeo
•
DEEP.QBSSRVATION HOLE LOO' - DEEI£OBSERVATION HOLE LOO' ,
- ' o
jale t aerwx.a fnN as.eZ J . pTwY4 Siena. m famxWY.M -W Myth hem $a Halm. SS lase sot cane as con
NeN an a
lenses.Men..egaidero.uwxw.. f
Omap '
o—i4 : °yL i�p S oM <
� o—iz . /!p f .
39 2 7ya ��� zz- c, ION' 2,5 y yrzkei
LG,t7ne,/J.3 O SO 5 9 /)
�a 7S C S<12/� ys v /eyrt Sun <v r . y ree-
inn «.. - 8° cZ 0 S-j , , Fie del../ s' E
75--//j" Gz c� p" " s3 `.. 5 � 'sCGa �/ �f i> u bGiv/cCl.-s .
'
•IiS •• a eo 2 laan u sn lR e n nwnAmleke 4mwgxywergaL
not i 0 Ta / f � /,i11 I/
Nme OrtIo .gu a.re Wow wa.w.il .J • wrwee.enaw 7-5-- P�..Iwr wewed U/ �// 5'/� • •' g�w rw d
/
G
Q
pay,naweeakes. ew+eww.e. w S • • ooPinbf"..""n G
x W Swami tier draw Wen µj W s t i ff e s t SOrJ NO O m n i Wotan f i /& r '
. `i/e4)r Ei/dur"
, .
•
.era e one . xwee /� �fz. .-�•
Percolation 'Peat
Test No. in
Reading Time 0 yS_ 900
Saturation (15 min) ci
fL q1e
/3
Ce
Perc Rate 5;0 Min/3.nch
Ground Elev.
Depth of Hole «8
n T5"6k
Test Pit .
Depth Soil Description
of -/e ars col.*?
c ry 5.4-74.•,0 Jog
ice- 73
ror enawater
Bedrock
Ground Elev
S.C.S. Soil
Bench Mark:
COMMENTS:
3/7/ND 4'444 ro
K7,/7tt oe/ ,%r//
Depth 7T- Elev.
Depth Elev.
,6-44017-
Description
Elev.
4 oo5_e
lCv
3,g-goM
.?1,46 /7/
Nez/»
Test No. -;/X0 L
Rending Time
Saturation ( 15 min)
//)
9
e
7
Pere. Rate. Min/inch
Ground Elev .
Depth of Hole
Test Pit/e
Test Pit
Depth
0-/Z
7?_ .°i')
Soil Description
Lon/77
T/2/4 n ht,pn To F/cco
Liv-!2,o 6/ ae/
Groundwater Depths Rlev.
Bedrock Depth _gElev,
Ground Elev . g/f4ci—,24'
Seasonal high Mater Table? /45 A/di-Ar 0
Description 5s t.t'
Date : ,rc 14s[.. yz
77/03m
Engineer:
Witness: ----
Lacation
FORM 12 - PERCOLATION TEST
Location Address or Lot No. /fir / es %JL/!/i/YJ/...71a
COMMONWEALTH OF MASSACHUSETTS
A/o/27-7{ 1// lox/.Massachusetts
518
s�r��.e+s-77o.v ruF (JO
• Minimum of 1 percolation test must be performed in both the primary ern AND
reserve area.
its Passed _/A Site Failed ❑
srformed By: _ /i(/1C.G//_j7Yj
'lhtecsed By:
nnmentsq_,.
S
..tiq 41ThRLt-
oV APPROVED roar.Ilia)
Percolation Test
Date:
Observation Hole N
`
V/9 /Q 17 f
Time: 9 O p
77g/ —/
7/1 r L
Depth of Parc
96 "
Start Pre-soak
s vs-- _ 9 co
U
End Pre-soak
9 00
q ea
9 i,S
JJgo i r- /
/a.erc 6r
NL�c z
Time at 12"
Time at 9"
Time at 6"
9 3 7_
42/9 is-PO B y
4019
Time 19"-6")
'773 - 2. 33
Rate Min./Inch
/G,$//,17 6a 6
0-76 •
l/.N i cs 0
518
s�r��.e+s-77o.v ruF (JO
• Minimum of 1 percolation test must be performed in both the primary ern AND
reserve area.
its Passed _/A Site Failed ❑
srformed By: _ /i(/1C.G//_j7Yj
'lhtecsed By:
nnmentsq_,.
S
..tiq 41ThRLt-
oV APPROVED roar.Ilia)
Location Address or Lot No.
FORM 11 • SOIL EVALUATOR FORM
Page 3 of 3
/ 7✓ /,(,c.PS7/&IflAA/ /L)
O✓2 e J ,ti,ijS5
Determination for Seasonal High Water Table
Method Used:
• Tie 7/, e
7 Doh observed standing in observation hole Inches 2,S ea
ISDjpth weeping from side of observation hole inches, 75- Edo
Depth to soil mottles .. . inches ENw j ,Silk t
❑ Ground wetet adjustment feet "
Set
Index Well Number Reading Date . . Index well level
Adjustment factor Adjusted gtound water laves
Deoth of Naturally Occurrina 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? ,l,Q
If not, what is the depth of naturally occurring pervious material? T
Certification
I certify that on Tr (date) I have passed the soil evaluator examination
approved by the apartment of Environmental - •to n and that the above analysis
was performed by me consistent with t re() ed aining, expertise and experience
described In 310 CMR 15.0 7-
Signature
aPP APPROVED?ORM•nmm
at da% V