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Lot #4 573 Soil Evaluation 2011 Commonwealth of Massachusetts pd ',CO/etc -5/l -.n City/Town of / %' i Form 11 - Soil Suitability Assessmen for/On-Site Sewage Disposal Ai, Less If �r '� ,4 . 1, 7 .S c--J —455e�SSocs M'A�.?/ Bf O&OVL ev ,I � C�C/o55 /om o ✓ Ve51e/ �o a A. Facility Information // / Oma,,,/, J2 L • ' Z&aI � 'IW/70•.2y 54 ✓ e/ �VG7.CO ,✓ Owner Name //O ,CL/e ctce iel 1-1:427/ Reay / :cool Street Address / Map/Lot# Vn . / fr/ m u, ,O� /A/ Alin OGD City / r State Zip Code B. Site Information 1. (Check one) New Constructionti ❑ Upgrade ❑ Repair 2. Published Soil Survey Available? IA Yes ❑ No If yes: Year Published Publication Scale Soil Map Unit Soil Name T' Soil Limitations 3. Surficial Geological Report Available? ❑ Yes ❑ No If yes: Year Published Publication Scale Map Unit Geologic Material Landform 4. Flood Rate Insurance Map �/ Ni Above the 500-year flood boundary? .S Yes ❑ No Within the 100-year flood boundary? ❑ Yes til No ` Within the 500-year flood boundary? ❑ Yes %No Within a velocity zone? K1 Yes 0 No 5. Wetland Area: National Wetland Inventory Map Map Unit Name Wetlands Conservancy Program Map Map Unit Name 6. Current Water Resource Conditions(USGS): Month/YearRange: ❑ Above Normal ElNormal ❑ Below Normal 7. Other references reviewed: t5form11 •rev.1/10 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 1 of 8 Commonwealth of Massachusetts I-r-or n City/Town of 1:. i1- r+ , Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (minimum of twoholesrequired at every proposed primary and reserved disposal area) 7 // Deep Observation Hole Number: -//��!�# Date Ti/G m 30AWeatherz /N titili Location _ ' Ground Elevation at Surface of Hole: Location (identify on plan): kf/Nr 2. Land Use (e.g.,woodier) ,agricultural fiel •vacan to etc.) Surface Stones Slope(%) i,-as5 1.,i, I Vegetation landform Position on Landscape(attach sheet) 3. Distances from: Open Water Bodyfeet Drainage Way feet Possible Wet Area feet Property Line feet Drinking Water Well feet Other feet 4. Parent Material: 4/7114.) Unsuitable Materials Present: /' Yes #3 No If Yes: 0 Disturbed Soil S Fill Material ❑ Impervious Layer(s) 0 Weathered/Witured Rock ❑ Bedrock 5. Groundwater Observed: Yes ❑ No If yes: 4 "t'57'3) --tt Az, Depth Weeping froDepth Standing Water In Hole 49Estimated Depth to High Groundwater: Inches elevation 3711 0 l% t5form11 •rev.1/10 Form 11-Soil Suitability Assessment for On-Site Sewage Disposal •Page 2 of 8 Commonwealth of Massachusetts City/Town of t. is=ita Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal '� C. On-Site Review (continued) T Deep Observation Hole Number: / � Redoximorphic Features Coarse Fragments Soil Horizon/Soil Matrix:Color- (mottles) Soil Texture %by Volume Soil Soil Depth(in.) Layer Moist(Munsell) (USDA) Cobbles& Structure Consistence Other Depth Color Percent Gravel Stones ( ) v z�/ 1 Thu fill «� I pi-9. - 71yf/ A 7,5y/s/Z LS a -.19 BW 5-jr. I"A L5 V -7�1, Li 7, 5yr6 42"— >&/. 5L 707-%(i cz ? ,Sy( 7 ) 51PEI Additional Notes: C5 NA lAJ = 3/47" t5form11 •rev.1/10 Form 11 -Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 8 Commonwealth of Massachusetts 1 T m City/Town of J •'= 73 Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal rA IL- C. On-Site Review (continued) Deep Observation Hole Number: —71P713 ----- Redoximorphic Features Coarse Fragments Soil Horizon/Soil Matrix:Color- (mottles) Soil Texture %by Volume Son Soil Depth({n.) Layer Moist(Munsell) (USDA) Cobbles& Structure Co(Moistnce Other Depth Color Percent Gravel (Moist) Stones 0—irt A 75141z. L5 410 " BiJ 75yr 5/a L5 5/. X-461' . Ci Sy( °/z 5 yo/ 60-7)" c -7,5yr'/z s Lot Additional Notes: I 1 IpnS9 QJ�Wt—sk p 51NiCile —y � rCl n, 1 Uui'inhlc_ -- gS Ff&W = X21' J t5forml1 •rev.1/10 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 5 of 8 Commonwealth of Massachusetts 1 -16-, p CityfTown of _� Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal S` C. On-Site Review (continued) Deep Observation Hole Number: #3 Redoximorphic Features Coarse Fragments mottles %by Volume Soil Soil Depth(in.) Soil Layer Soil Matrix:Color- (mottles) Soil Texture Consistence Other Moist(Munsell) (USDA) Cobbles& Structure (Moist) Depth Color Percent Gravel Stones OH " A 7•Syr4/z L3 yah " B 7.5yis LS oSO" CI Syr N 2.5 y,- Sit +-Ylet� S LlOv- ro_.e1 56-83" 7 ;yf s/l >5-i • 5 Additional Notes: &S(-16w =4 3y „ hi- / - t5fonn1I •rev. MO Form 11 -Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 8 Commonwealth of Massachusetts r,iittn City/Town of •' a Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation Hole Number: #4 Redoximorphic Features Coarse Fragments Soil Horizon/Soil Matrix:Color- (mottles) Soil Texture %by Volume Soil Soil Depth(in.) Layer Moist(Munsell) (USDA) Cobbles 8 Structure Co Moitsence Other Depth Color Percent Gravel Stones ( ) 0 y " A- 76 yr 44Z-5 * VI' 8 7.5yr %" L5 30-86" C, 5.1r '/4 2.5yr 3/4' S 4o 1 tt..,,r I gfr10" C, 7Sy( sl i '5/ 5 Additional Notes: F5)46IA) = 1-10''/ (2. 5yr3% '5" • rv,o+-tIes ) - t5form 11 -rev.1/10 Form 11 -Soil Suitability Assessment for On-Site Sewage Disposal -Page 3 of 8 Commonwealth of Massachusetts 'ge City/Town of fior Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal D. Determination of High Groundwater Elevation 1. Method Used: ❑ Depth observed standing water in observation hole in in -- inches inches 0 Depth weeping from side of observation hole inches inches A. ❑ Depth to soil redoximorphic features (mottles) In B. Ininches A. B. ❑ Groundwater adjustment(USGS methodology) inches inches 2. Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level E. Depth of Pervious Material 1. Depth of Naturally Occurring Pervious Material a. 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 ❑ No b. If yes, at what depth was it observed? Upper boundary: inches Lower boundary: inches t5fonn1I •rev.1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 6 of 8 Commonwealth of Massachusetts z-gv City/Town of € � Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal ' - ;_ , F. Certification I certify that I am currently approved by the Department of Environmental Protection pursuant to 310 CMR 15.017 to conduct soil evaluations and that the above analysis has been performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. I further certify that the results of my soil evaluation, as indicated in the attached Soil Evaluation Form, are accurate and in accordance with 310 CMR 15.100 through 15.107. Signature of Soil Evaluator Date Typed or Printed Name of Soli Evaluator/License# Date of Soil Evaluator Exam Name of Board of Health Witness Board of Health Note: In accordance with 310 CMR 15.018(2)this form must be submitted to the approving authority within 60 days of the date of field testing,and to the designer and the property owner with Percolation Test Form 12. t5form11 •rev.1/10 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 7 of 8 Commonwealth of Massachusetts f� _p. City/Town of F . , Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal Field Diagrams Use this sheet for field diagrams: Worrell •rev. 1/10 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 8 of 8 PI 6//7�f Commonwealth of Massachusetts P1 AZ/OO City/Town of F eti74,P_ss tt* Percolation Test /b36 Titinee,,, Form 12 b (1C7?USS (21 3 �/ 7 Sy/i/PS/et Pi Percolation test results must be su milled with the Soil Suitability Assessment for On-sit Sewage Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with the local Board of Health to determine the form they use. Important: A. Site Information/ When filling cul /l-r- �, /�lU!E_� forms on the computer,h use - onlynlythe tab key Owner/Na/mne /� to move your ( fl/ ceNrc PI A ( a -a cursor-do not Stree Mdress or Lot# use the return 0/06() /D!^ _ g kre�Y�T1 /Ol/ State Cite -�J City/Town / .� horn �reen/Aiw✓ i. P/✓SPS Contact Person(if different from Owner) Telephone N ber B. Test Results *" 6://V/ 9',26' iv �// -dr � a O Da Time Tim —ga ¢ _.0.2_ e Observation Hole# �- W2 r, - - 416) ” Depth of Perc - p VY, ii Start Pre-Soak - • L/v//��6/RIA00,,V End Pre-Soak � r Time at12" - %.- e/Ogit - 7% 76;1,0 moi, y d / //9n /" Time at 9" /C ;1 Time at 6" Time(9"-6") _ / Rate(Min./Inch) ,23, - - i' Test Passed: �C] Test Passed: Test Failed: ❑ Test Failed: ❑ orl�/f,ti . Test Perfo By: r / / L Witnessed By: q Comments: / // Perc Test•Page 1 of 1 t6form12.tloa 06I03