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ASSESSORSMAPNQ: ^ •��"� FORM 11 - SOIL, EVALUATOR FORK
Page 1 or .,
i
PARCEL N0: 32
Date:
No.
Commonwealth of Massachusetts
, Massachusetts
Suitabili Assessment or On-site ewes a D's osal
011 TvEsvr►�
Performed By: ...IC�c�d. . Date: �o 5,
n^Q.gl.... ..
Witnessed By: ........ ........ . .. ... ...:........ ...�... .
caner s W.ms. �t�WAltA nLizES Cl,, J AG1L
Leestion Address or (,1z. t,,� N� Address.Md ,f u G�—� v�IN o
�" ISO ��ttt viwe T. ln'I �Fu
CeNt p�.S I6 Z G�I'r�J1
ew Construction Repair ❑
Office Review ry
Published Soil Survey Available: No ❑ Yes U
�:2!� �PD. Soil Map Unit C C
Year Published 1����••�••�� Publication Scale • ••�•
r $IVN
Drainage Class
XC�S ......... Soil Limitations .............................................................
Surficial Geologic Report Available: No ❑ Yes r
J 97 :.: .
2�000
Year Published Publication Scale
....
a Unit) • ..0.......................................:.........................................................................................
Geologic Material (Map .
..........
Landform
Flood Insurance Rate Map:
Above 500 year flood boundary No ❑Yes -
Within 500 year flood boundary No L11�es ❑
Within 100 year flood boundary No UYes ❑
Wetland Area:
...:.......................................................................................................
National Wetland Inventory Map (map unit)
............................ ......
Wetlands Conservancy Program Map(map unit)
............................................................ .
JA�� Q�� ....._
Current Water Resource Conditions (USGS): Month S1
.Range :Above Normal ❑Normal ❑Belcw Normal
Other References Reviewed:
DEP APPROVED FORM-12/07/95
ZSZ Az- 3Z .;
FORM II - SOIL FVALUATOR FORS
Page 2 of
N Z >�/,,�1AJS �/�'
Location Address or Lo
t IJo.
On_��te Review
=S -Ito Time:. to n►''^. Weather
Z . Date:
Hole Number . .....
Deep ...:..:...::...:.:.::::... . U..........::...:.::,...:.:,::... ... .....
Location (identify on site p�j)__ .ape (01 �-� Surface Stones
Land Use
E
Vegetation Q -
Landform
Position on landscape (sketch on the back) feet
Distances from: J�� feet Drainage way feet
Open Water Body Soo, feet Property Line
Possible Wet Area Other .. ""
Drinking_
Water Well feet
DEEP OBSERVATION HOLE LOG' W
other
re Soil color Soil (Structure,Stones,Boulders,consistency.
Soil. Soil Textu
Horizon (Munsell) Mottling Gravel)
Depth from (USDA)
Surface(inches)
o .. r2„ A s� CoaM
O
/2 zs o
r � �
71
71, -�a
I
pepthtogedrock: r
(geologic) Weeping from Pit Face:
Parent Material(g Water in the Hole: ..�
De th to Groundwater: Standing
Eptimated Seasonal High Ground Water:
DEP APPROrED F001'12/07195
r
ISS
ISO
\ 0. 32 A6jm*
IQq � ISM
7�
w
IMP
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�. DORM 11 - SOIL. EVALUATOR FORA
Page 3 of
,
Location Address or Lot No. liz H� i�/S N
Determinatc'on 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 inches
❑ Ground water adjustment ................... feet
Index Well Number Alw.!�47 Reading Date JA!J...9G Index well level .....2.LP. .
Adjustment factor Adjusted ground water level ...................................... . .
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring soil absorption ptiterial exist
?in al area
observed throughout the area proposed for - ---
If not, what is the depth of naturally occurring pervious material?
# Certification
I certify that on (date) I have passed the soil evaluator examinatioi .
approved by the a rt ent of Environmental Protection and that
the and above
an a si
was performed by me consistent with the required training, expertise
nc
described in 310 CMR 15.017.
Signature ulm�
Date
DEP APPROVED FORM•12107/95
i
gG � FORM 12 - PERCOLATION TEST
Location Address or Lot No. Wiiz /� „�S Nc�x eex/7z vle zs-
COMMONWEALTH OF MASSACHUSETTS
Massachusetts
Percolation Test*
Date: .. . 6. 5 96 Time:.
Observation Hole #
Depth of Perc '
Start Pre-soak
End Pre-soak
Time at 12"
Time at 9"
Time at 6"
Time (9"-6")
Rate Min./Inch
Minimum'of 1 percolation test must be performed in both the primary area AND
reserve area.
Site Passed Site Failed ❑
....................................................................................................................................._._...............
Performed By: LaAgt) A
Witnessed By: ednisrwy 4 c1,-wi ySvG j 7a-vw or alwewe� Eo ��•
Comments: ............... . _. ..µ ..., ...........h... ....... ...... w .� � �.w ..M�.� ..r �w.�.,_-_....�... .
DEP APPROVED FORM-IV0719S