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R cL' FORM 11 - SOIL EVALUATOR FOR
Page 1 of 3
Date: A� io rQq
No.
........ _.. P.. '.�, z.,..
Die. 5; -e W %/9obos' Commonwealth of Massachusetts
Massachusetts.,_
_
Soil uitabil
• ' i :A essment or On-site�� ewa e Dis osal
S w ss
Date: ' =
ll-� ................................
` ........
Performed By ......X. . ... .-.:........................
Witnessed By:
t«.� Ma.en Or yea ..ro / c c� rp-
L.rt 2O. Tc4how r Q/L� &4e��+_�4+ (J
'54d�aL= a�"1 � I pn f30�. is%
o
C I d�-L£� -6 115,9
ew Construction:,¢-9L Repair w _.,...,�..�..._.,
ai ' � ' k s
Office Review
Yes
3 Published Soil-Survey .Available: No
i
.shed �,�Q bLcat ion,' � � Unit
pu i
:2 ,�vt, '1 Map
Year Publis
�. _._.. H.. V.. i*,....,...
o ,
E,S o�1. .:... Soil Limitations
Drainage Class - - _
Surficial Geologic Report Available: No ❑ Yes
1..4w .::. Publication Scale
Year Published ;
.. ...::............................................................................................................:..................
Geologic Material (Map Unit)
.........................................
Landform .............. v7'v .....:...... ....................
Flood Insurance Rate Map: '
. No ❑Yes l3
Above 500 year flood boundary -
' Yes ❑
Within 500 year flood boundary No ❑
f year flood boundary too ❑ics ❑ s
Within 100 y ,,
Wetland Area: k € ................................................................
National Wetland.Inventory Map (map unit)
Wetlands Conservancy Program Map(map unit)
s..................................................................
- - Current:Water..Resou=Conditions(USGS): Month"
Ran e':Above N'onm
ther al KNormal ❑Bela: Normal El g
O -References Reviewed:
DEP APPROVED FORM.12/07/95 } `
FORM 11 - SOIL EVALUATOR FORM
Qp� u f
'O..• '1 .• ,i.l.+ J `>� � t _:2,,, � :n' Page P g
•t
t No.
Location Addr
ess or LO
r0
<i
�..._.. .. __._ On-site Review
t:..�^'`.s,v �,;�.r}4Y4 ti: 4�i �,9- 1 `�.'.. �'? •: + 7i1,
. . `Ko Time. /n �.-t Weather Gct�/ .- C0
� Deep
Hole Number Date
3 Ian)��
Locat on:(ide. Ify on siteC.
p r.� _ ,:. v �Sufa St..:
M
.,, ..._�. ,
Land Use .::::.
/ CNT/t :C� Slope (%).. r. ce ones
Vegetation
..
Landform . �t2. �,t�A3l .::. ... .
Position on landscape (sketch'on the back)
E Distances fgm: ,..._,�._
r i 2v feet' '�' ' Drainage way feet`
Open Water Body
.�„
Possible Wet Area L. Z3....: feet,,,t s Property Line ..:::�-�. feet
feet Other ....:,.,
Drinking Water Well .......... >
OBSERVATION HOLE LOG
DEEP 0 _
"Other
Depth from ' "'•Soil'Horizon Soil Texture ..Soil Color,., $O1I 4 Gravel)
Boulders, Consistency, °�6
Surface(inches)
NSDA) (Munsell)'' `Mottling (Structure,Stones, „
0 oli
t SAnl,7
Xj
Aar/ /_ V
ito
H;-A { _i�$} `�i�s`YY 3ol
s•!#` .` 4r' .^ '"p Jai i:, '" 'Sa`
Ell
DepthtoBedrock:
' Parent Material(geologic) [�L�Gil+t:
"Weeping from Pit Face: J.
Death td Groundwater: Standing Water in the1Hole: d Z
...:..:....... .._ � .... __.. ,Jlo✓� ,, �•..,.� �
Estimated Seasonal Hi9 h Ground'Water .LPL Flo
DEP APPROVED FORM-12/07/95
r
y 'i7
FORM 11 - SOIL EVALUATOR FORM
Page 3 of 3
Location Address or Lot No.
Determination for Seasonal High Water Table
Method Used:
Depth observed standing in observation hole....�oL.... inches
❑ Depth weeping from side of observation hole.................. inches
❑ Depth to soil mottles inches
❑ Ground water adjustment ................... feet
Index Well Number /w.. � Reading Date le/ L_ 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? VOS
If not, what is the depth of naturally occurring pervious material?
Certification
I certify that on M 9�1991 (date) I have Passed the soil evaluator examination
approved by the Department of Environmental Protection and that the above analysis
was performed by me consistent wiih the.r equired training, expertise and experience
described in 310 CMR 15.017.
Signature,J_at ..-Q' r]
a:—Date 12
DEP APPROVED FORM-12/07/9S
FORM 12 PERCOLATION TEST
Location Address or Lot No. 20
COMMONWEALTH OF MASSACHUSETTS
Massachusetts
Percolation Test*
Time:,.-._JQ-. -.16 .:..:
Observation Hole.
Depth of Perc
Start Pre-soak
tv, i�;
I
End Pre-soak
Time iat 12"
Time at 9"
Time at 6"
: . Time W-61
Rate Min./Inch TJ43�
s,��•CT A I Pi w 2 AA,W
* Minimum of 1 percolation test must be performed in both the primary area AND
reserve a're
z
Site Passed' Site Failed. 0
;. Performed. By: t � —
04
Witnessed By: �� �, n
Comments:. J ...x:: .►I .. �: �N�
�aAD - 01JL1
DEP APPROVED FORM•12/07ro6