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HomeMy WebLinkAboutSoil Suitability Assessment Forms � _.___ .. : �' _'' FpF.P+�i �11 - SOIL EVALUATOR F4Rl�i � Page 1 of 3 . No. . � Date: � � � . Commonwealth of Massachusetts � ��ri„ov,��..� , Massachusetts . � � Soil Suitabilitv Assessment for On-site Sewa�snosal .. . /�9..... Pcrformed By: .....f...�...A�,��./....�:�-�-���....v........,�/T . Date: �... ... � �:�� �' ......................................_.� Witnessed By: �. .. ................................................ .... o,r�...... ..:r. . .i.. �....................................................... ., o�.,K:,N�. 1�ioa Addrus or Ad�ai.and 4t/ f��%L 9A/'�R..`!'7 TelepAaK� • )�� / / . //v�f��/IrlO!/f/� ., .. . �. �r Construction ❑ Repair G� � Q�ice Review ' , Poblished Soil Survey Available: No ❑ Yes � ' � . po0 �..9.... •Z Soil Ma Unit /..........5. .... p • Year Published �,.9..�.�..�� Pubhcation Sc'�le t ... ...�.........................._.. ............ .. Soil Limitations ..........::............................. . . . Dninage Class � .......................................... Sa�icial Geologic Report Available: No ❑ Yes l.� � - � •/O�O�o Year Published /.��..��� Publication Scale .r..�-.�.,� Cxologic Material (Map Unit) �.................................:...... .............................................�................................_ ........... . ,/��....Q.��Cil...G�.......���A...�l......./d.,�.l^.......C...�...s�....s'�.......s......._... Ia�ndform .... ..... .... .... • Fbod Insurance Rate Map: ve 500 ear flood boundary No ❑Yes � Abo y � . Within 500 year flood boundary No ❑Yes ❑ � . Within 100 year flood baundary No ❑Yes ❑ . . ,,c Wetland Area: • ......... National Wetland Inventory Map (map unit) ..................................................................................................... . Ma ma unit � ............................ Wetlands Conservancy Program P( P ........................................ ............................... Ccrrent Water Resource Cond' ions(USGS): Month ,s�� � �.,.-�.� . Rmg e :Above Normal Normal ❑Belc��Normal ❑ . �er References Reviewed: DEP APPROVF.D FORM-12lGf/95 . • _____ _ �• ' � FOI2IY1 I1'- SOIL EVALUATOR I�OKl1•1 ` ' � Pagc2of3 Location Address or Lot �Jo. /��A 9�rra �r� �is��Ai�v!/�'`�i � � On-site Review :�/� Time:././...-'_30' '4� Weather �0 f-�`..:Ori����s�'- Deep Hole Number �..�2 Date:. .� . � � Location tidentify on site planl � .....:.....::.._,,.:.........:..�......,,..,.,,.,�...,...,.x..,,.�....�..x... ....:................. ..... ,..,w,. ._.,,.. ... ...:.. .:...:..�.�..w.....,...:. ., Land Use .,/�r-s�����'`�`F� Slope (°�6) 3��' Surface Stones .. .r���!' � _..• ... . . Vegetation �/.;rr� ;j�"'F. f/�.��f� ., . .. . ,..,r...r.:,:..�..,.....,........�. . . . . . .. ......,.: :. . ..., ..:.......: . . . �. p���s�l. ./-'/�r, .1���s��..�..v..... : ..... . Landform ...:. ✓.�.�,...rti.i.G� .....,. .,.. . . Position on landscape tsketch on the back) ..�.... . � � � �•- � �� - '� " �, . � Distances from: � ` Open Water Body�/OlJ feet Drainage way ��.5 feet Possible Wet Area ,7/�� feet Property Line �/O.'.:. feet Drinking Water Well/i��^�"^� feet Other . ::.:..:......,..:,..,...,.....;.r.:... � ' DEEP OBSERVATION HOLE �.OG` � Depth from Soil Horizon Soil Texture Soil Color Soil Other � Surface Ilnchesl (USDA) (Munsell► Mottling (Structure,Stones,Bo vle"rs, Consistency, 96 T/�#..� G� " � sA�� o�/ ��'e . � �-�i '' /� s�,� �� / ��n � ��,- . �n � C��� G .�� _.'sy% --� Mo��j z-sy%(�'�:,�/ . .��� ` ,i , 1�`''�^� �o a 9� � �f��� � -- C/.��rr � S��. Ty�2 �-�/ /=i// ��/� — . — - . � // /� A ' .s n a�f� ��.�� ���e — /`f' �pA�'-� 7 Z� '' � ,►,.�y- py�� , � '— s�^� �; � ,, „s�-,il:�>-� .�J� �- �O G �1'�•.s� y�9 � � �/�r�`� � `_,�,., - ���� _ E ' - � �� Parem Material(geologic) �A'/v�/" _ �p�0�0�' T,��� De�tfi to Groundwater. Standing Water in the Hole: _� -���� Weeping from Pit Face: — Estimated Seasonal High Ground Water: . �� ��/✓���✓ T��-'� ��'""�s��/� DEP APPROVED FONJN-12/0�/9S ' �':y r � � , . /�/ll��r,�t- �� . lr/rs�y.r�o���i ' , . , s � ,; . - . /��/� � ' . Tff T�s'' , �2 �z •• � ❑ � �" � I ' �o � - � �v /�s� o � i� � N h� o '` A/ _ _ __ - � i'!� i�� a/� G� � a� � � � � . . , --- •- . • I���LI� l.'1 - SUIL LVALUATOR FORM Page 3 of 3 Location Address or Lot No. ��/f/�� Gi,, %�h-,o��,� , � . _ Determinah'on for Seasonal �i�h Water Table ' � Method Used• � . � . ❑ Depth observed standing in observation hole..................:� inches ❑ Depth weeping .from side o'� observation hole.................', inches L� Depth to soil mottles .¢..���,�....� inches ❑ Ground water adjustment ................... feet • '� = � index Well Number .................. . Reading Date ................... Index welf level ................... ; ;; ., . � Adjustment fa¢tor ................... Adjusted ground water level ..!�.......�:.......................................... ' . � Depth of Naturaliv Occurring Pervious Matefial . Does at least fou� feet of naturally occurring pe�vious material exist in all areas observed throughout the �rea proposed for the soil absorption system? ��t If not, what is the depth of natu�ally occurring pervious material? Certification - $► . � . . I certify that on:l�/a�� {date) 1 have passed the soil evaluator 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 �ate .���/��� �t .. , ' � � � _ _ _ , DEP APPROVED FORM-12/07/9S , . ��i • _ ____ . . „• M .. ' < • . , . ' .. - . � FQR�'Z 12 - PERCOLATION TEST � _ . Location Address or Lot No. /��/1���,��.� G�, , COMMONWEALTH OF 11/IASSACHUSETTS �r,,;o���� , Massachusetts , _. � �. Percolation Test' � :�. Date: .�v,...l�...�z/�9�� Time:..:_.,//.�.G.w��'t �J�servati�:� !-!�!e # �/ � � Depth of Perc �� �� �. Start Pre-soak � , � End Pre-soak /�—��� ��,��, , � Time at 12" � � Time at 9" _ � Time at 6° ' � Time (9"-6") Rate Min./Inch G� h.,,,j � i�� • Minimum of 1 percolation test must be performed in both the priniary area AND � reserve area. � - � Site Passed �Site Failed ❑ � . . Performed By: .��.7 Ci Gf�'�l/ / �iT- . ' . Wrmessed By: �or, C.-,���R C • k " Comments: ..�.. �.....,.�....�......_.�.,.�.....�,....�,....�..�.. ' w..,...�. � � ' . • _ . . DEP APPROVPa PORM-12/07/9S • • ' r