HomeMy WebLinkAboutSoil Evaluation form - 2001 FORM 11 - SOIL EVALUATOR FORM
11-2 r 1 E D Page l of 3
AUG 2 1 2001
HEALTH i H i EPT.
Date: x-16-c.)
No. fc.¢e � e
Commonwealth of Massachusetts
, Massachusetts
,Soil Suitability Assessment for On-site Sewage Disposal
sevzZ
i7g llo-cel
/zvC �1 9w/C/� " ' '- Date: 8"
Performed By ,� „ro Sr# CV -
Witnessed By: C42
- E 4 -775-3S3 37
-/7-7
Location Owner's Narne, E--
Mrs
nA:
LaaNa10 f� 0/K ZG Address,and C! Zej �,4
/-c-
W � oy / 3 9y-cze_ z / Telephone gSn-0n 70 z6
/2 efirv2-673
New Construction ❑ Repairt?'1getcody ?k /342-B f Z7 i2'i3_ov
Rk /c' '' /03 4-B (95-3 ler -l8 A
Office Review
Published Soil Survey Available: No ❑ Yes
g Publication Scale / �S�"12 Soil Map Unit .5e3P 2� Cd 4'
Year Published C ' s
/ adQ
Drainage Class r� y��r<«.55- Soil Limitations '7i y :. M
M�� 9{- ❑
Surficial Geologic Report Available: No ❑ Yes
Year Published Publication Scale
Geologic Material (Map Unit)
Landform sit 0'4/,)
Flood Insurance Rate Map:
Above 500 year flood boundary No ❑Yes n
Within 500 year flood boundary No nYes
Within 100 year flood boundary No Fl Yes I
Wetland Area:
National Wetland Inventory Map (map unit)
Wetlands Conservancy Program Map (map unit)
Current Water Resource Conditions (USGS): Month
Range :Above Normal. ❑Normal [ Belcwv Normal ❑
Other References Reviewed: /��/,�/3u� `1)2-a)/" 'Z 9
0 I P DEP APPROVED FORM-12/07/95
, 6-/6 - 0/
• FORM 11 - SOIL EVALUATOR FORM
. Page 2 of 3
•
Location Address or Lot iNfo. #39 �L7---)"" PO " ' 7owl- o��_,
•
On-site Review
Deep Hole Number Datee-
/6 ��� Time: P� Weather cimi 7 �(
Location (identify on site plan)
Land Use P cs(Q.( fT ' / Slope (%) (' ' Surface Stones J0,--/%-•:-
Vegetation L- PJ +
Landform C.f._ r°9`-r/ 5A's./D
Position on landscape (sketch on the back)
Distances from: / /�JSgsi�1�C� sem/ ��
PIRKE/Q (-r 04�Open Water Body /,0b t feet Drainage way feet d ip n a,�, r,/ay
R�vFR •
Possible Wet Area /v/4-- feet Property Line 20' feet
Drinking Water Wella/ feet Other
DEEP OBSERVATION HOLE LOG•
--r---0-4 -1 iJ(F f s o+J `YFanf n2Ek40i 5
042 •Itr,61VOLsrN,4 4 34 ?to cuict is O(-JP
�• r
Depth from Soil Horizon Soil Texture Soil Color Soil C24—CV Other o PA! A+i" ( )
Surface (Inches) (USDA) (Munsell) Mottling (Structure. Stones, Sould-ri, Consistency, % a✓
.5 r•- K/4O� •r:••l) Fc-J C� -'1 L"Ti`"
. Ns
dl, N
g t l pgyx ✓/yen,,
.� 4� �•$./. 5 r���O4Ro �. y ' ' � I.\ jig lba 2\ ird=e4eNI.
�r dw/ C=`i At . . q A-- `11 �`f2UW G
6
71? 1//)/e/ �OdvS2 ,r -
lek Plt 4 I d)° \ ii kfc•vETZNI- 9 'k
IP
i,. � �
• MINIMUtyf OF 2 HOLES REQUIRED AT EVERY PROPOSED D(SOSALA A
(�J
Parent Material (geolggic) 7/Gri4-S4 Cl/4' Depth Bedrock: A//�
Depth to Groundwater, Standing Water in the Hole: 7 -o n eeping from Pit Face: 7" {J ? _
Estimated Seasonal High Ground Water: �/ /21 t7 �X4,-1"{7/5i"/ (/ t 1'r/: 6 L 41'('�"%2 -33)1,;,./...,,t/44 G
/4426.76'3 � �- (—
0 �
-10•-1 (-2 -1,..(2.__
r :
9ll 2,G/- l 3 -' ,0A) 4?) ��n �
a �4 ,,,t, ,( V), 1ty
,( /, Z ' /2'i
, e
DEP APPRON D IR. ./071 /
0\. /.
1#/ �`o,,, '�' Z4
•
FORM 11 - SOIL EVALUATOR FORM
Page 3 of 3
•
Location Address or Lot No. *JY C«4"ofel- _ •
• ' . -77-'z Sia-z� 626 73 .
etermination or Seasonal 111,h h Water. Table
• Method Used:
•
f //
/i Depth observed standing in observation hole /`B inches
�.A Depth weeping from sid,e� of observation hole 7-8' inches
• . -s ! `.'. inches
14 Ground water adjustment ... . `'. feet 4/04 6. 33 I")?""e4.
• Index Well Number 9///t Reading Date /2°"/ Index well level g•3
Adjustment factor 2.•6/ = I.3r. Adjusted ground water level LoCJL4 'aa G'33'
�2—C.A. CCCch.'" " t.L el
Depth of Naturally Occurring Pervious Material
•
Does at least four feet of naturally occurring pervious material exist in II areas
observed throughout the area proposed for the soil absorption system? E5
If not, what is the depth of naturally occurring pervious material?
•
• Certification •
•
I certify that on �,� .S-"(date) I have passed the soil evaluator examination
approved by the D partment 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. Alio
Signature , — ' W "UP Date 46"/6-- q
,4 .
e ti/ie4/i o2 f-0 .
,. a •
•
�r = - , , y Ls�g-Z49C
•
b 1'P
DEP APPROVED FORM•12/07/95
/— 7�ERGJs° NJ '"Qu N/" nl9rc.ela,7,ts x.34. J rcoe6d1s
F___4 - S`�) t?,.vP - t3l./P,
" X- -A P7e le i?
r� i g7. '
I ii
- i f / • d
r •
r?r'iv i LO,-t- T7 63 4-- §8,, .
y
32 ( ( S( 1 gPfecr ) (�
4 4C.*- 41P it'
kt)\9 ,41p CV( N'''- ' -`(3 V
�, 7
- 1 t. nP'
CO
' {J� I A4,
Li��0 (4 Ib J �.
N `y �1 f �' U r"
c \ 'II st_Th i
le �/11___ t� I qy t o -��! ib y
S - 2�( l 2Yti 5�.11›,ill°
0\ Itit
p«+ • , c . '.
S
, I
o j 2S 5 2,c, 2 41
Z , ^,,, A ecr 6-82 e ZG
12 - uo`; -3 Ott LQx N
2'r89.70.,e /" .
JUM/°/dv�� , ( , 4.-b 1 3 / CO _2.)./4.,V 4 tV9- 1- 'CoQ (ILoLK)
j u\i- \ 0__,, 6v ...G oar SE I to
8 7, �j./ �'ov
v
i
nil
. tei - _t-77---- -0___7.
i>A--s r,\, t 7j74bc,1 c
q-- K1' . _gt„.„ .6J f .\\ 440, / , I
S:.
A r r .4 4 ''isk -r.,,,-,4• 1'7.77;;':` &'- :.. y' y h; +m t , f' t .q fi;.,t
�, J S,� k X ,4,Y..,•74 Yy t- x }wSi 11 i s+z qF+F r p«'�`�t.,�i z,,$ ;: ,,''" ,4 yk 4 ',51'i',-..'"„,,,,,...',,
a Vw
•
�. y-';':,':`':..1C.,,r,,.qr r i er r r c W �z yyH ¢ -.x,t �a t '� r 1 it d 1, lr tt,0 a.4 1,•••04r iy 2 } y,.` �.
�d w 1. f �, . ,a t 01 tis t z e "' ,p. j. { kk3,�
N.- 2,1.":-..';''''''
., >4c"# X4'xta }.M; -. 6°az5 Yb-4 stG ��.} ' ;41, a`7 ,- h4'£r:a i'V i 14,, 1' „ )' ,,S t ra'
h 3 ° +� '''� 4,°s a� ; ..-lv,; k ' fit} }f v ! 1
� s f .i� x 4 e ��k s i sa fi Ha i at Mfr
r fi 2r '4p ,5^$"�. ✓ 1` k s`4 ,a t-i: i E ii cx 4 k + >,
tS'' q#1.4.'?'
r . k,•.?„..
ti S '":;-,4';':';:;';''''f ;t ,'w y.ri4 ' r 1 l L� r , tt t A'', ru'•pit 4
ft
-,1-,,,,:13:1 ';'4,-:,.,
�l ��}l��yr1�A rfl �'�.'ti�o r�r y'h�`5t ,,,,,,,P,,,,,,,-,���� $'A,u � ,�}TA�1 �}i.��A���`.ff Ff5 N.F 4�} :�y y�F'w,�f /�T�(h�C`f2 d''1
, G d r�r'.. ,,4 , t v s ,„„:44.,;,,,,,i.,,,,„
r '"��¢
. '4'� , r /O N • }� y�y "4,',, y., ,_.:,+ 111 4 ' ,4, yAit'4;^ lYt tj i rl,l '"'' r ,}1k 7';i. w...
'wrr r ,r)"9a c .Z " . g .;.0-, }� i ,r'm4 Y inn i{ z. ,,a*s'oaq�+GS t�.4$t�t f�f'�-t�vtq i r,.
Pic
• '' .4> ,''.;2••';.'•V),'‘''''
e >�3fi7 f y i41 9 .. * n.. e eCr.=�'}r vr° 15,'S ..4 ' y x1' ,y a 1.
"� � '�' �;i � � � yR ,y r. r){�i yCs�,c y'�'7.^^4 x , .:
r-
..-•-14,,,, •• � '+1. .-1 �� 'a .,;� ti xla o- i Tb .iiTC :i' .
O� 1 -- i /' FCA' , i �1�d
5 .-„,„•:',.,.., ,,,,:i'4•..,,,47••,.-,4-,1:
�.rs
` Q
.•F' o
0 f� i z
8 A.a.S9' '1 QO
'
Q
_9 O
-0 \
011
Ir (.
O o
o
a
� o
V
O N
-2._
768 �� j..--1 v !
--) ?--
,ge� ,
p` f(, Si
C .j 8 g'
�,
,\NI— 3
big
�' A
O
si
A
L
\,\
01.1 IS
t4 IF c32 ,1 Pb' r1 0
o a85Ct
S6
V
• e
5'l �
1
• f
r ---o, ,rZ
s
e