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HomeMy WebLinkAbout0115 BAXTERS NECK ROAD - Health 115 Baxter Neck Road. Cotuit A= 056-082-X02 -�- - f i FORM 11 --SOIL EVALUATOR FORM Page I of 3 -7 No. P 9 2-2 Date: Commonwealth of Massachusetts Massachusetts Soil Suitability Assessment for On-site Sewage Disnosal .... . Date: Performed B ........ ...............................a......Witnessed By: ..... ....... ...................... ................ .... ....... ............... . ....... Location Address of owner's Name, Address,and Lot '0'0;WC Telephone I ew Construction Repair ❑ Office Review Published Soil Survey Available: No 0 Yes Soil Map Unit Year Published Publication scale Pe-- ..................................... .......... . ........................... ........... Soil Limitations ................... Drainage Class Surficial Geologic Report Available: No ❑ Yes Year.Published Publ',cation Scale ....................... .... ....................... Geologic Material (Map Unit) "�.v. .-r...........:...................................................................... ............ ...... ..... ............ ........... ..................... ......... ...... ............ Landform cj Flood Insurance Rate Map: co 4 Above 500 year flood boundary No E]Yes P-4 CD -n Within 500 year flood boundary No NYes CD Yes El Within 100 year flood boundary No Wetland Area: 1A CD M................... National Wetland Inventory Map (map unit) ......................................... .............. ...................................... Wetlands Conservancy Program Map (map unit) ....................................................... Current Water Resource Conditions (USGS): Month Range :Above Normal E]Normal E]Belc�-v Normal ❑ Other References Reviewed: DEP APPROVED FORM 12/07/95 FORM 11. - SOIL EVALUATOR FORM Page 2 of 3 . Location Address or Lot No. On-site Review -7 v Weather ".::.::::,::::.....:...:.. j Deep Hole Number Dam..... : ..::::.:.:...::. Location (identify on site plan) Land Use :: '" `' Slope (%) L.? Surface Stones .. Vegetation :.......................... . ..:::,...:: .. ., ... .. .. ....................... Landform Position on landscape (sketch on the back) ........ .... . Distances from:. Open Water Bodyfeet Drainage way. feet Possible Wet Area :..:. •...- feet Property Line .... ....' .:.. feet Drinking Water Well .,,:.:::'-:::::. feet Other DEEP OBSERVATION HOLE LOG Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(Inches) (USDA) IMunseo) Mottling (Structure,Stones, Boulders, Consistency, Gravel) r. 31r a ' Z r 6 T �z z'3/�. ���r325 r. r DepthtoBedrock: '7 p Parent Material (geologic) - �; _ Weeping from Pit Face: " Depth to Groundwater: Standing Water in the Hole: Estimated Seasonal High Ground Water: . �Xz� DEP APPROVED FORM-12/07/95 FORM 11 - SOIL LVALUATOR FORM Page 3 of 3 Location Address or Lot No. Determination for Seasonal High Water Table Method Used: ,canJ � .ter; ❑ 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. .................. Reading Date ................... 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? 'Yt If not, what is the depth of naturally occurring pervious material? Certification I certify that on (date) I have passed the soil evaluator examination approved by the Depaftment 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 1 �_ � Date ' DEP APPROVED FORM-12/07/95 r FORM 12 - PERCOLATION TEST Location Address or Lot No. COMMONWEALTH OF MASSACHUSETTS Massachusetts Percolation Test* Date: : 7 :. Time:. - ll'3U Observation Hoie ff Depth of Perc Start Pre-soak i vv End Pre-soak 7 . z z Time at 12" Time at 9 Time at Time (9"-6") Rate Min./Inch . G 2- Minimum of 'i percolation test must be performed in both the primary area AND reserve area. Site.Passed Site Failed ❑ ..............................................................................................:......................................._-......................... Performed By: ' �-� Witnessed By: r� , Comments: DU APPROVED FORM-12/07/95