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HomeMy WebLinkAbout0675 CEDAR STREET - Health 675 CEDAR--W. BARNSTABLE A=109-014.003 �t. b� TOWN OF BARNSTABLE C `� t LOCATION �4-5* CEDAR ST. SEWAGE # ©Z- VILLAGE. W• -bR44n1SEA-61a ASSESSOR'S MAP & LOT 0 14-3 INSTALLER'S NAME&PHONE NO. W k t cl-v,,, �n(�=tZ 5-0$ '�'�1'�410 SEPTIC TANK CAPACITY a-1 LEACHING FACILITY: (type) L CA Ch t h q Cham-deq (size) B n 2- 3- 0'xC1X L' NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility '10 bV60tr Feet Private Water Supply Well and Leaching Facility (If any wells exist ove1 on site or within 200 feet of leaching facility) 1�6 Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by i t4` C- 1 3 9 C - 4. s-C A - S 4 S` A - (v 1*4' 2 5 vae cr s I, � m THE COMMONWEALTH OF MASSACHUSETTS w BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS 1S To CERTIF� t the On- ewage Disposal System Constructed ( }d Repaired ( )Upgraded ( ) Abandoned( )by �%/. / y l at a has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.24M.--O L,-p _dated_. Installer Designer The issuance of this permit shall not be construed as a guarantee that the sy ra will function a>designed. z Date 5 "- a.( A6O Inspector - M o --------.-------- V W ZV Q Cf Lo Q a m N Cn Q7 a-1 n r` C m m a m m m N r` N r` m r 07/27/2000 11:43 15087718923 ASSURANCE CONSTRCTN PAGE 01 v � 550 Willow Street Hyannis.MA oMi (5m)771-7410 ConstructionAssurance Company Fax To: Glen From Steve Vages FAIc 5W79"304 PaW: 2(wb covet] Phow Data 07/27/00 RN COC for.675 Cedar St. M. d Urgent x For Ravkow 0 Please Continent D Please Reply ❑Please Reeyde *comments.. THANK YOU ! No. v Fee%f327 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Zippiication for Miopozal *p-5tem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) XCompleteSystem ❑Individual Components Location Address or Lot No. 675 Cedar Street Owner's Name,Address and Tel.No.(508) 778-4700 West Barnstable, MA Heritage Building Trust Assessor'sMap/Parcel Map 109 Parcel 14-3 1600 Falmouth Road, Centerville, MA Installer's Name,Address,and Tel.No. 50 —0109 Designer's Name,Address and Tel.No. (508) 888-4029 C. Advanced Technical Solutions 12 Vintro Crt E. Fa mouth, MA 02536�¢l ox 99, E. Sandwich, MA 02537 Z4r Type of Building: �141��1 S Dwelling No.of Bedrooms 4 Lot Size 52,584 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 110 gallons per day. Calculated daily flow 440 gallons. Plan Date 9-20-99 Number of sheets I Revision Date Title "Sewage Disposal System Design for Heritage Estates Realty Tr Size of Septic Tank 1,500 gallons Type of S.A.S. Description of Soil HOLE #1: 0"-10" O—A, Sandy Loam, 10 YR 5/2; 10"-60" B, Sandy Loam, 10 YR 5/6; 60"-120" C, Med-Fine Sand, 2.5 Y 7 3. HOLE ffT7 0"-10" 0—A, Sandy Loam, 10 YR 5/2; 10"-42", B, Sandy Loam, 10 YR 5 6; 42 -120 , C, Med—Fine San 7 3. Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issuedby t ' and of Hea , Signed // Date 1/4/0 0 Application Approved by Date Application Disapproved for the following reasons Permit No. jnd:�C) -- .�s Date Issued No. n DDe ; rJ d Fee&)E 5 THE COMMONWEALTH OF MASSACHUSETTS `Entered in computer: Yes L PUBLIC HEALTH DIVISION -TOWN.OF BARNSTABLES MASSACHUSETTS Zipprication for Mioaal * stern Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) XComplete System ❑Individual-Components Location Address or Lot No. 675 Cedar Street Owne sName, ,ddress and Tel.No.(508) 778-4700 West Barnstable,/ ' H , l a&�Building Trust Assessor'sMap/Parcel Map 109 Parcel 14s 1l�mouth Road, Centerville, MA Installer's Name,Address,and Tel.No. (SOS 45 ,signer ame,Address and Tel.No. (SOH) 888-4029 ""i ;trFnc• `/v Advanced Technical Solutions 12 VYntro Crt E. Falmouth, MA 02536 Box 99, E. Sandwich, MA 02537 Type of Building: Dwelling No.of Bedrooms 4 Lot Size 52.584 sq.ft. Garbage Grinder( ) Other-. Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 110 gallons per day. Calculated daily flow 440 gallons. j' Plan Date 9-20-99 Number of sheets 1 Revision Date Title "Sewage Disposal System Design for Heritage Estates Realty Tr Size of Septic Tank 1,500 gallons Type of S.A.S. Description of Soil HOLE #1:. 0"-10" 0-A, Sandy Loam, 10 YR 5/2; 10"-60" B, Sandy Loam, 10 YR 5/6; 60"-120" C, Med-Fine @and, 2.5 YR7 3. HOLE : 0"-toll 0-A, Sandy Loam, 10 YR 5/2; 10"-42", B, Sandy Loam, 10 YR 5/6; 42' -120 , C, Med-Fine Sand, 2. 7 3. �. Nature of Repairs or Alterations(Answer when applicable) j Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by 2thrig , nd of Heal . Signed ZA"514"- - Date 1/4/00` Application Approved by Date 1 - u - ASS Application Disapproved for th follo mg reasons i Permit No. 2 AO)n .2, �S Date Issued ---- `------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the Onsi ewage Dieposal System Constructed( Repaired( )Upgraded( ) Abandoned( )by at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2 dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the sy tem will function as designed. Date .S'- l !l0 Inspector_ ------------------------ ----------- No. -0oZ5- Fee (,b THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS M gpogal *paem Construction Permit Permission is hereby granted to Construct(�Repair( )Upgrade( )Abandon( ) System located at ` and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date: Approved by =::) C 0 9 -- 1 L( --3 Fee--------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Application-*r Melt Con!gtruction3permit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: Location — Address Assessors Map and Parcel ----------------- Owner Address -------�_ �- -- �-//_ _�___,�/_/_�% -- -------ice)-=------�44 ------------------------- - --- -- Installer — Driller Address Type of Buil welling - --- - -- - ------------- Other - Type of Building----------------------- No. of Persons-------------------------- Type of Well- - � �C - ----- - Capacity — --- - - ---— YP Y------------- ---- Purpose of Well — ---- — ------------ Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. Signed- �6;a 9 date Application Approved By __-_- l�as date Application Disapproved for the following reasons: ----------------------- -- -- --- - -- - ------------ date Permit No. ---- Issued----- -— -- - -- - —— ---- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of (Compliance THIS IS TO CERTIFY, That the Individual Well Constructed (-'*"), Altered ( ), or Repaired ( ) bY--_-����G��'�� Dom,/ -U---------------- ---------- --- - Installer -- ---has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. ---------------Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE—�� p�a�_ �_ Inspector-- ----— ----- — �F` -.. _ .. -�____-4-._,mow..>�--- _-•..- �W_ ___ .: � - .. +nh a -. ♦�...- _.-.rwr- --. ,• ,. i' �+.4i .-..gip:►'.. _ W � - � �� , � o4- _ eY - s ^r - o Fee---- - � NOS f N BOARD OF HEALTH - ------------` TOWN OF BARNSTABLE Application-*rVell Con.5tructionPermit a . Application is hereby`made for,a permit to Construct ( ), Alter ( ), or Repair( ' )an individual Well at: * Location Address Assessors Map and Parcel Owner Address - lam___- ----��---- �° - - ------ ---- - �•r�'x"°� `�'In'stAere Duller - —` -. Address 1 Type of Buil g ,i ,/Dwelling - --- - -- --------------- Other Type of'Building -- ------' No. of Persons---- ------------------ Type ;----------- yP 8 --- -- of Well. -: ------ Capacity-- - - --- ------ -- Purpose of Well---- - - i Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The ' Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate .of Compliance has been issued by the Board of Health. i i Signed date Application Approved By -------- ---— �� �-9�- date Application Disapproved for the following reasons: -------------------------------- __-------_-- _-- --__-__-----_-------______—_—_—_----_---__—__— date t u Permit No. -- — ------ Issued—=------------- date ' L!iYiwil3Yi±+`Gi!ifiT�Q2Yiw{w�fT!p�•!blo0i�'tw!i+l�'Si'#tle�w 3iaSf4fi9}ld1i;.,8@�9wf{iw,QB�li#i1i#iRtilJ3rq�sldTiwi4iliRili4e7Q?848tgryygglGl3{i1�A0a)i+�al�awp aeszse��rr,rse�F e.+•s�+w.sws._ ' BOARD OF HEALTH TOW°N ` "BAR.NSTABLE C trtif irate m'dDf Compliance THIS IS TO CERTIFY, That the Individual We 1 Constructed ( ), Altered ( ), or Repairedby ( ) Installer at 7S .� - - ---- - ------------------- --- ---- - -- -- W. has been installed in act ordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. --------------Dated THE ISSUANCE OF THIS CERTIFIC-ATE,SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION.SATISFACTORY.-' `` t DATE— > a� - 9 _, Inspector'--- __------ —- LYTf�•►w!,illitN�rilisiY'481�tti'wi1a9440ifiT0liwJiTi?i!YNBQi'!�SiSiTL4glil+B��b TiSATOsi 48'D�+ilZUBl ±i R.�.IBIIAATLliRi0iR3.M_'�r?iAi �.9lRa.�TiYv±i w41Y'/ri'if4���'i�ii i!�Si±'F�Mw?ifdf BOARD OF HEALTH TOWN OF BARNSTABLE Yell Conotruct ion Permit 6jV_g No. ----- ---- Fee- - i Permission is hereby granted to Construct (,-I, Alter t ), r Repair.( ) an Individual Well at: street as shown on the application for a Well'Construction Permit No._ 0Dated -- --------------------- ----�� Q Board of Health DATE �� :-- E r, m: CERTIFICATE OF ANALYSIS g - '` Barnstable County Health Laboratory Report Dated: 12/14/1999 Report Prepared For: Order Number: G9904510 Jeffrey Sollows 20 Trotting Bred Lane West Barnstable, MA 02668 Laboratory ID#: 9904510-01 Description: Water-Drinldng Water Sample#: 04510-01 Sampling Location: 675 Cedar St.,Lot 48,W.Bstable Collected: 12/13/1999 Collected by: Charlotte Stief Received: 12/13/1999 Routine ITEM RESULT UNITS MCL Method# Tested LAB: IC Lab Nitrate 5.3 mg/L 10 EPA 300.0 12/14/1999 LAB:Metals Copper <0.1 mg/L 1.3 SM 3111B 12/14/1999 Iron <0.1 mg/L 0.3 SM 3111B 12/14/1999 Sodium 19 mg/L 20 SM 3111B 12/14/1999 LAB: Microbiology Total Coliform Absent P/A Absent P/A 12/13/1999 LAB. Physical Chemistry Conductance 192 umohs/cm EPA 120.1 12/13/1999 pH = 5.8 pH-units EPA 150.1 12/13/1999 Note: The water sample has higher than average levels of Nitrates. Monitoring is recommended(2-3 times per year)to establish any upward trends. Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 L Page: 2 s CERTIFICATE OF ANALYSIS -' Barnstable County Health Laboratory Report Dated: 12/14/1999 Report Prepared For: Order Number: G9904510 Jeffrey Sollows 20 Trotting Bred Lane West Barnstable, MA 02668 Laboratory ID#: 9904510-02 Description: Water-Drinldng Water Sample M 675 Cedar St. Sampline Location: 675 Cedar St.,Lot 48,W.Bstable Collected: 12/13/1999 Collected by: Charlotte Stief Received: 12/13/1999 EPA 524.2- Volatile Organics by GUMS ITEM RESULT UNITS MCL Method# Tested LAB: GC/MS 1,1,1,2-Tetrachloroethane BRL ug/L EPA 524.2 12/13/1999 1,1,1-Trichloroethane BRL ug/L 200 EPA 524.2 12/13/1999 1,1,2,2-Tetrachloroethane BRL ug/L EPA 524.2 12/13/1999 1,1,2-Trichloroethane BRL ug/L 5.0 EPA 524.2 12/13/1999 1,1-Dichloroethane BRL ug/L EPA 524.2 12/13/1999 1,1-Dichloroethee BRL ug/L 7.0 EPA 524.2 12/13/1999 1,1-Dichloropropene BRL ug/L EPA 524.2 12/13/1999 1,2,3-Trichlorobenzene BRL ug/L EPA 524.2 12/13/1999 1,2,3-Trichloropropane BRL ug/L EPA 524.2 12/13/1999 1,214-Trichlorobenzene BRL ug/L 70 EPA 524.2 12/13/1999 1,2,4-Trimethylbenzene BRL ug/L EPA 524.2 12/13/1999 1,2-Dibromo-3-chloropropan BRL ug/L 0 EPA 524.2 12/13/1999 1,2-Dibromoethane(EDB) BRL ug/L EPA 524.2 12/13/1999 1,2-Dichlorobenzene BRL ug/L 600 EPA 524.2 12/13/1999 1,2-Dichloroethane BRL ug/L 5.0 EPA 524.2 12/13/1999 1,2-Dichloropropane BRL ug/L EPA 524.2 12/13/1999 1,3,5-Trimethylbenzene BRL ug/L EPA 524.2 12/13/1999 1,3-Dichlorobenzene BRL ug/L EPA 524.2 12/13/1999 1,3-Dichloropropane BRL ug/L EPA 524.2 12/13/1999 1,4-Dichlorobenzene BRL ug2 5.0 EPA 524.2 12/13/1999 2,2-Dichloropropane BRL ug/L EPA 524.2 12/13/1999 2-Chlorotoluene BRL ug/L EPA 524.2 12/13/1999 4-Chlorotoluene BRL ug/L EPA 524.2 12/13/1999 Superior Court House, PO.Bog 427, Barnstable, MA 02630 Ph: 508-375-6605 �1 1 4•Y:JY : m Page: 3 CERTIFICATE OF ANALYSIS Barnstable County Health Laboratory Re Report Dated: 12/14/1999 port Prepared For: Order Number: G9904510 Jeffrey Sollows 20 Trotting Bred Lane West Barnstable, MA 02668 Laboratory ID#: 9904510-02 Description: Water-Drinlung Water Sample#: 675 Cedar St. Sampline Location: 675 Cedar St.,Lot 48,W.Bstable Collected: 12/13/1999 Collected by: Charlotte Stief Received: 12/13/1999 Benzene BRL ug/L 5.0 EPA 524.2 12/13/1999 Bromobenzene BRL ug/L EPA 524.2 12/13/1999 Bromochloromethane BRL ug/L EPA 524.2 12/13/1999 Bromodichloromethane BRL ug/L EPA 524.2 12/13/1999 Bromoform BRL ug/L EPA 524.2 12/13/1999 Bromomethane BRL ug/L EPA 524.2 12/13/1999 Carbon tetrachloride BRL ug/L 5.0.. EPA 524.2 12/13/1999 Chlorobenzene BRL u&fL 100 EPA 524.2 12/13/1999 Chl.oroethane BRL ug/L EPA 524.2 12/13/1999 Chloroform 4.3 ug/L EPA 524.2 12/13/1999 Chloromethane BRL ug/L EPA 524.2 12/13/1999 cis-1,2-Dichloroethene BRL ug/L 70 EPA 524.2 12/13/1999 cis-1,3-Dichloropropene BRL ug/L EPA 524.2 12/13/1999 Dibromochloromethane BRL ug/L EPA 524.2 12/13/1999 Di bromomethane BRL ug/L EPA 524.2 12/13/1999 Dichlorodifluoromethane BRL ug/L EPA 524.2 12/13/1999 Ethylbenzene BRL ug2 700 EPA 524.2 12/13/1999 Hezachlorobutadiene BRL ug/L EPA 524.2 12/13/1999 Isopropylbenzene BRL ug/L EPA 524.2 12/13/1999 Methyl-tert-butyl ether BRL ugh- EPA 524.2 12/13/1999 Methylene chloride BRL ug/L 5.0 EPA 524.2 12/13/1999 n-Butylbenzene BRL ug/L EPA 524.2 12/13/1999 n-Propylbenzene BRL ug/L EPA 524.2 12/13/1999 Naphthalene BRL ug/L EPA 524.2 12/13/1999 p-Isopropyltoluene BRL ug/L EPA 524.2 12/13/1999 sec-Butylbenzene BRL ug2 EPA 524.2 12/13/1999 Styrene BRL ug/L 100 EPA 524.2 12/13/1999 Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 m: CERTIFICATE OF ANALYSISPage: ` Barnstable County Health Laboratory Report Prepared For: Report Dated: 12/14/1999 Order Number: G9904510 Jeffrey Sollows 20 Trotting Bred Lane West Barnstable, MA 02668 Laboratory ID#: 9904510-02 Description: Water-Drinldng Water Sample#: 675 Cedar St. Sampling Location: 675 Cedar St.,Lot 48,W.Bstable Collected: 12/13/1999 Collected by: Charlotte Stief Received: 12/13/1999 tert-Butylbenzene BRL ug/L EPA 524.2 12/13/1999 Tetrachloroethene BRL ug/L 5.0 EPA 524.2 12/13/1999 Toluene BRL ug/L 200 EPA 524.2 12/13/1999 Total xylenes BRL ug/L 10000 EPA 524.2 12/13/1999 trans-1,2-Dichloroethene BRL ug/L 100 EPA 524.2 12/13/1999 trans-1,3-Dichloropropene BRL ug/L EPA 524.2 12/13/1999 Trichloroethene BRL ug/L 5.0. EPA 524.2 12/13/1999 Trichlorofluoromethane BRL ug/L EPA 524.2 12/13/1999 Vinyl chloride BRL ug/L 2.0 EPA 524.2 12/13/1999 Note: Approved By: (Lab Director) IZ� k, Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 TOWN OF BARNSTABLE LOCATION CEDAR ST. SEWAGE # ©Z- VILLAGE w -bA<N ST-A-Sf 0 ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1 Soo ,,,,1 LEACHING FACILITY: (type) L G A A mZerS (size) I3'I(32. NO. OF BEDROOMS BUILDER OR OWNER G-1 er-To, e- i PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility '�0 �� 1 Feet - Private Water Supply Well and Leaching Facility (If any wells exist , on site or within 200 feet of leaching facility) e,r ��b Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) ���^�� Feet 1 Furnished by 9 S i i Z 59 S " d 1 4-01 Town of Barnstable P# YJ'/" Department of Health,Safety,and Environmental Services � > Public Health Division Date Q„ 367 Main Street,Hyannis MA 02601 I� + BARNSTABLE, � MASS 1639. � '"rEor� Date Scheduled yr Time / -f �Fee Pd. -� _ Soil Suitability Assessment for Sewage Disposal Performed By: LA/V 1 F0 X- Rssc)C� WitnesSedBy: LOCATH & GENERAL NFORIVIATIQ�V Location Address 7� 6 2 Owners Name Address 1(,D t) 0-1�;6N) Assessor's Map/Parcel: f [` Engineer's Name OV4,m—Z%4 NEW CONSTRUCt`ION REPAIR/ Telephone# Land Use Slopes % � p ( ) � Surface Stones Distances from: Open Water Body 'goo ft Possible Wet Area N �� ft Drinking Water Well> 50 ft Drainage Way 7 So ft Property Line > ft Other N A ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) i d� oglf C6A �, ��� CPW)X7 J Parent material(geologic:) Depth to Bedrock Depth to Groundwater: Standing Water in Hole: O�� Weeping from Pit Face Estimated Seasonal High Groundwater DETERIYIINATIQNFOR SEASONAL HIOH V�ATER TABLE Method Used: 1J � L::::I: Depth Observed standing in obs.hole: in. Depth to soil mottles. �V �� in. Depth to weeping from side of obs.hole ) in. Groundwater Adjustment ft. Index Well# _.__. Reading Date:.__._ Index Well level. __ Ad.j.factor—- Adj.Groundwater Level PERCQLATTON TEST Date f"' Time / / Observation Hole# Depth of Perc ��� Time at V"0'//, Start Pre-soak Time @ Time(9""6")") //v End Pre-soak `�,• 0'14-I q r r: Rate Min./Inch Site Suitability Assessment: Site Passed V Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back j Copy: Applicant . . DEEP OBSERVATION...HOLE LOG Hole#;> Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,° Gr el Q .<r/V L -n AEEP OBSERVATI(Jh HOLE LQG Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Co sistenc %Gr el z , DEEP>OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. —Consistency,%Gra el DEEP`:OBSERVATION HOLE LOG Hale# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling ,(Structure,Stones,Boulderes. Consi tencY,%Gr vel Flood Insurance Rate Map: l Above 500 year flood boundary, No_ Yes V Within 500 year boundary No , Yes Within 100 year flood boundary No Yes 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? FS If not,what is the depth of naturally occurring pervious material? Certification 1 certify thAEnvir � (date) I have passed the soil evaluator examination approved by the Departmental Protection and that the above analysis was performed by the consistent with the requirrtis n perience described in 310 CMR 15.01J7: Signature Date�/ 1 —� �CAi STtrt G V,1 E L ff S�E y � Fl.oT wE2 MF\4:�, iO'9 PL14-- 4 r36 ' I C. 5 �36 ,\ 1 �ELV 6 75 /M 1 U9 Pr- 11--,3 a �R N AGE 4.as , ►�� � j , J� /io E RyE vJ EtL� � � `♦ Exis>>�G �ELL��AZ � FRoN J c�a_ _ ` 1ST aR ♦ � �SiDE o>` Z,oj' ovCY 15�' ` ? /36 ` \ tH OF M S C 3 `t132 1 HARRY i I}LLAN s9c9 �r TtRL � z C J,\ LANTERY. JR. ti z C' fn o p No.26575 p C) KINGSBURY y 26101 � LF /ST F.0 �O M A P ! D9 P C. 19-Z , z2 '7o NAL E eq��u •P1R PCL lv rSo� �30 HERIT-NGc E SI I�.TFS Pc�T`i TR. � ' T- E PLA / (� 00 FPO-MDVTH RLD_ C-EN 1ERVILLE ,MN 02 (3Z SCAL_L : l " = �' — �xtSr��v� G75 C tDIl,,P. S R�ET ASSESSOR 'S MAP \C .3 Pc 14 -3 \,\/EST BR�IST�BLE MF\ 02630 �wN>\1C�7 T'� C r\, SDLUTION S CWJS\JL7 E.NC'�Z C. SAKa Mh- - DW G. �Z099,1