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Home My WebLink About0008 FOX RUN - Health (2) g `� �� C��fe�U►II e _ _ . _ a ��/ iy� ____ __ _ / \ f . � �� i lu�� u ul ll�tlust.►u►� � �` `S � � Department of Health,Safety,and Environmental Services bate Qublic•Health �M tot6on t►a 367 Mein Street.Ily nis Time_ FK pd. �100 t wue,t -I?ell, NAM 161p k0ete Scheduled Went or SewagQ Disposal sit suitability Assess► E f ti� �N N1cH� U tnewd thy: S I ► ' Performed By: �R l.A I,INFOPMATION. LC�CA1'ION & GENERA pwner'sName t,oKF�St/t��E G/1��U�-► ZO N oA� ' I,ocatlonAddrcss �j "��x 1 Address +3px 1`-1 •i �1��1 H flM1� >xnshteer's Name �W� C-Pr►"� Assessor's MOPMwel: y Z W S ) Telephone N v-' REPAIR NEW CONSTRUCTtO i © Surtbce Stones Lend Use 1IAK A.!" , slopes('h) -)>/'' Wen R n Water Body_�—n Possible Wet Arc, ' �—akirt�W Distances tlont: open R ProptatY Line �5_---a � t)fainege WRY o exact locations of test holes�pare tem.Iocde wetlands M Dtoxhnity M holes) SKETCH:(Street name,dimensions of lot, i q , � CD 0 (� �o�\ I•r y 7�, �� MO to Bedrock Parent materiel(geologic) Weepin`MIM Pit pace _ Depth i0 vi011tii1lN8ter:`S`Rhd{n WeteGin Hole: L Y ck d rj> I Estimated Seasonal High Oroundweter ° G�eJN ,,,►� INATION VO4 9EA9ONAt GH'WAT1g'�t'r ktILV '.., .. UCTCI tM In. N��- In. Depth to soil mottles: tt• Method Used: in• proundweter Adjushnent Depth Observed sfiomi side of obs.hole: Adj.rector _Adj.(Im"dwalet Levet_/J A Depth to weeping Index Well level.---- Index Well N__..... .Reading Uate: — pEhtCOLA`t`I+(�N'I'LS ': 16a+a< :.. 1 AM T at9" Observation lnle Hole N ,t 'lime ,11+t,. Depth of Pero W, 1 ter' 71tne(9"-6"I ' I E • '" start Pre-soak Time® Z to End pre-soak M /� LA `N/1- 1 Rate M1n.Rnch assed Additional Testing Needed(Y" Site Suitability Assessment: Site P Site Failed: _N final: Public Health Division Observation Hole Data To Be Completed on Back Ori --� R r'nnv: AnplIcAnt IroLr VA LUG. ' Soil Ullrcr 1)li�lils UI151�,IZ �110 Soil Color ' Mottling (Structute,Stones,norrldercs. Sall'fexlure Ikplh from Soil I lorizun (USDA) (Munsell) Surface(In.) LA M NO LjAz f �- Ntni�# he . I UrCI' 0[35C1[tVA'�toR 110LCILOG soil ponldtrct. Soil Texlute Mottling lSlruclurc,Stones, , th from roll 116tizon (USDA) (Munsell) CO Uep � Surface(In.) 2- A )0 6 �5 `�-?�0 3 2.C�y6 6 Iilil�# --other dr)SrhVA'r[ON IIOLCiL Dior Soil stones,ooulderot. Soil Texture Mottling (Structure, i)epth frm o SoilIlorlion (USUA) (Munsell) Sulfnce(in.) Solt Other llClap OUSERV ��IUN 110LCU soil (Stnrcturc,Stones,Douldcres. Soll'fexture (Munsell) mottling Ipcpth from Soil 1loriron (USUA) Surface(in.) t Yet,_.._ Above 500 year flood boundary. No Z O N C 13� -� Within 300 year boundary No Yes � .. .. Wi thin hln 100 year flood boundary No,✓ yes — 1 --,,.... ss,'.,` n rrinri YrlrYhllt,9..�11!`Elaas '^ Ilrnllt o 11 �r I occurring pervious materiel exist in all areas observed throughout the Does at least four feel of naturally �/ �i area proposed for the soil absorption system? —'"7— e depth of naturally occurring pervious material? -- If not,what Is(he P �-----� � , C, � �erlillCatlOrt j•J / �� f� OV �`�h (date)I have passed the soil evaluator exarnlnatton ap I certify that onp�v�by th° a of t:nvironmcnlal Protrclion and that fife above analysis was performed by rnr.consistent with I1irnarinlct, _ .,.. r.rihed in 310 CMR 15.017.