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HomeMy WebLinkAbout0025 JUDITH EVE LANE - Health (4) as J vck;-� l.ve Lcme- , ,�w,�� i Y �� FORM 11 - SO EVALUATOR FORM Page I of 3 Date 1 tq � (� No. Commonwealth of Massachusetts ­j ap,e, l,Tlap, c& , Massachusetts Soi l Suitabili Assessment for On-site Sewa a Dis osal w— Date: TtS Performed By: ......! .�G6�a1p......k.... .oX -,....:..... T -....,. � 'bw ..... .M2 . ... vw. l......v.>`...`$P�1tJ.S'I'h Witnessed By: RY......i. 192 ter 7-v7 f flame. STg1p�til�1� Location Address I Address.aid % H y MJ i`11 S 0 0 L� - / A&XC TS-Z-- Lot/ �� ltl� `A- Telephone/ t�, �L�1J 5 T• �y.4 h}� 7 ,L-LZ ❑ 43 New construction © Repair P8� Office Review ❑ � Published Soil Survey Available: No Yes❑ Soil Map Unit C� .g Year Published kOLg ............:..... Publication Scale Drainage ClassC�5�1us......... Soil Limitations ................................. Surficial Geologic Report Available: No ❑ Yes Year Published tci1�:: . . Publication Scale Geologic Material (Map Unit) 0 .................................................................................................................... ......................_.... Ln,�1 ..................................................... _. Landform -hy,AF .�......©. .ut s .....:................................................................... Flood Insurance Rate Map: Above 500 year flood boundary No [I Yes Within 500 year flood boundary No ©Yes ❑ Within 100 year flood boundary No ©Yes ❑ Wetland Area: 4r ow S maunit .............................................................................. ................... National Wetland,Inventory Map (map ) ............................................................................................. Wetlands,Conservancy Program Map (map unit) 1 Current Water Resource Conditions (USGS): Month to. 9 Range :Above Normal ❑Normal ❑Belcwv Normal Other References Reviewed: DEP APPROVED FORM-12/0719S r FORM 11 - SOIL EVALUATOR FORM Page 2of3 Location Address or Lot No. zD�- l5 •/yy�r (/� On-site Review Deep Hole Number ..:: 2 Date: 2.':0.17q a Time: /�.:.. ::� Weather �L�-��2, co G.: . Location (identify on site plan) A !.:r t�s Land Use .... pc�.T-iA.L—...::. Slope (%) . d-3.. Surface Stones :.. Vegetation ..::0000D,�� ' Landform Position on landscape (sketch on the back Distances from: Open Water Body '70a feet Drainage way Possible Wet Area Property GD' feet SQa: feet Pro ert Line ... . :::. feet Drinking Water Well ::::::,:"-:::: feet Other DEEP OBSERVATION HOLE LOGS Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(Inches) (USDA) (Munsell) Mottling (Structure,Stones,Bounders, Consistency, % -7 ,B ioye / o F2ia8ur 2(0►'-GS" C C'S /n ye 414- D 2�•°a c� S yv (.�,wejL 2 l25 10 SAL AREA Parent Material(geologic) DepthtoBedrock: ` Death to Groundwater: Standing Water in the Hole: Weeping from Pit Face: — Estimated Seasonal High Ground Water: DEP APPROVED FORM-12/07/95 " 1 FORM 11 - SOIL EVALUATOR FORM / Page 3 of 3 Location Address or Lot No. 4-� /'S JyD'Yw ✓S 44, Determination for.Seasonal High Water Table Method Used: ❑ 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 Sbw-252 Reading Date ..%%.. Index well level ...47,5 Adjustment factor ....... 011z Adjusted ground water level .......... 47%5........................ A/O W,4Y t=wdo v A)7 E� tN D t�P t/a L6 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? -DES If not, what is the depth of naturally occurring pervious material? Certification I certify that on MALI 9, a99!r (date) I 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 DXL. Igo ate T�n ttq(o DEP APPROVED FORM-12/07/95