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Home My WebLink About0001 LUMBERT MILL ROAD - Health (3) Lumberf �'h ►I Rom Ce�tmu�h� C FORM I - SO11, EVAL ATOR FORM ASSESSORS MAP N0: Page 1 of 3 PARCEL NO:No. Ica Date: Commonwealth of Massachusetts Massachusetts so—ilsuitabilitip Assessment for on-site Sewage Dis osal .. ..�.�<.�� Date: Performed By: . A .... .. . - . .� ' Witnessed By: � ETelept me. �Location Address �f� �oF/Q/ d La A �/ � � & 1—Jd�hZ - 36/5 ew Construction ❑ Repair z�-3Bo Office Review Published Soil Survey Available: No ElYes I ZSc?oa Soil Map Unit � R� R"`y Year Published CQ............ Publication Scale r r ...... Soil Limitations .......P P..�'....'!...�.'{C.� ........................................ Drainage Class �jc c.�+�,w(.......- Surficial Geologic Report Available: No ❑ Yes 1 8 6 : ::: Publication Scale Year Published QS a�, ....................................................... Unit 'NUNSvvpoe......??�. ........lp.l�- ',......1?- . ........ Geologic Material (Map ) ..................... Landform .........6-0 AS.............0.A..111,1A,,........................................................................................ Flood Insurance Rate Map: Above 500 year flood boundary No ❑Yes Within 500 year flood boundary No ❑Yes ❑ Within 100 year flood boundary No []Yes ❑ Wetland Area: lv k National Wetland Inventory Map (map unit) ....................................................................................................... Wetlands Conservancy Program Map (map unit) .......................................................................................... Current Water Resource Conditions (USGS): Month Range :Above Normal NNormal ❑Belau Normal ❑ Other References Reviewed: U��> `' S DEP APPROVED FORM-12/07/95 �F6 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot IJo. L Fyn 66,'t / lu_ W. On-site Review / Time:. /4. RY1'I Weather BnG� Deep Hole Number 1 Date:. 28 96 y . ..:.::..: .......:.::.:::::.:.:.:::,:....: ..::.:.::..:::..... .. Location (identify on site plan) .1o.pI::.-...:::.) ». D Land Use yfl-0 Slope (%) ,Z' Surface Stones Vegetation Landform .._ _... r /Z� 0,1,AJ Position on landscape (sketch on the back) lUE� ....... .... ....: . . ...::::.:.... .. Distances from: �� ti feet Open Water Body N feet Drainage way Possible Wet Area k1A feet Property Line .. (3.( . feet Drinking Water Well .k.14 feet Other DEEP OBSERVA 11 TION HOLE LOG Soil Other Depth from Soil Horizon Soil Texture Soil Munsell) Mottling (Structure,Stones,Gr Boulders, Consistency, °� Surface(Inches) 0 ---- 0 311 /earn y 161,S/Z 8 /G/�rn.� lO y�s�8 32" M60 $y 7- S�� l Zo Parent Material(geologic) Depthtoeedrock: /U/A - N�R Weeping from Pit Face: N�Q Death to Groundwater: Standing Water in the Hole: / $ � v D 06� Estimated Seasonal High Ground Water: DEP APPROVED F001-12/07/95 t: i Lof �B 13 r� a �v Ib J Lot R i. �3 tie FORM 11 - SOIL EVALUATOR FOR. Page e0 f Location Address or Lot No. Lum r ��- • On-site Review Deep Hole Number . .Z Date:. v28�C/6 Time: tO 4Y?i Weather yav� Location (identify on site plan) Land Use y19-19 .__ Slope M 17 Surface Stones Vegetation fi yr-4, .. .. .. .. .: . ..... . . ..: . ... .....:.. .. Landform Position on landscape (sketch on the back) Distances from: Open Water Body NIj� feet Drainage way AIM feet Possible Wet Area 419 . feet Property Line feet Drinking Water Well .iv])} feet Other . :.::....::.....:..: ..::.::. DEEP OBSERVATION HOLE LOG* Depth from ]Soil Horizon Soil Texture Soil Color Soil Other Surface(Inches) (USDA) (Munsell) Mottling (Structure,Stones,BoulGravders,Consistency. % . /D yr 6/Z r? /p C r)7 C-a z, sy 4/4 . i Ml Parent Material(geologic) 6Of IAJAJ h /)Z22? . De o o Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: 6 E;timated Seasonal High Ground Water: 3Q DO uJN = bA.1570 U120N TJ.S 6-1 _ I DEP APPROVED FORM-12/07/95 - f FORM 11 - SOIL EVALUATOR FOR1\'I Page 3 of 3 Location Address or Lot No. Determination for Seasonal Hi h Water Table Method Used: /Uo wA,4er TEs le S MAP EC5UA-7 -)AJ � �� ' ,q COVE -CP4 /Pve0 - �S?irrr9' 1`0 6C 3o' vG A0 ❑ Depth observed standing in observation hole........._ inches y A-116 ❑ Depth weeping from side of observation hole........ . inches A114 ❑ Depth to soil mottles . inches k1-4 ❑ Ground water adjustment ................... feet Index Well Number Reading......� ... Date ................. Index well level ....._.. ..... iU g Adjustment factor ....A119- 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? ES If not, what is the depth of naturally occurring pervious material? Certification I certify that on AW, /9 r.3 (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. �� to '51�"�96 Signature �Da DEP APPROVED FORM-12/07/95 d FORM 12 - PERCOLATION TEST 1 Location Address or Lot No. / &,rn �� 1(,C. 12' COMMONWEALTH OF MASSACHUSETTS Massachusetts Percolation Test* Date: ... 3/_28.��i6 Time:. Observation Hole # 2 Depth of Perc live', _ 73 �r . Start Pre-soak End Pre-soak 2 64160/05 /0.133 Time at 12" Time at 9" Time at 6" Time (9"-6") Rate Min./Inch rViinimum of i percolation test must be performed in both the primary area AND reservee area. 2,vO Aece- 7�� A, ,440,50 B91 &ei/, Site Passed LJ Site Failed ❑ Performed By: 6 13le-c,4gf, Witnessed By: ElbeyA- &4ry Comments: DEP APPROVED FORM-12107l9S