HomeMy WebLinkAbout0111 OLD POST ROAD (CENT.) - Health (3) �ti�t C�Ld �'r�-�' i2�c�;C�ter�o��e
2 c��►/c�c��Jooy�
� �
--- - - - �
FORM 11 - SOIL EV UATOR FORM
Page I of 3
9169 .
(?733 Date.
No.
commonwealth of Massachusetts
j3p&tI, �FA,5c,t97 Massachusetts
On-site -S e-w i a a -D isp o s a
Soil Suitab Asses
Date: .......
...............
Performed By: ..... 6 A
........................................I...... .........................................
Witnessed By: ......-Tow.f &F
Owmr a Nam. 0
Location Address Or Address.and
w# Teleph=11 ootly-
11
ew Construction Repair
Office Review
Published soil Survey Available: No D Yes
Year Published lctl, . Publication Scale Soil Map Unit ...............
A,( .. ....... .... ........................
Drainage Class R, ttt��qoil Limitations ........................................ ..................
Surficial Geologic Report Available: No El Yes
Year Published Publicati Scale Geologic Material (Map Unit) ..0.........0 0........................................................ .. .......*...............
. .............................
D �.�f ............................................................... ...............
Landform .......................C)U-F(PA:59............. .....-.A..
Flood Insurance Rate Map: o El Yes
Above 500 year flood boundary N
Within 500 year flood boundary No []Yes F-1
Within 100 year flood boundary No ayes
❑
Wetland Area: .................... ..........................
National Wetland Inventory Map (map unit) .....�---+PT Pam..........
. . .....................
Wetlands Conservancy Program Map(map unit)
Current Water Resource Conditions(USGS): Month
,rJ�� �fo -
Range :Ab6ve Normal ®Normal [1Belcw.Normal M
Other References Reviewed:
DEP APPROVED FORM 1210719S
FORM 11 - SOIL EVALUATOR FORK,
Page 2of3
Location Address or Lot No.
On-site Review
Deep Hole Number '
l2 Time:..:..1.1.::..� Weather
Date: :.
2 3
Location (identify on site plan) , t _ f
Land Use .. k5—S 1-DLW-TJA<-- Slope (%) .3. Surface Stones - -
Vegetation
"'
Landform ..O0TW 1-�
tJ .
:
Position on landscape (sketch on the back
Distances from:
Open Water Body feet Drainage way . -' feet
Possible Wet Area .....8 feet Property Line . feet
Drinking Water Well ..::.'"..::: feet Other .......... ......................_
DEEP OBSERVATION HOLE LOGS
Depth from Soil Horizon Soil Texture Soil Color Soil
Other
(USDA) (Munsell) Mottling (Structure,Stones, Bounders, Consistency, %
Surface(Inches)
�ih fir`
bri��, '�KoY Gk, (OYC S/4- o C�� GnNv —
&f lZa 15 L-o,dtiuy SAh� (0�S/(, O °lv
W'-qo' C ' e-Owg S1,� 1.0ye-C,/,
69A,1S15TWO 10Y4 7/� O to le 6,w
lob
ID�%I G� ASS �A*►� ��r'L � O 10 70
e}1 N
Parent Material (geologic) C'�[�L�a-S� � DepthtoBedrock:
Depth to Groundwater: Standing Water in the Hole:
Weeping,from Pit Face:
Estimated Seasonal High Ground Water:
DEP APPROVED FORM-12/07/95
FORM 11 - SOIL EVALUATOR FORM
Page 3 of 3
Location Address or Lot No. T- �b r-EWM91LV/CtF
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 ww...-'k5/b Reading Date 4.0.9.9 '1& Index well level ...7.�,r...
r
Adjustment factor ....`�U.9r� Adjusted ground water level ........`'"... -Cp...F................
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?
If not, what is the depth of naturally occurring pervious material?
Certification
I certify that on lG (date) I have passed the soil evaluator examination
approved by the De artment 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 ate
DEP APPROVED FORM-12/07/95
J to
FORM 12 - PERCOLATION TEST
i { n
Location Address or Lot No. OuD I'nn T
COMMONWEALTH OF MASSACHUSETTS
Massachusetts
Percolation Test`
Date: .::.:..: 3 .R� Time:.::::..:..��::
Observation Hole #
Depth of Perc ���
Start Pre-soak
End Pte-soak
Time at 12"
Time at 9"
Time at 6"
Time W-6"1
Rate Min./Inch
S,Nv,6' ►f�`UA(q CAS
" Minimum of 1 percolation test must be performed in both the primary area AND
reserve area.
Site Passed Site Failed ❑
.....................................................................................................................................
Performed. By: ��
Witnessed By: _ `� s
Comments: .. .........".... vxr:...�... ...... .....r. ........�.:................ ..N.v w.N.. .. ......_.v..�k............... ...»...�_�M M....._.......
DFP AFFROVW FORM-IV0719S