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HomeMy WebLinkAbout0944 OLD STAGE ROAD - Health (3) �L4L4 i�a �o��/ao-L 7 f- - - �r G FORM 11 - SOIL EVALUATOR FORM VVV Page 1 of 3 �4— 8GS2 Date: '2. 15• No. q� Commonwealth of Massachusetts Massachusetts soil uitabili Asses or On-site ewa a Dis osa� 2,� Date: ` ',1..c LR014......... .R X.T .................. PerformedBy. ................l�.P(?-�...I................... ........................ Witnessed By: ............ p1� GOWsNa . v1p. 'Do►Jhl/�. NoNome � «otfl sraua Qof� Tom, IqZ S�tgZN�s"1' iZn �Nr�2+I�t.�.Ls non nZ P4,qs�' G�+ar�dt.c.t,r. ew Construction ARepair ❑ ODL Office Review Published Soil Survey Available: No ❑ Yes : Soil,Map Unit G �................. Year Published ` ' �4 :, Publication Scale _ .................................................................... Drainage Class' exrM6!.y..0�.......... Soil Limitations �z .1<Li'1�........................ Surficial Geologic Report Available: No ❑ Yes Year Published l a.`1 ::.:::. Publication Scale Geologic Material (Map Unit) , ................................. ... . ..................... ............................................... ........... Landform ................................ �.�.P.�..........a,t.�.i.,lf.................................................... . Flood Insurance Rate Map: Above 500 year flood boundary No ❑Yes l� Within 500 year flood boundary No Yes ❑ Within 100 year flood boundary No 2rYes ❑ Wetland Area: National Wetland Inventory Map (map unit) .................. ............................................................................... Ma .. Wetlands Conservancy Program p(map unit) Current Water Resource Conditions(USGS): Month Ran a :Above-Normal ❑Normal ❑Belcw Normal LJ 8 Other References Reviewed: DEP APPROVED FORM-12/07/9S FORM 11 - SOIL EVALUATOR FORK Page 2 of 3�� Location Address or Lot NO. ��oT 44 0 Sra�� MAP t7Z On-site Review I0.,:.'3n Weather ... 2. 1 S. 4v Deep Hole Number 2';.: Date q!. Time Location (identify on site'plan) , "o p-3 Surface.Stones —S�,c 1T'I:A Slope ( ) Land Use ::..:�:: _.. . Vegetation : ...::.:..:. Landform ::.:..:. ....:._. WA Position on landscape (sketch on the back) f__ SST. .. . . . .: .: . : .. Distances from: / vID feet Open Water Body :V feet" Drainage way Possible Wet Area ..../StV. feet Property Line .::::,...20:.. feet Drinking Water Well :::.:::::...:.::. feet Other ....::..........:::::..........:..:::.::. :DEEP OBSERVATION HOLE'LOG� Other EDept:hhfrom Soil Horizon Soil Texture Soil Color $01l GravdqacInches) (USDA) (Munsell) � Mottling (Structure,Stones,Boulders, Consistency, °k' ye�yz Fa�Ae N a `iNE SAS , L,qC/AL 007IL/A DepthtoBedrock: Parent Material(geologic) l� Weeping from Pit Face: -- Depth to Groundwater: Standing Water in the Hole: Estimated Seasonal High Ground Water: DEP APPROVED FORM-12/07/95 NORM 11 - SOIL LVALUATOR FORM Page 3 of 3 Location Address or Lot No. Ot-D sf�G� e;r AMP /72 )96'- 9= Determination or 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 .SAw'z Reading Date ...... ��5' Index well level ..-7.r._. Adjustment factor ...:.......z Adjusted ground water level ..................................................._... Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring e soil sousabs ate system?rial exist in all areas observed throughout the area proposed for If not, what is the depth of naturally occurring pervious material? Certification I certify that on ti1� 9s (date) I have passed the soil evaluator examination approved by the Department of Environments 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 S 4 Z 49 NI 8 1�0 , 4-0cl4 iz�as � r f FORM 12 - PERCOLATION TEST Location Address or Lot No. �� �� C�►r M ��� /�� 93 COMMONWEALTH OF MASSACHUSETTS Massachusetts Percolation Test` Date: z-/S- 4. Time:. . Observation Hale # Depth of Perc �►i Start Pre-soak End Pre-soak # Time at 12" uWASL� 5k"A Time at 9" Time at 6" Time (9"-6") Rate Min./Inch 'L&.56 • Minimum:of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed Site Failed 0 ............................................................................._ Performed. By: Ad AfAz>_ Witnessed By: or- Comments: ��..rY� w....� ...w. �.w...w. w.....�.»....._...... uN �vm .�.�..�.�....�....,w. ..,w...�. .M� M.. .._.-.... .........:.. .. . .. . ... ... ... nEP AeovED FORM-w07ros