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0054 INDUSTRY ROAD - Health
54 Industry Ao , Marstons Mills f' A= 058 - 029 - -- - 0 .4 �'o�ir1l of�3a1-ustable t'ir a1`il 1 ])cpnrlmcut of Hc6ulatory Services aArunrrAerrt Public Health Divisio]I I)atc /: � D— 24c MAP( ,b p, 200 M1ill sllcct,11yanuis MA 02601 Ito MKS} Date,Schcdolcd 1�t�c 1'tl. `����•�n Soil Suitability Assessmicut fot' Selvage ,Dis; al Pcrfotmcd By:',5Lt_.f I►VO n, L �C��'ne.e'r►!x C. Witnessed py: LOCATION & GENERAL INFORMATION ' Nmc l 1 V cnlion Address Owners a v erf .F l� � L.o J� ,Zrn�,Usfri maXS/zw /i� ) -S Address q Od�35 Assessor's Mnp/i'nrrcl: 058P40?9 NEW CON.STItig.-nON V/ REPAIR Telephone 11 Sofa- t1d? 33 U L.nnd Use �01(11MC�C\'� _ Slopes(:10) Surface Stones , Distances fmin: Open Walcr Body _SO() it Pussible Wet Area SWIL Drinking Wnlcr Well Il Dininnge Way, R Proixity Line 20 R Other. Il S101 TCII:(Strrct nilmr,dimensions of lot,exact locations of trst holes k prre tests,locnte.milinds ill proximity h1 holes) 1Ell i S 0S 0 0 09 00, c4q , I 0 c ....... +LL O �'3 NI #A/J 7m LNDUs f Y R040 t� l Q m -`` , 7 < I'mm"t ninlcriitl(geologic)OVC�S _ Depth to Ilcdnrck � �•� ut Depth to Gronndwnlcr: Slandirlg Water in Ilole: NtD NG Wa.ping from Pit race N�Nt rslbuntcd Seasonal I ligh Groundwater +4 (c-L —�TuvAra \iAR�stAmte (e co I)E I ERMINATION FOR SEASONAL IIIGIMATER.TABLE Mclhod Used: A)^Air--ScP Ab>L�� In. in• Dc 11h to soil mollies: Dcplh Obsterved standing In obs.hole: I a. Depth to wctping front side of oils.hole: in. Gmundwnter Adjoslmcid_ Index Well M Rradhtg Date: Index WcII Icvcl Atli.factor Adj.Gioundwnlcr Level_ PERCOLATION TEST Date 1 t9lo� Time!©� Ohservntion Iolc d Timetit 9" ai y z —" — Depth of Pcrc Time at 6". Sind Pre•sonk Timc© ZS Time(9"-6") tN End Pic-conk 1 + Rifle Min./htclr Site StdiRbllity Assessment: SRc Pnsscd_� Site I'niled: Addilionnl'[rsling Nceticd(YIN) thiginnl: Public.Ilreldt hivislm, (�I,srrvllinn I iolc thin Tfi Fir Completed un 13ack----------- *""]f llcrt7oh(irill test is to be vollifildvil Ivithin 100' of 11,01Anil, yoll nnlst first 1101ify (lie Barnstable Con.smation Division M (cast one(1)`veclt brine (o 11cRinning. 0 111W•rn,wrml'n(T ORn1 VEE,P OBSERVATION MOLL LOG 1.1.01C It � Ucpdi fiuin Soil llorizon Soil Tcxaac Soil Color. Soil Ullicr 9urJhCa(In,) (USDA) (MIII)SOIJ) Motlling (SUacpno,Sltmcs,lJouldels. o- C lm s �N DEEP OBSERVATION HOLE LOG Hole It Z Depth from Soil I loriron Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Duuidcrs. Con4tatcy,1 GravclL 0-7-0 ZA -I Za DEFY OBSERVATION ROLL LOG Role/I 3 Depth from Soil,llorlwn Soil Texture Soil Color Soil Olhcr Surthce(in.) (USDA) (Muuscil) tvtuldhig (51ruchue,Stones,Douldcrs. Cunsislcn�,"(wit�Ycll_ DE EY OBSERVATION HOLE LOG 1101c 11 Depth Burn Soil lluriwn Soil Texture Soil Color Soil Ulhcr Surface(ln.) (USDA) (Munscll) Mottling (SUudole,Sloncs,tlouldcrs. ' C�rsis cnc °. iavc� ZZ-IZy (_ blood Insurance RaN Mai): Above 500 year flood bowrdnry No— Ycs Within 500 year boundary No�� Ycs Withhr 100 year flood buundnry No✓ Yes Denth of Naturnliy Occurring PCt' OUS MMt dell Does ntrlcast four feet ofnaturally occurring pervious ninterial exist in all areas observed throughout the area proposal for the soil absorption system? V E5 If not,what is the depth ofliaturally occurring pervious 11tatcrial7 Certl call 1 I certify Dint on &its . c6y (date)I have passed the soil evaluator examination approved by the Dopartmcut.of Cnvlronmerrtal Protection and that the nbove nonlysis was perrormed by me consistent,with the required trandug,ex Mttiso and experienco described in'3 I G CMR 1.5.017. Signature Date Q:IICALTi uwrimutcrorlM 1�I