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HomeMy WebLinkAboutMiscellaneous - 72 STERLING LANE 10/29/1997 FORM 11 -SOIL EVALUATOR FORM Page 1 of 3 No. Date: Commonwealth of Massachusetts IVr r f , Massachusetts Soil su tabi ft Assessment for On-site Sewage Disposal Performed By: Date: Witnessed By: Location Address or Owner's Name r 'j ff Lot# s Address and, 1F f r z r Telephone# e'_�-4 New Construction Repair Office Review Published Soil Survey Available: No Yes Year Published Publication Scale rr f ' Soil Map Unit Drainage Class / ,3. Soil Limitations �r Surficial Geologic Report Available: No .- Yes Year Published Publication Scale Geologic Material(Map Unit) Landform Flood Insurance Rate Map: Above 500 year flood boundary No Yes r Within 500 year flood boundary No Yes i Within 100 year flood boundary No Yes Wetland Area: National Wetland Inventory Map(map unit) Wetlands Conservancy Program Map(map unit) Current Water Resource Conditions(USGS): Month Range: Above Normal Normal Below Normal Other References Reviewed: DEP APPROVED FORM-17/07/95 wilev�l•�m FORM 1 I -SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. Z07 On - Site Review Deep Hole Number V—/ Date 01Z, 7 Time Jj,` Weather Location(identify on site plan) J � ) Land Use 7' Slope(%) ---J Surface Stones r Vegetation � �� ��xuC° Landfotm Position on landscape(sketch on the back) Distances from: Open Water Body 0-0 feet Drainage way )/0 CJ feet Possible Wet Area. > n feet. Property Line feet Drinking Water Well / ,,� �r} feet Other DEEP OBSERVATION HOLE LOG* Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(Inches) (USDA) (Munsell) Mottling (Structure,Stones,Boulders,Consistency,% Gravel) FYI f S.f *MINIMUM OF 2 HOLES REQUIRED ATtVERY PROPOSED DISPOSAL AREA Parent Material(geologic) ��Z Depth to Bedrock:} `� Depth t.Q Groundwater. Standing Water in the Hole: ��� j/ Weeping from Pit Face: Estimated Seasonal High Ground Water: 7 trr l DEP APPROVED FORM-11107/95 w1lev�l.um FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. On -Site Review Deep Hole Number Date Time 1 P�'.�;J Weather Location(identify on site plan) Land Use . �z Slope(%) Surface Stones Vegetation Landform Position on landscape(sketch on the back) Distances from: Open Water Body �; feet '� Drainage way f� feet Possible Wet Area f � feet Property Line S�feet Drinking Water Well l - feet Other DEEP OBSERVATION HOLE LOG* Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(Inches) (USDA) (Munsell) Mottling (Structure,Stones,Boulders,Consistency,% Gravel) T, b , i O ` f A l + •MINIMUM OF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA Parent Material(geologic) l C Depth to Bedrock: 9� Depth to Groundwater. Standing Water in the Hole: Weeping from Pit Face: Estimated Seasonal High Ground Water: c , r DF3 APPROVED FORM-12107/95 wilevvaun FORM t I -SOIL.EVALUATOR FORM Page 3 of 3 Location Address or Lot No.. r' r Determina easn . Water Table, Method Used. F-1 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 Reading Date Index well level Adjustment factor Adjusted ground water-levet 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 occuring pervious material? Certification I certify that on (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 d training, expertise an experience described in 310 CMR 15.017. Signature Date ' DPP APPROVED FORM-11IMS toilwd.um FORM 12 - PERCOLATION TEST Location Address or Lot No. 7-� COMMONWEALTH OF MASSACHUSETTS , Massachusetts Percolation Test* Date: Time: Observation Hole# / Depth of Perc Start Pre-soak End Pre-soak Time at 12" Time at 9" Time at 6" /f I Time (9"-6") -7 Rate Min./Inch *Minimum of 1 percolation test must be performed in both the primary area j AND reserve area. Site Passed � Site Failed f Performed By: Witnessed By: Comments: DEP APPROVED FORM-12/07/95 PemtmtSAM DATE: LOCATION: � _MJ° � ENGINEER: BOH WITNESS: PERCOLATION TEST # f� � t BOTTOM DEPTH OF PERC TEST: TIME OF SOAK: r r 7 4 (At least 15 minutes long) TIME AT 12" U TIME AT 9" ` L TIME AT 6" t 47 OVERNIGHT SOAK TIME STARTED NEXT DAY SOAK: (At least 15 minutes) TIME AT 12" TIME AT 9" TIME AT 6"