HomeMy WebLinkAboutMiscellaneous - 94 SHERWOOD DRIVE 4/26/1996 i
FORNI 11 - SOIL EV, LU ATOR FORM
Page I of 3
'No. Date: t� f
Commonwealth of Massachusetts
�,joe,To Aor, ee_ , Massachusetts
Foil Suitability Assessment Lor On-site Sewage Lisp_ s
/ � 3. - Date:
Performed By: 4 _ , _
Witnessed By:
LewConstructi(on ress or AddfCSS,ihd _50 0 .T °t"' °',R"O'relepnare r 9 Repair ❑ C ` 1
Office Review
Published Soil Survey Available: Ni o ❑ Yes
Soil Unit !�.....
Year Published � ,. Publication Scale P
�� ��.,a .......... Soil Limitations Drainage Class i ..............
Surficial Geologic Report Available: No Yes ❑
Year Published Publication Scale
Geologic Material (Map Unit) .................................................................................................................
..._ .............,.,.
L' dform ................. .........................................................................................................................
Flood Insurance Rate Map:
Above 500 year flood boundary No Yes ❑
Within 500 year flood boundary No es ❑
Within 100 year flood boundary No ®`Yes ❑
1
Wetland Area:
National Wetland Inventory Map (map unit)
.............................. ...........................................................
Wetlands Conservancy Program, Map (map unit)
Current Water Resource Conditions (USGS): Month
Range :Above Normal ❑Normal ❑Bel v Normal ❑
Other References Reviewed:
DEP APPROVED FOMM• 12/07/95
,' ,i
FORM 11 - SOIL EVALUATOR F0101
Page 2 of' 3
Location ,address or Lot Ao.
On-site Review
4
Deep Hole Number ` 1 Date: 'a?.�lµ� �� Time: F-' Weather F P\t
Location (identify on site plan) ._' .: �Aa —"Nat--r
Land Use Slope (%) Surface Stones
Vegetation
Landform wry
Position an landscape (sketch on the back) � �=
Distances from: °
Open Water Body JED -A.feet Drainage way JJ0`i•-5 feet
Possible Wet Area 1?b A/ feet Property Line d `�l feet QC--T
Drinking Water Well h1bh1 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)
}
i
i
Parent Material (geologic) " SInJ �r DepthtoBedrock:
Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: @
Estimated Seasonal High Ground Water:
DEP APPROVED F0101-12107!45
I
FORM 11 - SOIL EVALUATOR FORM
Page 3 of 3
Location Address or Lot No. �. .1 ' \\r --,
Determination for Seasonal High Water Table
Method Used: tt
❑ 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 level . _. _ ._....... _ .... _.......
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in II areas
observed throughout the area proposed for the soil absorption system? Y
If not, what is the depth of naturally occurring pervious material?
Certification
I certify that on 11/94 (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.
Signature w Date 5 1 96
DEP APPROVED FORN1- 12/47/95
03-21-1996 14:36 617 932 7615 OEP NORTHEAST REGIONAL P•02
FORM 12 - PERCOLATION TEST
Location Address or Lot No.
COMMONWEALTH OF MASSACHUSETTS
i 1 �YZ & mow , Massachusetts
Percolation Test'
Date: j 1° , ` r Time:
Observation Wale #
Depth of Pero fat
Start Pre-soak C ''t
End Pre-soak
Time at 12"
Time at 9"
Time at 6"
Time ( "-6")
Rate Min./inch z ell
Minimum of 1 percolation test roust be performed in both the primary area AND
reserve are q.
Site Passed Site Failed
Performed By- --1. 9' Ida
Witnessed ay -' m
Comments:
t7"A7' OY=roRm•17/07/91