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DWCP No.
DISPOSAL WORKS.CONSTRUCTION SUMMARY
TOWN OF MANSFIELD
BOARD OF HEALTH
DWC LOCATION I (__-E-rv� "
SUBDIVISION LOT NO. .
APPLICANT TELEPHONE
STREET TOWN STATE ZIP
FEES:
$150.00 Perc for New Construction
_$150.00 Construction, Upgrade
_$ .75.00 Septic System Plan Revision
_$ 25.00 Septic System Repair
_$ 25.00 Disposal System Reinspect
_$ 25.00 2nd Reinspect ion
SDS Certification Inspection
Date Received' �� ?
Date Received
Date Received
Date Received
Date Received
Date Received -
Date .Received
INSPECTIONS:.
1 st Inspection Date Approved Disapproved
Comments:
2nd Inspection Date Approved Disapproved
Comments:.
Reinspection Date Approved Disapproved
Comments:
word.dwc
Commonwealth ojMamachusetts Town of Mansfield
Soil Suitability Assessment for On -Site Sewage Disposal
Fee $150.00 dNew ❑ Upgrade Site Number -
Location address: L t y( 7 i RE)E77 Applicant: `r� , wP�S N
Subdivision/Lot: Lp T 9 RO �j 1`A6 1=iE-L�S V1 LL Address: A� �.Eo JC? , MA -Z o3
Owner: Telephone: 5aS G 9 9 2-51 1
Performed by: RIM ENG I NECK 1 r1G Co. t t1C , Witness: Scott Leite, Health Agent (Site Evaluator)
Address: 15 c) iNot�i 1 } MAIN 5 i EE j Address: Six Park Row, Mansfield
Telephone: (�bl 339 --� 1 Telephone: (508) 261-7366
Office Review
Soil Survey published 1978 Publication scale 1:20,000 Soil Map Unit 14- N Drainage Class "UNC.KL�__
Soil limitations /�
SurficialGeologic Report not available. Geologic Material GLAC,tA(_ C�iJTWA-SH Landform PL.A.!
Flood Insurance Rate Map: Above 500 year ❑ Within 500 year ❑ Within 100 year flood boundary
Wetland Area: National Wetland Inventory Map (unit) Wetlands Conservancy Program Map (unit)
Current Water Resource Conditions (USGS) Month 2. 11 Range: ❑ Above Normal KKermal ❑ Below Normal
Summary
TH 1 TH -y Locus
Soil class
Percolation Rate to
Adjusted ground water
Certification
I certify that on April 30, 1993, I have passed
the 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.
Scott Leite Date
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