HomeMy WebLinkAboutCarleton Est.: Briggs St. #4 & 5 off West St. - 10/29/1992 - not developedTOWN OF MANSFIELD, MASSACHUSETTS
50 West Street, Mansfield, MA 02048
APPLICATION FOR ON -SITE SEWAGE TESTING
PERC NO.
DATE
PERC ADDRESS 4 4 1&0-%&(o-S
aFF
W SST sT .
FEE $75.00
SUBDIVISION LOT NO. Co
OWNER C A 9 L70I 4 R TELEPHONE 5 4
ADDRESS 7 RLD2rc/a �1� CITY �c->nja2cJ STATE ✓n
APPLICANT S,A-m 97 TELEPHONE
ADDRESS
CITY STATE
ENGINEER NJtc`1 F.1S--C fZc� 53��1jG� TELEPHONE 33c7 - Z3 ? c/
ADDRESS_ N c-Y S! CITY -LDSTATE�
1. In order for the Board of Health to take action on the application, you
must get numbered address from the Assessors Office at the Town Hall. No
application will be accepted without this information.
2. Fee is $.75.00 per lot. Application and fee must be filed ten (10) days
before testing date.
3. Percolation testing and groundwater testing may be done all year.
4. You must know before the Town's Agent comes out to your lot where the
on -site sewage test is to be done.
5. Requirements needed at time of testing:
a. Your own engineer.
b. Backhoe or similar equipment to dig 10-12 feet.
C. Enough water for on -site sewage testing.
d. Sufficient 4" pipe for a monitor well.
6. Permit will become invalid if percolation test is not performed within one (1)
calendar year, provided that testing has not been suspended by the Board of Health.
Fee is non-refundable.
7. All septic system plans and DWCP applications must show soil testing number,
address and lot number.
Original to Board of Health, 1 copy for Treasurer's Office and Applicant
Revised October 1989
Revised March 1991
TOWN OF MANSFIELD
SOIL TEST REPORT BOARD OF HEALTH
Perc No. 9ZZ Stree
Subdivisio
Date ;1) G 4 , 1 99 '�2�- Repair
Owner/Builder
Lot_ Performed by
NOTES:
Witness by Scott Leite, Health Agent
SOIL DESCRIPTION: TEST HOLE NUMBER Groundwater
TYPE: CONSIS ENCY: DRAINAGE:
- Top and Sub ✓Loose o--E-Sccess i ve
- Fill Friable o Well
-7945 Outwash - Firm o Moderate
Stratified Drift -_ Cemented o Poor
Ice Contact Deposit
Ablation Till
Basal Till
_- Restrictive Layer
Refusal
Bottom
STRUC URE:
MOTTLIN G --- -
s ranular
o Few o Faint
o Blocky
o Common o Distinct
o Prismatic
o Many o Prominent
o Platy
OIL DESCRIPTION: TEST HOLE
NUMBER Groundwater
=
TYPE:
CONSISTENCY:
DRAINAGE:
Top and Sub
-_ Loose
o
Excessive
_-
Fill
-_ Friable
o
Well
_-_
-_ Outwash
-_ Firm
o
Moderate
- Stratified Drift
- Cemented
o
Poor
-_ Ice Contact Deposit
-_ Ablation Till
STRUCTURE:
-_ Basal Till
o Granular
- Restrictive Layer
o Blocky
-_ Refusal
o Prismatic
Bottom
o Platy
DERCOLATION TEST
THJ—
Depth of Perc: 6 ff'
TH_
Start presoak
//;
End Presoak
Time at 12'
9'
�G
6"
Time (9"-6")
[Rate Min/Inch
2
MOTTLING: _-
o Few o Faint
o Common o Distinct
o Many o Prominent
ROUNDWATER ADJUSTMENT
o #1 Berry School
o #2 Gilbert Street
o #3 Gilbert Street
o #4 Fruit Street
Reading Date:
ADJUSTMENT FACTORING:
INDEX WELL LEVEL
Less: Index high
(St Drft)
(Ab Till)
(OW/Perm)
(OW/Seas)
Adjustment Factor
SITE LEVEL
Less: Factor
ADJUSTED GROUNDWATER
TOWN OF MANSFIELD, MASSACHUSETTS
50 West Street, Mansfield, MA 02048
APPLICATION FOR ON -SITE SEWAGE TESTING
�'
PERC NO.
-
FEE $75.00
DATE
l'
CL fS
oFF
PERC ADDRESS
'- 6W S
SUBDIVISION
LOT NO.
OWNER
TELEPHONE
S -' 3 - $
ADDRESS 7 R i)2I6M RD
CITY �vn(jo2u
STATE /rylf3
APPLICANT
Sd}-M
TELEPHONE
ADDRESS
CITY
STATE
ENGINEER VAO CU A ELEPHONE 3-9C� - z 3 ? I
ADDRESS Zyo 61,ftY2 N C-Y S! CITY_/l�fJ�l_ ,f(& DSTATE !P/19-
1. In order for the Board of Health to take action on the application, you
must get numbered address from the Assessors Office at the Town Hall. No
application will be accepted without this information.
2. Fee is $.75.00 per lot. Application and fee must be filed ten (10) days
before testing date.
3. Percolation testing and groundwater testing may be done all year.
4. You must know before the Town's Agent comes out to your lot where the
on -site sewage test is to be done.
5. Requirements needed at time of testing:
a. Your own engineer.
b. Backhoe or similar equipment to dig 10-12 feet.
C. Enough water for on -site sewage testing.
d. Sufficient 4" pipe for a monitor well.
6. Permit will become invalid if percolation test is not performed within one (1)
calendar year, provided that testing has not been suspended by the Board of Health.
Fee is non-refundable.
7. All septic system plans and DWCP applications must show soil testing number,
address and lot number.
Original to Board of Health, 1 copy for Treasurer's Office and Applicant
Revised October 1989
Revised March 1991
TOWN OF MANSFIELD SOIL TEST REPORT
Percf No. 9Z, Street q "�'fc'IPM Owner/Builder
Subdivision Lot_ Performed by
BOARD OF HEALTH
Date 7 _ ' _,1992r- Repair Witness by Scott Leite, Health Agent
SOIL DESCRIPTION: TEST HOLE
TYPE:
�3, -���� Top and Sub
-T Fill
ET-i- Outwash
_-_ Stratified Drift
_-_ Ice Contact Deposit
_-_ Ablation Till
_-_ Basal Till
_- Restrictive Layer
_- Refusal
Bottom
SOIL DESCRIPTION: TEST HOLE
IITYPE:
Top and Sub
_-_ Fill
_-_ Outwash
-_ Stratified Drift
_- Ice Contact Deposit
_- Ablation Till
_- Basal Till
Restrictive Layer
_-_ Refusal
Bottom
NOTES:
NUMBER Groundwater V Ir --
CONS STENCY:
DRAINAGE:
�----Loose
o--Excessive
Friable
o Well
Firm
o Moderate
_-_
- Cemented
o Poor
STRUCTURE: MOTTLING:) r
o--Granular o Few o Faint
o Blocky o Common o Distinct
o Prismatic o Many o Prominent
o Platy
NUMBER Groundwater
=
CONSISTENCY:
DRAINAGE:
-_ Loose
o
Excessive
Friable
o
Well
_-_
-_ Firm
o
Moderate
- Cemented
o
Poor
STRUCTURE: MOTTLING: _-
o Granular o Few o Faint
o Blocky o Common o Distinct
o Prismatic o Many o Prominent
o Platy
DERCOLATION TEST
TH I
Depth of Perc:
TH
Start presoak
End Presoak
Time at 12'
9 "
%A%l)I-
6"
Time (9"-6")
Rate Min/Inch
I`Y`
iNUUNUWH I tN Huuuo 1l,I 141
o #1 Berry School (St Drft)
o #2 Gilbert Street (Ab Till)
o #3 Gilbert Street (OW/Perm)
o #4 Fruit Street (OW/Seas)
Reading Date:
ADJUSTMENT FACTORING:
INDEX WELL LEVEL
Less: Index high
Adjustment Factor
SITE LEVEL
Less: Factor
ADJUSTED GROUNDWATER