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Planning Board Application 408/412 2005 • • Print foetal' 1 �I✓�.ii J LS I CITY OF NORTHAMPTON IUT JUN - 9 2006 PLANNING BOARD APPLICATIONS CITY CLERKS OFFICE NORTHAMPTON MA 01060 All of the following information is required. Incomplete applications will not be accepted. If you wish to review application materials with the Senior Planner prior to submission,please call 413-587-1287_ T. •ro)ect Type -ec :ox Information's located on Building Inspector's Review Form,which is a prerequisite to filing this application Intermediate Projects($200.00) or -New construction or additions of 2,000-4,999 gross square footage (excluding single family homes and agricultural uses) - Projects requiring 6-9 additional parking spaces - Planned Village Projects that are not a Major Project -Flag lots(additional fee required) Major Projects($500.00)plus 50 ELper square foot of proposed new building square footage -New construction or additions of 5.000+dross sq. ft. -Commercial Parking lots and parking.garages -Take-out restaurants and convenience stores(Except in the Central Business District) -Automobile service stations -Projects that require 101 additional parking spaces -Residential Incentive and Business Park projects $(Site Plan (complete 1-8F) r Site Plan (complete 1-13) r Special Permit with Site Plan(complete 1-13) I 2. Permit is Requested Under Zoning Ordinance Section(s) and Page(s) From /Q / /t2/ I _/ I Building Inspectors Review Form Section/Page Section/Page Section/Page 3. Parcel Information Iddress: 409 4(2 l%ORTffFF{r2n?S Pb 1 FCORnice Assessor Identification'Map#,Parcel#: 7-6 7 1 2nd Map#,Parcel#: r7—if (if applicable) Recorded in Hampshire Registry of Deeds or Land Court Book: Special Permit with Site Plan(complete 1-8H) / I / Secion/Page Section/Page MA Zoning Distnc 2 Page: 4. Applicant Information me KeeQv4HOITAs / A Address / Na ddress 4o Al/72TH F4r?srr5 .eTj Telephone 1 F.mail Fax [status of IN<Owner p Contract Purchaser Applicant I Lessee ,r- Other' 5.Owner Informationnfalrrerent from Applicant) fl'4- 045€? K C fbrus -z- ) Cos1C's. A/C 58-& ' "06€ Applicant's Signam DateLE -O(v Owner' ignature' Date H cenif_ the information contained herein is true and accurate to the best of my knowledge; the abovesigned owner(s) grant the Board and its agents permission to enter the properly to review this application; 1 understand all documents will be entered into the public record and will be available on the interact; I understand that if neighboring issues have not been addressed/ resolved prior to the hearing, the IBoard will continue the hearing. `Owner's signature or letter from owner authorizing applicant/representative to sign on behalf of owner. 4/W2005 1 ql PM 1 003 pd FOROFFICEVSE Dst B f t Sr.Planner By Id n§4' 'DPW (2) F-e 'Poker..o- BOI+ PleasereviewrAtereldo tst the SP/Man tEn m 4datet2ndTh stay, ' FhTIA) ay_dfJ Fete March. C: x� _. API .,MaY- ,June .. 6. Check boxes below indicating that you have provided the following documentation: Site Vicinity Map/Plan W1 Site or Plot Plan at 1"=40'or greater Filing Fee made Payable to the City of Northampton(S200 or for Major Projects and Flag Lots 5500.00 plus 80.05/per sq foot of proposed new building sq footage Amount Enclosed: S ❑ Stamped,Self Addressed Envelope(s)to Owner and Applicant. 16 complete packages(original and IS copies).Each packet must include all application material and he —= collated,stapled and banded together. Two separate rubberbanded sets of stamped envelopes addressed to each of the abutters within 300'and planning boards in adjacent towns.The abutters list can be found at www_northarraptonma.goviopd1. If within 300'ofa neighboring town,the envelopes must include the abutters within said town. The return address of all the envelopes should be labeled as:Planning and Development.City of Northampton.City Hall,210 Main Street,Room 1 1.Northampton,MA 01060-3198_ FT A printed list of all abutters(from above section)_Number of Abutters on the list is: / 7 Zoning Permit Review Form with Building Inspector's endorsement and application. Site Plans for major projects prepared and stamped by a Registered Architect,Landscape Architect,or Professional 7 Engineer(At least I plan must have an original stamp;remaining plans must either have an original stamp or cop of original stamp) Folded Plans-all plans 1 P x 17'or larger must be folded and collated with each appplication( f24"x 36" plan r7 sheets are included,they may contain 7 full sets with the remaining 9 at II''x 17'size.) ❑ Traffic Study (Applicable to major projects) Stormwater Management Plan,including soils information and depth to groundwater(Applicable to major projects) /NC X Building Elevations FT Lighting if applicable WAIVER REQUEST. All items below are required unless a waiver is requested.To request a waiver for an `item,check the item and provide your reason for requesting a waiver. (— Site plan(s)at a scale of 1"=40'or larger f- Name and address of the owner and the developer,name of project,date and scale plans: r- Plan showing Location and boundaries of a. the lot,with adjacent streets or ways b. all properties and owners within 300 feet c.all zoning districts within 300 feet j Existing and proposed: a. buildings b. setbacks from property lines c.building elevations d. all exterior entrances and exits(elevation plans for all exterior facades structures are encouraged) 67 Present and proposed use of: a. the land RES L 4cce°SSORY ,r,YCTUee b.building R c5:oCA✓T14L ACCe5S02% S772t/CTI-1/2E 4/I'2005 ❑21 PM 2 003.pdf r_ Existing and proposed topography(for intermediate projects the permit granting authority may accept generalized topography instead of requiring contour lines)showing: a. two foot contour intervals b. wetlands,streams,surface water bodies c. drainage swales and tloodplains d. unique natural land features Location of a. parking and loading areas b. public and private ways c. driveways and walkways d. access and egress points e.proposed surfacing • Location and description of: a. all stomiwater drainage/detention facilities h. water quality structure c. public and private utilities/easements d. sewage disposal facilities e.water supply facilities (— Existing and proposed: a. landscaping,trees and plantings(size and type of plantings) b.stone walls c.buffers and/or fencing ✓ Signs:existing and proposed: a.Location b.dimensions/height c. color and illumination • Provisions for refuse removal,with facilities for screening of refuse when appropriate Lighting: a.Location b.Details c. Photometric Plan showing no more than 0-5 foot candle at property line An erosion control plan and other measures taken to protect natural resources&water supplies (major projects only) Estimated daily and peak hour vehicles trips generated by the proposed use,traffic patterns for vehicles and p pedestrians showing adequate access to and from the site,and adequate vehicular and pedestrian circulation within the site(major projects only) I understand that it is required that I take this application to get date stamped at the City Clerk's Office first,prior to filing it with the Northampton Planning and Development Office. 4/1/2005 L21 PM 003 pdf 7. Describe proposed project/work below: 3g2, Sq, FT- (ZESrDe&iv(AC_ AcceSSo2Y ( be-TA CHeT> ) s-flat}GT(J i2 E 8. Site Plan and Special Permit Approval Criteria.of any permit criteria does not apply,explain why.) A. I low will the requested use protect adjoining premises against seriously detrimental uses? How will the project provide for: surface water drainage: G/00 bias CL6AR1,04 4RO✓Nr) 7>uO14-J.JC7 fS ro r3F GA-ane.ve? 4` Ge4ss*> sound and sight buffers: Re-5 r7>eti7C� iii. the preservation of views, light and air: 2 Est •'« 13. I low tvil I the requested use promote the convenience and safety of pedestrian movement within the site and on adjacent streets? How will the project minimize traffic impacts on the streets and roads in the area? M(xir rn 4-L ( Pin la 4-Cr ii. Where is the location of driveway openings in relation to traffic and adjacent streets? sf+Aaa hziueco4- cuf 7+ nxrsr—ftJ5 PFS(D es What features have been incorporated into the design to allow for: access by emergency vehicles. 2C r 7C}.JG e- h. the safe and convenient arrangement of parking and loading spaces: /VA- c. provisions for person A- h disabilities: 4/1/2005 121 PM 4 003.pdf C. How will the proposed use promote a harmonious relationship of structures and open spaces to: the natural landscape: RE5t >cic-JCC ii.to existing buildings: iii. other community assets in the area: D. What measures are being taken that show the use will not overload the City's resources,inclu t. water supply and distribution system: Fiat ✓R-"1 CA)ELC. ii. sanitary sewage and storm water collection and treatment systems: �RIVh'CT= SEPTtc 3YSTC N'1 iii. fire protection,streets and schools: How will the proposed project mitigate any adverse impacts on the City's resources, as fisted above? NO Int PA-cy E. i.i>< the section(s) of the Zoning Ordinance that states what special regulations are required for the proposed project(flag lot,common drive,lot size averaging. etc.) se-CT' 0 N /6, . 7 ?,4f. I • .0 How does the project meet the special requirements?(Use additional sheets if necessary) YoO7r04 2A IX) 5 A eel)n1D FcuODATO/0 6KIT1cj DO DAY LI4HT. Al DRA/NS IN CELLA-/Z CCA-co I- 42C7t- 1 . State how the project meets the following technical performance standards: i. Curb cuts are minimized: 001— A7ab e 73 Check off all that apply to the project use of a common driveway for access to more than one business use of an existing side street r use of a looped service road 4/12005 1 21 PM 5 003 pdf t Does the project require more than one driveway cut? NO • YES(if"ye explain why) Are pedestrian,bicycle and vehicular traffic separated on • YES • NO(if"no explain why) Applicants for Intermediate Site Plan Approval ONLY,stop here. LSPFCIAL PERMI. PP tton art MAJOR PROJECT app /cations o contain e o owing: G. Explain why the requested use will: Not unduly impair the integrity or character of the district or adjoining zones R1-111-9-1_ Pesraru-n4L ARE4 - 3ac t FEET (Ze-5 t pea./cE nL not be detrimental to the health,morals or general welfare: iii. be in harmony with the general purpose and intent of the Ordinance: TO AJEA-KIST H. Explain how the requested use will promote City planning objectives to the extent possible and will not adversely affect those objectives,defined in City master study plans (Open Space and Recreation Plan; Northampton State Hospital Rezoning Plan:and Downtown Northampton:Today.Tomorrow and the Future). Applicants for Intermediate Special Permit Approval ONLY, stop here. Ooapdt MAJOR PROJECTS MUST ALSO COMPLETE THL FOLLOWING MAJOR PROJECT APPROVAL CRITERIA: 9. Does the project incorporate 4foot sumps into the storm water control system? YES I— NO(explain why) 10. Will the project discharge stormwater into the City's storm drainage system? r- YES NO(answer the following) Do the drainage calculations submitted demonstrate that the project has been designed so that there is no increase in peak flows from pre-to post-development conditions during the: 1,2,or 10 year Soil Conservation Service design storm? F. YES • NO(if"no",explain why) Ii. Will all the runoff from a 0.4 inch rainstorm (first flush)be detained on-site for an average of 6 hours? C YES NO(if"no",explain why) 12. is the applicant requesting a reduction in the parking requirements? F YES-If"yes',what steps have been taken to reduce the need for parking and number of trips per da}? NO 13.Traffic Study: Estimated daily and peak hour vehicles trips generated by the proposed use, traffic patterns for vehicles and pedestrians showing adequate access to and from the site and surrounding intersections.and adequate vehicular and pedestrian circulation within the site What mitigation is proposed for incrcmenml impacts? 4/1/2005 121 PM 7 003.pdf File it MP-2006-0112 • • APPLICANT/CONTACT PERSON HOMSTEAD KERRY M&NEIL P ADDRESS/PHONE 408 NORTH FARMS RD (413)584-0458 G PROPERTY LOCATION 408 NORTH FARMS RD MAP 07 PARCEL Or 1 001 ZONE RR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FO FILLED OUT /67? �Y1/lJ<5 ee at Building Permit Filled out Fee Paid LLyeofConstruction: ZPA-DET ACCESSORY W/UNDERSTANDING ZBA APPROVED BREEZEWAY BEFORE OCCUPANCY OR BLDG PERMIT New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building,Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRE NTED: proved IrAdditional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER: § Intermediate Project: Site Plan AND/OR Special Permit with Site Plan Major Project: Site Plan AND/OR I/Special Permit with Site Plan ZONING BOARD PERMIT REQUIRED UNDER:§ Finding Special Permit ✓ Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee ars? Adiril sf0 Permit from Elm Street Comryrysion Signature of Building Official Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. *Variances are granted only to those applicants who meet the strict standards of MGT 40A_Contact the Office of Planning&Development for more information. Date L C6 J 2, P06///2, Pant APPILA 01 4§i0.2) Please type or j int it information and return this form to the Building Inspector's Office with the$15 filing fee (check or money order)payable to the City of Northampton 1. Name of Applicant: ft)(%rL E Kc"7z12 Y Fi/Oaa S Vt 74 V Address: .}O - tl%r72774 FA?M S - Telephone: S, 84 - 045Y 2. Owner of Property: r P e/22 NOVta S 77-- Address: 479<1 ,10,217.E FR,2P1 G j?b Telephone: S-24 - 0 4 s— Sr" 3. Status of Applicant Owner ./ Contract Purchaser Lessee Other (explain) 4. Job Location: SAt44 L Parcel Iii_ Zonin Parcel# eetD)strict In Central:Business District . T0:3E FILLED:IN BY THE BUILDING DEP3 RTMENT). 5. Existing Use of Structure/Property: 27" i r 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): Dc iecI{C7 ArceCSO,eb S-T2Jcrur' L CO - --Ace leici 1NC Z,73 °B2tF7ELDAY 011C rt tBufcr 6EEEo2C uccuR4aJCY I ggkHrr og issocNiCC . 7. Attached Plans: Sketch Plan Site Plan AC Engineered/Surveyed Plans Has a Special Permit/Variance/Finding ever been issued far/on the site? NO >15),. DONT KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES IF YES: enter Book Page and/or Document 9.Does the site contain a brook, body of water or wetlands? NO DONT KNOW IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained NhDocument,A sin YES Ala Obtained date issued: Building-Inspector Zoning-Permit-A pa]'raunn-passive doc (Form Continues On Other Side) 8/4/2004 10. Do any signs exist on the property? IF YES, describe size, type and location: YES NO Are there any proposed changes to or additions of signs intended for the property? YES NO IF YES, describe size, type and location: Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan of development that will disturb over 1 acre? YES NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. 12. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION This column reserved for use by the Building 13. Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. Date: 4-26 - O Applicants Signature NOTE:Issuance of a zoning permit does not relieve an applicant's burden to comply with all zoning requirements and obtain all required permits from the Board of Health,Conservation Commission, Historic and Architectural Boards,Department of Public Works and other applicable permit granting authorities. W VDocurents\FORMSb nginal ABuilding-IaspecmrZaning-Pemmit-Application-passrvedoe 8/4GA04 EXISTING PROPOSED —REQUIRED-BY ZONING Lot Size AC2ES 5kyr,C 'O 000 Frontage 13 0 Fr S Aw C Setbacks Front Side Rear L: R: i 000 x 1: (z6 R: 140 3 70 / L SO (s RvS-- 3o Building Height 20 / 3 s` t Building Square Footage ? 92 sr.FT %Open Space: Not area minus building & paved lSd)Qo05q,P7 8°,0 #of Parking Spaces #of Loading Docks Fill: (volume &location) 13. Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. Date: 4-26 - O Applicants Signature NOTE:Issuance of a zoning permit does not relieve an applicant's burden to comply with all zoning requirements and obtain all required permits from the Board of Health,Conservation Commission, Historic and Architectural Boards,Department of Public Works and other applicable permit granting authorities. W VDocurents\FORMSb nginal ABuilding-IaspecmrZaning-Pemmit-Application-passrvedoe 8/4GA04 Search results for Parcel IDy07_067 butters: Buffer=300 feet,18 records found r limigaap.-Cownioad results as a delimited tat file for use with mail merge ClaeryapaI.-OisplaY labels in your browser for Imnhng-Avery 5160 MS EL/z X714- R).VS'E`r Hn5 1 g55E3 kW hY HCUA (Z .e-,5 JOAPAJ Pi CARD [-LAVE X9DUEb 'i � 8Y LoT 07 - OS 2 - col is Now OC:Thisb SOHN C . MURPHY BT-067-001 NORTH FARMS RD -s'ir*V35.-k:tlattaW515155Sn1355 HON I)KERRY M&NEIL P 408 NORTH FARMS RD w. FLORENCE MA 01062 07-014-001 NORTH FARMS RD MACKLER FREDERIC S&SUSAN 395 NORTH FARMS RD FLORENCE MA 01062 07-013-001 NORTH FARMS RD PASQUALE DANA C 390 NORTH FARMS RD FLORENCE MA 01062 07-058-001 NORTH FARMS RD PICARD RICHARD T&)OANN 397 NORTH FARMS RD FLORENCE MA 01062 999-999-001 PlanningBoard Westhampton Tovm Hal WESTHAMPTON MA 01027 999-999-002 PlanningBoard Easthampton Town Hall EASTHAMPTON MA 01027 999-999-004 PlanningBoard Hadley Town Hall HADLEY MA 01035 999-999-003 PlanningBoard Hatfield Town Hen HATFIELD MA 01038 999-999-005 PlanningBoard South Hadley Tovm Hall SOUTH HADLEY HA 01075 999-999-000 PlanningBoard Haydenville Town Hall HAYDENVILLE MA 01039-0447 07-059-001 NORTH FARMS RD RWGEY DAVID C&ELIZABETH A 381 NORTH FARMS RD FLORENCE MA 01062 07-053-001 NORTH FARMS RD STRYSKO EDWARD C&KATHLEEN M 400 NORTH FARMS RD FLORENCE MA 01062 07-054-001 NORTH FARMS RD VOUJNGER HELEN T 430 NORTH FARMS RD FLORENCE MA 01062 gg,,�ga 07-023-001 NORTH FARMS RD VOLLINGER IOHN I&GRACE F 460 NORTH FARMS RD FLORENCE MA 01062 07-066-001 NORTH FARMS RD WADE MARION L 426 NORTH FARMS RD FLORENCE MA 01062 07-009-001 NORTH FARMS RD WADE ROBERT N&AUDREY S 422 NORTH FARMS RD FLORENCE MA 01062 07-018-001 NORTH FARMS RD WARNER EDITH B&GARY M&DAVI 332 NORTH FARMS RD FLORENCE MA 01062 07-012-001 NORTH FARMS RD WARNER GARY M 406 NORTH FARMS RD FLORENCE MA 01062 r limigaap.-Cownioad results as a delimited tat file for use with mail merge ClaeryapaI.-OisplaY labels in your browser for Imnhng-Avery 5160 MS EL/z X714- R).VS'E`r Hn5 1 g55E3 kW hY HCUA (Z .e-,5 JOAPAJ Pi CARD [-LAVE X9DUEb 'i � 8Y LoT 07 - OS 2 - col is Now OC:Thisb SOHN C . MURPHY to N 0 ° roQ\11344 m .,F-I g D C y 3 h -O �� �llt/1/ " 3 t sti, O .„ay6 IV 4 re 1 / o � 3 % d4 \a$�1 . I, _, N Je t P T p , Y �I a 09 3tTnN3pA< BErt i�CY • fY IIr K " „ivy:5 * , :. .2 , „ , . I ■ D MI 0q , E okyit", et r 51 A n J I ma 1 °1 • 1 El Prarillierle-e 6 i: __ 11111*:: '''''L :11 4, ' ai� N.tl°N ?� alli:� W.*. Write" sr. °u W ° — _.>• r [�".ate' ,:w,roa \' s` Am 01 , -"'�ieWli7 ,1111 1�I 64 I O le MIS,q1II a ly � � NE E 7 PS t. 9y 5h � FYI iiip - © �.�1/4 ,_A 95 HOW 9NIOP -- --�+ NO1dWVH1HON 66 ' 14 oust S.;-1-4. 412 Nor+1 Farms Rd. Bureau of Resource Massachusetts Protection Department of Environmental— Wastewater Permitting PrProtection ogram Site Address or Map/Lot Number Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal D. Determination of High Groundwater Elevation 1. Method used , /2/Depth observed standing water in observation hole A. (30" g l Depth weeping from side of observation hole A. !30" B. Depth to soil redoximorphic features (mottles) A. Sb • ❑ Groundwater adjustment(USGS methodology) A g 2. Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level E. Depth of Pervious Material 1. Depth of Naturally Occurring Pervious Material a. Does at least four feet of naturally ccurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Yes 2.No❑ b. If yes, at what depth was it observed? Upper boundary 23 Lower boundary: 136"+ F. Certification I certify that I have passed the soil evaluator examination' approved by the Department of Environmental Protection and that the above analysis was�pperrformed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signa 7743/41 ree of Soil E a4 Iualor u Oa •^7 asp 2005. HILL TOWN ENVIRONMENTAL CONSULTING P.O. BOX 314 Mark Thompson April 29, 1997 CHESTERFIELD,MA 01012 Typed or Printed Name of Soil Evaluator tale of Soil Evaluatoe Exam (413)196-4499 None- Name of Board of Health Witness Board of Hearth DEP Form 11 Soil Suilability Assessment for On-Site Sewage Oisnnsal •Pans 4 n1 a _. . _ Massachusetts Department of Environmental Protection +12- I■lor+l. Eve,: Si . Noel-kew-po^ Bureau of Resource Protection -Wastewater Permitting Program Site Address or Map/Lot Number Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal A. Facility Information ' f Owner Name: H& t t-1nwt 5 h&c( HILL TOWN ENVIRONMENTAL CONSULTING n P.O. BOX 314 Street Address 40b Nor1■ frmt Rd. Map/Lot: CHESTERFIELD, MA 01012 MA (413) 296•4499 city, Florence- State: MA Zip Code: 01062- B. Site Information • 1 (Check one) New Construction Uv� Upgrade ID Repair ❑ 2 Published Soil Survey available? Yes 3y/ No ❑ If yes: I98I I 15-911-0 Pc:B, Paxi-oh Year Published Publication Scale Soil Map Unit Soil Name Soil nmitatlons Per(5 SIO W ly • 3. Surficial Geological Report available? Yes ❑ No ❑ If yes: Year Published Publication Scale Map Unit Geologic Material Landform 4 Flood Rate Insurance Map: . ,�/ ,,/ Above the 500 year flood boundary? Yes IE No ❑ Within the 100 year flood boundary? Yes ❑ No Ly Within the 500 year flood boundary? Yes ❑ No Within a Velocity Zone? Yes ❑ No ❑ 5. Wetland Area: National Wetland Inventory Map Map Unit Name i Wetlands Conservancy Program Map Map Unit Name ,�/ 6. Current Water Resource Conditions (USGS) 06/05 Range- Above Normal ❑ Normal lam' Below Normal Li Mont /Year 7. Other references reviewed: - • DEP Form 11 Soil Suitability Assessment for On-Site Sewage Disposal •Page 1 of 4 . . r-- Environmental 412- Nio>1-L. f H+iv-s Rol . Nov4Lay.1)k,.,° Site Address or Map/Lot Number Bureau of Resource Massachusetts Protection Department of—Wastewater PermiProtection tting Program Li. \ Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (minimum of two holes required at every proposed disposal area) Deep Observation Hole: Date: 25 0 Time: Noor1 Weather k Rt/ 80• 1, Deep Hole Number I_ r . • i e Location (Identify on Plan 2. Land Use: -( clot Surface Stones: {'ew Slope(%): 5-10/ Vegetation. Gvarre5 (e.g.woodland,agricultural field.vacant lot,etc a Landform: G.00nd Moraine Position on landscape: 3. Distances from: Open Water Body toot ft. Drainage Way loo 4- ft. Possible Wet Area loo+ ft. Property Line 90 ft. Drinking Water Well LOU ft. Other ft. 4. Parent Material: Gloom ; 11 Unsuitable Materials Present: Yes ❑ No RI/ If Yes'. Disturbed Soil0 Fill Materiial❑ Impervious Layer(s)❑ Weathered/Fractured Rock ❑ Bedrock ❑ 5. Groundwater Observed: Yes 10 No ❑ If Yes: Depth Weeping from Pit 130 j Depth Standing Water in Hole 13 0 Estimated Depth to High Groundwater: SB Redoximorphic Features Coarse Fragments Depth Soil Soil Matrix: (mottles) %by Volume Horizon/ Soil Texture Color-Moist Depth Color Percent Gravel Cobbles Soil Structure Soil Consistence • (In.) Layer (USDA) (Munsell) &Stones (Moist) Other D -5 A 5 (_ IoYKq-/v Crtiw.to loose 5-23 3,4 5L 2 SvSk innA53;Ve .crIALL' is" /23 -I3C SL 2 :5Y5/L 5S " y4i 5% 5% I 01 w,nss:vt -wialle Additional Notes HILLTOWN ENVIRONMENTAL CONSULTING 1 P.O. BOX 314 nFP Fnm, 1l Gn oer��.'on, n...............r_.n_ ra_ _