HomeMy WebLinkAbout0149 BEECH LEAF ISLAND ROAD - Health 149 Beech Leaf Island,Road - *k Z!, �? .
A = 187-063
Centerville
SMEAD
No.2-153LOR
UPC 12534
smead.com • Made In USA
P�fll VS�N liii PRODUCT UI!
SFI HSAFROMM
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Town of Barnsiaable P#
4 gT� Departinent of Regulatory Services .
Public Health Division Date m
�p aeyq 200 Main Street,Hyannis MA 02601 ff r
Date Scheduled t
Tl t Fee Pd. D
Soil Suitability Assessment for Se I)is
n.
PerformedBy: Witnessed By: ,
LOCATION&GENERAL INFORMATION
I.ocadon�d s � -
• � ��� Owner's Name J
Address
Assessor's MaQ/PameL• Engineer's Name - - -
NEW CONS'IRUCPION REPAIR Telephone -
Land Use Slopes M -Surface Stones
Distances from: Open Water Body R Possible Wet Area � R Drinking Water Well - - ft - --
Drainage Way ft Property tine ft Other
SKETCH:(Street name,dimensions of lot.exact locations of test holes&pem tests,locate wetlands in proximity to holes)
�' _ £ r �..w..ff. � ` -, 'ti•�L ` .� -t �i f,x;_v._ `:_^i" � �p �v� �-�� s "Ki:�s-�-..�y f
.s
t
J.
� .. § - •--`- -- ,��`- ` sae-.tr �'���� r�.r�f tTxcS `��2"ar�.��e�'"Y.
s".r+�_ -.j #'C 'S" ." s��Ta' � `s�nTF— �'TG"-F•_.•3�� �i- �" � 2
--
.. - Depth to Bedrock _. .. -
- --' --Depth to Groundwater. StandingWater in Haler- - -— -
. . ..
Weeping 11•ain Pit Pgce
Estimated Seasonal High Groundwater - - - -
DETERMINATION FOR SEASONAL•HIG' H WATER TABLE
Method Used:
Depth Observed standing in abs.hole: In, Depth to soil inottles: In,
Depth to weeping from side of obs.hole: ht, Groundwater AJ)ustment ft.
.- Index Wel!C Reading Dater Index Well ie�al Adj.Ihetor.,.._._�AdJ_Oroundwaterl_eval,�, -
OLATION TEST Date Thne
Observation
Hole N
—'-1�-�-- � Time at 9"
Depth of Pen Time at 6"
Start Pre-soak Time @ Qf L Time(V-0)
. I '
End Presoak - 1
Rate MihjWch. - l r. - -
Site Suitability Assessment• Site Passed Site Failed: Additional Testing Needed(YM)- .. -
,Original: Public Health Division Observation Hole Data To Be Completed on Back.
***If percolation test is to be conducted within.100'of wetland,you must first notify the
Barnstable Conservation Division at least one(1)week prior to beginning.
QASBPTrC1l'ERCr0RM.D0C
D � �S
DEEP-OBSERVATION HOLE LOG Hole#
Dt2tlr from Soil Horizon Soil Tatum
. Soil
Surface(n:)�. Soil Color - Other
I ., (USDA)- (Munsell)_ _ Mottling - "(StnucNm,S[anes;.Baulders. -
!? _ rststeney,%%raven - - -
'
l
Vti �
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Surface(in.) (USDA) �Other - '
(Mansell) Mottling (Structure,Stones,jB-.1dd.-
Q-WEPTlC%PERCFORM.DOC
.•� ('o 'Fen -
V.q.
• N r �:
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Sail Color Soil
Surface(m). ther
(USDA) __(Mwseil) Mo[ding _(StnrcturOe Stones,Boulders.77
�4`�:s.�.�.�..,..�� '-� "'�"�* .R „� ,rs•��'�v�v'..i� r�r T'�� r c"�' � z¢ -y r- aT,�ata ,ate �+s'4 �,,.T •t -a w. :..� �,,
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil - Solt Other
SurfacaCn) :NSDA) - e(Mansell) MOalln -' z -
g (Structure Stones Boulders �.-z�<-���• i
- e I n
.,.. � .Ys < rt,,.,. "'� _"'t�'"s4 -., � r� '�.fw's-2-�� '' �,�",b.^•''is-�w''�;�. '���� ...��°��3�.•'t.3.` "�'��"�#-'�'
2 s.
ti
r �
�. h
Flood Insurance Rate Man
Above 500 year flood boundary No�fYes
Within 500 year boundary No Yes
Within 100 year Flood boundary Na
Death of Naturally Occurrine Pervious Material
Does at leas[four feat of naturally occurring perw s m terial exist in all areas observed throughout the .
area proposed for the soil absorptibn system? _
If not what is the dep of`aturalIy occurring pe ious materiel?
Certification .
I certify that on 0 (date)I h ve.passed the soil evaluator examination approved by the
Department of Enviro a tat Prot on a t e above analysis was perform by me consistent with
the re ti raining,expe s an aped n a abed in)10 CMR 15.017
signature Date ��
- .. - .
i
r LOCATION �T a ��l �C'n �e< -� �`��a�"i� �clAl� _ N0. P- 9 l a -=--
VILLAGE - 4_ i I �-C DATE q - �•9'" g5
APPLICANT r4 ' jUj-A. FEE
ADDRESS _ di ;- �f(� TELEPHONE NO. (Non-refundable
ENGINEER �•^ TELEPHONE NO. oZ 4
DATE SCHEDULED ll- 14 - 5 10;0 0
(Applicant' s signature
. . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
V� Vb7 SOIL .LOG ,
SUB-DIVISION NAME DATE y�SrS� TIME 40=yo/
EXPANSION AREA: YES ✓NO r�si z `fyE Zr- ele,- ENGINEER 'N
TQWN WATER✓PRIVATE WELL J7, cv-n BOARD OF HEALTE
' • • ,/}'L- EXCAVATOR
r '
SKETCH: ,(Street name, ete. ,dimensions of lot, exact location of test holes and
'•`percolation tests , locate wetlands in proximity to test holes )
' NOTES :
Lo�- Z
qq
2
PERCOLATION RATE:(ASS TiA�2n1c,�,nc��
TEST HOLE NO: ELEVATION: 36 t TEST HOLE NO: ELEVATION:
1 y .So 6sa�C- 1
2 2
3 S.g.vo Y 3
6 6
7 7
8 1yIG-� 8
9 S�NrJ 9
10 10
11 11
12 : 12
13 13
14 14 ------------
15 15
16 eL.Sr�s lk��IwQ,TN 16
SUITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD `LEACHING PITS
• LEACHING TRENCHES
UNSUITABLE FOR SUB--SURFACE SEWAGE. REASONS :-
NOTE : ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION
ORIGINAL: COMPLETED IN ENTTRETY BY P . E , AND RETURNED TO BOARD OF HEALTH
COPY: RETAINED' BY APPLICANT
I_ .