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HomeMy WebLinkAbout0009 CENTER LANE - Health 9 Center Lane Centerville A = 251 —060 uu up 1i&14 ,�► �iTN►Oi�YM TOWN OF BARNSTABLE t &ATION a/ C�`=�/'T`.` '.it �tOt r� SEWAGE # VILLAGE ��^'��"''�' ��` ASSESSOR'S MAP &LO Q INSTALLER'S NAME&PHONE NO. OQ1-17t—LN/As' o j ��-q�f 7 SEPTIC,TANK CAPACITY LEACHING FACILrN:.(type) S ���'u` 3' `) (size) I Z- x`t-,+ NO,OF BEDROOMS S ; BUILDER ORQWNER ����''�` �® '"'so 'j r PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjfisted Groundwater Table'and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by F T 901 qJ 0 A2, i 44 r � /2' Town of Barnstable P# Department of Health,Safety,and Environmental Services 1W Public Health Division Date I'L- � 367 Main Street,I lymmis MA 02601 BAMffABM MASK. "rFo � Date Scheduled Time Fee Pd. b0 Soil Suitability Assessment for Sewage Disposal tirr Witnessed By: LL�s d ? tY'4 Performed By: �a-c,r�Lu_ � �i -- �� LOCATION &GENERAL INFORMATION o Location Address ( wr ©� Owner's Name 3.3b.rA,.. �1u,l�nrs c1. � of (SON 95 Address (; }.eV�vi lt.a.. h N Assessor's Map/Parcel: �S� (Aar) Engincer'sName (3eXJ~r, f, �°`lcAkVn '1 NEW CONSTRUCTION ✓• REPAIR 'telephone# <1.Z8-q 13 1 Land Use Slopes(%) Surface Stones 4 _ f- _ Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) �ou -141 �►�2t,9� � 3 i '"1'p �"2 TlP�'► S. N 5 i 0. Parent material(geologic) (91'c'r.R 44 hA,,C, Depth to Bedrock, Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater t3 TE'RIV.. -ATION FOR SEASONAL NIGH 'WA TER TAT3LE Method Used: _ _Depth Observed standing in obs_ho_le: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in.- Groundwater Adjustment ft• Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level_ ' PERCOLATION TEST Date W1 T'trn'c': .oa � r Observation 1 Hole# Time at 9" ' Depth of Perc Time at 6" `�!Z_ Start Pre-soak Time @ Time(9"-6") End Pre-soak ync-lotR. bo Rate Min./Inch Mir ih Site Suitability Assessment: Site Passec_&I" Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back-� Copy: Applicant DEEP OBSERVATION HOLE LOG Hole# Darer Depth from Soil I lorizon Soil Texture (Munsell)ril color Soil Munsell) Mottling (Structure,Stones,Douldcres. Surface(in.) ° O /oaf- �8 r� $u,f:4 hood ive /0 yf' i +L(��- 132 ff DEEP OBSERVATION HOLE LOG Hole # Soil other Depth from Soil Ilorizon Soil Texture I Soil I Mottling I(Structure,Stones,Douldcres. Surface(in.) (USDA) (Munsell) o 04,1 60lf %,a VP ------------ DEEP OBSERVATION HOLE LOG Mole# Soil Other Depth from Soil Ilorizon Soil Texture Soil Color Moulin (Structure,Stones,Douldcres. Surface(in.) (USDA) (Munsell) g l tt o llEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other °i Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Douldcres. o Flood Insurance Rate an: Above 500 year flood boundary No_ Yes y t Within 500 year boundary No f/ Yes 1 Within 100 year flood boundary No t/ Yes Depth of Naturally.Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system.? If not,what is the depth of naturally occurring pervious material? Certification I certify that on 4// (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 31 CMR 15.017. Signature %'%. Date IZ /7 Town of Btarnstable P Department of health,Safety,and Environmental Services �IHE Public Health Division Date , � Q 367 Main Street,I lyanuis MA 02601 RAWMABLK MAn A�ED►AAt� Date Scheduled 1�. r p� Time q Fee pd.—top Soil Suitability Assessment for Sewage Disposal Perronned By: �h�.a /y/s T�.��' Witnessed By: LOCATION &`:GI.NERAL INI+ORMATION Location Address r lmor 5 /�. .,� LA- Owner's Name (�G�4 r Jo 0"i I c erg CiA v7�_� Address P.o. 11leA 9 Ce004•"vfIle Assessor's Map/Parcel: E:;I �(�j �� � Engineer's Name NEW CONSTRUCTION REPAIR / 'Telephone N Land Use Slopes(%) Surface Stones Distances from: Open Water Body It Possible Wet Area fl Drinking Water Well ft Drainage Way Il Properly Line It Other It SKETCFI:(Street name,dimensions of lot,exact locations of lest holes&perc tests,locale wetlands in proximity to holes) t, I I Thz— TP I C �1 A-L N ; t Parent material(geologic) GIG c kwk. 0eJts.+i.8h Depth to Bedrock Depth to(iroundwatcr. Standing Water in Ilole: Weeping from Pit face Estimated Seasonal I ligh Groundwater DETERMINATION FOR;S +ASONAL IUGII WATER'IABLE Method Used. Depth Observed standing in obs.hole: in. Depth to soil mottles: Depth to weeping from side of obs.hole: in. Groundwater Adjustment Index Well Weil h- RnAtiliig7are: Ihifex Well level Adj.factor" Adj:Groundwalcr Level ` - — - -- -- --- - j r I ERCOIA1'ION'<TEST: Bite- ' Time I Observation Vlole N Time at 9" Upth of Pere �Sl_ Time at 6" r SSrt Pre-soak Time n 'rime(9"-6") Etil Pre-soak l��Jt, rt�puit< i Rild Min./Inch .t Site Soitabilily Assessment: Site Passed Site failed: Additional Testing Needed(YIN) Original: Public Ilealth Division Observation Hole Data To Be Completed on Back 3 Copy: Applicant llrEP ODD E RVATION Depth from Soil I lorizon Soil Tcxlure Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,nouldcrcs. Consislenc " iravel ASgVk hOc;�Y�_ i.o '?i2 V-3 SaY..eQ VYU'VtQ 10 4'I4 . i — -- DEEP. OI3SERVATIO HOLE LOG Hole it 3 Depth from Soil 110rizon Soil Texture Soil Color Soil Olhcr Surface(in.) (USDA) (Munsell) Molding (Structure,Sloncs,Iloulderes. :onsislcnc "/ Qravcl G 4. 31, cco'u- n toti)Ii�! 7l4. — --- llEEI';;013SF-, A* ION'IIOLE LOCI . Depth from Soil Ilorizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Molding (Structure,Stones,Ilouldcres. 'onsistcucy %Cravcl - DELI' 0135)vltV�1TION_:IIC�LL:LOG Hole# Dcpfh from Soil II rizon Soil'I'cxlure Soil Color Soil other Surface(in.) (USDA) (Munsell) Mottling (Structure,Slopes,Iloulderes. Consislenc 10(iravel) I I Flood Insurance Rate Mal): Above 500 year flood boundary No_ Yes l� Wilhin500yenrbo:ndaw, No—//' Yes Wilhin 100 year flood boundary No-/ Yes t DeWh of Naturally Occurring, Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout i"'Ic area proposed for the soil absorption system? )W If not, what is the depth of naturally occurring pervious material?_ Certification certify that on (elate) 1 have passed the soil evaluator examination approved by Ale Department of Environmental Protection and that the above analysis was performed by me consistent \r'll the required training,expertise and experience described in 310 CMIZ 15.017. Sign, Date i In 10 P)4A� V J�v 4 Wiii j��,L7 it, . �'� , '' '.. ����++^aa�„yyz XTmnfi�xRNI.E,... 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