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Home My WebLink About0072 CLIFTON LANE - Health F '72 Clifton. Lane Centerville A= 247-006 S M E A D No. 2-153LOR UPC 12SU smoad.com • Made In USA FM usa a llSPIMUCTL" �IREro ]Department of Regulatory Services s rSnwlaTA9ae : Public Health DflvllSfl�ll7l ]Date �b /D MAS& 200 Main Street,Hyanuis MA 02601 i6y q. ti� Date Scheduled_ d U 1 tm e V Fee Pd. Yp_/V U• UU Foil Sizitability, Assessrizent for Sewage Disposal Perfonned By:' Witnessed By.; Dalli rJ L61s LOCATION ark GEI� JL ][IV][�RA ORIVitATION Location Address 41 �'o Owner's Name/-�-vAddress Assessor's Map/Parc ` Engineer's Name�G NBW CONSTRUCTION REPAIR Telephone IF Land Use. Slapes(%) Surface Stunes Distance's from: Open Water Body OV)W— It Possible Wel Are4 /L///f—fl Drinking Water Well �fl Drainage Way 41 ff= ft Property l-hir .7 ft Other It i SIX'TC H., (Street came,dimensions of lot,exact locations of I oles 8c pert tests,locate wetlunds-in proxinuly to holes) • I Z`' I lG /-- I-P c P 42 t 7q \� 7f ( _ Parent material(geologic)_Q Depth LQ 130drock J— Depth to Groundwater: Slan ding Water in}tole: A Weeplhg fI'0111 Pit PROP_ A/ Estimated Seasonal High Groundwater DlCTEPAIINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: In, Depth 10 soil 310L Ig8: lu, Depth to weeping from side of obs.halt:. 111. C)roundwuLar Adjuslment„e. fr. Index Well I# Reading Date: Index Wel leVnl _„ Adl,factor Aal.C)rl?ulttlwuter Lxvel 4 PERCOJLAT1.0`41 '7l'lCST Observation ^ W�I-fait tP 1 '['rote it[9" Depth of Pere 90 Time a1 6" _ Start Pre-soak Time @ /lO - Time(9"-6") End Pre-soak Rate Min./Inch Site Suilability Assessment: Site Passed_ SiL.q,Failed: Additional Testing Needed(Y/N) Original: Public Health Divi:;ion Observation Hole Data To Be Completed on Back----------- k**1f percolation test is to be conducted vViLlain 100' of vvetland, you must first u0tify the. Barnstable Conservation Division at least One (1) weel+i prior to begaaluiug, Q:\SCPTl0Pl3RCFORM.DOC Depth from Soil Horizon 1101e Surface(in.) Soil Texture `5dll Color Soil (USDA). (Munsell) - Mottlin Other g (Structure,Stones;Boulders, Con isle c % ravel -271 Lvy25��6 LS Z,-5--ly 6 DEEP ®�3,S]ERVATION Depth from Soil Horizon ROLE, �'®� I1I0le# Surface(in.) Soil Texture Soil Color (USDA) Soil Other (Munsell) Mottling (Structure,Stones,Boulders. Consis enc %Gravel a7-IZ� L ' lG y2sf6 G �Yi+c�S Z, ------------- --- -- Depth from Soil Horizon a'®� Dole# Surface(in.} Soil Texture Soil Color Soil er (USDA) (Munse)l) Mottling (Structuree,tStones,Boulders. CousistencY %-------------- Onvell DE Ell" OBSERVATION Depth from Soil Horizon S ®�'E LOG' Hole Surface(in.) oil Texture Soil Color Soli (USDA) ., (Munsell) MottlingOther (Structure,Stones;Boulders, Consl�enCV °h t7favr1l • Dood Insurance]hate IbMap� Above 500 year flood boundary No Ycs 'Within 500 year boundary No_ Yes ' Within 100 year floodboundary No� yes . De>(rtl>I o� IIVlccu Occurring Pei vlous aterlal Does at least four fe©t 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 matorigl?_ C�fitn$"ca�bous .. I certify that on 4.. (date)I have passed the soil evaluator examination ap proved ed by the Department of Environmental Protection and that the above analy.-is was performed by me consistent with the required training, expertise and experience described in CIO CMR 15.017. Signature ,<�-- Datb�� t Q:\SEPTIC\PERCFORM.DOC