Loading...
HomeMy WebLinkAbout0151 CLIFTON LANE - Health 151 Clifton bane Centerville A = 247 — 206 S M EAe No.24IMIAM .r UPC 1=4 onmd com • Mads In URA . i Town of B• nstable. P# Department of Regulatory Services ' 9 Public Health Division Date /y / NAGS i6 y tee$ 2t1D Main Street,Hy#nnis MA 02601 �>fD µAY�' '• ..i Date Scheduled ✓ v 'Time Fee Pd. ! it su-tab-l' Assessment, 'or Sewag,6 Disposal v r L- '�/ Witnessed By: Performed By: "� � W LOCATION & GENERAL INFORMATION. Location Address�. ( � �n Owner's Name T gA-tJ ,P;0"t'JVL&k- �, Address Assessor's Map/P4rcel: l / �0 I Engineer's Name D6AW' A- NEW CONS' U(� 10N REPAICt Telephone# 3 F Land Use fCC C9.�d Slopes(go) /b Surface Stones ' ®�� Distances from: Open Water Body Zooft Passible Wet Area t ft Drinking Water Well 1�ft ,l Drainage Way— `(]� ft Property Line ` V ft Other ft mcnsiods'of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) SKETCH:(Street name,di CL I a TOWN OF �RNST,AS 1 � 7013 JA 711 � 9 i D lSTOr_} ,J.: (` i Parent material(geologic) ' i Depth to Bedrock t Face Depth to Groundwater. Standing Water in Hole: /v i Weeping from Pl Estimated Seasonal;gigh Groundwater I D&E ATION FOR SEASONAL HIG[I WATER',TA 3LE Method Used: ! I ]n. Depth abperved standing in obs.hole: n. Depth td Sall tnotusin tk Depth toiweeping from side of obs.hole: in. ©.A&Of ntef AdJutlttnent � ! _ A ,faetor.�.._,r� AdJ:(JroundwnterLevel— In ` dex Well# Reading Date Index Well level -- PER 10 km COLATION TEST Observation' I Time at 9" 'v Hole# Lj Time at Depth of Perc (a to t j Q I Time(9"-6") — -1t Start Pre-soak Time. @ d (. 3'� i End Pre-soak ---c hate MinJlnch Additional Testing Needed(YIN) Site Suitability Assessment: Site Passed Site Failed: Original:.Public l:eith Division Observatioti Hole Data To Be Completed on Back— ***If percola#On test is to be conducted within 100' of wetland,you must first notify the Barnstable C4..Oservatien Division at least one (1)weak prior-to beginning. r • r DEEPIOBSERVATION HOLE LOG Hole# I Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent g'o Gravel 0"'' ( b CVVV JV\ l l ` C,� DEEP'OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel) 0 tr t` ®, ON fL> /rC 'S DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel DEEP OBSERVATION HOLE LOG Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Corisis(en m I Itj N4 So 2 S Flood Insurance Rate'Map: Above 500 year flood boundary No— Ye.,/S.,- Within 500 year boundary No / Yes Within 100 year flood boundary No 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 per ious material? Certification I certify that on (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 trYm*ng,1ex�perfis and experience described in 3,.10 CMR 15.017. Signature l .. �,,,-- Date l� Q:\SEPTIC\PERCFORM.DOC