HomeMy WebLinkAbout2156 FALMOUTH ROAD/RTE 28 - Health 2156 FALMOUTH ROAD
CENTERVILLE
A= 169-017
No. 42101/3 ORA
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LHE Town of E airnstable P#' /� 7�-B 0
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Department of Regulatory Services
eesrsreare,: Public Health Division Date
9�u 39• �sA° 200 Main Street,Hyannis MA 02601
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Date Scheduled � ) Time JC) Fee Pd.
ppSoil Suitability
(Assessment,for,S` age Dispos/a�l L
Performed By: Witnessed By: )'�l
a /LOCATION&GENERAL]NI'ORNLATION
Location Addr=.ss 1MUhf� p//_ Owner's Name -
Ce-veer Address
Assessor'sMapTarcel: M 9�7 E;gincer'sN e
NEW CONSTRUCTION REPAIR D `�7J
Telephone
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Land Use U/ood e ! �•1 Slope$(%) � �-� Surface Stones
Distences from: Open Water Body�!w ft Possible Wet Area->/I00=t Drinking Water Well ��C`g
Drainage Pray �!(GGi ft PropettyLine >r`I.1 f Other
SKETCH:(Street name,dimensions of lot,exact locations oftest holes&per tests,locate wetlands in proximity to holes)
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Parent material(geologic) Depth to Bedrock
Depth to Groundwater. Standing Water in hole: /�" Weeping from Pit Face
Estimated Seasonal High Groundwater /V 1711—
D{ RIIIIIIATION FOR SEASONAL HIGH WATER TABLE
MetthcdUsed: W
Depth Ohse:-ved standing in ohs.hole: in. Depth to soil monies:_;i�
Depth to weeping from side of ohs.hole: n. Groundwater Adjustment It
Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater level
Obsery PERCOLATION TEST Dnte"%2�
Hole#ati on 15ma IU:G�
� /
//'') time at 9"
Depth of Per 5z ' C7 it Time at 6"
Start Pre-soak Time @ Time(9."-61)
Ead Pre-soak
RaterAin./Inch L� .�/ /jC
Site Sunability Assessment Site Passed Site Failed: Additional Testing Needed(Y(N) Ai _
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 beginliing.
QA lSEPTICTERCFORM.D OC
DEEP OBSERVATION HOLE LOG Hole
Depth from Soil Horizon Soil Texture Soil Color soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency-94Grawl)
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DEEP OBSERVATION HOLE LOG Hole.#
Depth from Soil Horizon Soil torture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency-%Orave
0 l)
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re
2:
DEEP OBSERVATION HOLE LOG Hole
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
0-/�- 1 Gyp Qgnaistency-% vel
Gra )
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Mace(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders,
Qgnsistercv-%Gravel)
0-/0 A L 5 MW
Flood Insurance Rate Map:
Above 500 year flood boundary No_ Yes
Within 500 year boundary No V Yes
Within-100 year flood boundary No7 Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious�2iterial exist in all areas observed throughout the
area proposed for the soil absorption system? Y-e
If not what is the depth of naturally occurring pervious 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 training,expertise and experience described in 310 CMR 15.017.
Signature Date
Q:\SBPnC\PERCFORMDOC