HomeMy WebLinkAbout0023 GOLDENROD LANE - Health (3) r
oldenrod Lane
rville
9-130-016.
5 M E A E;j
No.2453LOR
UPC 12M
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OLF I OF D*SR
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Town of Barnstable
P#_ ;3k4
SIRE 7tjl
JDepartmQxlt of Regulatory Services 7 /Z
Public Health Divisioii
!LAANtirAB" a
iMAS& 200 Main Street, Hyanuis MA 02601
9
Date Scheduled_ Uf Time Fee Pd. Vp
`oil Suitability Assessment for Se Pa Disposals k's
Pcrfonned Dy: Witnessed By:
LOCATI[ON & GENERAL I[11FORVIATION y
Location Address c 2 G 04- Q / Owner's Name /I
Ce,v\ C Address
Assessor's Map/Parcel: /L30— 16 Cugiucer's Name W O LJ � e
NEW CONSTRUCTION REPAIR � Telephone 11 �U�) ',J V a �( K
Land Use. 2� �1lL? Slopes(%) U — Surface Stunes
Distance's from: Open Water Body T li Possible Wet.Arco /*VY ft Dr!ukirig Water Well Ae/—�ft
Draiha.ge Way It Property Line ft Other it
l
SKE 7I CH' (Street name,dimensions of lot,exact locations of lest holes SL perc tests, locate wrdands'in pracinuly to holes)
�G <7
7
`: (i
l�
Famnt material(geologic)_ I Depth tQ Aerb'oclt,
Depth to Groundwater: Standing Water in Hole:_ _ _ Weeplltg Pral!t Pit piton la/
Estimated Seasonal High Groundwater //f
IDIETE][ I�TA.'> ION FOR SEASONAL HIGH WA7l']GR TAB LEI
Mcthod used:
Depth Observed standing in obs.hole: lu, OepLla to s411 I%IL)ltLSs:.T�_ _ lu,
Dcpth to weeping from side oPobs.hole: _ I!a, druuuslWutet Adf usihtent„�_ �Ft.
Index Well f) Reading Dale: Index Well IeVnl r Add,6wtof AL{i,drowiciwuter t.,eVel
Observadon
Hole ft "Chile at 9'!
Depth of Perc —f-- TImp al 6"
� G
Start Pre-soak Time @ (/ /d rGt� Timo(9" G")
Sid Pre- oak
zy �
�Rote Pvtin./!Heil
Site Suitability Assessment: Site Passed_;� Sitg-Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hott;Data To Be Completed on Back----�l
*"If Percolation test is to be conducted vVitiltin 100' of vVetland, You must 6rslt notify We
Bitrnstsable Conservation Division at least one (1) weelc prior to begiauuui➢.og.
Q:ISEPTIC\PLRCPORP,j.00C
DE'R r - --___
Depth front �--
Soil Horizon Soil Texture 1OLE, LOG ]Dole #�
ON
Surface(in.) Soil Color
il So
• (USDA)_. Other
(�9unsell) Moulin
g (Structure,Stones'; Boulders,
YA
-----------
DEEP O_BgpRVAa'I®IeT H®L LOGDepth from Soil Horizon Role ff Z Surface(in.) Soil Texture Soil Color
(USDA) Soil
(Mansell) Moulin Other
8 (Structure,Stones, Boulders•
L Consi encv. Gravel)
In
Depth Prom Soil Horizon S Hole
Surface(in.). oil Texture Sall Color. ��—
(USDA) Soil
(Mansell) Other
Mottling (,9tructure,Slones,Boulders.
' t',onsistengY,qwe
-------------
---_�,7�,�t ��r���rr�� p r�x }�7 HOLE
I
�JE EP 0j?, b1 � 1�:11J1 AQ�1W JLIl�A,��
Depth fi,om Soil Horizon LOG Hole
Surface(in.) Soil Texture Soil Color
(USDA) ., J°II Other
(Munsell) Mottling (Structure,Stones; Boulders,
Consistenc�ay ^
Mood Insuira ace Ra
te Roa
Abovc 500 year flood boundary No Yes
Within 500 year boundnry No
Yes. _m
Within l oc year flood boundary No
)I�e t�>I ®�1`�atanlr�lBy__ce"IrringPqrvA_ iousMaterial
Does at least four feet of naturally occurring pervious material exist in all areas observed thl-oughout the
area proposed for the soil absorption system?
lft not, what is the depth of naturally occurring j)erv10Us material?
��'ICtJIfH�a(fiOP➢
A certi' c� •
fy that on 7 (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 R-equired training, expertise and experience described in CIO CltdR 15.017.
Dake
QtS,HFTICTERCFORM.DOC