HomeMy WebLinkAbout0066 HAYES ROAD - Health 66 Hayes Road
Centerville
A=210- 164 . 001
Illl �
UPC 12534 '
No.215� 3. LOR
YwJtT�Miis.NM
Town of Barnstable
P# I� — l D, 70y
j? �pFTHE Tp�y V v
P p Department of Regulatory Services
Public gealth Division Date
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BARNSWIL r
v MASS. �01 200 Main Street,Hyannis MA 02601
1639
prf0 IAA A � 00 ..
Date Scheduled S I7 �� Time
Fee Pd.
Soil Suitability Assessment for Sewage Disposal
Performed By: �,� Witnessed By: U V`• n i �i
• I Ana��L.� L• ;
LOCATI N& GENERAL INFORMATION
Owner's Name lly(QJ
Location Address
le
Assessor's Map/Parcel: /D / /„ (�� Engineer's Name CL� Pe Sf
/ Telephone# 2
NEW CONSTRUCTION REPAIR �^
Land Use .� - Slopes(%) * Surface Stones
Distances from: Open Water Body _ft Possible Wet Area_fl Drinking Water Well ft
ft Property Line _'��-Y--ft Other tt
Drainage Way P tY
SKETCH:(Street n ne,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to•holes)
IQt'J
p 16�^z
W6a106V 9T
Parent material(geologic) Depth to Bedrock // A
Depth to Groundwater: Standing Water in Hole: Q' /.Weeping from Pit
Face
Q/�
Estimated Seasonal High GroundwaterrC .
DE TERNIlNATI�O,�N,,�FOR SEASONAL HIGH WATER T LE
Method Used: )A Jc r� �n,ov l4f&Tt4 D°vl`'epqstsI3 &A t6 U*Q.
Depth Observed standing in obs.hole: in. Depth somottles. 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 Time
Observation
Time at 9"
Hole#
Depth of Pere rr Time at 6"
Start Pre-soak Time Q -1�--—J Time(9"-6")
End Pre-soak I ' +
Rate Min./Inch S
Site Suitability Assessment: Site Passed_ Site Failed: Additional Testing Needed(Y/N)
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 no the
Barnstable Conservation Division at least one(1)week prior to beginning.
Q:HEALTH/WP/PERCFORM
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DEEP OBSERVATION HOLE LOG Hole# .�
Depth from Soil Horizon Soil Texture Soil Color Soil Other
(USDA) (Munsell) Mottling (Struoture,Stones,Boulders.
Surface(In.)
�ansistenov %aaravel)..._...._�._
T Z•SY
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency %Gravel)
T.
DEEP OBSERVATION HOLE LOG Hole#
Soil Texture Soil Color
Depth from Soil Horizon Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Stntctura Stones,Boulders.
Consistency %Gravel)
DEEP OBSERVATION HOLE LOG Hole#
Other
Depth from Soil Horizon Soil Texture Soil Color Soil Structure,Stones,Boulders.
Surface(in.) (USDA) (Munsell) Mottling
Con is enc °o ravel
-------------
Flood Insurance Rate Man:
Above 500 year flood boundary No Yes
Within 500 year boundary No.G11- Yes
Within 100 year flood boundaly No, Yes
De th of Naturall Occurrin 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? r
If not,what is the depth of naturally occurring pervious material?
Cert ification
I certify that on S (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was p consistent with
performed by me
the required training,expertise a d experi scribed in 310 CMR 1.5.017.
Date�- —
Signatur
6h A Y 6S: IQI�
Q:HEALT}UW P/PERCFORM