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Home My WebLink About0052 SKUNKNET ROAD - Health 52 Skunknet Road A= 192 -061 Centerville V I Tom of Barnstable Departinent of Regulatory.Services zil Public Health Division C-3 ^� 200 Main Street,Hyannis MA 02601 ryyl Date Scheduled Tune_ e �l_� Fee Pd. l U d nn Soil Suitability Assessment for Sewage Disposal Performed-By: boln',,el �S Witnessed By: t �k1- LOCATION& G T"RA INFORMATION LaeationAddregs J-1, sfjL,(_V\ / Owner's Name 7-1ka0 C e t1 V!! t e Address Assessor's Map/Parcel: I Engineer's Name jov"o, e NEW CONSTRUCTION REPAIR �'T"elephone# �� J,/V� L�/ Land Use:L a W~1 Slopes(%) y—J Surface Stones /�d� e Distancesfrom: Open Water Body (or f1 1'ossibleWetArea Drinking Water Well Drainage Way �(Oy ft Property Line � H " ft Other ft SIMUCH:(Street name,dimensions of lot,exact locadons of test holes&pero tests,locate wetlands-in proximity to holes) T/+►qj So P • E,�;S�nod Parent material(geologic)G�GIC�f Q �u Depth to Bedrock DepthtoGrouudwater. StandingWaterinHole: /V` 1 _ ZLIA • Weeping from Pit Face• Estimated Seasonal High Groundwater A IA HETE ATZON FOR SEASONAL HIGH WATER TABLE Method Used: Al r) I✓ _ Depth Observed standing in obs.hole: Iq, Depdt to soll mottles. In, Depth to weeping from side of obs,hole- In, Groundwater Adjuettnent Index Well# Reading Datc: Index Well 1pVol _ Adj.Actor—Adj.GromldwaterLevel , P'ER.COLATZON TEST bate, T n e Observation � Hole# Tlma at 9" /'7 Depc.:ofP arc. — F / - Time At6" — Start Pre-soak Time @ �0�.j 'Time(9"-G") iMr� End Pre-soak Rate Min./Inch Site Suitability Assessment: Sitc Passed Sitg Filled: Additional Testing Needed(YIN) l • i 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 Cousgvation Division at least one(1) week prior to bcghlulug. Q:IS BPTICIPE.R.CFO RM.D O C DEEP-OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Sdil Color Soil 0(hcr Surface(in.) (USDA) (Munsell) Mottling (Structure, Stones;Boulders, o i tcn;y,%'Gravel) 0 - � S� COX 31 60 C t f75 Z,sv�lz &0-/32- Cz 2,5-Y- , o -DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsis en go Grave /0YA5/� 2Z wig Ct S �,� (l? S V3Z Cz iUr�� z,sys DEEP OBSERVATYON)GIOLE LOG Hole#. Depth from Soil Horizon Soil Texture Soil Color Soil Other' Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. ConsistrDry, Gmyrn DEEP OBSERVATION BOLE LOG Hole# Depth from Soil Horizon Soil Texture Solt Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stories,Boulders. Ca si ten • v Flood_Insvlrance Rate Ma�- / Above 500 year flood boundary No Yes U _ Witten 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 m iterial exist in all areas observed throughout the area proposed for the soil absorptibn system? y -e If not,what is the depth of naturally occurring pervious matdriall Certification //L I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protectlon and that the above analysis was performed by me,consistent with . the requited training,expertise and experience described in�10 CIVM 15.017. Signature Q:\s.EPTlaP.ERCF0RM.D0C ' f No..J-'V-�-------- FR$....ZA fd.......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............................... W App iratiou for Bitipaoal Marko Tonstrurtion Vanfit Application is hereby made for a Permit to Constrict ( ) or Repair ( ) an Individual Sewage Disposal System at: 'n .......L ...................`� /!!�B� C ...,... .1... . .1 ��' , ....,_... -��. Locatio Lo d ? . tNo . .f. ....... .............................. O Address a ...... .. G*�i .:.........F U LL ....a.......................... ................................................... Installer Address Q Type of Building ? Size Lot............................Sq. feet U Dwelling—No. of Bedrooms........3................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons............................ Showers — Cafeteria Pr Other fixtures ------------------------•-------•---••----......••••-- W Design Flow........... ..............................gallons per person per day. Total daily flow...................................---------gallons. WSeptic Tank—Liquid capacit/eO/J--.gallons Length................ Width................ Diameter..............-- Depth................ x Disposal Trench—No...............:..... Width.................... Total Length.--................. Total leaching area....................sq. ft. Seepage Pit No.f11Gd 61;_ !�� Diamete.`P`............ Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ riq Test Pit No. 2................minutes per inch Depth of Test Pit..........------.... Depth to ground water....................--.. r4 ................................................... ..................................................................................................... 0 Description of Soil--------------------------------------------- --- -------------------------------------------------•------------------------------------------------•----•••-------- U -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ...... .......•-----------......•----- ............................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss y the board of heft. q1....... .. . .... - •YI �-- to--------------- Sign Application Approved B ( '' �„ � -: Date Application Disapproved for the following reasons---------------- .....-----------•---------------------------------=------•-----------.........••••....... -----•---------------------------------------------------------------------------•--••------------------- ------ Date PermitNo......................................................... Issued....................................................... Date No... ....... Fes$.. :' ' b .....�............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ ... . �.'...: ...QF.......... d"rt j�.,A icw4 y�..«"°............. Appliratilin for Uigvollal Works Tonstrurtion Vantit -Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: f �? / . �� prti F f.✓ !Y {w 7 F ��;e`�'gr� ��Y � .� iF''`r y'"'".. Y Location ddress or Lot No ..... r. r F P ........................ .................... ......................,..... ,,��^^ ♦Oer Add�� r^5 ..... � �... .F,c. ..!�... �. .(= T............................... ........................................... .............................................. Installer Address Q Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.......:. ................................Expansion Attic ( ) Garbage Grinder ( ) pa, Other—.Type of tBuilding ______________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other f*tures ••••......................... W Design Flow............4 ... ...._ ...gallons per person per day. Total daily.flow.......................... .................gallons. 0� Septic,Tank—Liquid cap acrt}v ? gallons Length................ Width................ Diameter................ Depth............... xDisposal.-Trench No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No ...... Diamele?. 'k.'............. Depth below inlet--.................. Total leaching area..................sq. ft. Z Other Distribution box;'(- ) Dosing tank ( ) aPercolation-Test Results Performed by.......................................................................... Date........................................ a Test Pit No. 1................miiuites per inch Depth of Test Pit.................... Depth to ground water-_--__-_----_--__--._... ti Test Pit No 2 minutes per inch Depth of Test Pit_................. Depth to ground water--_-__--_--____.-_-__.-. Description of Soil " --. ------- - � v , U rJo --•------------------------•----... W r,� UNature'of Repairs or Alterations=Answer when applicable._--------------_---__-._.____--.-___--_-_------_---•---_------__------_-__-____---_----._-_-. ..•----------------------------------------•---------.. ------j)------------_•-__------------------••-•----------------------------------------------------------------------------------------- Agreement: z, The undersigned agrees,to,.install the aforedescribed Individual Sewag Disposal System in accordance with the provisions.of Article XI.of the State Sanitary Code a undersig fu'1 �,agre not to place the system in operation until a Certificate of Compliance has been iss edl ar heals S1gne& .4. _.... •.._....__ ^ to h ...... Application Approved By..." Date ....... Application Disapproved for the following reasons:............... ............................... ---.....--••------------------------------•-.......------.......------------------•--.....------ ----•.................................................................................................. Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH. 1 y 4 �. '$............. O F..... �rrr�if ir�t�r �f ��a�tt��tttttre THIS IS O CER IFYPhat 1 ndividual Sewage Disposal System constructed ( Repaired ( ) b .----•• -••--•- y t .................. t - I ter �a`1s has been installed in accordance with the provisions of Article XI o� e State Sanitar4_17�21_7? Cod s de i ibed in the application for Disposal Works Construction Perrnit No________________ _________ __...... dated ~ ____...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT RE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................. Inspector...................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD O� HEALTH .............O F...... - - o- FEE- 12. t , belt Wrmit Permission is hereby granted.-,t,:-----�`. ' ':-�`� ........ _t . r'��'`............................................................................ ': to Constr et 7 ) 12e air ( ) an �. tvidua, 'a e Dis sal S stem atNo.r . .. ...:.: � .,.�I t .. `.,�" t r�. .... . ......................................................... tree g as shown on the application for Disposal Voris Construction Per 't No.._ 3.l ..- . Dated.__ . .. ... . `I3oar f I3cdltli DATE.................................................... ., . FORM 1255 HOBBS & WARREN,, INC.. PUBLISHERS -