HomeMy WebLinkAbout0721 PITCHER'S WAY - Health 721 Pitchers Way f
Hyannis
A=271-183
Town of Barnstable
oFlime P#
Department of Regulatory Services
BARMAR M Public Health Division
Mew'• Date
6 200 Main Street,Hyannis MA 02601
Date Scheduled
Time Fee Pd._��
Soil Suitability Assessment for Sewage Di'g sposal
Performed By:
Witnessed By: --
Location Address �ao LOCATION&GENERAL INFORMATION
Owner's Name
Address
Assessor's Map/Parcel: o�
Engineer's Namet:'dsh✓b /y� J- —p
NEW CONSTRUCTION REPAIR
Telephone#
Land Use
Slopes
Surface Stones
Distances from: Open Water Body ft possible Wet Area
__.._ — ft Drinking Water Well ft
Drainage Way, ft Property Line
Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlandsn proximity y to holes)
Z
Parent material(geologic)
Depth to Bedrock
Depth to Groundwater. Standing Water in Hole:
Weeping from Pic PsVe
Estimated Seasonal High Groundwater
Method Used: DETERMINATION FOR SEASONAL HIGH WATER TABLE
Depth Observed standing in obs.hole:
Depth to weeping from side of obs.hole: in, Depth tt)soll mottles: In.
v index Well# Reading Date: Index Wetl level in' Groundwater Adjustment r
.an Ad1,&ctor Adj.()roundwaterjgvel,
(� r Observation PERCOLATION TESL' bate— Time
H toe# .
e Time at 41,'
@-- 1 e th of Pere G —--
Time at 6"
l , Start Pre-soak Time @ I -
try G Time(9".6")
t Enii Pre-soak
C) h /
7
Rate MinJtnch
Situitability A serg?ment: 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 notify the
Barnstable Conservation Division at least one(1)week prior-to beginning.
Q:ISEPTIC�PERCFORM.DOC
DEEROBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders.
'Consistency,% ravel
u
G 5 �
w`C> moo. ✓ 2
DEEP OBSERVATION HOLE LOG Hole"#
Depth from Soil Horizon .Soil Texture Soil Color Soil Other
Surface(in.) (USDA] (Munsell) Mottling (Structure,Stones,Boulders.
onsi to %Gravel)
wt 5 l
Hole DEEP OBSERVATION HOLE LOG e
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell Mottling (Structure,Stones,Boulders.
Consistency, o Gravel
i
DEEP OBSERVATION HOLE LOG Hole#
` Depth from Soil Horizon Soil Texture Soil Color Soil other ,
Surface(in.) (USDA) (Munsell Mottling (Structure,Stones:Boulders.
Consistency,
E ,
'Flood Insurance Rate Map:
Above 500 year flood boundary No— YesV_.____
Within,500 year boundary No `✓' Yes,
Within t00 year flood boundary Noz 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?
Y
Certification
I certify that on D (date)I.have passed the soil evaluator examination approved by the
Department of Envir nmental Protection and that the above analysis was performed by me consistent with'
the required training,ex ertise a d xp rience described in 310 CMR 15.017.
y � Date Z
SignaturdZ
i
Q:\SEFTICVERCFORM.DOC . I
i