HomeMy WebLinkAbout0030 PRINCESS PINE ROAD - Health rA
30 Princess PineHyannis=269 - 086
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Town of Barnstable P# 11�7M
Department of Regulatory Services = ��'
BARMABM : Public Health Division Date
MASS.
t6;9. `d$ 200 Main Street,Hyannis MA 02601 n
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Date Scheduled Time Fee Pd.
Soil Suitability Assessment for Sewage Disposal
Performed By: 2/�W r V 1✓I) Witnessed By:
LOCATION.& GE'NERAE INFORMATI ON
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Location Address Owner's Name
Address
Assessor's Map/Parcel: �� '✓�;, Engineer's Name
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NEW CONSTRUCTION REPADt 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 ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
(L #
F—A
CD
Parent material(geologic) w w � Depth to Eedt'clelc _ ._ _I o
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Depth to Groundwater: Standing Water in Hole: �} Weeping from Pit Pacc
Estimated Seasonal High Groundwater 4
DETERMINATION FOR SEAS.ONA:HIGH'WATE
Method Used:
Depth Observed standing in obs.hole: in. Depth to soil mettles: _- _. 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
XY
PEIICDI.At" TEST i�xit� . ltne
Observation
Hole# Time at 9"
Depth of Pere Time at F
Start Pre-soak Time @ W k IbA I L-,/ Time(9"-6")
End Pre-soak
Rate Min./Inch
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 notify the
Barnstable Conservation Division at least one(1) week prior to beginning.
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Q:\SEPTIC\PERCFORM.DOC
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DEEP OBSERVATION HOLE LOG Hole# '7
Depth from Soil Horizon Soil Texture Soil Color Soil Other /
Surface(in.) (USDA) (Munsell) Mottling
(Structure,Stones,Boulders.
Consistency,%Gravel
S 6
36 G /j1, / Q 7 �
DEEP OB3ERVATION HOLE LOG'. HoTe# 47
Z
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,%Gravel
W'2�4
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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
DEEP OBSERVATION HOLE LOG Mole
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consiste Gravel)
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=i = Flood Insurance Rate May:
Above 500 year flood boundary No_ s-----
Within 500 year boundary No Yes
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Within 100 year flood boundary No Yes
-Death 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? rj"
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If not,what is the depth of naturally occurring pervious material?
Certification
I certify that on Z
(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,expert a and ex6perience described in 310 CMR 15.017.
Signature. Date
Q:GSEPTiC\PERCFORM.DOC
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