Loading...
HomeMy WebLinkAbout0556 YARMOUTH ROAD - Health 556 YARMOUTH RD.,HYEiNNIS A= 39491 07G oo� Cape Cod Lincoln,Mercury,MAZDA * a i i e I 5 7• t :rt " [TOWVMOF BAR/NSTABLE � `LOCATION SEWAGE # .:VILLAGE,- 7Ylfi7f7/5; ASSESSOR'S MAP& LOT 3YY-07G., wy -INSTALLER'S NAME&PHONE NO. I'J`l��G�n`j .�p/i'✓� �71-��?�� .;`.:SEPTIC TANK CAPACITY LEACHING FACILITY: (type) <'NO...OF BEDROOMS l3CUDER OR� PERMITDATE: COMPLIANCE DATE:_ (1. a cl y ::Separation Distance Between the: :Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet :'Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by .F1 �y t , No. _ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes 111 PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for MigpoMl 6potem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade(( )Abandon( ) LYComplete System ❑Individual Components Location Address or Lot No.5_r���rQlwy Owner's Name,Address and Tel.No. �y Assessor's /ylel Ma /Parcel p y" lel Installer's Name,Address,and Tel.No. Designer's Name,Ad ress and Tel.No. 7 7/-1,43 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(Zir:5) Other Type of Building COr o.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow �� ��� gallons per day. Calculated daily flow gallons. Plan Date Number of sheets / Revision Date 7 0- %r Title /�B i!SB Size of Septic Tank l Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) T),>-/ Ef Date last inspected: Agreement: The undersigned agrees to ensure the construction of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by t ' Board o �alt Signed Date Application Approved by Date_ Application Disapproved for th following reasons Permit No. Date Issued '++A No. Fee THE COMMONWEALTHF MASSACHU$ETTS Entered in computer: f /es PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS v Z(PpYication for`-Migoml *pztem Con!5truction Permit. Application for a Permit to Construct )Repair( )Upgrade(Abandon( ) L complete System ❑Individual Components Location Address or Lot No. � BB Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. . Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( Q Other Type of Building, D 4 o. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow_ 5 1 & AaW gallons per day. Calculated daily flow - gallons. Plan Date .11 7111 7 Number of sheets ¢/ Revision Date Z Title r :Cie ' S A Size of Septic"Tank Type of S.A.S. r Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agr ement• ,, The undersigned agrees to ensure the construction e of the afore described on site sewage disposal system .in,accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of alt Signed Date f. Application Approved by - '—Date Date o -7 Application Disapproved for th ollowing reasons f Permit No. '.` Li/�-j Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded(j/}� Abandoned( )by atW!!�/ D has been constructed in accordance with the provisions of Titl 5 and the for Disposal System Construction Permit No. dated Installer BDB-7tO e- j��� Designer ef"Aa :! L The issuance of this permit shall not be construed as a guarantee that the system w will function as designed. Date in c� -• c1 Inspector k _ __/�/ __CC-7 _ No.----�L L/--------------------������'®%Fee V� . THE COMMONWEALTH OF MASSACHUSETTS Y PUBLIC HEALTH DIVISION - BAR NSTABLE MASSACHUSETTS Mizpoar *pztem Con.5truction Permit Permission is hereby granted to Construct( )Repay ( )Upgrade( � Abandon( ) System located at rill ,�i�✓'7` r 1 and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date: - Approved by ASSESSOR'S MAP NO. PARCEL LW� TION SEWAGE Z�, ��� rPE SIT NO. VILLAGE GL4-1 o70 -� , INST !:ll 'S NAM E A ADDRESS B UILDER OR OWN ER DATE PERMIT ISS ED DAT E COMPLIAN-CE ISSUED' �� Q O -C:' �' ® I 1n9 J �' v ' (6 ,� '� �„ �•�, No. t Fps............................ THE COMMONWEALTH OF MASSACHUSETTS BOAR® F` HEALTH le, . -...-.......0. ..................................... .___ .............................................. Appliration for Dispaii al Workii Tons nr�" ami# Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at• (A) 51 ,- •---••..... ......-•-•-••------• --- -•--- ...................... .................................................. ..q.1 ..... �ocat or Lot No. ----•-. ........................................................ e /"���j/ dress a ........ .......................................................... ........• ................................ ............................................... Installer Address dType of Building Size Lot............................Sq. feet V Dwelling— Expansion Attic ( ) Garbage Grinder Other—Type of Building ___- ----- No. of persons........1.�_____.___. Showers ( ) — Cafeteria ( ) Otherfixtures ----------- •-•---•--•----••-•-•--•---I---•-•-------•-•-•-----•-------------------•-------•------•--•-----------••---•........-------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity------------gallons Length................ Width---------------- Diameter---------------- Depth................ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) '-� Percolation Test Results Performed by.-------------------- -•--------------- -................................... Date...............--....................... aTest Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ (i Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water--------.-_-___--.___-_- .....----•-------------------•-------------•-•---••-----•-•-•-•---••---.........----.......------------....---•--.........-----------•----------•----•------ 0 Description of Soil........................................................................................................................................................................ x U ------•--------••------------••-------.....•---..._..-•-•---•-------•-•-•••--•--•--••--•------•------------•-------------------•-•---------•-----•------•-•--••---•--------•------------------------•--- W �.. ---------- a -- -- - �,,..►- -- ----- --- UNature of Repairs or Alteratio ns er_when applic `� --- .......................................................... Agreement: .The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i I Ll'. 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the bo rd of health. Signed ---0:.....---•-----------------•---•----------------•---•----•-------- _.... Vatj_ - Application Approved . '(!!y ... — --�------ Da e Application Disapproved for the following reasons-------------------------------------•--•----------------------•---------------------------------•------•--••---- --•----•-•-••--------------------•-•--••--••••----•----•-•-•......•-•--------••-•---•---•-•-•-------------•-._.....-------•-•-•••---•---•--•----••-•-•-••••-••••---•------•------------•--••••-••------- Date Permit No. �. ... Issued_ ------------------------- Date THE COMMONWEALTH OF MASSACHUSETTS EOAR9�E HEALTH �.. ..............OF........-.. ---- . ............................. Appliratilan for Dhipasal Works Tomarran ' ' Permit Application is hereby made for a Permit to Construct ( ) or Repairdividual Sewage Disposal System at: W .................................................................................................. -'••--"--------•._........_._....•--•-"'------•-•----•-'--•----""-"-"'-"'-'.............••- YLoc i � / G G /t `� /',G� ���/�� or Lot No. wr, dress ....'------�.--L .. .-----•-•-----------------------------•--:..... " .........-L.Y- G/V/ ------------------.._.._..-•--•------------------- Installer Address Type of Building Size Lot............................Sq. feet - _, Dwelling—No -of—] eve Expansion Attic ( ) Garbage Grinder ( ) ayp Other—Te of Buildii .lJ_� ! W� K...�No. of persons......1_0............ Showers ( ) — Cafeteria ( ) Other fixtures . If ---------------•-------------------------------------------------------------•---------------... -----------•-------- W Design Flow............................................gallons per person per day. Total daily flow____________________________________________gallons. Septic Tank—Liquid capacity............gallons Length_______________ Width................ Diameter................ Depth................ xDisposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area_-..................sq. ft. Seepage Pit No..................... Diameter.............•...... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water_-____________._______-- Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water----------------­------ ................------•---------------------------------------------------------------------............--'---_----'-......................................................... 0 Description of Soil............................................................................................--------------._._.._..----------------------------•--•--••--------------•- x U W ----------------------- -------------------------- --------- _ _________________________________________________ _____ _i�_ _ J____ UNature of Repairs or Alterations-,,Answer when applicgble.__�_____ _____________'_�_...._A��_______._______`�.��__":_�\/F-e, 'J ....................................................___ _ __.__. ..........................�________.__-.._-_ __ ........................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TTLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the b and of health. Signed.... -.........� Application Approved ....:- ' Application Disapproved for the following reasons:------•--------•----------------••----------•----------•----•-------------------------------------------------- --•------•----••---------------•---------------••-•---•---•--.....------•....-------•---•-----••-------"------•-----•---•-•-•------------••----•-•----------------•---•--••----•-------------•...------ /� Date Permit No....... --_Lr1__......� ...................... Issued_ Date THE COMMONWEALTH OF MASSACHUSETTS .-- ---� BOARD OF HEALTH ..........................................OF............=............................................................... k""'rrtifirab of f omplittnrr THIS IS,-_T_O_CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by.............. y _' ------------- --------------------------------------------------------------------------------------------------------- Installer S � L,C �1 at --------•--- ....................... ---------� has been installed in accordance with the provisions of L i L tit'. j of The State Sanitary Code as descr b('e�d/in the application for Disposal Works Construction Permit No..... =�--.�. ___ . 1. dated__...__ ._ __S�__SO._______ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUAR NTEE THAT YHE SYSTEM WILL FUNCTI N TISFACTORY. DATE ....-•"-"-•--'-"___-'_. Inspector -��---...-•----••--------------••-----'-..._....-----......---•----- THE COMMONWEALTH OF MASSACHUSETTS //" BOARD OF HEALTH NO. S.Sl._._ 1�................�...- � ..OF..-......-. -� 1�.._._......._._..............._.__......... FEE 7:70. i �a<<tt_ nrkii �aanstr uan Permit Permission is hereby granted .--••• ��"----.�-- ... _.__. to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at T Y r street r as shown on the application for Disposal Works Construction Permit N6 ..... 1"5___ Dated____..... _________ Board ai Health -� DATE=----------- ----- c .............................'_ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 1�. ,r- -t2i�2r _JTOWN OF BARfNSTABLE � `` LC'�-,ATION .1 Yll°��1®L� /"�, SEWAGE # I VILLAGE /�YQ/l�l�S ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY CA-LS— r LEACHING FACILITY: (type) 6 skA& Vyze) ��i- J��I •��1C�.r NO.OF BEDROOMS BUILDER OI<fSji� PERMITDATE: COMPLIANCE DATE:�'rY1 � c� "7 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist . within 300 feet of leaching facility) Feet Furnished by �-a- 4$ — 4 c 6 1•,J BENCHMARK SOIL TEST p e .9 4 TOP OF SLAB 10 FT. MINIMUM FROM CELLAR DATE OF SOIL TEST ELEV. 10 FT. MINIMUM 10 FT. MINIMUM FROM SLAB OR CRAWL SPACE SOIL TEST DONE BY (AIMED 24' MANHOLE CLEAN SAND -` 5 v a - 43�is� WITNESSED BY �'. y •- •, ,•°�_ COAS 24' HDC1 MANHOLE COVERS 4' SCHEDULE 40 PVC PIPE "'"20 T OES��TIONEHOSE MIN./INCH A��- INCHES MIN. PITCH 1/8' PER FT. AYER OF DEPTH HORIZ TEXTURE COLOR MOTT. OTHER TO 1/2'4' CAST IRON PIPE �, ED STONE (OR EQUAL, MINIMUM '. VA, VENT -PITCH 1/4 PER FT. ,� 4 PVC�20 �; 4, - -, 1 CU. FT. OF FLOW LINE I CONCRETE �/� 1G),10 Alf e fH t o a.en l l lVC s�f-rz, c vEL� ANCHOR "3 _ + 10 Flow LINE E= �.s: 90 �► 1Z ff o o 1 k � z 00..W) y ELEV. �. —TMIN. - �,- r 10' c 0. .5, '+ 3a �? G�.S MIN. }ELEV. a yG' — BAhFLt _ r _1 �_ �t�' -' ! Ccsn rJ ,. `3�?S 172� G n `)S 9S 6 SUP - 4,Z I �. _ �. _.+----L' _L n d � ELEV. µ BANELE, ELEV �- a 1 c9 N 0 C O N Tr9 C T�, '. Lw-tp OUTLET DISTRIBUTION Ems,, _ ; EW-F-M TEE4 14 1= 1C ' .7 T ,'\i aI B 0 X .: C:✓,r!T.F �IIITIi STONE IN AN 8 19 IN TO BE PLACED ON FIRM BASE) TO BE WATER TESTED TRENCH FORMATION - a9 ' 7 .1 6 FEET 29 IN 1000 GALLON S00 GALLON IF MORE THAN ONE OUTLET � - `� '� Z NO WATER ENCOUNTERED AT 1 ELEV. a a 34 IN SEPTIC TANK (TO BE PLACED ON FIRM BASE) SOIL ABSORPTION -) 1NE11 sof# aote E� UcwID OUTLET SEPTIC TANK - `� C 1 3/4 TO 1 1/2 SYSTEM (SAS) ZONE 4 14 INCHES ` � �`' ' il WASHED STONE ADJUST DESIGN CALCULATIONS ' 6 FEET 24 ICH INCHES IH 2 A , C IZA:: FLOW .Vow �PRiNX j-r n.sa. izooC' F, 7 FEET �g INCH S BOTTOM OF TEST HOLE ELEV. - &7 ? E �, s�: u{E S.,e r:�'Y .� .5 z w&ErCs'� Ds rs 8 FEET 34 INCH S OBSERVED WRIER TABLE ( / / ) ELEV. �— Y.i,�TD ,Esax �s�. +'x 4ax?off GAL/DAY SEWAGE DISPOSAL SYSTEM PROFILE MINIMUM DESIGN FLOW GAL/DAY NOT TO SCALE REQUIRED SEPTIC TANK CAPACITY 1 0 GAL DEPTH FEET LEGEND: SIZE OF FIRST TANK (a h/ r��/c:� ` o o aGAL YA - EXISTING SPOT ELEVATION 00„0 SIZE OF SECOND TANK ( P R ©AO J Iaj0 GAL `�SQ,R N1 0 ul R L_. EXISTING CONTOUR ----00---- SOIL CLASSIFICATION S \ FINAL SPOT ELEVATIONCWjf_ DESIGN PERCOLATION RATE MIN./IN. FINAL CONTOUR— LOCATION EFFLUENT LOADING RATE ' GAL./DAY/S.F. SOIL 9q UTILITY POLE -0- TOWN LEACHING AREA ''2,.S ,' { SQ. FT. i - WATER —W LEACHING CAPACITY (AREA X RATE " GAL/DAY CATCH BASIN ■ ,. k, .; I 0 - GAS LINE G\i RESERVE LEACHING CAPACITY GAL/DAY i I • H NOTES: 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. + TITLE 5 AND THE TOWN OF 13 A R N s 7-A A 4 L- RULES AND REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO FINISHED GRADE WITH 24' HDCI MANHOLE COVERS. 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF �I WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE I i f I USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. 4 UPITS USED TO BRING COVERS TO GRADE SHALL BE MORTARED IN DEEDED OR ZONING REGULATIONS. OWNER APPLICANT IS TO t� 5. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH ~' OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. 6. UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR IS TO CALL 'DIG-SAFE' AT 1-800-322-4844 AT LEAST 72 HOURS ( PRIOR TO COMMENCING WORK ON SITE. ' 7. CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. 8. PARCEL IS IN FLOOD ZONE t'-M!'t ZS'a4O ' a�OSC 9. LOT IS SHOWN ON ASSESSORS MAP AS PARCELS / : -r-�A,f ► 1.� ln/' r . a OLD { C, lrn�.f"t,►1G P/T' Ta 8er It A-- RPIcL£T, 4 .6LA t #_.__ - - c-.0,V rZ T ,q TO H F3 Lx .5 *' :. . 51"rr "`��`.__ -�r_ t �. I L&F 4 C H P / T S foj O �: 7'f s 77- T D 4F-5 E lk'/G 1 lv LF E X 04 r z Ir,++t I .S P E c: o N ©,v F x i-5 r,/w 4�r .5 E P &I K f •t A�5 T 1 A/�, _ t Z X�x L 2',. 2 � 7'&AE"C I-^� �� ,ZH OF t�R 1 O Ti ?'rJ -.S T i? k.T 3 F C ©)�/„5 T lL V C T t�.hl 2 V E/V TJ— S��T l C T A,•�K �R t-C7.:E I� D I S T. ,Q Co( FiG31t� �Q CRAM �sG ttCo+ z`L , APPROVED: BOARD OF HEALTH ;DR O?CJ)-''T .S'_-p ri' '"; T"d-1.�llC � :� J�'• .a '?R.J g9lJ 3.94 f 9 ,P i t REstrrtvLr ztiS Az-A DATE AGENT _ PROPOSED SEPTIC DESIGN FOR W1 Ni" HR JP V 'lLr'3Jksr. % PROJECT LOCATION � A<r,,- �I, CRAIG R SHORT PROFESSIONAL ENGINEER 5-65 DENNIS,OMASS1 385-6530 02638 � . - P '_' j DATE SJL�'1� '' I SCALE N 2 0 REVISED -712819 7 JOB NO. LOCATION MAP SHEET / OF / � i 01997 CRAIG R. SHORT, P.E. Department of Environmental Management/Division of Water Resources WELL COMPLETION REPORT F � � era WELL LOCATION GEOGRAPHIC DESCRIPTION Address A N S E W of i��,SZ-�I �A ,c (feet) (circle) City/Town �-5k�;rs�1-•' Well owner,,)q s` �=5 i-r1r C (road) Address C.b z c� A N S E W of (mi.in tenths) (circle) Board of Health permit obtained: yes Elo.n D-- Intersect. w% (road) WELL USE WELL DATA Domestic❑ Public❑ Industrial ❑ Total well depth Zn ft. Monitoring Ei-^Other_ _ Depth to bedrock ft. € Water-bearing rock/unconsolidated material: Method drilled 4A Description -( f:�,Q N C3 Date drilled 7 - ►R ? AA 2a Water-bearing zones: c CASING 1) From - To Z o' € Type L Q y* A-0 .r C c=3T 2) From To Length 101 ft. Dia(I.D.) -7.—in. 3) From To Length into bedrock ft. Gravel pack well: dia. Protective well seal: dia. Screen: , , � Grout ❑ Other b�N�o���T� Slot# \h length\d from Itos STATIC WATER LEVEL(all wells) . Static water level below land surface_ X) ft. Date 7-'ST�-2600 WELL TEST (production wells) Drawdown .ft. after pumping hr. min. at gpm How measured Recovery ft. after_ hr. min. LOG of FORMATIONS COMMENTS 0 Materials From To N A � Driller 49E!S__�� ��-_ Firmr%f.S 9rAp .iraL a rAr Address '5 City/Town c4 � AN S Supervising Driller Reg.# i dnature of e-isin gis red wel tiller: Please print firmly BOARD OF HEALTH COPY: 10:41 TOIAIpd OF BARMST � 3 V HBLE 1+,,t'„+775+,,3c)4 P.©2%02 ayrrna V1 @Ad[a >ta�lA0.ldG Y!# l� L4 Department of Health,Safety,and Environmental Services 9 f 3 ' Public Health DliVision Date��' 367 Alain Street,Hyannis MA 02601 RARNa1`AB[$ v NAM t67q. ion + Date Scheduled - "7 Time Fee Pd. pc� Foil Aitability Assessmrent fog• Sewage Disposal Performed By: C r a-J q l2 . S A o r L, i-'E Witnessed By: Se= r r` -DV n e7 r h 9 LOCATION& GENERAL INFORMATION Ldcation Address 6-6- � �A Owner's Name Win. w1(6�r irk 72S Ceo/Qt- Tre-eN« PC/, f l�hn15 Address M .5 tic q M,//s �'t C 1G48 Assessor's Map/Parcel: .3 4 T/ 7 G - / Engineer's Name C►^w,#5 lz . Stior�C- NEW CONSTRUCTION REPAIR ✓ Telephone (5-06) 3 98 1/ Land Use C o-�-,r�-s cr /CA Slopes(0/0) /. Surface Stones A/m Distances from: Open Water Body Possible Wet Area — ft Drinking Water 1VcII R Drainage Way ti �9 e S Yft Property Line _7S ft other tt SKETCH:(street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) y'} 2/'N C Gj 00 r* 8a Parent materiel(geologic) C a Depth to Bedrock Depth to Groundwater: Standing Water in Hole, Af o n C, Weeping from Pit Face ALJ Estimated Seasonal Nigh Groundwater .t l)FTERIVIIN:4'I" Method Used; .c-/,q ION FOR SEASONAL.WGHI WATER TABLIE _ Dept of bselcd standing in obs.hole: Depth to weeping from side ofobs,hole. to Depth to soil mottles; in Index Well k in. Groundwater Adjustmcgt Readin ft g Date:,- Index Well level Adj.factor J Adj.Groundwater Level PERCOLATION TEST Date rimy Observation Hole q �, Time at 9" 140 4 3:O o Depth of Pere (�O f r Time at 6" / 43 .3 0 Start Prc soak Time(� / :.,3(o: 40 d Time 9"-6" 3 .SEC r c4 q Q/s ( ) End Prc-sock /,n : 4 1 : 4a 6 Ratc Min./inch Site Suitability,Assessment: Site Passed &-11' Site Failed; Additional Testing Needed(Y/N) Originate Public Health Division Observation We Data To Be Completed On Back Coov: Aoolicant ---�' TOTAL P.02 1 DEEP OBSERVATION IIOLE LOG Ilole N / Depth front Soil I lorizon Soil Texture Soil Color Soil other Su face(in.) (USDA) (Munscll) Molding (Strucluic,Slone%,Houldues. 5 ych i 1 2 PQ V-e.+'fe.!t s�•,dy ioY� <o am 3 / L o or# •%y 3 „ Q SG v►d - --- Go,. C 1o�r��. y) ` ci�a�e / _ --- DEEP OBSERVATION MOLL LOG I101c N _ Depth lions Soil Ilorizon ,. Soil'I'cxlurc Soil Color Soil Other Surface(in) (USDA) (Munscll) Moll fir rg (SUucturc,Slnncs;llouldctes. ' C:4lisislctrSY.1.�(ar;tt�cl� DEEP OBSERVATION HOLE LOG IWe 11 Dcpllt from Soil I lorizon Soil Texturc Soil Color Soil Other Surface(in.) (USDA) (Munscll) Molding (Structure,Stuncs.Iroulderes. DEEP OBSERVATION HOLE LOG hole N Depth from Soil I lorizon Soil Texture Soil Color Soil other Surlitce(in.) (USDA) (Munscll) molding (Sinrciurc,Shares,nouldcre%. . r I�ysl In�►r;tncc Itatc Man: Above 501)year flood boundary No_ Yes Y Wilhin 500 year boundary No ✓ Yes Within 101)year flood boundary No Yes P--Rltluj-[Vtttltr lly Qccurring Pervious Maternal Does at least tour feet of naturally occurring pervious material exist in all areas observed I1111-ough6ill Ilie area proposed for file soil absorption system? yt x If nol,what is the depth of naturally occurring pervious material? i Qtdi-rwali.lz1 1 certify that on N/e✓ ,941" ((late) I have passed the soil evaluator examination approval Iry the Department of Environmcn(al Protection and that the above analysis was performed by ale consi.:lcirl tvidl (lie required fraining,expertise and experience described in 310 CMR'15.011. Signaltirc - —`-� — -�--- Date ��� ;! Town oil B.-arlista lll I'N 1 t V ; Moo rintr n(of Hen lilt,Safely,and Environatenlal Services i Public IIeallh Division vale 1 •_ } 367 Main Street,I lyminis MA 02601 t. MARMAltl ra7P ` rto " Dale Scheduled .5` `- y 'Time /a-caG Fee I'd. / y U Soil Suitability Assessment fog• Sewage Disposal. ...Performed By; q 2 �?mob Witnessed By: J Jw -7-1 e9_ -- ` LOCATION & GENERAL INFORMATION Location Address S3�, %a�-�-�o u T� �����/�o�Uwncr's Name VVe,v �� v.-�n/� /h 1.2J��cfa.-- Ti-r r i✓�. �. I i _ Address i Assessor's Mnp/Pnrcel: .: 3 Q 0 7 G ©,® � Engineer's Nnme O Z 4 �' NEW CONSTRUCTION REPAIR ` 'feiepiwne /: Land Use 4e 'O, Slopes("/o) 5urfnce Slones Distances from: open Water Body N/ R Possible Wet Area ^K/' 11 Dtiokiog Water Well A/.;% II tDrainage Way �V is¢ R Properly Line f It Other — R # SKETCH:(Street name,dimensions of lot,exact locations of lest holes&picric tests,locale wellnods In,pmxhnily to holes) 9 V r S 3. 7S ti 1 Parent material(geologic) CQ V- ✓t'r. e Depth to Bedrock /✓/� I)eplh to Groundwater: Standing Water in I tole: Weeping from I'it Face li 1honted Seasonal I ligh Otoundwalcr S VS �S ritar� DE I'I'RMINATION VOR SEASONAL 111G11 AVATER TAM A,' ntcmnd I ISM: v G s --7� Depth t)bst-n•C(I standing in ohs.hole: in. Depth In soil rn1,111Cs i„ I)Cplh Ina-ecpinp frotll side of obS.hide_ --- —_ in. (irtnmdw:licl Adjuslnu'm it Index 1V1:1111 -- I(crlding Date: Index WCII lCVCI _ Adj.factor -__- _-Adi.1;mmot.:,jt I rt,l - PF,RCOL,ATION TEST call — Iiml• - __._ t,bservation I lulc 0 Tinlc al 9" Depth of Pere ZL ca— 'I ime a1 6" %`Y ` ¢3.'•� `' Sinrt Prc-soak'fink tjt) / 3��-'c'C . 1 trod Prc-sunk 1 i Italic Min./Inch C 2.' / Site SIIIIaI111it`y A ssCssillcol.,Site Pas ✓ SIIC I:IIIC(I: •�'A(Illtllltll;ll ICSIIIII!NccdullYr!I —_--� Oligilull: Pllblic IICa1111 Division OIlse 1.va l ioll I Iule D10 To Ile 01 Ill I 1 Ic 11'1 I o11 1t:11,N---•—•---1 O)py: A111ii and I Uli;l%1' U13Sl 1tVA'I'ION IIOLh; I..U(v hole H / I)cplh I'iuin Soil I lorizon Soil Texlure Soil Color Soil ^(Abet Surface(in.) (USDA) (Monscll) Molding (Suuclow,Slonr�.Ilouldues. • _�.._ _l�(!rlsislc'rr�Y.,i�.lhn1'SI) +Vl e d .Sct,%.- / L A4 L.6Ca �r Lac,BSc' Z.S UL11' 013SLltVA'1'IUN IIULI�, I,UG — Depth from Soil I lorizon soil'I'cxlutc Soil Color Soil 1 nhcr Slit We(in.) (USDA) (Monscll) Molding (Shuchuc,Sloncs.nouldeles. _S kills i'mcpcy.-;e(;r yo. j) 1)I,I�,I' U13Sl:1tVA'1'IUN IIU1,1; I,OG Ilolc i'= Depth floor Soil Ilorizon Soil'I'cxlorc Soil Color Soil (Ilhcr Surface(in.) (USDA) (Munscll) Willing (Slnrc4nc,Sloncs.Ilnuldcres. — —. �,QIrCIglltnSY.1^.(il�rYll) . DEEP OBSERVATION HOLE LUG Ilole /I Dcplh from Soil I lorizon Soil Twurc Soil Color Soil (nher Surface(in.) (USDA) (Monscll) Molding (Slnrclure,Sloncs,Ilooldcres. � (�S!R�.islcPcy,10(.ira!'SI) L19tlll I.)rs nl(Sg_Ittllc Alai): Above 5011 year flood boundary No` Yes Wilhio 500 year boundary No Ycs Wilhio 100 year flood boundary No Yes — ))clr�J!ujfV;(1)n's►Ily Oct(( n 'ervi lug 11tg(cl-iil,l Does al Iensl liver lint of naturally occurring pervious material exist in all aiew; olscl r e,I Ihrnul,hrnd the area propnce(1 tin'(Ile soil absorption sysfcnl? If not,what is the depth of naturally occurring pervious nlalerial? r 1 cerlil'y that Im iJt)y I have passed the soil evaluator exan(inalinn appr(rvcd I,v lhr DeparUnent ul'I?nvirnnmenlal ('rolecliun and that tle almvc analysis was pel101lite([ I,y Ile con»;i:Icnl (eill, Ills required training,expertise and ex )cricnce described in 3 10 CM It 15.017. Signature ,c >% Date