HomeMy WebLinkAbout0038 WATER VIEW CIRCLE - Health (2) 38 Water View Circle
Centerville
A= 120-092
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No.2•153LOR
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TOWN OF BARNSTABLE
LOCATION 3$ WpT/Y 114W 6eelr_- SEWAGE 14� 39y
VILLAGE ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO. '��y2D_g738 �/llSr�Li �..l3rrmS
SEPTIC TANK CAPACITY IDD�
LEACHING FACILITY.(type) at,:-, Sf1rG YG (size) 2SX 91,3
NO.OF BEDROOMS
OWNER
PERMIT DATE: //— /y—// COMPLIANCE DATE: // _A9—
Separation Distance Between the:
Maximum Adjusted.Groundwater Table.to the 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
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Town of Barnstable P# qL
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$ Department of Regulatory Services
,,, ABM Public Health Division Date eQ s it
639.A�� 200 Main Street,Hyannis MA 02601
MRt
Date Scheduled l/ Time Fee Pd. '�=���' !
Soil Suitability Assessment for S age Disposal
Performed By: Fg_ > -. 1"`C 5,\+ _f J _�, Witnessed By:
LOCATION& GENERAL INFORMATION
Location Address 3g: W44-e r V 2 w ear C Owner's Name
6 s���s�� �eJ�e✓Se�v
C-e n}e i 1 1lt Address
Assessor'sMap/Parcel: 23 q-/��- Engineer's Name
NEW CONSTRUCTION REPAIR o'- Telephone# 5_6?—7 37—(i 7(a 8
Land Use P--eS %Ai'l. -! Slopes(%o) _5ZJ Surface Stones
Distances from: Open Water Body 73 `'Y' ft Possible Wet Area �L•� ft Drinking Water Well � ft
Drainage Way 7-5-0 r ft Property Line -S — ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
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Parent material(geologic) J�'"�5� t Depth to Bedrock �o
Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face X)
Estimated Seasonal High Groundwater �j I
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.hole: in. Depth to soil mottles: 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
Hole# /c1 Time at 9"
Depth of Perc J [ -1 Time at 6"
(`l�.s
Start Pre-soak Time @ Time(9"-6")
G( /�
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.
Q:ISEPTICIPERCFORM.DOC
II
DEEP OBSERVATION H OLE LOG Hole'#
Depth from Soil Horizon Soil Texture . Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistenc %Gravel
�►`I- -Z.� C tom-C S`C.
II
DEEP OBSERVATION.HOLE L'OG Hole
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.%Gravel
IS
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Cc —I Z.J �— tt/1—C S c�e c� �. Y /� v G✓ 3,<Z,^41
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 Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.%Graven
Flood Insurance Rate Map:
Above 500 year flood boundary No_ Yes
Within 500 year boundary No Yes
Within 100 year flood boundary No Yes
Depth of Naturally Occurrins 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? ej-
If not,what is the depth of naturally occurring pervious material?
Certification
I certify that on (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with
the required training,expertise and experience described in 310 CMR 15.017..
Signature V l� Date
Q:\SEPUC\PERCFORM.DOC
/ OWN OF BARNSTABLE
LOCATION im) •tZ.. SEWA -
'W� Z� w T�e.V C�. G E �
VILLAGE} C°2-WThW 'flt"- ASSESSOR'S MAP & LOT.2-3
INSTALLER'S NAME & PHONE NO. "-te cctF4 M N..V- Z 6
SEPTIC TANK CAPACITY ,000
LEACHING FACILITY:(type) (size)
NO. OF BEDROOMS ""3 PRIVATE WELL PUBLIC WATE
BUILDOR OWNER m\C UL �
DATE PERMIT ISSUED: `1 g 3
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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