HomeMy WebLinkAbout0103 DEBBIES LANE - Health 103 DEBBIV S LANECotuit
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f TOWN OF BARNSTABLE
LOCATION f'O JeA/C5 low SEWAGE#,Z0/3— 12 7 `
VILLAGE 1"14), rO4S �h,/�,� ASSESSOR'S MAP&PARCEL do /—0/�
INSTALLER'S NAME&PHONE NO. OF-Y2OI YSF Jo
SEPTICTANK CAPACITY /000
LEACHING FACILITY: (type) tj ui�rk (size) 29 X I t,3 2-
NO.OF BEDROOMS 3
OWNER f4,k d!F
PERMIT DATE: Y-16 - /3 COMPLIANCE DATE: y-/7- /3
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
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LOC TION SEWAGE PERMIT N0.
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DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED oaf.
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Town of Bdrnsta�ble �� Q � —
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Department of Rej;tflatory Services
Public Health`Division Bate
,K 9 tee$ 200 Main Stree4 Hyannis MA 02601
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d / 'Time 1 Fee Pd.
ate Q
y D Schedule i
`oil SuitabiliO ,Awss�ient for,SOWage Disposal
Performed By; A Y �.i/1� L V 1 4Q Witnessed By:
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LOCATION & GENERA.L INFORMATION
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Location address i Owner's Name 1/•ro m-6,5 H,�/vt�L
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f�e7 1" A WI Vj� ✓ j Address
Assessor's Map/P4rcel: Q P / I j Engineer's Name It�d1' M
NEW CONSIRUit.nON REPAIR
Land Use � T1�'t Slopes(90) � ' f 4% Surface Stones
Distances from: Open Water Body ,•. - ff Possible Wet!Area 0� ft Drinking Water Well eft
Drainage Way Q 'ft. Property Linc. 1 U a-
ft Other ft t
locate wetlands in proximity to holes) �^
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,
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Depth to Bedrock
Elarent r4ra'�erial(geology U (. Gti - _ -
Depth to Groundwater Standing Water in Hole: �'� I F Weeping from Depth
Face
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Estimated Seasonal High Groundwater :��d l)
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DtTERABNATION FOR SEASONAL F[IGEI WATER TAI#LE
Method Used: I Depth to soil nnottles:
in. De lt•
Depth 00perved standing in obs.hole: p
Depth toiweeping from side of obs.hole: in. aroundwnter pdiubtment '
! A .faetor.�.____ Adj,C7roundwateri evel.,,,,�•
Index Well# Reading Date:- Index Well level �...
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PERCOLATJCON TEST Ddee , 74ut
Observation . I ti Tiine�at911
Hole# i
, 6 Time at 6" �--^-----
Depth of Perc r - r
tn� Time(9"-6'
Start Pre-soak Time.@ It
End Pre-soak .
Rite Min./Inch
Site Failed: Additional Testing Needed(YIN)
Site Suitability Assessment: Site Passed
Original:.Public x,.e`alth Division Observation'Hole Data To Be Completed on Back--
• ***If percolafiibn test is to be conducted within 100' of wetland,-you must first notify the
Barnstable C4nservatien Division at least one (1) week prior to beginning.
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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
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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)
It
DEEP OBSERVATION HOLE LOG Hole# P1
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistenc %Gravel
1
DEEP OBSERVATION HOLE LOG Hole# Al ,
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency, ra I
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 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 pervious material?
Certification
I certify that on a (date)I have passed the soil evaluator examination approved by the
Department of Enviro enta Protection and that the above analysis was performed by me consistent with
the required t 'nin ;expertise and experience described in 3,10 CMR 15.017.
Signature � �� "` Date
Q:\SEPTIC\PERCFORM.DOC