HomeMy WebLinkAbout5026 FALMOUTH ROAD/RTE 28 - Health 5026 FALMOUTH ROAD
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Town of Barnstable P 0 l SLe S r
Department of Regulatory Services
i Public Health Division Date to
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• � 039.A� ,,�200 Main Street,Hyannis MA 02601 • ,� �,�,,, '
tEl1 AIKI 1' cl! e� .��
Date Scheduled
Ttme J l Fee Pd._
Soil Suitability Assessment for S e Disposal ,e�
Performed-By: C� -. �:' Witnessed By:
LOPTI!T � INFORMATI N
Location Address ,/ 94J Owner's Name D17WJ)1- ' Zl, 3 Address C>Z(o C/jlar/IZfC �T ZP'i 1
Assessors Map/Parcel, /�'�.�� Engineer's NameC /�(/ /l(
NEW CONSTRUC'I'IO REP Tele hone# ✓r��/ ' �_/" 3(,od
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Land Use l �a Slopes(96) l Surface Stones—moo�G �k CUl"7
UG(/
Distances from: Open Water Body �l �� ft Possible Wet Area ft Drinking Water Well tt
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Dralhage Way r� ft Property Line �G-� ft Other �" 6lsr ft
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SI C (street name, c 'ens of lot,exact locations of tes oles&pere tests,locate wetlands-in proximl to h Ics)
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Parent material(geologic) cOC°�/ou 1 k2 d�J Depth to Redroak
Depth to Oroundwater. Standing Water In Hole:. X/O V&1 Weeping fram Pit Faoe
Estimated Seasonal High arbundwater "'r
DETERMINATION FOR SEASONALIHIGH WATER TABLE
Method Used:
Depth Observed standing in obs.hole: In, Depth to sell mottles: in.-
Depth to weeping from side of obs.hole: In, Oroundwater Adjustment
Index Well-0 Reading Date. Index Well levMC� Adj,.factor--, - ,`Ad.tlroundwater•Leval.,
PERCOLATION TEST bats ¢ /,-- Thnd /�4"
Observation —
Hole# Time at 9"
epth of Pero 1"ffd", �Q �J Time at 6"
Start Pro-soak Time @ , /U'/U iU: Zo Timo(9"•6")
Had Pro-soak '
Rate Min./InchU S�"N Z''��l Z Sat,r Z r1lx 1
Sitc Sultability Assessment: Sito Passcd Site Palled: Additional Testing Needed(Y/N) 'T
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:\SEPTIC\PERCFORM.DOC
DEEP.OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Shcl Color Soli• Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stoned;Boulders.
Consistency,%'aravol)
DEEP OBSERVATION HOLE LOG Hole# 2
Depth from Sall Horizon Soil Texture Sol]Color Soil 'Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Sall Texture Sall Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders..
// Consistency,
6 An
DEEP Gav �t er
DEEP OBSERVATION HOLE LOG Hole# _
Depth from Soil Horizon Soil Texture Soil Color Snll Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Slopes;Boulders,
CoCy. 0myell
d
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 pervi s mtiterlal exist in all areas observed thrpughout the
area proposed for the soil absorption system?
If not,what is the depth of naturally occurring pe vlous material?
Certification 'qq'
I cord fy that on /S (date)I have passed the soil evaluator examination approved by the
Department of En ironmental Protection and t It the above analysis was performed by me consistent with .
the required traini or' and dp, 'e described in�10 CNM 15.017.
Signature DatbG
' Q;1$BpTIC�PBACPORM.DOC