HomeMy WebLinkAbout1055 MAIN STREET (COTUIT) - Health 1055 MAIN STREET
Cotuit
A = 034 - 016
TOWN OF BARNSTABLE
LOCATION 10.5-
..5- �A-, 5, SEWAGE# Aot4-C63
VILLAGE Cv 7-,Lt ; ASSESSOR'S MAP&PARCEL 1/6
INSTALLER'S NAME&PHONE NO. iz_,�c?L[�'(
SEPTIC TANK CAPACITY _5 O -4A4—
� s
LEACHING FACILITY.(type) (size) So._5PK �• �c�.
NO.OF BEDROOMS ac. Lv�
OWNER
PERMIT DATE: - 3 COMPLIANCE DATE:
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) tY Fes. Feet
FURNISHED BY
�-ior3-
�j iul�
r¢ A
Jri��G�
0
� � ��
o �, l�
e i09'' r'
s_ �1�b.
— Z 00 //9-� niti
'own of Barnstable P#
-
' Department of Regulatory Services
Public Health Division Date I a //y
,116 V.h� 200 Main Street,Hyanais MA 0 601
Date Scheduled
Tie 0 /!7 r7.
.,., ]Fee Pd, lv
.
SOU SuitabiliO AssesSmentfor Se ®s
Performed By:- ! t/e Witnessed By:
•LOCATION-& GENERAL,INFORMATION
Location Address ()l�.l
Owner's Namc
10 Address (/
Assessor's Map/Parcel: 3 /s7 Engineer's Name Q,ti K_
NEW CONSTRUCTION REPAIR Telephone
Land Use: L Slopes(%) _rD —�� Surface Stoaes N oltl ) P
f
Distances from: Open Water Body /'/w ft Possible Wet Area ft Drinking WaterVyell >`"`' ft
Drainage Way 71Ov ft Property Line P rty i ��� ft Other ft
SIE'TCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands ifn proximity to holes)
' vl
90
s Iv
o
Parent material(geologic)614 > 0-01
_/ —Depth-to Bedrnck__
Depth to Groundwater. Standing Water in Hole: /V Weeping from Pit Fnee
Estimated Seasonal High Groundwater NIA
DE ERNIIWATION FOR SEASONAL HIGH WATER TABLE
Method Used: -4 G w t7—
Depth Observed standing in obs.hole: ln, Depth to Boll mottles: ln,
Depth to weeping from side of obs,hole: In. Groundwater Adjustment ft.
Index Well# Reading Date: Index Well laval � Adj,&clor �T Adj.Groundwater Level ,
Observation
PERCOLATION' TEST bate
Hole#
Tima at 9"
Depth of Pere (!/ Time at G"
Start Pre-soak Time @ Time(9"-6")
End Pre-soak
Rate Min./Inch
Site Suitability Assessment. Site Passed Sitq Failed: Additional Testing Needed(YIN) /y
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(I) week prior to beginning.
q:NS EPTIC\PERCFORM.DO C
DEEP•OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture .Shcl Color Soil• Other
Surface(in.) (USDA) (Munsell) Mottling (Structure, Stones;Boulders,
o i ten w.%(irayell
04
DEEP OBSERVATION HOLE LOG Hole# z
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
'i
-Coligistency.%Grave
3(� -120 C L� yR(elk
DEEP OBSERVATION HOLE LOG Hole#.--
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling
(Structure,Stones,Boulders.
Z / Co i to c p e
-g L Sri y ���
DEEP OBSERVATION HOLE LOG Hole# IJ
Depth from Soil Horizon Soil Texture 5011 dolor Soil Other
ryr Surface(in.) (USDA) (Munsell) Mottling
(Structure,Stones',Boulders.
Collsistgnoy: Ora-vol)
23— �3
33-13Z C_ /f'J5 (G
Flood Insurance Rate Man: '
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 aterial exist in all areas observed throughout the
area proposed for the soil absorption system? y
If not,what is the depth of'naturally occurring pervious materlal?
Certification \
I certify that on It (date)I have passed the sail 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�10 CMR 15.017.
Signature .. _ _ ' `...�, Datb l
Q:15L1'T1C\1'h12CPORM.'DOC