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HomeMy WebLinkAbout1386 MAIN STREET (COTUIT) - Health 1378 Main St. r t_ _ Cotuit A= 033 047 t 4 Town of Barnstable P# a ' Department of Regulatory Services o`er►a�, Public Health Division Date ? 200 Main Street,Hyannis MA 02601 = BA8NMSI Time Gd Fee Pd. r yr Date Scheduled Soil Suitability Assessment for Sewage Dis osal OI Performed By: Se yV d I so— Witnessed By: ✓ 7 MIT PI•t I. ! ::!u'ra,xr,ura:luni,!!nl,dm II!,!;al;;,,..��4`'4 Pr��F:'•�,.y.i:'�4I;�:I�I i.��.',v!.r I,!5'r.::;.;'7I I�Ir'•i.,l•L:1.a�I,r 11!i.,,.:�•pp'IIL Iv�l!:ll,l•I g�II f•p.p nI,L'I,:IL':��P,,iv1I.!1I I!II.I!::�I.I�J,i!,In.�III,1oP1,111,IGII i�1 II ., !..41111 1 .! II L Ili. I i4t ry 9'N: uI ito, i 1 1 I ::a.m�li!n!II i!I�'I,;I IIuer!mWl:xh::I!u a..I.�I I!�iliI 191iL,`I I!s�qI6!1�Lx9•,ill..li-Ita sI ll lII vlI l�I'Ii!,'IiI�.�'1Iu�I�'�.iI.l64.I.I.Y�l1.!II;,I il�!1,.�,I;I6I6�ii',j��II I,LI`l.l;!'I iIryrydi ' Owner's Name;unv� Sc�e cca Location Address jz _�K­t, CO- ` C',(-v.t .� 137 g o 33 a tr7 Address '0133 47 Assessor's Map/Parcel: M /7 14 f`Z Engineer's Name Stcve W;1 so,; 13,Q H Q f/ REPAIR Telephone# 508-A vir —1113 NEW CONSTRUCTION Slopeso Surface Stones V10 � w I Land Use (/o) I Distances from: Open Water Body / ft Possible Wet Area ft Drinking Water Well ft O �-06 0 d� Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands in proximity to holes) C44 q2 <.,;� NoT Ta scA��E l Parent material(geologic) Gtaclat dv+wosk Depth to Bedrock Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater p ....... ... .� ,. ,�, N:,,,,,:::-':"^'!r!"rl!!!;,,,e"li '�na w:'I!nr;ry"npera•;Irrn!�'!'llann:!a!Ix:r',rn .Ir�a ij!I�,a, m'�I�I'na!;I•'x: :I II�II!i lHlili.i����;r;I911C'I ,yrc'..:•a:n,,m,::-rr,:,ril p;'m'i;Ii lau I., :I:y.il°I!iI'm' SL p ,I!rl_I.i!:n.,l it I, ,I tl .!IIII„ :!�II;I !: y, I I G: I i �..! t IL. AIR! II:I:CI'I:�11I,�I'I�'.II!Yi IiII :,,, II�IL.I :� WY:`•1!I'ILII�N�IIIi!III{'1��9111I'9:ula�lll�lll� Method Used: in, Depth to soil mottles: ` --Depth Observed standing in obs.hole: P -- - z >�in.. _Groundwater Adjustment p Depth to weeping tiom side of aos:i,aic: - ate Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level ... :..:::::::•::•::::.:�-:,!:,.:!x�'::..=.r'c:'n:�'n"q,.:,L.i!I:PII�''I"''�i�af!�'�ul'!�lih4t:'1'"r il;;i!II(tl i:iii?I,il I„IIY!Ii;ll:"' "°Ld Ili ' ...... �.,!a!!�:!I!•'':r.!t;:'�a:,.; ;:::! :;t n.. ::uy.,.......! 1. y, 'L,!..p L,I.,,:IIII I,,O,...': !II:I.v,,•,gll LI. ,u. :rwxx:all!!rlm:,:I I:•rf'In,.::!,.::I�,:. ! ,;,. ,L:I ! I"" I, III I.Ii:•:!LI ..I ,:L,.LI U LVu I �.... i„7i:, ,,.n• ':I) •::Iq.•"II!;I�!!!nru n'r!'!n9,lu'! ,!!:i.. .!I;: I.,;!.4 .y,:I!:Ili�l+lu•I :.II L, ,.I !.yl. 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I!II!pl.{,:II,,.Iillllrlu;u:,,,ll!I:��:r.11_L,ILd,:IP,!.I!.:r.:.;ryIII;II.,:!,•i:l,:�IL;l�ll.i.....,.I,.,l v'ul�,nil'I�x P, .. �'''�IL���.I�I . :,"iTG,ai"':h?!ia!6:��'•::,:!: :L'1ry:�!I!�•Lil_L,a.d,Il�jL.. ;;,�;!dlir{��'liIE2��N��I!�Ililis!:I!Ihi6iil?dd!J!!41'w4�rll�illlul!u!.W::dI,,:N�JI.I:�Jo-a.N:,,.N:I:L.LyI :lil ,?f� , Observation Time at 9" Hole# !� Time at 6" Depth of Perc Start Pre soak Time Q I I Time(9"-6"). f End Pre-soak U 6(x Jv A Rate Min./Inch U Site Suitability Assessment: Site Passed V Site Failed: _ Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back-----,-- Q;HEALTH/WP/PERCFORM l _� .....:...;: .....:,......... .;;..:..::...,.'.....r:i''.';•' %`:`: :' :::'::::':::`i'�:# ..�:..'••.'.:..._::: t?i:::MEN '::':<:::%?'r Depth from Soil Horizon Soil Texture Soil Color Soil •Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. . % 12G. C. W1�c�. SrVac� Depth from Soil Horizon Soil Texture. Soll Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. 0 �.. '• saa�y �aym io Y2 6/r NZ iZo f Depth from Soil zon S Texture Soil C Hori oil olor Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. 0 a Gravel) + I . I Depth from V Sol or Soil Texture : Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. C onsistcogy,%Gravel) Flood Insurance Rate HI Above 500 year flood boundary No— Yes V*' Within 500 year boundary No t" Yes Within 100 year flood boundary No bf Yes Depth of Naturally curritig Pervious INatcrial . 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 r;/s iffy (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 31d CMR 15.017. No. ----- Fee BOARD OF HEALTH TOWN OF BARNSTABLE Zpplication-*r Well BrOtruction.Permit - Application is hereby, f e it to destruct an Individual Well at: 17 YKA 1�1 1 �� -33 4 7 _ r- ation — Address Assessors Man,and Pare-)Owner A6�s \(`� fiLoc -- Installer — Driller ^�— — �— Address Type of Building Dwelling i Other - Type of Building-- ------ No. of Persons----- Type of Well Capacity u'N, `fir Agreement: "4? The undersigned agrees to destruct the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of-Heak Priv a Well Protection Regulation. Signed— --to - - 1` _ date Application Approved By.f - — -_ ✓ date Application Disapproved for the"following reasons: date Permit No. — Issued --f- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well destructed Installer at . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has been destructed in accordance with the provisions of the Town of Barnstable Board of Health as described in the application for Well Destruction PermitNow,. . . . . . . . . .. . . . . . . . . . . . . . . . . . . '. . . . . . . . . . . . . . . . . . . . at. . ./ � . . I. . .v/.�. . . . 0 '. . . . . . . . . . . . . . . . . . .. .. . ... . . . .. .. .. .. .... . has been destructed in accordance with the the provisions of the Town of Barnstable Board of Health as described in the application for Well Destruction Permit No. . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . .. .. . . .. .... DATE------_--_______ _ ___.______ __ Inspector -- BOARD OF HEALTH TOWN OF BARNSTABLE Well Deotruction Permit No. - - ---- Fee — Permission is hereby granted— —----- ��—_ — to destruct an Individual Well at No.-- D-� ---------------------------___— ' � street as shown n e applic for a Well Destruction.Permit 1 No.--V�d --- -- ---,---_.—__ Dated-- �___ — Board of Health DATE __— � r No.1 W----------- -- F �� BOARD OF HEALTH TOWS! OF BARNSTABLE 0.pplication,for lVell Megtruction 3Permit Application is hereby made far a pe it to destruct an Individual Well at: i^^-!ion — Address _ Assessors-Man and Parma''s.", r k Owner f Address u� h _ vA('V"3W V1,. flInstaller — Driller Address Type of Building R`� `nq��\* �1 1 tw��h4v�s�E. ©�W\V^a Dwelling -- Other Type of Building-----___`___ No. of Persons Type of Well-- a�V`�h°' '�"�----- -- Capacity—\AV3\( VN. Agreement: The undersigned agrees to destruct the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation. Signed _— Application Approved By date Application Disapproved for the following reasons: - date Permit No. ! — Issued-----'- �� --- date BOARD OF HEALTH TOWN OF BARNSTABLE- Certificate (Of Compliance THIS IS.TO CERTIFY, That the Individual Well destructed by----- _`_ Installer at . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has been destructed in accordance with the provisions of the Town of Barnstable Board of Health as described in the application for Well Destruction Permit No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . j . . . . . . . .... .. ... ... . .. . ........ .. .. .. ... . . . has been destructed in accordance with the the provisions of the Town of Barnstable Board of Health as described in the application for Well Destruction Permit No. . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . .. . . .. . . . . .. . .. . .. . ...... ..... .. DATE Inspector--- —. BOARD OF HEALTH TOWN OF BARNSTABLE lVell Zegtruction Permit i No. — - Fee --_-_. r - Permission is hereby granted-------____ _______ ___________---------_--__.____ � / r to destruct an Individual Well at No.---�VT)__----- 11,3 street as showrn� onf/the applic n for a Well Destruction Permit --- �No.—I,)/ ) , � Dated — Board of Health DATE— = -- -- ---- - -- -- -- -