HomeMy WebLinkAbout0166 PEPPERCORN LANE - Health 1
166 PEPPERCORN LANE I
Cotuit
A= 004 - 013 - - - - --- - ------
Town of Barnstable P#
31.E
OFIKE
Department of Regulatory Services
BARN�BLE ' Public Health Division Date t�43 _J�
039. 200 Main Street,Hyannis MA 02601 Xj
FD AAA't s • l��t
S
Date Scheduled ° 1 Time Fee Pd.
U)
o'l Suita ility Assessment for Se e Disposal
Performed By: e� Witnessed By: 0, 121
i
& GENERAL INFORMATION,,-LOCATION, _ I
Location Address l bb 4o-C(7 p- � Owner's Name L o�l4� �[ �n
Address 3 b ST 12g
n S i �1j
Assessor's Map/Parcel: p O HI o2 Y►''
J Engineer's Name
NEW CONSTRUCTION REPAIR Telephone# 2(?
,t� s Ii^'► 50 L
Land Use `L 7 1 `Ct\ w Slopes(%) tl/`" Surface Stones (J
Distances from: Open Water Body ft Possible Wet Area 7,0V ft Drinking Water Well- ft
Drainage Way 4* It Property Line ft Other ft
i
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests;locate wetlands in proximity to holes)
Parent material(geologic) ' aL � Depth to Bedrock
Depth to Groundwater: Standing Water in Hole: / 0 Weeping from Pit Face /t<
Estimated Seasonal High Groundwater I
_od Used: DETERMINATION FOR SEASONAL HIGH WATER TABLE
Meth `
De th Observed standiT . _
p ng 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.Groun w to evel
J.
PERCOLATIONJEST Date Time
Observation Hole# I 2 Time at 9"
Depth ofPerc Time.at.6"
Start Pre-soak Time @ �i / 1�� Time(9"-6")
End Pre-soak
Rate Min./Inch �z!144i
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:\SEPTIC\PERCFORM.DOC
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
04 a ve,6"Ic jiOR,2D,Z 1\ohe
3 5 bVNVA
4 61 t0Af S1- 5Psh►�
ba_1z- G F lilt-^m 0., jo R b13 nl ova
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)
Z s 9n1'Dy ..
9-68 GZ �f � z,� �N b pot- 5 toWe
A-t20 Zg
DEEP OBSERVATION HOLE LOG Hole# 3
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,%Gravel
O-6 eD 6+R hRI C I lb`lA 217- Al he-
I S-IS 3 tb wm 5-1 ek A We-
�-`(� G r tz v 4 W- .
r6
VD
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
i b W 2. L P
3 -Zvi
64
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 u 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 �N� lop I certify that on V date)I have passed the soil evaluator examination approved by the
Department of Environ ental Protection and that the above analysis was performed by me consistent with
the required training,expArtise and experien a described in 310 CMR 15.017
Signature f Date 1 J
Q:\SEPTIC\PERCFORM.DOC
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