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HomeMy WebLinkAbout0000 PINE ROAD - Health _ f 0 PINE ROAD Cotuit / - - A = 018 - 086 f h e 1 f °F,t,E 1b Town of Barnstable 1! P# Department of Inspeciional Services 3 9B KSSS6LE' A � Public Health Division i Date q � 16 q prFp Mp! 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 i 1 Date Scheduled Time Fee Pd. y:. X. Soil Suitability Assessment for ewage Disposal Performed By: Witnessed By: :: LOCATION 8r4GE1�ERAT. ORIVIATIONMM Location Address (7 71 n Owner's Name Cr i �'R -- - --Address--. Assessor's Map/Parcel: /A g log cp - Engineer's Name Engineer's Email: ( SV-,Cz @,G M41 L. Co 6V, NEW CONSTRUCTION REPAIR Telephone# I Land Used S � 1 a, S /u Surface Stones Slopes(%) /�' la Distances from: Open Water Body ►� ft Possible Wet Area t) /Pt ft Drinking Water Well Drainage Way IQ a ft Property Line o?D ' ft Other_ _ft SKETCH:(Street name,dimensions of lot,exact locations of t;st holes&perc tests,locatewetlands in proximity to holes) S C � r( J1 ZA �2 i I I i Parent material(geologic) Depth to Bedrock Depth to Groundwater: Standing Water in Hole: N(y,7.2 OkL-'15: Weeping from Pit Face t�(pGl.2. OwJ &Q '` Estimated Seasonal High Groundwater ` �[ i� --,so Tsl ec I -IFS DET�ERNIINATION FOR SEASONAL IIIGT3 WATER TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. 1 Depth to weeping from side of obs.hole: in. Groundwater Adjustment Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level_ T ime 4 PERGOLA '1® f Observation I Hole# Time at 9" Depth of Perc oy, 3 d '�(� Time at 6" i Start Pre-soak Time @ Q© -A 0 Time(97_6") End Pre-soak A , ® Rate Min./Inch wZ QI MP Site Suitability Assessment: Site Passed Site Failed: Additional.Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----y--- ***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:\App►ication Forms\PERCFORM 2018.doc i i . .. DEEP OBSERVATION HOLE LOG' Hole# .7777 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) cDl �� LS Ia4►� �T ��G�l� • `` ` '', DEEPh QBSERVATION`HOLE'LO'G'' = � ` Holes#, , � ' �" Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) J rot c.JLS Alf-) Sd, 0, -c a,s Z-!!� - mv.\r Soria 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 i 9,q 3 L � DEEP OBSERVATION HOLE r,OG Hole:# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) 10 u 23/a A)/a Pc-l-r-biP L CD ya5 Flood Insurance Rate May: Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes Within Within 100 year flood boundary No t/ Yes I Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring, iaas material exist in all areas observed throughout the area proposed for the soil absorption system? ZS If not,what is the depth of naturally occurring pervious material?__ Certification I I certify that on III aCot (date)I have passed the soil evaluator examination approved by the Department of Environmental Prot J t the above analysis was performed by me consistent with the required training, expertise and ex p ienc des. ib '310 CMR 15.017. Signature Date <) I 1 g Q;\Application Forms\PERCFORM 2018.doc I j • i