HomeMy WebLinkAbout0420 VINEYARD ROAD - Health 420 VINEYARD ROAD
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Departtneat of Regulatory Services
Public Health Division Date
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200 Main Street:Hyannis MA 02601
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Date Schedule Time I Fee Pd: IJ CD
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,foil Suitability Assessment for Sewage Das osar �r
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Performed By: I �` , "� Witnessed By. J;
LOCATION &-GENFRA,L-INFORMATION
Location Address Owner's Name
/6-rU i T , t/1/1 /} I Address'`' -U 6 AL_L,M W A D 2 ���� o E Az
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Assessor's Map/P4tcel: 1G.l 0. �w Q Q i I. Engineer's Name J ;t lv�7��1
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NEW CONSIRUenON REPACK Telephone# 9 3 60 "
Land Use
pnL Slopes(4'0) Surface Stones AAK e,
Distances from: Open Water Body ft Possible Wet Area ?2_y6fz Drinking Water Well >-3�U ft
y >Z d"® , ft .Property Lane > ft Other
Ucninaga Way ft
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SKETCH:(street name of test holes&pere tests.locate wetlands in proximity to holes)
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Patent material(gcdlOgic) v 1 w("LS 11 Depth to Bedmc • I /�
Depth to Groundwakdr. Standing Water in Hole: N I Weeping from
Pit Face r ry r.
Estimated Seasonal1"igh Groundwater
Dt' Mst=admgtp
TION.FOR SEASO"'L HIGII WA'T"R TALE ,
Method Used ln.
Depth C1bperved obs.hole: --lo. Depth to soil motflvst
i in, Groundwater Adjustment
Depth towvee ping a from side of obs.hole: ; � A ,WtOf Adj.0roundwater Level",,,,e,
Index Well# Reading Date Index Well lev4I —
PERCOLATION TEST . D�tt: . 'Pluiie
Observation 3 I Time tat 9" •------- .
Hole#
a
7 Time at ..-•.—•----
Depth of Pere --r---
A g Time
Start Pfe-soak Time.
End Pre-soak
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Site Suitability Assc$sment Site Passed
Site Failed: Additional Testing Needed(YIN) •
Observation Hole Data To Be Completed on Back
Original:.Public He'�lth Division
***If percola ji0n test is to be.conducted within 100, of wetland,.-you must first notify the
t one 1 week prior to beginning.
' n at leas )
at1Dn DiV1S10 � s
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DEEP OBSERVATION HOLE LOG Hole# 1
Depth
from Soil Horizon Soil Text
ure Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure.Stones,Boulders.
Consistency.% ravel
37 �� ( are �� 6
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3Z 3LIAE.0 (,� f
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DEEP OBSERVATION HOLE LOG Hole#_
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consis enc %Gravel)
bFl
5 AeA.
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, o Gravel
to —
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DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
n iste
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Flood.Insurance Rate Man:
Above 500 year flood boundary No Yes
and year
Within 500 Y �'Y o7 Ye
s
es
N
Within 100 year flood boundary No Yes.
Depth of Naturally Occurring Pervious Material
Does at least 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 per ious material?
Certification
I certify that on (date)I have passed the soil evaluator examination approved by the
Department o it ental Protection and that the above analysis was performed.by me consistent with
the required ainin ,ex ertise nd e e nce described in 3;10 CMR 15.017..
Signature Date Z1
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Qa.SEPTICVERCFORM.DOC