HomeMy WebLinkAbout0045 EAST AVENUE - Health 45 East Avenue'
Dsterville ..
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Town of Barnstable
Department of Regulatory Services
i Public Health Division Date
MAE.4
200 Main Street,Hyannis MA 02601
��lEb AAId A
Date Scheduled ILI • Time 4��-4_M - Fee Pd._�
Soil Suitability Assessment for Sewage Disposal
Performed-By: � 1 r / / J: j
---�I 4 Witnessed By: r �-'t`'�• �I
LOCATION&.GENERAL INFORMATION
4 Location Address G �����► Owner's Name�//,44;440 4raT5
�r/i✓�l�l� /�1� eur.. � Address Z� '/ �G.CL'1Cr�l✓ �j7
Assessor's Map/Parcel:` l3910 7g Engineer's Name
NEW CONSTRUCTION REPAIR Tele honettG•� �
Land Use �i�'S Slopes(%) 3— `Q Surface Stones
Distances from: Open Water Body � ft Possible Wet•Area �ft Drinking Water Well LtZAft
Drainage Way �' tt Property Une 7 L o ' ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes dr.pere tests,locate wetlands fn proximity to holes)
----------
A Z-,' !r'�
Zly, A,-
1 .7
l3"l`
( f
_ z3� 4z't
Parent material(geologic) Depth to Bedrock
Depth to Groundwater. Standing Water in Hole: z'� � Weeping*om Pit Pace ki 4A
Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL-HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.hole: In, Depth to soli mottler In.
Dc{th to weeping from side of obs,hole: in, Groundwater Ad)uatment $.
Index Well-p Rending Date: Index Well level Adj,thetor Adj.Groundwater Leval,,.,
PERCOLATION TEST We , Time
Observation
Hole 0 _ 3_ Time at 9"
Depth of Pere 4QL'= A0 4` Time at 6"
Start Pre-soak Time @ LO oo 11m0(9"• "
End Pre-soak In I ' l 2
S�VLwTAT'1
Rate MinAnch
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 percolntion 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:SEPTIOPERCPORM.DOC
DEEP.OBSERVATION HOLE LOG Hole#
Depth from Soli Horizon Soil Texture Still Color Soil. Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stonei;Boulders.
COT e _
LL,aoc..�t .0
0"4+
8" '� '�t.LJ ►—S lby jL r/b b` w CK_►-z.4.
3lo t Z.��( !off ov
DEEP OBSERVATION HOLE LOG Hole#
Depth from Sol Horizon Soil Texture Soil Color Soil ►—ffther
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
6
3 , tZ0 L z ,s' L/3
DEEP OBSERVATION HOLE LOG Hole#
Depth from Sol]Horizon Soil Texture Soil Color Soil Otlrer
Surface(In.) (USDA) (Munsell) Mottling (Structure,Stones,Boutders.
161mil_ Lb
l�G
3L131 p
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders.
hJlC6.G,
i sib tZD U T=.ti, _ 4 L4
Flood Insurance Rate Man:
Above 50o year flood boundary No— Yes
Within 500 year boundary No^ Yes '
Within 100 year flood boundary No.t_ Yea
D uth of Naturally Occurring Pervious Materlal
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?
Certif iicatlon
I certify that on (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 experience described in 410 CMR 15.017.
Signature Date tZ,—�—(�
Q:1SBPT1CG PBRCPORM.DOC