HomeMy WebLinkAbout0028 GARDINER LANE - Health 14 Gardiner sane
Osterville
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Town of Barnstable P# op
Department of Regulatory Services
Public Health Division Date a 2 a
MANS
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t63q �u 200 Main Street,Hyannis MA 02601
�prED MA't�
T Date Scheduled __ Time 1n Fee Pd.
Soil Suitability Assessment for Sewage Disposal,
Performed By: Witnessed By: DAI
LOCATION& GENERAL INFORMATION
Location Address �� (5Rr.cj/n e:2 G D s-rw/.(t l,c Owner's Name S U e
Address 28 6 And at r
Assessor's Map/Parcel: 1.L t 03 Engineer's Name G q�eo✓,'�(o e'�t iP�t�cS
NEW CONSTRUCTION REPAIR, Telephone# 56_ V'1c2_1� Lt r,2-f
Land Use Slopes(9'0) Surface Stones
Distances from:. Open Water Body ft Possible Wet Area ft Drinking Water Well ft
Drainage Way ft Property Line ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes)
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sty
Parent material(geologic) Depth to Bedrock /
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Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face
Estimated Seasonal High Groundwater
DETERARNATION FOR SEASONAL HIGH WATER TABLE
Method Used: ff
Depth Observed standing in obs.hole: in. Depth to soil mettles: .,.. in.
Depth to weeping from side of obs.hole: ` in. Groundwater Adjustment ft.
Index Well# ^ Reading Date: Index Well leve Adj.factor Adj.droundwater level
PERCOLATION TEST butp 1R ONi. Tltne A
Observation
Hole# Time at 9"
Depth of Perc Time at 6" / : s fS
Start Pre-soak Time @ / ----7 lime
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End Pre-soak f
Rate MindInch
Site Suitability Assessment: Site Passed Site:Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on,Baek----------- .
***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:XSEPTIC\PERCFORM.DOC
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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.
Consistency,% ravel
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DEEP OBSERVATION HOLE LOG Hole#R-,
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistengy.% ravel
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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.
C nsistepcy.%
Gravel)
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y 3 p �s 9c� iia�-- l� �to:.cr7/ Nljp 4fla
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31 otA '-q06q . ,6 yet g.
DEEP OBSERVATION HOLE LOG Hole# i
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
ons'
Aj A 1/, n•So a 7,
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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 Naturallv Occurring Pervious Material
Does at least four feet of naturally occurring pery ous 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 Jay 5/4 (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 trat ing,expertise d exp n ce described in 310 CMR 15.017.
Date
Signature /'A-Zol.
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Q:\SEPT10PERCFORM.DOC