HomeMy WebLinkAbout0904 MAIN STREET (OST.) - Health 904-MAIN-ST�4SrTERVILLE
A= 035-091
S.
Town of Barnstable P#
' Department of Health,Safety,and Environmental Services
Public Health Division Date 1-t I o j
Q, 367 Main Street,Hyannis MA 02601
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% BARNerABM
MASS
1639.
rED Mld�`� Date Scheduled J y 1 Time / AM Fee Pd. Q� /
Soil Suitability Assessment for Sewage Disposal
Performed By: J b/A/ Witnessed By:
LOCATION &'GENERAL_ INFORMATION
Location Address
�/ y� �j r' Owner'sName
I 0 . rnA�W S/71 6 T Address 7� �yS7E�? Lj°IjEE�I�y
A50K /0�7 �S7rf�E
Assessor's Map/Parcel: Engineer's Name C7S LG� �dZ S 5-
�/frl L- C At vie M.7 c 7�
NEW CONSTRUCTION REPAIR Telephone# $o 9- 833-6600
a
Land Use YA K/ Slopes ftJ
(%) �� c Surface Stones
Distances from: Open Water Body It 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&perc tests,locate wetlands in proximity to holes)
62 ` n'f lNS7 �7
N
0
l ? 2 ^�
Q�
33,
6'-3
Q_A&'4
Parent material(geologic) (50 IAMM Depth to Bedrock
Depth to Groundwater: Standing Water in Hole: 7 �d Weeping from Pit Face
Estimated Seasonal High Groundwater
DETERMINATION FOR,SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.hole: j Z 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.Groundwater Level_
PERCOLATIONTEST '``Dste`! vt Time /I Al"
Observation f
Hole# Time at 9"
Depth of Perc 36-5 r' Time at 6"
Start Pre-soak Time c@ I•'2 7 Time(9"-6")
End Pre-soak
Rate MinAnch `0 t17
Site Suitability Assessment: Site Passed_� Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on Back--�
_ Copy: Applicant
DEEP OBSERVATION 1[J0LE`L0G Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling
g (Structure,Stones,Boulderes.
' Consistency.%IsEMU-
r— ^
34 A50 S4,-P
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DEEP'CJ�BSERVATION HOLE LOG
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Consistency,°
' D
D-z '
e� z
DEEP OBSERVATION HOLE LOG
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
en %Gravel)
i
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil 1 Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Cmistency.°
Flood Insurance Rate Map: `
Above 500 year flood boundary No_ Yes
Within 500 year boundary No Yes
Within 100 year flood boundary No_ Yes
Depthf Naturally Occurringer 'o Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption system? V26
If not,what is the depth of naturally occurring pervious material?
Certification
I certify that on 1f/ 5 7 (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 training, expertise and erience described in 310 CMR 15.017.
Signature , Date X1/a�