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Home My WebLink About0000 OLD MILL ROAD - Health (3) -0- OLD MILL ROAD Osterville A = 142 - 048 0 r Town of Barnstable P# Department of Regulatory Services MUM ABM Public Health Division lS� taeag. , Date 200 Main Street,Hyannis MA 02601 Date Scheduled / Time— Fee Pd. i Soil Suitability d,A� ssessment for Sewage Disposal Performed By: ��1.�'g1 elf Witnessed By: LOCATION& GENERAL INFORMATION a Location Address C) O)d1 Mill I_-Op Owner's Name iQwn f fJ�7f CDSLefvl l L-C 1 MA , f ddress 1A�U5 �in ALAI '►,'MA7 Assessor's Map/Parcei: ( �� Q�-�'� Engineer's Name lj-40111 n I S )m A NEW CONSTRU G 1 REPAIR; Telephone# a$ 3 �ls�ti Land Use' Slopes(%) Surface Stones Distances from: Open Water Body ft Possible Wet Area � ft Drinking Water Well _ ft i Drainage Way ft Property Line ft Other SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) ; U/l - Parent material(geologic) �C `a,"" 1 Depth to Bedrock N Depth to Groundwater. Standing Water in Hole: '"' ! Weeping from Pit Face �� I Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATM TABLE Method Used: Depth Observed standing in obs.hole: __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.tkCtor.�,m,� Adj.Clroundwater Level PERCOLATION`('EST Date i07�, 0 Time,r� Observation # Iza Hoe lion Time at 4" �f � V. . Depth of Perc Di tb/ Time at 6" Stan Pre-soak Time @ �L1 �?%� ( 'time(9"-G') - End Pre-soak I V-1A M),Z✓q Rate MinJInch LZ I Site Suitability Assessment: Site Passed _ Site Failed: Additional Testing Needed(Y/N) . Original: Public Health Division Observation Hole Data To Be Completed on Back----------- a$*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:ISEPTICIPERCFORM.DOC DEEPP-OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(im) (USDA) , (Munsell) Mottling (Structure,Stones;Boulders. consistency"%GliAe yD► to tea DEEP OBSERVATION HOLE LOG Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.% ~tckM IDYL c� Njo ()If,S1 1p �P4. DEEP OBSERVATION HOLE LOG Hole# �l Depth from Soil Horizon Soil Texture Soil Color. % Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. ( C to Gravel) EEP O BSERVATION HOLE LOG Hole# D Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in:) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Cans' C=5,1,E L4A 54 -%Z to Flood Insurance Rate Man: Above 500 year flood boundary No_ Yes ti Within 500 year boundary No Yes,:_, Within too year flood boundary No Yes / Depth of Naturally Occurring;Pervious 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? ' If not,what is the depth of naturally occurring pervious material? , Certification (� t ) p I certify that on � (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 experience described in 10 CMIt 15.017-.7 Signature t4 A 4 Date F Q:\SEpnCVERCFORM.DOC Town of Barnstable P# ' $ Department of Regulatory Service I. _ Public Health:Divisi / a�rr►a� On Date 200/Main Street,Hyannis MA 02601 Date Scheduled Time—.[—`� Fee Pd. Soil Suitability Assessment for wage Dis osal Performed By. V Witnessed By: ,. LOCATION& GENERAL INFORMATION Location Address v 0 1,4 M / Owner's Name I,, fny qbk /bl6N cYtPfv,1L(— MA X Address 110 'IMa1 n �• Assessor'sMap/Parcel: ij(Z Engineer's Name I s5(ey W't*cf1 Gr:*1P NEW CONSTRUCTION _ REPAIR Telephone# 5�8 833 10 Q b Land Use 0AA A]• 9KT( Slopes(%) C) Surface Stones Distances from: Open Water Body ft Possible Wet Area^� ft 'Drinking Water Well ft Drainage Way e ft Property Line -ICJ ft Other ft proximity SKETCH: d:(Street name,dimensions of lot,exact locations of test holes perc tests,locate wetlands i`n proximity to holes) Tia � e fb / - Parent material(geologic)® Depth to.Bedrock Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: / Depth Observed standing in obs.hole: __ __- 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,„e PERCOLATION TEST Date o Time Hole# � Observation � Time at 9" e r 11 _ ! .._.ram Depth of Perc � )J Time at 6" 1 i Start Pre-soak Time @ ' ,c_ Time(9"-6") End Pre-soak Rate MinJinch Site Suitability Assessment: Site Passed SitcFailed: Additional Testing Needed(Y/N) Original:' Public Health Division Observation Holt;Data To Be Completed on Back---------- ***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:\SEPITC\PERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in:) (USDA) , (Munsell) Mottling (Structure,Stones,Boulders. Consistengy. Gravel) 1-V) StIt Lu sir- 0 ' ."4� U,441 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon. Soil Texture Soil Color Soil I I Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. ns' to LD 1�gIl� C� NO DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color. soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Cmsistengy.%Gravell 1®t`—SoIf l0 SirP� Iui,F% I NO F-&AbL DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones:Boulders. Con ' e Flood Insurance Rate Man: Above 500 year flood boundary No— .Yes Within 500 year boundary No Yes - Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occumng perviou 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?,.1�.._-- Certification 1 I certify that on LfZ- P(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,expe tise antd&xperience described in 310 CMR 15.017. Signature 'L .� Date 1 I Q;\SEp-n0pERCFORM.DOC