HomeMy WebLinkAbout0048 STARBOARD LANE - Health 3-STARBOARD LANE
Osterville
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Town of Barnstable P# Z/O
Department of Regulatory Services /
BARNsrear a.
Public Health Division Date
200 Main Street,Hyannis MA 02601
` / Time AfC
Date Scheduled � Fee Pd.
Soil Suitability Assessment for S e Disposal
Performed By. �k 7 ��� Witnessed By:
•LOCATION &GENERA_ L INFORIVIA 'IO ll��
Location Address Owner's Name( e—
0 '
Address I`0. (
5 4Ci�OI L��. Nit I� �t�sS 25�j7
Assessor's Map/Parcel: ] f�� / Engineer's Name&ttk
.V eka( t CC a ��Hi h
NE W CONSTRUCTIOI 6 "IREEPAI Telephone# °T i�—,3 5
Land Use yQCGf fl-��/C eS taC'�i��'a( Slopes(%) ld.- S Surface Stones
Distances from: Open Water Body ft Possible Wet Area dG ft Drinking Water Well r ft
Drainage Way ft Property Line ld` G ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes)
k�
$gyp
Parent material(geologic) Depth to Bedrock SSG
Depth to Groundwater: Standing Water in Hole: 4A0 At-e Weeping from Pit Face A1011 'e
Estimated Seasonal High Groundwater
DETERMINATION.FOR SEASONAL,HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.hole: in. Depth to soil mottles: M.
Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft.
Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level_
PERCOLATION TEST Date Time, f0
Observation
Hole# 3 Time at 91,
r'
Depth of Perc "1 d7 Y Time at 6"
Start Pre-soak Time @ Q Time(9"-V)
End Pre-soak
Rate Min./Inch . <FM 1 ;h <ZA.n r'dl
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 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:\SEPTIC\PERCFORM.DOC -
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DEEP OBSERVATION HOLE LOG Hole# 7
Depth-from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistent ° Gravel
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DEEP'OBSERVATION HOLE LOG Hole# 2—
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistent %Gravel
tC' .nit
41el' ��Yr` /'l�sd IC, �/c ? t
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistent %Gravel
0--6 « Sq Lo r2 z
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.%Gravel)
O-C
_Y • �w �oQm Sah Lo�� 4'
Flood Insurance Rate May:
Above 500 year flood boundary No_ Yes L�
Within 500 year boundary No Yes
Within 100 year flood boundary No C�Yes -
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1
Depth of Naturally Occurrin¢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? Y'f S
If not,what is the depth of naturally occurring pervious material?
Certification
I certify that on `f l2 (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 tra' W ,expertise and experience described in 310 CMR 15.017. ,
Signature Date
Q:\SEPTIC\PERCFORM.DOC
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i OWN OF BARNSTABLE
LOCATION �� �jGCsrC �n SEWAGE #
VILLAGE ASSESSOR'S MAP & L r
INSTALLER'S NAME & PHONE NO.
J
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) �2) (size) 4x4l
N NO. OF BEDROOMS l PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER -a L,
DATE PERMIT ISSUED: r
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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