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HomeMy WebLinkAbout0216 WASHINGTON AVENUE - Health 216 WASHINGTON AVE N ULE 0 tery lle A = 139 - 082' I i TOWN OF BARNSTABLE LOCATION InJ&ww► mAl Aoe- SEWAGE# VILLAGE ��� , ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY. (type) (size) NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY i C,_ ' LvC-A-1?6,3 �[ �h . ""-1 tyri-sNiwGtraN Ayt. � • F wT , �Of - o Z I� - Ma:h Ce55�od� stt*,- Ztry cdss fw A? 7 • 'own of BArn Stable P# Department of!Regtilatory Services. J I f ;Hate_ 's �„gt�. : Public Hf alth Division ' 63�Mee$ 200 Main Street,Hyannis MA 02601 `? Fee Pd. �� Date Scheduled. J i Ts. _ Ir • -Soil' Suitability A.sse,�s�rier�t,fop_Sevage Di�posar I � T Performed By: ���� r��_1� 6'�!1.L�LI P.it f _'• Witnessed fay:__c_r� LOCATION & GENERAL INFOR ATION Location Address Owner's Name � iZ �.- ( �� j _v, fl r�' I Address t` k Assessor's Map/P4rcel: Q�S 'z i I Engineer's Name w /. dA�t�yl NEW CONS1'RU!'.LjON REPAIR Telephone 0,/ • Surface stonesr�— Land Use f y i� .1 f/ u,-:.- Slopes(To) I > Z-(�,) ft Drinking Water Well (J u ft Distances from: Open Water Body it Possible Wet Area g . Drainage Way T ft. Property'Line �? ft Other ft . i z SKETCH:(streetnar I 1 I � holes) z s•ta - z F .z I.( r n i Q 0. I. Z 7 cp i ` z X 5 ©. c W .A I Q • i p De th to'Be r6e erock ri Parent material(geologic) Depth to Groundwater. Standing Water in AoleF �'` �� Weeping from Pit Face , Estimated Seasonal11jigh Groundwater T.. tT- ERMINATION FOR SEASONAL HIOg'WATER WL]C Method Used: in. Depth to soli motths: in Depth Observed standing in obs hole: — f in. Oroundwnter Ad juatment it- Depth toiweeping from side of obs.hole: . i A ,factor��� Adj.Oroundwater Level Index Well# 1_1 � Reading Datg Index Well leval„ 1 PERCOLATION TEST vaIt 'xp: Observation Tittle at Hole# i Time at 61' Depth of Perc F� Start Pre-soak Time,@ �(� v Ti me(9"-V) ------ End Pre-soak l Z AA, / i Rate MinJInclr ✓y Site Failed; Additional Testing Needed(YIN) Site Suitability Assessment: Site Passed ; Be Completed on Back izPwth nivicinn Observation Hole Data To .------ DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color ;Soil ' . Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel 041,414? 1-4 f +c �rlls � ice, Cdy�2 b ��orP r��tt �, t?.e� �.rtc '`�•�� ' Gay • DEEP OBSERVATION BOLE LOG i Hole#, Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gra el l - 11 J l"��(t `� ,►• � n �I1` �.ar�r l j '. Ij . i, DEEP OBSERVATION HOLE LOG Hole# h Depth from Soil Horizon 'Soil Texture Soil Color j %Soil Other Mottling (Structure,Stones,Boulders. Surface(in.) (USDA) (Muusell) . I Consistency.%Gravel i r . I e k DEEP OBSERVATION HOLE LOG Hole# !� Depth from Soil Horizon Soil Texture Soil Color So(I Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, ra i i Flood Insurance Rate M3A: Above 500 year flood boundary' No— Yes—Z Within 500 year boundary No_�` Yes,. �. Within 100 year flood boundary No_e Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist.in Ill areas observed throughout the area proposed for the soil absorption system? k �A r s If not,what is the depth of naturally occurring peous material? Certification I certify that on d q (date)I have passed the soil evaluato l examination approved by the Department of Environ" ental Protection and that the above analysis was performed by me consistent with the require ni g,exper ise and experience described in 30 CNM '5.017. ,� � k4j, Date Y �` Signature ! v � I n:\.SPPTIC\PERCFORM.DOC TOWN OF BARNSTABLE LOCATION��(� 04Stlu.a� ,U i�v� SEWAGE#' VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. Z SEPTIC TANK CAPACITY: - LEACHING FACILITY: (type) (size) S- NO. OF BEDROOMS OWNER PERMIT DATE:_ .. COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private.Water Supply Well and Leachin Facili Feet g ty(If any wells exist on site or within 200 feet of leaching facility) . Edge of Wetland and Leaching Facility(If any wetlands exist within Feet 300 feet of leaching facility) FURNISHED BY n Feet -- - --- - - ,F 1 a rJ LA, y n n z N