HomeMy WebLinkAbout0165 BAXTERS NECK ROAD - Health o�S' oo /XOE-
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Town of Barnstable
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Department of Health,Safety,and Environmental Services
tHej Public Health Division Date Ae
SA 367 Main Street,Hyannis MA 02601
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Soil Suitability Assessment for Sewage Disposal
Performed By: � . WitnessedBy:� � � "�►�
1(� ' LqC.*,**N &GENERAL INFORMATION
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Loc4D Address Owner's Name�
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Address
Assessor's Map/Parcel: Engineer's Name �<fL=4�.CQZ
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NEW CONSTRUCTION REPAIR Telephone# 7
Land Use " \ lk4Slopes(%) Surface Stones
Distances from: Open Water Body'^ ft Possible Wet Area �14 ft Drinking Water Well _tt
Drainage Way ' "' ft Property Line -4"1 D ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
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Parent material(geologic) Depth to Bedrock
Depth to Groundwater: Standing Water in Hole: AIM" I Weeping from Pit Face
Estimated Seasonal High Groundwater -vz; Al/
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b TER1 INATIQIri '0 SEASONAL M W.ATE 'rA3 . `:........:>::
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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._.___ Ad.j.factor Adj.Groundwater Level_
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,. °.:.':.::. ...::::PE..... TI( l i.TEST.....::.....::..patio':::>:'> : :: ::T e:.
Observation ++
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Hole# � I Time at 9"
Depth of Perc t Time at 6"
Start Pre-soak Time @ 1'�I Time(9"-V)
End Pre-soak
Rate Min./inch
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
DEED' OBSER ATION OL::EOG Hale#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
%
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DEEP OBSERVATION HOLE LOG Hoh#.
Depth from I Soil Horizon I Soil Texture Soil Color I Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
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DEEP OBSERVATION HOVElTole...............
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Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
%
DEEP OBSERVATION HOLEwo
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
%
Flood Insurance Rate Map,-
Above 500 year flood boundary No Y Yes
Within 500 year boundary No_ Yes
Within 100 year Flood boundary No V 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 na rally occurring pervious material? LK
Certification
I certify that on ' �F (date)I have passed the soil evaluator examination approved by the
Department of Enviro mental Protection and that the above analysis was performed by me consistent with
the required d a e
training,expe anrienc described in 310 CMR 15,017.
Signature Date
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