HomeMy WebLinkAbout0195 BAXTERS NECK ROAD - Health �)eck lewd
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SOIL EVALUATOR& PERCOL
ATION TEST FORMS
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1HE'°`�' Town of Barnstable
1 BAR STABLE- Department of Health, Safety, and Environmental Services
Eo 39* 14 Public Health Division
367 Main Street, I-lyannis MA 02601
Ofl 1cc: 509-790-6265
FAX: 509-775-3344
'I yuj LdAssessineDt forSewe Dls oral
ASSESSORS MAP NO 135
PARCEL NO',--
�. Date: f 61 11-7
NU.
-f
t Date: 1 --309
Performed By:
Witnessed By:
Owllcr'sNamc O,�a hmP6
I.ocalion Ady)Fcss �to1�4
t.ota:
/�/IA�S IV^+S M l� Address.and
- LC ISSg3�
�5� Lr- 14
relcpl,one a
Assessor's map/Parcel:
NEW CONSTRUC'rION REPAIR
OfreReview ✓
Published Soil Survey Available: No Yes
Year Published l Publication Scale �'L�,,ac�D Soil map unit
Drainage Class A_ Soil Limitations
Surficial Geological Report Available: No Yes V
Year Published I_k`7_i, Publication Scale 24 OVD
Geologic Material(Map Unit)
Landform lkt�l
Flood Insurance Rate Map:
Above 500 year flood boundary No Yes
Within 500 year boundary No Yes
Within 100 year flood boundary No ✓ Yes
n
Wetland Area:
National Wetland Inventory Map(map unit)
Wetlands Conservancy Program Map(map unit)
Current Water Resource Conditions(USGS): Month VAC q�
Range: Above Normal ➢t Normal Below Normal
Other References Reviewed:
DL'•P APPROVED FORM- 12/07/95
FORA l l - S011, ENAMA-1.OR FOIt(11
Pigs 2 of 4
Loc<ation Address or Lot No. C5 J 9MM-9-
On-site Review
Deep Hole Number Date: 30.9% Time: /V A*-, Weather CL4:A2
Location (identify on site plan) / /oo` gAc- . `�Z 14v` SA,R 4
Land Use F'S6;,0rWj7'jA-L- Slope M A—C Surface Stones
Vegetation 1.1900b � �/SC-4V6
Landform .0� f/lWA6X _ i4
Position on landscape (sketch on the back)
Distances from:
Open Water Body 6;�O feet Drainage way feet
Possible Wet Area .40 f feet Property Line .3a feet
Drinking Water Well feet Other
DEEP OBSERVATION HOLE LOG'
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(Inches) (USDA) (Munsell) Mottling (Structure,Stones, Boulders, Consistency, %
Gravel)
wo
MINIMUM OF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA
Parent Material(geologic) 0Oj WA-S4 lit--.&1 W DepthtoBedrock:
i •Depth to Groundwater: Standing Water in the Hole: - — Weeping from Pit Face:
EAtimated Seasonal High Ground Water: s091=A-eX
DEP APPROVED FORM.12/07/9S
1
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4,
FURM I1 _ SOIL L;VALUAT01t 1F0101
Page 3 of
Location Address or Lot No.
Determination or Seasonal Hi li Water Table
Method Used:
El Depth
Depth observed standing in observation hole inches
El Depth weeping from side of observation hole
❑ Depth to soil mottles inches
❑ Ground water adjustment . . .
feet
I Index Well Number .M/ . .
w21 Reading Date ... . U Index well level 10.E
Adjustment factor
IJ,n Adjusted ground water level ..'��°�
Depth of Naturall occurrin Pervious Material
Does at least four feet of naturally
pervious material
in all areas
he area proposed for the oil bsoptionsystem?
observed throughout t
If not, what is the depth of naturally occurring pervious material?
Certification
uator examinatior
I certify that on 5 /9 4� (d veonmentaPProtect on and that I have passed the soil lthe above an lys
approved by the Department of En
was performed by me c n 017 t with the required training, expertise and experience
described in 310 CMR
I ate
Signature
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DEP APPROVED FORM• 12/07/9S
FORM 12 - PERCOLATION TEST
Page 4 of 4
Location Address or Lot No. �5
/07- /* Lcc /s�s93
COMMONWEALTH OF MAS SACHUSETTS
Massachusetts
Percolation Test*
.Date: /—30 -7 7 Tin ne:. <a /j-�
Observation Hole #
Depth of Perc ' S c-T-
Start Pre-soak
End Pre-soak
Time at 12"
Time at 9"
------------
Time at 6" 1 t
Time (9"-6")
Rate Min./Inch
�,Sf?yYJ E3 ® �9
Minimum of 1 percolation test must be performed in both the primary area AND
reserve area.
Site Passed
Site Failed ❑
B
Performed y.
Witnessed By: �'
Comments: ...:..:. .. . .... ..._. . . . ............. . ,..:...... .. ..........._......... .._..�..r.��.w,.
DEP APPROVED FORM•12/07/95