HomeMy WebLinkAbout0221 BAXTERS NECK ROAD - Health Sao' � s Pack
SOIL EVALUATOR& PERCOLATION TES',FORMge I of S
114EIpk O Town of Barnstable
' Safety, and P,nvirontnental Services
m
t BARNSfABLB. I)epartcnt ()f Health,
MASS.t639Public Health Division
�'prEoru�► 367 Main Street, I lyannis MA 02601
OI l ice: 5()8-790-6265
FAX; 509-775-3344
� c' Assesslrl ell,- IOI� S e wa e Dls osizl
- S o11 �u��,�)111 t ^ ORs MAP NO'
�5
ASSESS �
PARCEL NO' J Date: I 1-.Z, 111-7
NO
F t Datc: _L__a0__?__1
Performed By: -1
Witnessed By:
—D,1
()vncr'sNan,c Otbl 4Mpr.
I.neatinn Address LEI zie,449x_> SL—I FY—A
Q'A~$p')t`C'I e. �a� It T A mAllzAez ZC>
M M r Address.and \/A_6 vtj
Lot a: L+ (S59 3
�`7 / �� "felcphrn,c a
Assessor's Map/I'arccl: l
NEW CONS'I'RUCI'ICN
V REPAIR
Office Yes
Published Soil Survey Available: No
Year Published Publication Scaleo 1'.2�,i'� ' Soil map unit
Soil Limitations
Drainage Class Yes
Surficial Geological Report Available: No
Year Published IN'7i Publication Scale �y�
Geologic Material(Map Unit)
Landform r*IW
Flood Insurance Rate Map: Yes
Above 500 year flood boundary No
N0
,Yes
Within 500 year boundary ✓' Yes
Within 100 year flood boundary No
Wetland Area:
National Wetland Inventory Map(map unit)
Wetlands Conservancy Program Map(map unit)
Current Water Resource Conditions U Month
) GS). MBelow Normal
Range: Above Normal D� (
Other References Reviewed:
DEP APPROVED FORM- 12/07/95
FORM I - S011, EVALUATOR I-'0101
I Page 2 of 4
Loc:alion Address or Lot No. -
1C, aft LC (GSq(3
Ora-site Review
Deep Hole Number 2 Date: _3p 'Oj 7 Time: /1411 Weather Ce 6DVC,
Location (identify on site plan) 4/ /-50f ,34e4 42 Ito®' S
Land Use Slope (%) —r Surface Stones O
Vegetation "LIW6
Landform ponce/A 6.,/ 61,1-114
Position on landscape (sketch on the back)
Distances from:
Open Water Body 6a�V feet Drainage way feet
Possible Wet Area 4-co feet Property Line 60 feet
Drinking Water Well feet Other
DEEP OBSERVATION HOLE LOG'
i
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface (Inches) (USDA) (Munsell) Mottling (Structure, Stones, Boulders, Consistency, %
Gravel)
, p r! yC JI`d�7
�1401C J�� /aye5/3 .s.I,�SSov6 F2 i,4.Br✓r�
/v/2 7/ o P�
S�
2
i I
MINIMUM OF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA
I
Parent Material(geologic) I IJ DepthtoBedrock:
1 Depth to Groundwater: Standing Water in the Hole: — Weeping from Pit Face:
Estimated Seasonal High Ground Water: F7' B-c[�K1
l
+
I
DEP APPROVED FOKA1- 12107l9S
tl
1�01tn9 l l - Soil lsVAI,UA'f 01t F0101
Page 3 of
(7) ��xr
Location Address or Lot No. /5573
Determi�tati �i r easonal Hi li Water Ta le
Method Used:
inches
El Depth observed standing in observation hole inches
El Depth weeping fro m side of observation hole
inches
El Depth to soil mottles feet
❑ Ground water adjustment .... ... . ....
Reading Date ... 4� Index well level
Index Well N umber ..J�i/w.?`�
'���
Adjustment
factor A�i Adjusted ground water level
i
MeaOccu
Depth Nau o �
l areas
t of naturallyedcfor the soil bso ptionmaterial exist system7 in al
Does at least four fee
observed throughout the area propoS
If not, what is the depth of naturally occurring pervious material?
Certification
ertif that on $ /� 4� (date) I have I P otection and th tssed the soil ithe above an lys
Ic Y
approved by the Department of Environments
was performed by me consistent with the required training, expertise and experiencE
described in 310 CMR 15.017.
Signature
ate
i
i
UF.P APPROVED FORM•12/07/95
i
8�57 FORM 12 - PERCOLATION TEST
Page 4 of 4
Location Address or Lot No.
LG 15613
fCo
COMMONWEALTH OF MASSACHUSETTS
Massachusetts
Percolation Test
Date: 1 s Se,a 97 Time:. �o A
Observation Hole # f
Depth of Perc ---------------
Start Pre-soak
End Pre-soak
Time at 12"
Time at 9"
Time at 6"
Time (9"-6")
1A1A4G&r 7ZU S.Q` vf2r4J
Rate Min./Inch �'' i,-j 7Y
Minimum of 1 percolation test must be performed in both the primary area AND
reserve area.
�-,/
Site Passed U Site Failed ❑
.............................................
Performed By: �
Witnessed By:
Comments:
1
I
VEp APPROVED FORM-12/07/9S
I
1_