HomeMy WebLinkAbout0029 CARLISLE DRIVE - Health 29 CARLISLE DRIVE
Marstons Mills '
A = 122 — 134 i
4 TOWN OF BARNSTABLE
LOCATION =i.�f E.L= �i� SEWAGE#
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VILLAGE a s t ASS O S MAP.&//PARCEL J- - 131+
INSTALLER'S NAME&PHONE NO. _—,Zte=M1 �_f I
SEPTIC TANK CAPACITY CX1(J!r6F6 /Ce6-mod-_• y✓U
LEACHING FACILITY.(type) (size) AC_/p•�3�' f, =
NO.OF BEDROOMS rz5
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) A— Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) IC[ Feet
FURNISHED BY
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Town of Barnstable P# p
' Departiment of Regulatory Services
]Public HealthDivision P
Div1s;<on Date
iDiv. 200 Main Street,Hyannis MA 02601
Date Scheduled U
Time
_kY� Fee Pd.
►of Sul ability .Assessment for Se i s C7 �
Performed By:
Witnessed By:
02 �LOCAT ON� GF.�TERAL INFORMATION
Location Address f �UU - Owner's Name
(, Lc Iva C,
• /.j �� Address
Assessor's Map/Parcel: ` d./(J y Engineer's Name Q vlj L—
e
NEW CONSTRUCTION REPAIR Telephone
Land Use: �G L4,/F--) 96 !5)o es G
P ( ) Surface Stoacs
Distancesfrom: Open Water Body (GG ft Possible Wet Area �ICG
�f �^ ) ft Drinking Water Well
Drainage Way �U`� ft Property Line 7 C ft Other {t
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands-in proximity to holes)
-�.. -7 7
W�
Co .
,SZ i-5 1
Parent material(geologic) Depth t0 Bedrock / �00
Depth to Groundwater- Standing Water in Hole:' A 111�- Weeping from Pit Face 1
Estimated Seasonal High Groundwater
T/1
]E ATION FOR SEASONAL HIGH WATER TABLE
Method Used: AV1
Depth Observed standing in obs.hole: In, Depth to soil inattles: ln,
Depth to weeping from side of obs.hole: In, Groundwater AdJustment ft,
Index Well# Reading Date: Index Well]eye[ _ ___ Adj,factor Adj,Groundwater Level
Observation PERCOL,ATION TEST Dille- Thna_
Hole# Time at 4"
Depth of Perc Time at G"
Start Pre-soak'lime @ i i i Time(91).611)
End Presoak
Rate Min./Iach
Site Suitability Assessment Site Passed V Site Falled: Additional Tcsting Needcd(YIN)
Original: Public health Division Observation Hole Data To Be Completed on Back----------
***I£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:\S EPTIC\PBRCFORM.DOC
DEEP-OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture .Sdil Color Soil• Other
Surface(in.) (USDA) (Munsell) Mottling (Structure, Stones;Boulders.
—�� � o i ten=Y.96'(iravel)
(0y
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3y--oo C
DEEP OBSERVATION HOLE LOG Hole# Z
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) , Mottling (Structure,Stones,Boulders.
Consistency.90 Gravel)
35-120
DEEP OBSERVATION HOLE LOG Hole
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
o f to e O e
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stapes',Boulders.
Co si ton
y
Flood Insurance Rate Map:
Above 500 year flood boundary No Yes
Within 500 year boundary No`//1 Yes
Within 100 year flood boundary No. 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? y� S
If not,what is the depth of naturally occurring pervious material?
Certification
I certify that on /t' (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 requited training,experdse and experience described in�10 CMR 15.017. /
Signatures^ � Data 7(1 G 1
Q:\S.EPTlaPERCPORM.DOC
LOCATION 29 SEWAGE PERMIT NO.
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VILLAGE
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INSTA LLER'S NAME ADDRESS
6UILDEIt OR OWNER
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DA T E P ER III IT ISSUED
DATE COMPLIANCE ISSUED ����
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