HomeMy WebLinkAbout0086 CEDAR STREET - Health 86 CEDAR STREET
West Barnstable
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TOWN OF BARNSTABLE
� C '� "� SEWAGE# '' d r 3i ® �LOCATION
VILLAGE 015J' b74
ASSESSOR'S MAP&PARCEL 136 l�7
INSTALLER'S NAME&PHONE NO. Q�
SEPTIC TANK CAPACITY
Y: r
LEACHING FACILITY.(type) y" flrp ' �'14AM AaS (size) . 0 X 4®`X -J z
NO.OF BEDROOMS
OWNER(D R/5CIe.&A !�ZcLzertc
PERMIT DATE: I C to 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) r Feet4 i;
Edge of Wetland and Leaching.Facility(If any wetlands exist within
300 feet of leaching facility) Feet
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Town of Barnstable P#
Department of Regulatory Services
� aAMrraraerE, Public Health Division DateKARL
.639• �� 200 Main Street,Hyannis MA 02601
Date Scheduled /C.,) Fee Pd.
Ail.,suitability Assessment for Sew �isposal
Performed By: �1 V Witnessed By:
LOCATION& GENERAL INFORMATION
Location Addr Q G A� �.a�..� ��_`T Owner's.Name;i �SI 1 r i p l�i4tMJrY.+
p0.%ko�rAj5ja Address S P rn 6 45"VLot.,p-r t oU
Assessor's Map/Parcel: ISO 1 Engineer's Name GOwrAL 0� •.
NEW CONST....RppRUpUCTION % REPAIR .Telephone# 74*8 ro 51
Land Use T1 a L Slopes(%) -9 Surface Stones YM-S
Distances from: Open Water Body 16N 4 ft Possible Wet Area too ft Drinking Water Well /Jo4 ft
Drainage Way 00+ ft Property Line ~3 a ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes,&pert tests,locate wetlands in proximity to holes)
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Parent material(geologic T Depth to Bedrock
Depth to Groundwater. Standing Water in Hole: /I l rym Weeping from Pit Face
Estimated Seasonal High Groundwater lg i
DETERMINATION FOR SEASON : HIGH WATER TABLE
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 Adj.factor Adj.Groundwater Level_
- _ PR ®LATI®loi TEST,.-.
Observation
Hole# Time at 9"
Depth of Perc -7, h Time at 6"
V
Start Pre-soak Time® ( ) II
G
End Pre-soak �S �.� t Time '-6"
Rate MinAnch 2
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN)
Original: Public Health Division Observation Hole Data To Be Completed on Back-----------
***If 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:ISEPTICTERCFORM.DOC
I
DEEP;OBSERVATION'HOLE LOG Hole#'
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
° Gravel)
1D y- �.
Sb vwS
DEEP OBSERV 0 S;HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,%Gv I
ar� V
DEEP OBSERVATIONHOLE LOG, Hole
.._. . -
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
1 Consistency %Gravel)
1
lef
Rb
a y�
LAD
DEEP O SERVATION HOLE LOG .- Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,° Gravel)
g u , qR
y 46 G \-::!P
Flood Insurance Rate Mal):
Above 500 year flood boundary No \_ Yes
Within 500 year boundary No 3 Yes I Z�(� A UQlk" Jb
~
Within 100 year flood boundary No Yes
Death of Naturally Occurrine Pervious Material 3L _14q
Does at least four feet of naturally occurring pervio material exist in all areas observed throughout the SA�o Ian
area proposed for the soil absorption system? t5 1
If not,what is the depth of naturally occurring pervious material?
Certification ,�L I�J
I certify that on rl` (date)I have assed the soil evaluator examination approved by the
Department of Environmental otec on d t the above analysis was performed by me consistent with
the required training,expertise d p en ce cribed in 310 CMR 15.017.
Signature`'.. - Date l b Z3 1 L
Q:\.SEPTIC\PERCFORM.DOC _