HomeMy WebLinkAbout0388 HIGH STREET - Health 388 HIGH STREET
West Barnstable
a A = 111 — 012
o .
e A
a
r`
oF�
Town of Barnstable P# - 3
Department of Regulatory Services ^
BARNSUBF4 : Public Health Division Dat
NAM
�p i639• 200 Main Street,Hyannis MA 02601
TEo r�+t � 'q Zc
Date Scheduled I ( 0 Time� Fee Pd. /tw
Soil Suitability Assessment for Sew e Disposal
Performed By:_�/"r� MIA
Witnessed By:.%lN`
LOCATION & GENERAL INFORMATIOdV�
Location Address S r Owner's Name C ryJ
Address
Assessor's Map/Parcel: f' f
Engineer's Name (/4 n k e c s ✓`!
NEW CONSTRUCTION REPAIR elephone
Land Use Slopes(go) h Surface Stones
Distances from: Open Water Body ft Possible �Wet Area 'DV ft Drinking Water Well ft
Drainage Way ft Property Line I y_ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,loca�e wetlands In proximity to holes)
e
yI e� .ter
1
y <, 1
Cn �,
Dr
Parent material(geologic) Depth to Bedrock
Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face
Estimated Seasonal High Groundwater
DETERMINATION FOR SEASONAL 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 v, Adj.factor- Adj.droundwater bevel,,
- I PERCOLATION TEST bate..�. , Time—
Observation
Hole# Time at 9"
Depth of Perc Time at 6" '
Start Pre-soak Time @ Time(9"•6")
- End Pre-soak
Rate MinJInch .✓�, �W
Site Suitability Assessment: Site Pass Site Failed: Additional Testing Needed(Y/N)
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:ISEPTICIPERCFORM.DOC ,
DEEP.OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Sdil Color Soil_ Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders.
Consistency,% ravel
0 1Z '
a- I to kb
DEEP OBSERVATION HOLE LOG Hole# `
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consi ten % ravel
44
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,%Gravel)
vvl
• a
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil ther
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders,
Consistency, QmveI
Flood Insurance Rate Map:
Above 500 year flood boundary No— Yes
Within 500 year boundary No��, Yes
Within 100 year flood boundary No Yes
Depth of Naturally Occurrinji Pervious Material
Does at least four feet of naturally occurring pervio aterial exist in all areas observed throughout the
area proposed for the soil absorption system.
If not,what is the depth of n turallyoccurring per ious material? --
Certification
I certify that on �� (date)I have passed the soil evaluator examination approved by the
Department of Enviro men 1 Protection and that the above analysis was pe orm by me consistent with .
the i fining,�( send e e ence described in 310 CNM 15.01 .
Signat Date l t Z
QAS EPTiC1PERCFORM.DOC