HomeMy WebLinkAbout2085 MAIN ST./RTE 6A(W.BARN.) - Health 2085 Main Street
West Barnstable
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9- /3 7 �f Town of Barnstable P# 2��
Department of Regulatory Services
• Public Health Division Date
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• rutwerest.t:,
200 Main Street,Hyannis MA 02601
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ArFD M1A'l�
Date Scheduled + v Time ) Fee Pd.
Soil Suitability Assessment f or• Sejv ge ¢sposal
Perfonned By: 1.
R C �� Witnessed By: v
LOCATION& GENERAL W ORMATIOl7
Location Address l 1� 6/ Owner's Name
- A.._/,4 /'ll tl ce Address 1
Assessor's Map/Parcel: OZ / / Engineer's Name WO W L-
NEW CONSTRUCTION 1f1 REPAIR Telephone If 6d_0 J 260- I J_�n�n' ,
Land Use-.
, nM-\ _"� Slopes(%) Surface Slones 4fQ� �rlQC-4 U
Distances from: Open Water Body ft Possible Wet Area ft Drinking Waster Well ft
Drainage Way ft Property Line 1 L - ft Other Z-?,- ft `
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands�n proximity to Boles)
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Parent material(geologic) ��(ZR1N� Depth to Bedrock
Depth to Groundwater: Standing Water in Hole:
f.,lq N Weeping from Pit Pltce �N
Estimated Seasonal High Groundwater
DE.TERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used:
In. Deplll In 5011 tzlottls:
Depth Observed standing in obs.hole: _ a
Depth to weeping from side of obs.hole: a In, Oroundwnter Adjustment
Index Well# Reading Date: Index Well level A(l,f:.letor_ Adj.Croundwater Level
PERCOLATION TEST Date Time
Observation �xt► Time lit 9" _ __--
Hole#
Time at 6"
Depth of Pere
Start Time:(9"-6")Pre-soak Time @ `S
End Pre-soak,
Rate Min./Inch
Site Suitability Assessment: Site Passed Site.-Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Coinpleted on Back-----------
***If percolation test is to be conducted within 100' of wetland,you must first notify tile_
Barnstable Conservation Division at least one (1) weelc prior to beginning.
Q:\SEPTIC\PERCFORM.DOC
DEEP.OBSERVATION HOLE LOG
Depth from `]HOIe#
Soil Horizon
Soil Texture Soil Color Scri;l''
Surface(in.) (USDA) Other
(Munsell) Mottling (Structure,Stones;Boulders.
Z Con istenc % ravel
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�L'A.6 L va5"ts XJ/1 HI
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DEEP OBSERVATION HOLE LOG
Depth from Soil Horizon Soil Texture Hole
Surface(in.) Soil Color ' Soil(USDA) Other(Munsell) Mottling (Structure,Stones,Boulders
Consistency %Gravel)
1~�
Z
(T
qt cg
DEEP OBSERVATION HOLE LOG
Depth from Soil Horizon Soil Texture Hole#
Surface(in.) Soil Color Soil Other
(USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Co siste cY. Gravel)
DEEP OBSERVATION IIOLE LOG Hole#
Depth from Soil Horizon Soil Texture '
Surface(in.) Soil Color Soil Other
(USDA) (Munsell) Mgttlln
g (Structure,Stones;Boulders,
Consi ten a l
Flood Insurance Rate MR
Above 500 year flood boundary No Yes
Within 500 year boundary No_ Yes
Within 100 year flood boundary No Yes .
Depth o� f Nnturall.V Oceurrine 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?
If not, what is the depth-of naturally Occurringpervious 1 s matertal7,,. ___,,,
Cent--_fieatlon
I certify that on cC'4 (date)I have passed the Soil evaluator examination approved
Department of Environmental Protection and that the above analysis was performed by me consistent with
the required training,expertise and exp fence described in�10 CAIR 15.017.
Signature A �j s. . q
Date � Z'/ �/G •
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QAS13 PTICU'ERCFOR M.DOC
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