HomeMy WebLinkAbout2506 MEETINGHOUSE WAY/RTE 149 - Health dqw Rm4t 1
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Town of Barnstable P# 9 W �
Department of Health,Safety,and Environmental Services
Public Health Division Date 11Z6 ao
Q, 367 Main Street,Hyannis MA 02601
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BARNBTABIE,MAFM
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r��► Date Scheduled 2a � 0. Titn'e /0•'00 Fee Pd.. 1060)
Soil Suitability Assessment for Sewage Disposal'
Performed By�'-r`' ✓��^� Witnessed By�' 1/� "'�"�1
LOCATION & GENERAL INFORMATION Location Address Owner's Name
1/1/ Acf'dress
Assessor's Map/Parcel: I5S 15 Engineer's Nam • t w5 'V/
NEW CONSTRUCTION REPAIR Telephone# 8c5:g_4-4
Land Use I DCT( Slopes % C N p ( ) Surface Stones Distances from: Open Water Body�R Possible Wet Area IV4' R Drinking Water Well�fW��yy��
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Drainage Way R Property Line 10' w R Other t R
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
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Parent material(geologic) Depth to Bedrock O
Depth to Groundwater: Standing Water in Hole: { Weeping from Pit Face' I
Estimated Seasonal High Groundwater z / W �o
bar : :. ::NAm c N..:�O� AS NAB,HY���v�TE�'Y'A)�E�:::
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 R.
Index Well#_ .__._ .Reading Date: Index Well level.._ Adj.factor_ Adj.Groundwater Level
I'ERCOL�ITIOIV TEST': :: z>' te t TimelTO
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Observation I�
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Hole# I Time at 9"
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Depth of Perc 120 r Time at 6"
Start Pre-soak Time @ Time(9"-6")
End Pre-soak
Rate Min./Inch
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Site Suitability Assessment: Site Passed Site Failed: Additional'Testing Needed(YIN)
Original: Public Health Division Observation Hole Data To Be Completed on Back
Copy: Applicant v
DEEri OBERVA�IbN 1IbLE LbG Hole(#
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Depth from soii Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Consistent %Gravel
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DEEP OBSERS'AJON H+1)LE to. Hole
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Depth from Soil Honzony Soil Texture 1 Soil Color Soil, Other
Surface(in.) (USDA) 1 (Munsell) Mottling (Structure,Stones,Boulderes.
Consistency,° Gravel
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DEEP OBSERAT>ib1V HOLE L(�G Dole#
Depth from Soil Horizon Soil Texture Soil Color Soil Othe
Surface(in.)
(USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Consistent %Gravel
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:DEEP OBSERVATION HOLELO;G Hole
..
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Consistency,% ravel
Flood Insurance Rate Map:
P-
Above 500 year flood boundary No_ Yes
Within 500 year boundary No r� Yes
+. 'Within I00year flood boundary No r Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areasobserved throughout the
area proposed for the soil absorption system? � S _
If not,what is the depg2tal
lly occurring pervious material?
Certification
I certify that on (date)I have passed the soil evaluator examination approved by the
Department of Envirootection and that the above analysis was performed by me consistent with
the required training,expertise ex erie ce es ribed in 310 CMR 15.01 ..
Signature Date 00