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HomeMy WebLinkAbout2346 ROUTE 149 - Health WeAr Biirnstable }_ 6 0\�-- i Town of Barnstable r# Department of Regulatory Services q y 3 + BARNbTARLE r Date Public-Health Division ,.rEDt w`6� 200 Main Street,Hyannis MA 02601 Fee Pd. Date Scheduled 12 I©3 Time soi l suitability Assessment y Sewage Disposal ' . MNI-Of ► T vgz � Witnessed By: Performed By: pp n r I i •1 k U t y'Ikl x Al ner's Nasrsa 1 Ow C C C 1C I e r�e r e Location Address tt23 t{(p � Q_ I W')Si 6C�✓N s 66- Address ``II Engineer's Name '�jF.r.�tltf,TT�� 0��1"i Assessor's Map/Parcel: �5 J 'G`t(o` U(11 (o(0,3c-� NEW CONSTRUCTION X_ REPAIRTelephone# r70�' � tjo Surface Stones �aN� Land Use 5I►� l�l Slopes(%) Distances from: Open Water Body + ZOO It Possible Wet Area ..�-�00 g Drinking Water Well ((70 ft . Drainage Way ft Property Line �ft Other ft SITCH:(Street name,dimensions of lot,exact locations of test holes&pert tests MI ,locate wetlands In proximity to boles) t ^4 t � . 32 IH�P.M C Depth to Bedrock wl A Parent material(geologic) I� We from Pit Face — Depth to Groundwater: Standing Water In Hole:Estimated Seasonal High Groundwater IN ro n r Ce1W7'RT"a�k p p; t :�. F M1. i S1 . ' '•e; , t�� i I' ru's!, tt dWrJIUfTj.�iF.COAr aaPa...aa.,g,...d' Method Used: in. in. peptic to soil mottles: ft. Depth bserved standing in obs.hole: in. Groundwater Adjustment Depth to weeping from side of obs.hole: Ad.Groundwater Level_ Index Well# — Reading Date: Index Well level — Adj.factor� j . • .n. t a #mo ."W I to I, e r Observation Time•at 9" Hole# ,o Time at 6" Depth of Pere Q;00�ay Time(9"-6") Start Pre-soak Time`� f2;oo End Pre-soak 0; Rate MinAnch LZMW 14 ' CUP.passed Site Failed: Additional Testing Needed(YIN)�.�L .-5Prr Depth from r Soil Horizon Soil Texture o or" SIR Soil OUrer Surface(in.) (USDA) (Munsell) Mottling 5WClare,Stones,Boulders. Consislenz V.Grave 1=tN>r I 3/z r o -31 1LT- LO Awl I(7 ��to titer I - 2 GI 51 Le I( e. IZ - 1 _ ...�_CZ �tN� SArJn 0 $ d �nos� ra p R 1 soil Other Depth from Soil Horizon Soil Texture Soil Color Surface(in.) (USDA) (Munsell Mottling Structure,Stones,Boulders. Contielpmv U.Gravel CI - I l of 0 Ft eih -� G 29- 6 0 I L eldSE of Depth from Soii Rut Zoii boil TzxiuI ' Sail Color 5r1 Other Surface(in.) (USDA) (Munsell) Mottling Structure,Stones,Boulders. Consisten • Gravel Depth from Soil Horizon Sod Texture Soi Color Soil Other Surface(in.) (USDA) (Munsell) Mottling Stiuchue,Stones,Boulders. Consisten % ravel Flood Insurance Rate Map:_ Above 500 year flood boundary No_ Yes Within 500 year boundary No T 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? If not,what is the depth of naturally occurrm ious material? y t Certification M�}-� T. +..��_• I certify that on "Z (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 . " , -P-vn r1k4ll 15.017. _.. .ti.,-....,.3,.�...^w=,:r✓�.bJY'YYk..i4r+.....^+'."C9.....-.�,.r,,,,....,�.-v.-.••.„ •,,,,:`' - ..... TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION MAP NO. PARCEL NO. C .1 TO ADDRESS OF TANK: I Y ' c % /� / VILLAGE: rf�' `' *'�� Numbbr �tr��t MAILING ADDRESS ( IF DIFFERENT-FROM ABOVE) : � � ' r OWNER NAME: 7 d'r Al R,-1 �J ' `Zr PHONE: 7,'-; INSTALLATION DATE: BY: ., � 1 INSTALLER ADDRESS: � i .:, CERT.NO. *TANK LOCATION: t�'�' . °ram 'r� '` r1 ��C �'f/ i TANK tLOCAT I ON WITH Rt®i-CCT TO 8U I LD I NO) r. CAPACITY'/l?"e .' TYPE OF TANK ! !? r.�="'Z",GAGE AF4'�''YRS. FUEL/CHEMICAL TESTING CERTIFICATION C ] PASS C ] FAIL DATE LEAK DETECTION C ] CHECK IF N/A TYPE/BRANDiP.. ZONE OF CONTRIBUTION C ] YES C ] NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED C I YES C I NO DATE CONSERVATION Cyr] CHECK IF N/A DATE BOARD OF HEALTH TAG NO.'- C'' '` ''�, ] DATE * PLEASE PROVIDE A SKETCH SHOWING. THE TANK LOCATION ON THE BACK OF THIS CARD V � Fv Tt1 Jy � C n � ou 7,5 y.� • " / -- -` . - .�..,�ti;,r-'�„.,w.,,.�..t'..r.rrnn.vw.•ar..++.ti,.,.d�w. �`-'ti.s •----•_""-'--.-�'-' V TOWN OF BARNSTABLE — UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION MAP NO. /o�V PARCEL NO. ADDRESS OF TANK: � 'lU �=� / y y VILLAGE: Gv 4-1'7 /y-��•F'^'f ��1 Klum bar atrdowt MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) : OWNER NAME: 7/?4�. / /L , �, �,�/ ;a f ��. PHONE: f' - c� 2 6 INSTALLATION DATE: BY:,, INSTALLER ADDRESS: tJ $ CERT.NO. STANK LOCATION: Y ✓,7;�flia �'; j¢ - AI f�IWK- (DtaC/RIfit.,TANK LOCATION WITH MKORCCT TO HUILDINO) jf TYPE OF—TANKS d'r �ccf AGE /17 CAPACITY t'. �' t�'YRS. FUEL/CHEMICAL[> i ^ =� i= ='S 4" TESTING CERTIFICATION [ ] PASS [ ] FAIL DATE LEAK DETECTION [ ] CHECK IF N/A TYPE/BRAND ZONE OF CONTRIBUTION [ ] YES [ t ] NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED [ ] YES [ ] NOtt `DATE CONSERVATION [4-f tCHECK IF N/A DATE BOARD OF HEALTH TAG NO. [ ] O ATE '7� ' * PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD W /J Oo0 41 AD/57-6) G19.r 77,4Nfi w o � N �0 7'-F / /y