HomeMy WebLinkAbout0049 ICE VALLEY ROAD - HAZMAT 49 ICE VALLEY �t �i�
A=119-003
Town of Barnstable P# 5� 7$_4/ J
Department of Health,Safety,and Environmental Services
�I Public Health Division Date � r�. 4 pt
367 Main Street,Hyannis MA 02601
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MASS.
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�3 Date Scheduled lK/
`' 7Z?-7-- Time Fee Pd. ZGV,
Soil Suitability Assessment for Sewage Disposal
tJ Performed By: ,4 OL111 64-) ..S te AC WWWitnessed By: 6 d
AT
...: ......:.:..:: . ..
Location AddressOwner's Name
Address
Assessor's Map/Parcel: f l Y- Engineer's Name
NEW CONSTRUCTION REPAIR Telephone#
Land Use Slopes(%) Surface Stones
Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft
Drainage Way ft Property Line 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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7
Parent material(geologic) Depth to Bedrock
Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face
Estimated Seasonal High Groundwater
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 Adi.factor _ _ Adi.Groundwater Level—.—
::..
PERCH. »::::>::.
::: ATIUI.TEST:::::::::>:::::::; t .
Observation
Hole# Time at 9"
Depth of Perc Sz Time at 6"
Start Pre-soak Time® \ a� Time(9"-6")
End Pre-soak
Rate Min./Inch
Site Suitability Assessment: Site Passed x Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on Back j
Copy: Applicant
r �DIY�11J1\ [i1,E Y. ►. 11Q1� ..
.. .
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
%
LoAn Consistency-
3 LoAmZ SANI) 10y2 g
Ig` I200 to `{2 ��� +tiont . nose tr;ti51�
.
DEEP OBERATZN HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
°
v l d A SShc! L m 1 *'117,
\i= \a0` C, Mec`. (-&%yo `n -1to 0n loose -4�i�S�c
EE E� EIt Vi�'t()lYU1,E t,OG
ul6
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
° ra el
DEEP OBSERVATXOl�i MOLE LOG
Ha�)is
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Cons 3lency.° r
Mood Insurance Rate Map; l '
Above 500 year flood boundary No— Yes X
Within 500 year boundary No 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? : IQS
If not,what is the depth of naturally occurring pervious material?
Certification
I certify that on (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
the required training,a �ertise�nd experience described in 310 CMR 15.017. 1
Signature .n `,�' Date