HomeMy WebLinkAbout0155 DEBBIES LANE - Health (2) 155 Debbies Lane
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TOWN OF BARNSTABLE
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LOCATION `O i `O� O -job it?5 I n SEWAGE # '?6" lQq�
,,�I LLAGE ,tar<-p r\S M AI I ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO.COee Cod SfgTt.CS 30— 62V
SEPTIC TANK CAPACITY. 1000 GAI
N LEACHING FACILITY:(type) QCe0csT j9iT (size) 00 C'AI
U NO. OF BEDROOMS'_PRIVATE WELL OR
BUILDER OR OWNER EnCey H®me..S'
DATE PERMIT ISSUED: 1 b �7S/27
DATE . COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No ?C
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Town of Barnstable P#
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Department of Regulatory Services �/,/A
nk.xsrear�, Public Health Division Date
200 Main Street,Hyannis MA 02601
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Date Scheduled Time Fee Pd. IDDr�
Soil Suitability Assessment for Se isposal
Performed By: CPlq I -, /�(� Witnessed By: S -
LOCATION GEN�ER�y�'L INFORMATION
Location Addresss��vS � S L p / Owner's Nam qM/,�y } ►f L
�'/ 41'C,+l� Address�W1 v` � v�_
Assessor's Map/Parcel: ZZ /28 - Engineer's Narrf��0Grl(]I'.
NEW CONSTRUCTION REPAIR Telephone6C.
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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Parent material(geologic) Depth to Bedrock
'b Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face /
Estimated Seasonal High Groundwater rn
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 Adj.factor Adj.Groundwater Level
PERCOLATION TEST Date Time
Observation
Hole# _ Time at 9"
Depth of Pere Time at 6"
Start Pre-soak Time @ / Time(9"-6")
End Pre-soak ` 1
Rate MinAnch 1 1
Site Suitability Assessment: Site Passed 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:SEPT10PERC170RM.DOC
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DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders.
Consistency.%Gravel
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
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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)
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)
Flood Insurance Rate Map:
Above 500 year Flood boundary No_ / Yes_
Within 500 year boundary Noy es_
Within 100 year Flood boundary No Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pery erial exist in all areas observed throughout the
area proposed for the soil absorption system? rvWt�
If not,what is the depth of naturally occurring pe tn4 ous material?
Certification
I certify that on (date)I have passed the soil evaluator examination approved by the
Department of Envir nmen 1 Protection and that the above analysis was performed by me consistent with
there fi�traffiffig, ' n 5�e�ridescribed in 310 CMR 15.017.
Signa Date
Q:\SEPTIC\PERCFORM.DOC