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0110 ANNABLE POINT ROAD - Health
j10 AnnnbI-e C6l'af C tevu e --- 7 Town of Barnstable P11 Department of Ilealth,Safety,and Environmental Services of� Public Health Division Date 367 Main Street,Ilyannis MA 02601 S 11 rutwerAs[.e, � I Mass. tarp. � q rtotvct� Date Scheduled Time 14, S,111 Fee I'd. j o O Soil Suitability Assessment forJBy: Sewage Disposal — NE0 Yft/1CS/ S (4/Y/✓FT/,/O'DQE��e'sf'� !Y l9Performed By: Willir h/1'i/ N ><tA tNCotimCATZO.N...... . : Location Address LWI Owner's Name CN�/T�.PY/GCS /YJ� Address 13. j-jv�P,'Y eoC Ya )IV 57 Assessor's Map/Parcel: V 3 Engineer's Name JA.N67 �I�i�`ys, 'es. NEW CONSTRUCTION REPAIR __L Telephone il S0,�-- t-o ( G a Land Use E /��,c/7/JJ�C / Slopes(%),.,3'-8 o Surface Stones /I e""V,N- Distances from: Open Water Body (oD R Possible Wet Area 30 RL Drinking Water Well R Drainage Way JU R Property Line c 720 R (Other R SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) WEQO^XC 1 LAY,6 J Parent material(geologic)�h���Oi> fJC��CSoC /D�?6/7D pth to Bedrock o26R� / Depth to Groundwater: Blending Water in I tole: 3 Weeping from Pit Face 3 / ) Estimated Seasonal High Groundwater f" FC0L D 1r,1'hIaZ t7 —- POIp SAS0NAY. TXGlT'V4'A'I' )(2'1'AT3L ... ... . ........ ?4ethod Used: :::.:::::: Depth Observed standing In obs.hole: in. Depth to soil mottles: Depth to weeping from side of obs.hole: in. Groundwater Adjustment R. -Index Well N -Reading Date:_ Index Well level ___ Adl.factor Adj.Groundwater Level DID MIT ��w,crr� ,��i�'C' Tom? �v�/��7Z���f �: Observation �/PUC�/1/U �iL)� S�L�i/� ^/✓'T,0Xme at_ '/� Bole N Depth of Perc C P / Z Time at 6" Start Pre-soak Time© Time(9"-6") End Pre-soak Rate Min.Anch Site Suitability Assessment: Site Passed _ Site Failed: Additional Testing Needed(Y/N) � Original: Public Health Division Observation Hole Data To Be Completer) on Bacic j Conv: Anolicnnt llLLI' UI3lY"VA CXO1ZCJT� LOG Iulc# Depth Prom Soil Ilorizon Soil Texture Soil Color Soil Other i Surrace(in.) (USDA) (Munsell) Willing (Structure,Stones,Doulderes. 0 y� Lcs.�rr 4/ 1/ /0�' Y/'iq 0 LaHm 0 Y/i:' S� a/V� CJ/Tt/ o7S%c S/cT n 31Yivo C �S ✓� /U y z��E e® ram��,�inr C�BS�RY:i:Wo IUL�LOG Dole# Depth rrorn Soil}lorizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Bouldcres. e DCIt C�I3SttVA'1'xON Zi()L 1,OG bolt;# Depth from Soil I lorizon Soil Texture Soil Color Soil Other Surface(in. (USDA) (Munsell) Mottling (Structure,Stones,Doulderes. D��I' OIS�IZVATION �UL LOG Depth Prom Soil horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,tioulderes. e Flood Insurance Rate Map: Above 500 year flood boundary No— Yes Within 500 year boundary No A Yes Within 100 year flood boundary No_4 Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout [fie area proposed for the soil absorption system? YE IS If not, what is the depth of naturally occurring pervious rnateria17 Certification I certify that on ► j _Jy—914 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and flint the above analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017. Signature ��/� /„iy, l Date _ _n9 U.S. STANDARD SIEVE NUMBER HYDROMETER 114 5 10 18 35 50 70 140 200 100 90 Bo r 70 x W � � 60 m I , z W 40 � U h W 4 Cry 20 \� 010 5 1 0.5 0.1 0.05 0.01 0.005 0.004 0.0005 0.0001 GRAIN SIZE IN MILLIMETERS FINE COARSE MEDIUM FINE RYFIN SILT CLAY MEDIUM GRAVEL GRAV£L SAND SANG SANG SANO U.S. BUREAU OF SOILS CLASSIf1CAT10N r.St/Y.04.� PROJECT Goft I NG N O S AAAPL E NO�"S - DEPTH ELEVATION REMARKS GRAIN SIZE DISTRIBUTION DIAGRAM SOILTEST INCORPORATED 86 ALBRECHT DR. • LAKE BLUFF,ILLINOIS,60044 U.S.A. DCL- 8 BENNETT & O'REILLY, INC. 84 Underpass Road P 0 Box 1667 Brewster, MA 02631. . Sheet of PROJECT SAMPLE NUMBER 6c�,� s® �) DATE 2- (9199 PROJECT SIEVE ANALYSIS SAMPLED BY DATA AND COMPUTATION SHEET TESTED BY DTI/ WEIGHT OF SAMPLE 9Z• JOB NUMBER Sieve 0 enin s Weight Cumulative Project Milli- Sieve Retained Percent Percent Manual Inches meters Mesh in Grams Retained Finer Specifications CUM, Cud. �0 2. 4. 2- 4- 1, Z 8 9 34.3 /6.1) ��7 92, 3 3S 6. 3n. ,8 1(,,"7 5 3z . 60 27, 2 >���.3 /4¢ 18l• 9 /0 0 / 166, 9 �: S 187. 4 12, C, ion 6.8 s 3• S 90. { t . i Passed Mesh Sieve TOTAL REMARKS: BENNETT & O'REILLY, INC. 84 Underpass Road P 0 Box 1667 Brewster, MA 02631. 1 Sheet of PROJECT SAMPLE NUMBER �Z �(�� So•c ) DATE PROJECT SIEVE ANALYSIS SAMPLED BY DATA AND COMPUTATION SHEET TESTED BY WEIGHT OF SAMPLE /93 3 gm. JOB NUMBER Sieve 0 enin s Weight Cumulative Project Milli- Sieve Retained Percent Percent Manual Inches meters Mesh in Grams Retained Finer Specifications ld 6117 61.7 ZO 1• (3 .8 �S zs. 8e . 6 12. 9 -�4.8 ss- z 33 .o /zG,8 Zo. 60 29. 3 /s3. 1 13.6. I .0 2 /00 4.3 16 7.4 73 (66, 3 /3• 7 2oo 4 1,64,6 I ' s 3 �• '7 I c I Passed Mesh Sieve TOTAL REMARKS: 14'0104 11 - SOIL t?VALUATOR FORIII I'al;c I of 3 No. z�O9e Date: Commonwealth of Massachusetts Massachusetts Soil Suitability Assessment,for Ott-site Selvage Disyosal Performed By: ..... , / S ( . ��✓N s OiPFic�y Date: J(�/yC.... .....��/. ..... ...:........... .. Witnessed By: .-�lw.y...0 �✓/Y//Y6.... i �'/I.IS/ , 3C .-., CT�/ .�G Y% _. . ..... Location Address or /�� �/l��✓/7 r(��'LC /��Q//�// s�LD Owner't None. �� /C'��'�/C'/, N/�� . Lot. "�..Pl//C�C—/ �>/ � Address,a/c / ew Construction ❑ Repair ' Office Review Published Soil Survey Available: No ❑ Yes ® Cq �/� �Oq/J7�CC �CSc� �✓� Year Published 1.�✓...g� Publication Scale .................. Soil Map. Unit Drainage Class ................. Soil Limitations ........................................................ Surficial Geologic Report Available: No ❑ Yes 0 Year Published 9 Publication Scale Geologic Material (Map Unit) �� G% ./� Pc ..-. ,tPEox� C�;. C% 5/✓S Landform ih q. .... �.,,&7 f.119.e.ce...... ........................... Flood Insurance Rate Map:. Above 500 year flood boundary No ❑Yes IZ Within 500 year flood boundary No BYes ❑ Within 100 year flood boundary No [MYes ❑ Wetland Area: . National Wetland Inventory Map (map unit) ... ............................................................................. . Wetlands Conservancy Program Map (map unit) ...................................................................................... ... .. Current Water Resource Conditions (USGS): Month D ✓nl c Range :Above Normal ❑Normal ❑Belc w Normal ❑ Other References Reviewed: DEP APPROVED FORM•11/07/95 F( RNI 11 - SOIL EVALUATOR FORM Page 2 of 3 Lucaticni Address err 1-.cr1 iJu. Y On-site Review Deep Hole Number Date: . j_07/— Time: /0 :00 Weather Location (identify on site plan) i Land Use Slope Surface Stones � !c Vegetation Landform Positiori_on•landscape (sketch on the back) Distances from: Open Water'Body feet T Drainage way feet — _ Possible Wet Area 30feet t' Property Line 20feet 7 Drinking Water Well /y/4 feet Other DEEP OBSERVATION HOLE LOG* Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(Inches) (USDA) (Munsell) Mottling (Structure, Stones, Boulders, Consistency, % )q Gravel) 1 S<c,7 l/j G��4�✓v S�rv� . 34 Nolve l MINIMUM OF 2 ES REQUIRED AT EVERY PF19PUSM71715709AL AREA Parent Material (geologic) /�DepptthtoBedrock: ' Depth to Groundwater: Standing Water in the Hole: , �1=7--�1.2 peeping from Pit Face: / C=L- •Z�� Estimated Seasonal High Ground Water: 38 3-1 ----- - t. T+►t5 TCACPS E•H•6.ifd AT A. 101 I�30V6 A1ST7N& 62AD6- . DE11 APPROVED FORM• 12/07/95 f FORM 1 I - S011, 1"NALU7\'1OR I ORNI P Ile 2 ul' 3 L.ucatiun / ddicss ur Lut No. //Q On-site Reriew Deep 1-lole Number Date: time: Weather Location (identify on site I)larr) Lang Use Slope ('/',U) Sur lace Slunes Vegetation j Landfunn j Pusition un Imidscape (sket,:h un the Lack) Distances Iron": Open Water'Budy Ieet U►airraye way feet Pussihle Wet Brea Ieet 1'10perty 1_irre feet Drinking Water Well [eel Other DEEP0(3SEI�V/\'1-ION HOLE LOG' Depth fromSoil I Ivrizon Soil I rxlwe Soil Color Soil Ullror Surface (Inches) (USDA) (Munsell) Mottling (Structure, stories, Uoullders, Cunsistancy, "o i i I IAIUIUFR-017-2- 1�iCE�liE�iUI�EGATEVEf1YTs�6(�ijSECGIS(�a�AL—Af1E Parent Material (geologic) Deplhtol3edrock: Depth to Groundwaler: Standing Water in the I tole: __ Weeping)rum Pit race: Estimated Seasonal High Ground Walw ___ Dr•.P AI'PROVEA)10101- 12107/95 FORM I I - ,�l)11, I,v��Lu,�'t'vIc l�clttnl Page 3 of 3 Location Address or hil Nu. %/d �/v/�/3F<<�' i� D�[ �✓'� � Determination J r Seasonal High 1,11uter• 1 able Method Used: Depth observed standing ir1 observativn hole 3G' inches Depth weeping hum side of vbsurv,atiuri hula inches tU Depth to soil mottles inchus U Ground water adjuslrnenl . (eel Index Well Number ...... ._. . lieadkig Uate ... Influx well level Adjustmehl factor .... ......... Adjusted ground water level ....... Depth of Naturally Occurriny 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? k5 _ If not, what is the depth of naturally occurring pervious material? Certification I certify that on /J/� (dale) 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, expertise and experience described in 310 CMR 15.017. Signature �/��� Date I a?S uer AITROVED F0101. 12107/95 FORM 12 - PERCOLATION TEST Location Address or Lot No. /1(] �/jy/� j/50 COMMONWEALTH OF MASSACHUSETTS Massachusetts Percolation Test i Date: Time:, lU UU. Observation No!e / Z Depth of Perc Start Pre-soak End Pre-soak F 17GYJ/Y� Time at 12" S 'CVO y/) ZZ 15 Time at 9" ON Time at 6" '! Time (9"-6") i Rate Min./inch R Minimum of 1 percolation test must be performed in both the primary area AND reserve area. ,i �- Site Passed ® Site Failed ❑ ......................................................................................................................................_..._................. Performed By: h/C-'� vc- i / :.i Witnessed By: Comments: DEP APPROVED FORM-12107/95 i i I Permit Number: 91-yDate: / �/ _ Completed by: 7 ( HIGH GROUND-WATER LEVEL COMPUTATION I Site Location: Owner: Address: I Contractor:l��USf=iCiEZ� I Address: Notes: i � STEP 1 Measure depth to water table n to nearest 1/10 ft. .............................................................................. Date month/d y/year ' STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: C� Appropriate index well.................................................... el-7 C> Water-level range zone ..................................................... STEP 3 Using monthly report "Current :i Water Resources Conditions" _f determine current depth to r water level for index well ........................... �� m th/year i 1 I STEP 4 Using Table of Water-level Adjustments ' for index well (STEP 2A), current depth { to water level for index well (STEP 3), and water-level zone (STEP 2B) g determine water-level adjustment ........................................................................................... n i j-_ STEP 5 Estimate depth to high water a... by subtracting the water- level adjustment (STEP 4) from measured depth to water level at site (STEP 11 ................................................. i= l•f ' RBovC exispN ' Figure 13.—Reproducible computation form. a 15