HomeMy WebLinkAbout0054 BAIRD WAY - Health (2) lUa� ,� CeAfer 0r�f�
Town of Barnstable I'# !14-/-)
Department of Health,Safety,and Environmental Services
�tME Public Health Division Date q-2� °l
367 Main Street,I lyannis MA 02601 b
aA HAS&IF..
6 � � D
�o Fee Pd. D
Date Scheduled Time
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Soil Suitability Assessment for Sewage Disposal (�
Performed By: k
3rF-1�tE•— !�! )it,Witnessed BY'
' LOCATION.& GENERALTNFORMATION
Location Address W 4\/ Owner's Name Gt�a� MA4 L)1eE
- CearGeVILLz Address a Tqp►2t5AV W. cwr
Assessor's Map/Parcel: i 1 2�'7
Engineer's Name'Lt{,XTFV, <" ►vY 114c—
NEW CONSTRUCTION REPAIR Telephone# L�—z�
Land Use1`D�1.Tj�,ML� Slopes(%) d n:?> Surface Stones
Distances from: Open Water Body >5� R�L+ossible•Wet Area R6—Drinking Water Well
Drainage WayR Property Line _R Other
ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
*M2• w,2-J 9 �- I-,
� /� t4 t•S�
5
Parent material(geologic) Depth to Bedrock
Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face
Estimated Seasonal High Groundwater
ILzETERNrYNATtONOTt SEASONAL HIGH'WATETt 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 R.
Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level
PERCOLATION TEST Date G�' Ti me'/D
Observation
# Time at 9"
Hole
Depth of Perc �`A '� Time at 6"
Start Pre-soak Time @ �N�r�L �r*/' "r/ Time(9"-6")
End Pre-soak -sS1fm
Rate Min./inch
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on Back—�
Copy: Applicant
` DEEP OBSERVATION HOLE LOG Hole # /
Depth from Soil I lorizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Doulderes.
Consistena,Y2 Gravel)
IMI S,#At, 71- , S
N rr alb /,Z. "14
DEE 11 P OBSERVATION HOLE LOG, : Hole# Z.
Depth from, Soil Horizon Soil Texture Soil Color Soil Other Doulderes.
Structure Stones,,
f Mansell � 'Mottling !(
USDA I ( ) I
Surface m. (USDA) °
Consistency,
A
it
I
Y
DEEP'OBSERVATION HOLE`LOG' Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other ._
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Doulderes.
Consistency,°o Gravel)
I
' DEEP (OBSERVATION HOLE LOG'' Ho e
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Doulderes.
Consistency.° 'r I
,f
i
Flnod Insurat'ce Rate Man: J/
Above 500 year flood boundary No_ Yes
V
Within 500 year boundary NoYes
Within 100 year flood boundary No V/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? V45 '
If not,what is the depth of naturally occurring pervious material?
Certification
I certify that on 11W 117f r (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 requiredMtraineid a erience described in 310 CMR 15.017. QQ
Signature Date ,li /'7