HomeMy WebLinkAbout0240 FIVE CORNERS ROAD - Health (3) �® Flue Cofr efr
CeA f 4/U o I le,
oup
_7
Town of Barnstable P#
Department of Health,Safety,and Environmental Services /1
Public Health Division Date �4
$ 367 Main Street,Hyannis MA 02601
eAxtaareetK
Mnas.
t639 �� �✓
�FDMA'tr' Date Scheduled . Time Fee Pd.
Soil Suitability Assessment for Sewage Disposal
Performed By: ��t1I(� �'� D( Witnessed By:-ity-a
T
.. .......
..
LOCATIQN&.GENERAL INFORMATION
Location Address;.:; ........... Owner's Name;;:: ...........................................................
Z.No," iJ> carrUfes .rzo : .: �Rr�-(uA t�U�Eat.:S <:<..
CEU /[QQl f�(/►7/ 0-:1(0 3A Address
Assessor's Map/Parcel: C> l U vu Engineer's Name
V
NEW CONSTRUCTION PAIR Telephone#
Land Use - N�IW &opes(%) Z Surface Stones- 0
Distances from: Open Water Body ft Possible Wet Area J I W ft Drinking Water Well M� ft
Drainage Way 'V�' 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)
a
J
1
Parent material(geologic) —1"''—' � �'��` Depth to Bedrock 4_I 00 /
Depth to Groundwater: Standing Water in Hole: kliur pff at weeping from Pit Face 44
Estimated Seasonal High Groundwater + 1 3 /
T t GNAT Ol i 'tJR SEASO .AL HIGH ..A.. t t TA L .' :....................... :
Methort
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 A j.Iroundwater Level_
pERCQ .AT. OIY.TEST" Date . .
Time
Observation -41
Hole# Time at 9"
Depth of Perc N �o Time at 6"
Start Pre-soak Time® Time(9"-6")
End Pre-soak
Rate Min./inch Ik
Site Suitability Assessment: Site Passed I Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on Back
Copy: Applicant
. .
DEEP OBSEItATION IIOLE LOG $ode#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Consistency.° Gravel)
Its
7-
,5
T
DEEP OSSERVATTON HOLE LOG Holy
Depth from Soil Horizon Soil Texture Soil Color I Soil I Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Consistency.° Gravel)
_. ..
DEEP. B„ ERVATION HOLE LOO Hole
.
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Consistenev.%Gravel)
DEEP OBSERVATION HOLE LOG Hole#
�.�,�. ..
_.
Depth from Soil Horizon Soil Texture Soil Color -, Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Consistency,° Gravel)
Flood Insurance Rate Map:
Above 500 year flood boundary No ✓ Yes +
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?
If not,what is the depth of naturally occurring pervious material? AlAq
Certification
I certify that on // y (date)I have passed the soil evaluator examination approved by the
Department of Enviro mental Protection and that the above analysis was performe by me consistent with
the required training,expertis nd peri described in 310 CMR 15.017.
Signature Date