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Town of Barnstable P# YY 4o f�
Department of Health,Safety,and Environmental Services
Public Health Division Date
367 Main Street,Hyannis MA 02601
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Date Scheduled / le,, 27 Time Il AA Fee Pd.
+ Soil Suitability Assessment for Sewage Disposal
Performed By: �41z7 ltrr, T 0���P Witnessed By:
Ltd► A'TIbN & �GEI�I�RA INVb1�tA�`tl�l�t
Location Address Gp7r-- 3 Owner's Name ! �W r P-
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�, �� Address
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Assessor's Map/Parcel: I' 1, '— b ° Engineer's Name G°Q Y� T ,boy/e
NEW CONSTRUCTION A REPAIR Telephone# f( —Y,777S
Land Use Gl0 &_e6 Slopes(%) 0"3 0/0 Surface Stones
Distances from: Open Water Body It Possible Wet Area__&/�ft Drinking Water Well ft
Drainage Way ,Ak1,052 ft Property Line ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands in proximity to holes)
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Parent material(geologic) BUTLr/ I , 10/r j Depth to Bedrock N/iA
Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face /Y/#
Estimated Seasonal High Groundwater 30 I:t Q ITL 7T2 Ole— Co n 161 V I_5 1074tjo
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bETE1NATtbI'�i 'OY SEA50A . T'VVATEIt;TAE
Method Used:
Depth Observed standing in obs.hole: /¢ in. Depth to soil mottles: Nlf74 in.
Depth to weeping from side of obs.hole: &I N in. Groundwater Adjustment ft.
Index Well# Reading Date: Index Weli ievei Adj.actor P.dj.Groundwater Level
PERCOLATtOIi TEST Hate Time
Observation
Hole# Time at 9"
Depth of Perc ,��/1`g6 wr Time at 6"
Start Pre-soak Time @ Time(9"-6")
End Pre-soak
Rate Min./Inch G e SOi�S
Site Suitability Assessment: Site Passed _ Site Failed: Additional Testing Needed(Y/N) N
Original: Public Health Division Observation Hole Data To Be Completed on Back--�
Copy: Applicant
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DEEP OB'S ........
..... ........-ERVATI+b1�1 IIOYE LOG Mole# ..
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling Structure,Stones,Boulderes.
%
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96 0 G Abe PclA, 101 y/" /0 ose-
DEEP OBSERVATION HOLE LOG Hole#;
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling Structure,Stones,Boulderes.
%
llEE> OBSERVATION IiOE LOB dole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling Structure,Stones,Boulderes.
%
DEEP OBSERVATIOI'd HOLE LC1G Hole#
Depth1. from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Stricture,Stones,Boulderes.
%
i
;DEEP OBSERVATION HOLE LdO I �nle
.
Depth from I Soil Horizon Soil Texture I Soil Color ( Soil I Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
%