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Town of Barnstable P# o
0 R I G I N A L Department of Health,Safety,and Environmental Services
"we Public Health Division Date
367 Main Street,Hyannis MA 02601
Date Scheduled 'A"LAA, 1:3 Time Fee Pd. ce_C>_0
Soil Suitability Assessment for Sewage Disposal
Performed By: ,7, Witnessed By:
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TDCATIQN,&GENERAU INFORMA !���
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Owner's Name 0 0--h,%�_T%i
Location Address LJAI_
Address
Assess or's Map/Parcel: _ZXZ— Engineer's Name STEPHEN J. DOYLE & A SOC.
42 Canterbury Lane
NEW CONSTRUCTION East Falmouth, MA 02$36
REPAIR Telephone 508/546-2543
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Land Use Slopes(1/o) Z�/(. Surface Stones
Distances from: Open Water Body ft Possible Wet Area fit Drinking Water Well ft
Drainage Way ft Property Line �O 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) Depth to Bedrock
Depth to Groundwater: Standing Water in Hole: VVA Weeping from Pit Face
Estimated Seasonal High Groundwater
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........:....���DE TE....R. I- .....�........O-..N.FOR:S.E....A.....S O.....N. AL. HIGHMATER.Z...A.....B....L E
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Method Used: 1= J4 v 6-Tf::A L
Depth Observed standing in obs.hole: in. Depth to soil mottles: in.
Depth to weeping from side of obs.hole: in. Groundwater Adjustment ',AIA ft.
Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level
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............ ...................... ........ PERCOLATION
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Date313 Time
XX. ......
Observation
Hole# Time at 9" 1 3 3
Depth of Perc :54,�e Time at 6" 3b Ll.
Start Pre-soak Time @ 17[,-4,> Time(9'-6") 15-h1'" 4 Kk
End Pre-soak 1D:0C>
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 LO.G Hole
Depth from Soil Horizon Soil Texture Soil Color Soil er
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Consistency.° Gravel)
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DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil er
Surface(in) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Consistency.°o ravel
St— —PLO ��ti►.C.�
Co wrS
DEEP OBSERVATION HOLE LO,G Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
C n isten °o ravel
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(m.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Consistency.%Gra el
Flood Insurance Rate Map: l.�MISYiAbove 500 500 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?
Certification
I certify that on k(kCk 5 (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 required training,expertise and experience described in 310 CMR 15.017.
Signature ��1��\J��-- Date j1-019