HomeMy WebLinkAbout0103 LONG POND CIRCLE - Health (3) G"��� Comte J),
Town of Barnstable P#
Department of Health,Safety,and Environmental Servwes
�V6 Public Health Division Date l qq
367 Main Street,I lyannis MA 02601
SAIWSfASM ..
° 0 Date Scheduled A Time_ ()� Fee Pd. `C70,y O
Soil Suitability Assessment for Sewage Disposal
Performed By: 71.4����� �Q h % e..& t' Witnessed By: Pei- K ti C r q n d i*
LOCATION a GENERAL INFORMATION
Location Address ,0_5LcytPA-ld L.G Owner's Name 5ju e4l �(
l Address
Assessor's Map/Parcel: aped Engineer's NameoQ� -�
NEW CONSTRUCTION REPAIR f✓ Te!cp� c# �77-72�'21 i
Land Use /-/s . Slopes(%) Surface Stones
Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft
Drainage Way ft Property Line ft Other ft
SKETCH:(Street n me,dimensions of lot,exact locations of test holes&pere tests,locate wetlands in proximity to holes)
Parent material(geologic) Depth to Bedrock
Vepth to Groundwater: Standing Water in Hole: Weeping from Pit Face
Estimated Seasonal High Groundwater
I•JTERMINATtON F OR>SEASONAL HIG" WATER.TABLE
Method Used:
Depth to weeping from side of obs.hole: in. 'Groundwater Adjustment ft.
Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level_
PIERCOLATION TEST. 'Date < : 'Time
Observation
Hole# Time at 9"
Depth of Perc 6 �I Time at 6"
Start Pre-soak Time @ •�'� Time(9"-6")
End Pre-soak ' SY
Rate Min./Inch `
i
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 Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Consistency.° Gravel)
l�Y/Z
w
r.
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)
DEEP OBSERVATION HOLE LOG : : Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Consistency.°o Gravel)
DEEP OBSERVATION MOLE LOG Hole#
Depth from Soil Ilorizon Soil Texturc Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Stricture,Stones,Boulderes.
Consistency.°o ravel
I
Flood Insurance Rate Map:
Above 500 year flood hcundary No_ Yes
Within 500 year boundary No f/ 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
1 certify that on �S� (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, ertisseee and experience described in 310 CMR.15.017.
Signature G�=�`�f g Date S"' 7— Imo- rj'