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Department of Health,Safety,and Environmental Services
Public Health Division Date
367 Main Street,Hyannis MA MARMANA
NAM
ON Date Scheduled Time Fee Pd. LQa
Soil Suitability Assessment for Sewage Disposal
Witnessed By:
Performed By: BAN 1E�-
LOCATION & GENERAL INFORMATION ':
PORMAT3O �- �>
Location Address L—c)l- 5 .N1%N'Sv tJ I.AN�
—?r4 RN 9 j?1v I.-C woo D5 SQZ*-1)v• Address 5�,V P1Nrc s i• • W r'�
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EngineersName 1:ow. J c-A m— ehf(,\N
Assessor's Map/Percel: 1-1 LA /—j, x QJ l ¢-1-r-
NEW CONSTRUCTION ✓ REPAIR I r Ion/ua� Telephone N6p$•362 ' `l5H
Land Use
t WVOb1(i Slopes(%) C,'— 2-0 Surface Stones
V h-r;�rs_/
It possible Wet Area - ft Drinking Water Well
Distances from: Open Water Body ft
R Property Line It Other ft
Drainage WRY
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
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115. 7ti
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Parent material(geologic) QSM r7ANDMZ- �'�' Depth to Bedrock wR
Depth to Groundwater: Standing Water in Hole:
Weeping from Pit Face '—
Estimated Seasonal High Groundwater
r- n/�iA• (Va ��N'Dw7�-i�l'L �cVN ,7
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DETERMINATION FOR SEASONAI HIGH WATER TABLE
Method Used: In.
In. Depth to soil mottles: n
Depth Observed standing in obs.hole: in. Groundwater Adjustment
Depth to weeping from side or.
hole'ndex Well Adj.factor Adj.Groundwater level
Index Well 0__.._.. •Reading Dale: level...___PERCOLATION TEST 1Drte' 'iL=1 1ltni:: '�o
Observation "i'H 2 Time at 9" —_--
Hole p
n "
Depth of Pere e�6 _ Time at(i
Sleet Pre-soak Time Q rn
Time(9"76)
End Pre-soak cJ
Rate Min./lnch LZ hn,H/i"`
" Site Felled: Additional Testing Needed(Y/N)
Site Suitability Assessment: Site Passed
Original: Public Ilealth Division Observation Hole Data To Be Completed on Back--�
Copy: Applicant
LdG Ilole#�-�
I)Ir,LP 01151�,ItVA'1'IUN 1IOLr son oQ,cr
Soil'1'cxlure soil color
FI)Cpl�lh front Soil I lorizun (USDA) (Munsell)
Mottling (Structure.Stones,pouldercs.
Surface(in.)
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olio
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UCCI' OBSERVATION II So LClO sou other
Soil Texturc ( Color Mottling (Structure,Stones,Doulderes.
Ucpih from Soil I lorizon (USDA) (Munsell)
Surface(In.)
0
0-1- w•a.-
S- 1/b k5 A�oovt
3
1, S 1--4y
y.�'711,J --------------
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UI 1;1' OIISCItVATION IIOLC Lt�O;.:... sou other
Soil Texture Soil Color
Depth from Soil I lorizon (USDA) (Munsell) Mottling (Struclure,Stones.Douldercs.
surface(In.)
GC I' 013SCRVA'I'ION IIULC LOG 7 it
U Soil Other
Soil Texture Soil Color
Ucput from Soil i lorizon (USDA) (Munsell) Mottling (Stntclurc,Stones-Dotdd� ens
Surface(In.)
r
FJ�1lI1lL1SLCD1I��R'
bound No Yes
Above 500 year flood �Y
Within s00 year boundary No Yes,
✓
Within 100 year flood boundary No_,__ Yes -
-•�-�•rrally O urrino Perms viou�1Vl�terial
served throughout the
Does at least
four feet of naturally occurring pervious material exist in all areas ob
area proposed for the soil absorption system?
If not,what is the depth of naturally occurring pervious material?
proved by the
I certify lltal on
QU 15- (date)I have passed file soil evaluator examination Op
IV
Department of Environmental Protection and that the aboalysis CMR I Ss0)performed by me consistent Willi
rtin rermired Ir expertise and rxr�crience described in 310