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HomeMy WebLinkAbout1200 OLD STAGE ROAD - Health Iaov oLc� s+r. Ko rz-� I�13 � v /va t Town Of 11111,I)sta>tble I'# �---- Department of llealth,Safety,and Environmental Services — �1� Public Health Division Date 367 Main Street,Hyannis MA 02601 aARNFRARES, NAM °rEo 116 Date Scheduled — 7 TimeJL\9— Fee Pd. l00 Soil Suitability Assessment for Sewage Disposal - dfl l/�� Witnessed By: Se- !±: ' Performed By: �u/a�\�� `7 LOCATION &GENERA INFORMATION n Owner's Name C1r/73 y-C/lq�L'j Location Address ' � �O 6 (Or- �'�' Address R p.edX 6 ­� O a4 3a Assessor's Map/Parcel: 3 (Do°� Fj© Engineer's Name NEW CONSTRUCTION s/ REPAIR Telephone# On7D CA-0 frV c7vrV- �j` i'.'.: Slopes(%) l0• •� Surface Stones I'ID rl e Land Use Distances from: Open Water Body ti//i2 R Possible Wet Area 3 R..Drinking Water Well R Property Line 3v n Other — R Drainage Way A/_ f__,/�_ p -- SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) i A� a I 9t . C-i.5thrnrG 0 O 35r oo� Parent material(geologic) n,7"i 4nh 04—7 Depth to Bedrock Depth to Groundwater: Standing Water in Ilole: Weeping from Pit Face Estimated Seasonal Iligh Groundwater .30 0b, 17-e Fier - 5�1 MuXG•w. llCTLIlMINATIONTOlt SEASONAL:HIGII-WA'I'EItTABLE Method Used: C tyuc,c4&y4rr (Lc imuf`� Depth Observed standing in obs.liole: A1I� in. Dept in to so mottles:h soil ttles: ��� Depth to weeping from side of obs.hole: �//I� in. Groundwater Adjustment R• Index Well# _ •Reading Date: index Well level _ Adj.factor Adj.GroundwaterLevel rc°vrovS PpKTPsr5 r-OP7 iYrcr� SP $ �' lrow o-Ae ro ' I)I♦Jl2.COLATION'I'ES'r DAIp � 9.Tlrne /10 wcrter l/3eca/ 04v& 7'6 .5o11/S 7,V e- Observation Time at 9" Bole# /-'p2 _ Depth of Pcrc 'rime at 6" nimi Me.xonk'rime(a Time(9"-6") ' End Pre-sonk Rate Min./Inch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back---� Copy: Applicant I)EEP OBSERVATION;HOLV LOG Hole# L Depth from Soil Ilorizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. % p-� ArLnua.yS¢ti iornY/ Ghabl� of din d Z08-/��' Gv� *��o.'e-1 -DEEP OBSERVATION HOLE LOG Hole:# . : Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. % a- q ow rho offer' Y/� 7 Syi? 6/ L,�ose DEEP.0 SEIZVA 'ION IIOLE'LOG ''Mole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. i ° 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 Man: Above 500 year flood boundary No_ Yes c"f 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? lyGS If not,what is the depth of naturally occurring pervious material? Certification I certify that on e GT7 (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 A Date