HomeMy WebLinkAbout0076 PLEASANT PINES AVE - Health (3) C� rieci'molt ela� N.e - - -M
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SOIL EVALUATOR&PERCOLATION TEST FORMS
THE�o� Town of Barnstable Page 1 of 4
BAR NSrABLE. Department of Health, Safety, and Environmental Services
9 MASS.
0.191. Public Health Division
367 Main Street,Hyannis MA 02601
Office: 508-790-6265
FAX: 508-775-3344
Soil Suitability Assessment for Semwe Disposal
NO. 7" Date:
Performed By: Date: '
Witnessed By: �a����i�i
Location Address Owner's Name
Lot#: Address,and
Assessor's Map/Parcel: ?�v j/����' Telephone#
NEW CONSTRUCTION !� REPAIR
Office Review
Published Soil Survey Available: No Yes
Year Published Publication Scale Soil map unit
Drainage Class ,,
,Zk;y �o!✓ , Soil Limitations
Surficial Geological Report Available: No Yes !/
Year Published /f-0"a Publication Scale
Geologic Material(Map Unit)
Landform
Flood Insurance Rate Map: /
Above 500 year flood boundary No Yes
Within 500 year boundary No Yes
Within 100 year flood boundary No Yes
Wetland Area:
National Wetland Inventory Map(map unit)
Wetlands Conservancy Program Map(map unit)
Current Water Resource Conditions(USGS): Month
Range: Above Normal V Normal Below Normal
Other References Reviewed:
DEP APPROVED FORM-12/07/95
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FORM 11 - S011, I;VAI,UATOR FORM
Page 2 of 4
Location Address or Lot No. lvt �-Z �e4;S-av2
On-site Review
Deep Hole Number Z Date: Time: 12,/s Weather
Location (identify on site plan) -
Land,Use" Slope (%) 3 Surface Stones
Vegetation
Landform �Aihf ���� P�i•� ,O�oS"i �`S . : . . ..
Position on landscape (sketch on the back) �,� , �i'�c;�, �;"'•
Distances from:
Open Water Body /U feet Drainage way feet
Possible Wet Area feet Property Line,>2-.a feet
Drinking Water Well Other
DEEP OBSERVATION HOLE LOG*
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(inches) (USDA) (Munsell) Mottling (Structure, Stones, Boulders, Consistency, %
Gravel)
Tff#Z
A,
MINIMUM OF RED AT EVERY PRC - - - NL AREA
Parent Material (geologic) DepthtoBedrock: I ���
Depth to Groundwater: Standing Water in the Hole: A4.7 I, Weeping from Pit Face:
Estimated Seasonal High Ground Water: >/:"�?
DE:P APPROVED FORM" 12/07/95
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FORM 11 - SOIL LVALLIATOIt FORM
Page 3 of 4
Location Address or Lot No. Hof J
Determination for Seasonal High Water Table
Method Used:
❑ Depth observed standing in observation hole ........ inches
❑ Depth weeping from side of observation hole ... inches
❑ Depth to soil mottles inches
❑ Ground water adjustment .............I..... feet
Index Well Number ..... ..... Reading Date .................. Index well level .
Adjustment factor Adjusted ground water level ..... .. ... . . . . ..... . .
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? yPS
If not, what is the depth of naturally occurring pervious material?
Certification
I certify that on (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 J2-� Date
DEP APPROVED FORM- 12/07/95
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FORM 12 - PERCOLATION TEST
�JPage 4 of 4
Location Address or Lot
COMMONWEALTH OF MASSACHUSETTS
Massachusetts
Percolation Test*
Date: Time:,
Observation Hole #
Depth of Perc .
Start Pre-soak
End Pre-soak /sue,/;
Time at 12"
Time at 9"
Time at 6"
Time (9"-6")
Rate Min./Inch
Minimum of 1 percolation test must be performed in both the primary area AND
reserve
area.
SitePassed Site Failed 0..........................................................................................:.........................................._.._..............._
Performed By: ��-
Witnessed By: /�v��—�rv'l
Comments: .::.........:. ........ . . . .............. .. ..... ........................._.......,........r..................,....�..�,.�...,,,,.,�.,w..._.,......
DEP APPROVED FORM-12/07/95