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Department of Health,Safety,and Environmental Services
Public Health Division Date—
367 Main Street,Hyannis MA 02601
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Soil Suitability Assessment for Sewage Disposal
Performed By: �"�[ �z% ?a Witnessed By: c-S e e—-
LOCATION &GENE RAL;INFORMATION.'
Location Address So 'T.e lh L Al Owner's Name
Address �escl��st��'i 2/y f4.f7'8
Assessor's Map/Parcel: (AAA)
Engineer's Name C F--e=, /
NEW CONSTRUCTION �� REPAIR � t AAA) Telephone# ,510% 3 98-- �
Land Use Slopes(%) /,5 Surface Stones All,=,
Distances from: Open Water Body 90 ft Possible Wet Area ft Drinking Water Well ft
Drainage Way I'q ft Property Line 6-6' Z It Other ft
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Parent material(geologic) cL r ` C�� Depth to Bedrock All�•
Depth to Groundwater: Standing Water in Hole: /1JC�, 2 < Weeping from Pit Face OLJ ez)
Estimated Seasonal High Groundwater 3 a r
DETWUNATIOldt E:)Io SEASO AI,M-2'rg WATEI'?TI AHLT'
L"e ire l e ver�g jr- u@ L e
Method Used V✓Q��r f
Depth Observed standing in obs.hole: in. Depth to soil mottles: in.
Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft.
Index Well#_ Reading Date:_ Index Well level. Adj.factor Adj.Groundwater Level
PERCOLATION TEST Date.'I ime .
Observation
Hole# Time at 9" s Q 7
Depth of Pere Time at 6" Z:3 `,I—o
Start Pre-soak Time @ l 3 v Time(9"-6") `3^1 f Z, /�cLi Z
End Pre-soak
Rate Min./Inch
Site Suitability Assessment: Site Passed i-" 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 9 .
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
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DEEP OBSERVATION HOLE LO'G Hole#I
Depth from Soil Horizon Soil Texture I Soil Color I Soil Other
Surface(in.) (USDA) (Mansell) Mottline (Structure,Stones,Boulderes.
Consistency.°oGravel)
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;DEEP OBSERVATIONHOLE.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.° Gravel)
Floo Insuranc..e Rath.Man:. K
Above 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? Xe-s
If not,what is the depth of naturally occurring pervious material?
Certification
I certify that on 93 (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 Date i