HomeMy WebLinkAbout0048 WILTON DRIVE - Health (3) �{g Wil,� O)Ve, Cwfeyo-Oc
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U
ul� � Town of u-nstable r u
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Department of health,Safely, and Environmental Services
�"IM '�� Public Health Divisioll Date
Q 367 Main Street,Ilyannis MA 02601 !O d J
HARNSTABLZ
�Ar 1679. Date Scheduled
Ev� v �'ime Fee Pd.
Soil Suitability Assessinent.for Sewage Disposal
I'erfonned By: CWitncsSed By: ` D y L)I0#. kA tU'-4►9 0 1
LOCATION A GENERAL INI+ORMATION
Location Address Owner's Name
Address I _
Assessor's Map/Parcel: - / ^ �G ��`��L Engineer's Name
NEW CONSTRUCTION iEPAIR o� I V I 'telephone H
Land Use 1p!��44-- Slopes(%) rJ- �S Surface Stones
9rL.t�l
Distances from: Open Water Body 1,)�R Il Possible Wet Area _ _III Drinking Water\Srcll fl J
Drainage Way �u IA�II Properly Line '�l Il Other fl
SKE TCI I: (Street name,dimensions of lot,exact locations of lest holes&perc tests,locale wetlands in proximity to holes)
I
1 AJ _
Lor 3 I
r
�14 I 1 t� � r -"o c'+,
Parent material(geologic) C&wk" �1..� Dcpth to Bedrock O A
Depth to Groundwater: Standing Water in Hole: Llm,� Weeping from Pit Pace
Estimated Seasonal Iligh Groundwater _
DIJTEI2IVIINATION:FOR
SLASONAli IIIGII WATER TAI3LI✓
Method Used:
Depth Observed standing in obs.hole: in. Depth to soil mottles: in.
Depth to weeping from side of obs.hole: in. Groundwater Adjustment
_ Index Well H _ _ .. ., Rrading Date: . Index Well level _ Adi.factor Adj.Groundwater Lcvcl _
I'ERCOI,ATION.'I EST fiats
Observation ( Z- fb 1R/►�ll�
I tole 11 'time at 9"
it tl
Depth of Pere 4 Time at 6"
Start Pre-soak'time n Z� - At, Al t
UT
�7
End Pre-soak t
Rate Min./Inch
Site Suitability Assessment: Site Passed Site Failed: Additional Tesliug Needed(Y/N)
Original: Public Health Division Observation hole Data To Be Completed on Back j
Copy: Applicant
DEER 01WERVATiON IIOLL LOG, hole #
Depth from Soil I lorizon Soil Tcxlure Soil Color Soil Other
Surface(in.) (USDA) (Munscll) Mottlin
g (Slruclurc,Slnncs,lknddeics.
-- -- C�isisleilcy,^/Q(irav_cl)
S
16 �_.----- -- ------ --
hk
S
MIFEP Dim: ZVA`I'ION 110/LEILOG Hole 11
Depth from Soil I lorizon Soil Tcxlure Soil Color Soil Olhcr
Surface(in.) (USDA) (Munscll) Mollling (Slruclurc,Stones, Ilouldcres.
Cons islcnc %Gravel
'
Z Lc
L,
llEEI':0118.1 WA`I'ION 110LE LOG
Depth from Soil I lorizon Soil Texlurc Soil Color Soil Olhcr
Surface(in.) (USDA) (Munscll) Mottling (Slructuic,Stones,Ilouldcres.
m�cncv.".�CiravelL—
D + I';,O»SL tVA TION HOLE LOG Ilolc #
Depth from Soil Ilorizon Soil Tcxlure Soil Color Soil Other
Surface(in.) (USDA) (Munscll) Mollling (Slruclurc,Stones, Iloulderes.
Consislcncy—, b(iravcl)
I �
('lood Insurance Rate Maw
Above 500 year flood boundary No _ Yes
Within 500 year boundary No Ycs
Within 100 year flood boundary No '/Ycs
llepth of Naturally Occurriug Pervious M•llerinl
Does at least four feet of naturally occurring pervious ntatcrial exist in all areas observed tluoughorlt Illc
area proposed for the soil absorption system? 'T
If not, What is file dep(h of naturally occurring pervious material?
Certification
I certify that on (date) I have passed the soil evaluator examina(ion 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 CM 15.017,
Signature Date