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HomeMy WebLinkAbout0098 SMITH STREET - Health (2) - � A7 �00 kjV Town of Barnstable P# 9 a. 3 V �Q>v Department of Health,Safety,and Environmental Services Public Health Division Date 367 Main Street,Hyannis MA 02601 0 9ARMAffi$ KASS. Date Scheduled �.�]- Time Fee Pd. ' (,d b Soil Suitability Assessment for Sewage Disposal Performed By: hnA t� Witnessed By: V _.............................................................................................................................................................................. ........................................................................._.....................,........................._..........._................................... LOCATIQN&GENERAL INFUR1YtA 'I4N . Location Address N°;� Owner's Name Address <I$W Assessor's Map/Parcel: 6 L Engineer's Name A, V� "l� NEW CONSTRUCTION REPAIR Telephone# 3(p Z--4 5f-6 c q 6f Land Use �p���[je�Y Slopes(%) l^ ! (a Surface Stones Distances from: Open Water Body A"M ft Possible Wet Area ft Drinking Water Well L�ft Drainage Way © ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) P� A. \,wtl.' � I 4-- At 7 s ► n� �L +� Parent material(geologic) 6.m t� Depth to Bedrock 3� Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater V-s-ex- 9 —Q .......................................................................................................................................................................-......................................................... D TE NATION�'OTt SEASONA :HTGH'V ATEt2 TA ............................................................... ............... . MethodUsed:.::.::.................................................................................................................................................................................................. 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._.__— Mi.factor Adj.Groundwater Level_ PERCO .ATION TEST Hate � � . Observation Hole# Time at 9" Depth of Perc 36 Time at 6" Start Pre-soak Time® '1 Time(9"-6") End Pre-soak Rate Min./Inch L W d Site Suitability Assessment: Site Passed_ Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back Copy: Applicant ^�� �`OCA.J 6 ............ ....... ::::DEEP::OBSERTION HOLE L Dole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.° Gravel) E TOBSERNHQLD tQ: OG Hole Depth from Soil Horizon.; Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.° Gravel) DEEP OBSERVAT-ION HOLE LOG dole p.;.s..:;.....:.:.:........._.:...:.............::::.:...... ._ De th from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.° Gravel) DEEP OBSER` ATION 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 Map 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? If not,what is the depth of naturally occurring pervious material? , Certification I certify that on �ez 9 (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. � G'—O Date ©6 0