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Home My WebLink About0260 STRAIGHTWAY - Health (2) S�h'af,�Ei1'ala.ft , FJrlannis r i l 01� a ul 1;aru5lable V ;, _moo 9 ---- ,i� Department of Health,Safety,and Environmental Services Public Health Division Date d 367 Main Street,Hyannis MA 02601 turtt+ar 1° ►''� Date Scheduled Time 1Z 2LA� Fee Pd. zo y Soil Suitability Assessment for Sewage Disposal Performed By: �"' OJA LPt. C-D C- Witnessed By: J'C-ytfL D6,V N11�+G C►'z�►�1) LOCATION & GENERAL INFORMATION :: Location Address Owner's Name A L,z,51�t k e m zn�5 a Address Qvzbz Assessor's Map/Parcel: �. o Engineer's Name ,� ;et C�6 i✓N��►`� NEW CONSTRUCTION f REPAIR Telephone Land Use VR�� Slopes(%) d S Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line hw`}`�'' ft Other ft SKETC H: Street name,dimensions of lot,exact locations of test holes et pere tests,locate wetlands in proximity to holes) ' 1��f� �s . XT1Y p ->H-r �© 16 L "� Tit i 711?- S V, 4. Parent material(geologic) oV-rW N Depth to Bedrock Depth to Groundwater: Standing Water in Hole: N Weeping from Pit Face Estimated Seasonal High Groundwater (VC) �j uNDWA� I.Z T=oV N� DETERMINATION FOR SEASONAL HIGH'VVATER TABLE Method Used: Wo (r-Rall-JDW o vN t7 n. De th to soil morales: In. Depth Observed standing in obs.hole: P ft Depth to weeping from side of obs.hole: in. Groundwater Adjustment el Index Well H_ Reading Date:� Index Well level...___ Adj.factor Adj.Groundwater Le,.. PERCOLATION TEST ' Dili Observation -T-H ITime aE 9" Hole N �✓�� Depth of Perc — Time at 6" Start Pre-soak Time® 0110-0 Time(r-61 End Pre-soak Rate Min./Inch Site Suitability Assessment: Site Passed ✓ Site Felled: Additional Testing Needed(Y/1� Original: Public Health Division Observation Hole Data To Be Completed on Back--� Copy: Applicant 116 # Uh,I,P OIISI:ItVA'1'ION 10 0LOG Snil other Soil Soil Color Structure,Stones,noulderts. 1)cpllt from Soil Ilorizon (Munsell) Mottling ( • (USDA) Surface(in.) sL 7, G G r YJ' 3 $ -2� Any �,AND 1�0 IC# UCCI' 0 SE,RVATI N 1I01A L0 soil otherli Soil Texture Soil Color Structure,Stones,Doulderes. Depth from Soil I lorizon (USDA) (Munsell) mottling Surface(In.) (�A � �L -7 �j L 3 dole# Url;l' OIISERVATION ROLE LING son Other Soil Texture Soil Color Stru,4-ire,Stones,[louldercs. Depth from Soil Ilorizon (Munsell) Mottling ( • (USDA) Surface(in.) . ` . 110IC# llGCI',013S1;ItVAT10N lIOLE LOC Soil other L(USDA) xture Soil color I)cpth from 4. Soil I lorizon (Munsell) Mottling (Slntclurc,Stogy es,Iloulderes. surface(in.) �lo0 1��nsuraticp R9tc lYl�i 250c'n 1 ObU$�7 vas C P/v Above 500 year flood boundary Nod .��... ._ • ` No • Yes "— Within s00 year boundary Within too year flood boundary No_ Yes - _ • �.t ( ` t all O rrrfn•,P rvlousNtal�thl._ • _ - •-�-• pervious material exist in all areas observed throughout the Does at least four feet of naturally occurring p Q area proposed for the soil absorption system? G if not,what is the depth of naturally occurring pervious materiel? I certify that on examin Ion approved by the and that DY� ! (date)I have stl a aboveianalysis twas performed by me consistent with Department of Environmental Protection it llic requilyd training,expertise and experience described in 310 CMR 15.017.