HomeMy WebLinkAbout1601 SERVICE ROAD - Health o(��OoZ
SOIL EVALUATOR&PERCOLATION TEST FORM
Page 1 of 4 .
Town ;of Barnstable
i sraMAINUL j Department of Health,Safety,And Environmental Services
�o '� Public Health Division
367 Main Street,Hyannis MA 02601 q
Wee: 508-790-6265
FAX: 308-775-3344
' "1 Assessirlellt for Sewa e l�fs �Osal
SUIT suild ly
ASSESSORS MAP N 11H ,
PWA y
1Z
NO.1ZL`�-
Performed By: Date:
r
Witnessed By:
Location ddress Owner's Name
Lot N: Address,and
Assessor's Map/Parcel: Telephone N
do(0 - 002-
NEW CONSTRUCTION _ REPAIR _
Office Review /
Published Soil Survey Available: No Yes ✓ tZ
Year Published Publication Scale 1,TS My . Soil map unt«t iJ
Drainage Class Soil Limitations
Surficial Geological Report Available: No Yes
Year Published Publication Scale
Geologic Material(Map Unit)
Landform
Flood Insurance Rate Map: /
Above 500 year flood boundary No Yes
Within 500 year boundary . I No Yes
Within 100 year flood boundary No Yes
Wetland Area 4
National Wetland inventory Map.(map unit)
Wetlands Conservancy Program Map(map unit)
Current Water Resource Conditions(USGS): Month
Range: Above Normal Normal Below Normal
Other References Reviewed:
DEP APPROVED FORM--12/07/95
FOWNI I I -SOIL ]EVALUATOR FORM
I
' Yaw, 2 of 3
Location Addressor Lot too.
Oil-site Review
E
s
Deep Hole Number �. , v"�ate:'.��./a���0 Time:"`11�h fW" Weather:b� Sun)
Location (identify on site plan)
TZN V.�12�?e �' ;
1 P .. . j
Land Use VAT '4'! — Slope M Ile; Surface Stones Y
Vegetation V.tvcY%tE
. Landform /V�(LA% JC'
Position on landscape (sketch on the back)
Distances from:
Open Water Body feet Drainage way feet
Possible Wei Area ', 'j feet Property Line feet
Drinking Water Well feet Other
DEEP OBSERVATION HOLE -OG'
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface (Inches) (USDA) (Munsell) Monling (Structure.Stones.soulders•Consistency.$o
• Gravel)
r
a
Parent Material (geologid t)epthtol3edrock:
Mot toGroundwater: 'StandingWater+n the Hole: rWeeping fromPAFace: f
' 4
s'fit rr181ed r ' Yr• S ._
t5easortaCfrf h.G ound- ate f'
I1LP APPRO\E)rok t-2210719$
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FOWNI 11 - SOIL EVALUATOR FORM
I'agc 2 of 3
Location Address or Lot 140. L-CT- Z 15�\t\C'e
On-site Review
"0 z VN
Deep Hole Number R(ifjDate:. �9r1 Ti M me: :;LZ L Weather 65 r�
Location (identify on site plan)Land Use VAr A-t%t7j Slope (°lo) 15 Surface Stones
Vegetation
Lendform /tl&0n�P /I-v-kc
'Position on landscape(sketch on the back)
Distances from:
Open Water Body feet Drainage way feet
Possible Wei Area feet Property Line feet
Drinking Water Well feet Other
DEEP OBSERVATION HOLE -OG*
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface (inches) (USDA) (Munsell) Mottling (Structure.Stones.Boulders.Consistency. %
• Grave,)
p
� 5
5 36
35 ►OYN16 h
t�6 K `I
PC` I-CL
DIES RiQUIRLDX-T ARLA
°=Parent Material 10eolopicl Mpthto8edrock:
Death ta.G.oundwater: ,:StandinDVJater,ntf►eHok: WeepinahomPaFace:
��w�ttrmeted SeasonatjJ•IiDA GrounOlRatef. � r - �,
L
VLP ArPROf E)FOWN11-1210745
FORM 11 - SOIL LVALUATOR FORM
Page 3 of 3
Location Address or Lot No.
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 ...:............... feet
Index Well Number .................. Reading Date .................. Index well level ........... ..
Adjustment factor ................... Adjusted ground water level ......�f ------....................
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 A/UV ��� (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 l Date It
DEP APPROVED FDK%l-12107195
I
J FORM 12 - PERCOLATION
1
Location Address'or Lot No.
COMMONWEALTH OF MASSACHUSETTS
Massachusetts
Percolation Test' '
. ate. ._.:_..:....:...:.. . Time:
-Observation Hole # •
Depth of Perc
e, 't TaP e 41
Start Pre-soak
End Pre-soak
Time at 12"
Time at 9"
Time at 6"
Time (9"-6")
Rate Min./Inch �Z (ivN
Minimum of 1 percolation test mlurzt he performed in both the primary area AND
reserve area.
Site Passed LIB Site Failed ❑
..............................................................................................:..........................................•._.--..._
Performed By: of tN v4 -t> LE
Witnessed By: so A-)
comments:
F
DFP APPROVED FORM-U107/95