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Town of Barnstable P
Department of Health,Safety,and Environmental Services
�09 Public Health Division Date
367 Main Street,Hyannis MA 02601
RARNaTABIA
MA99.
�ArFD 1Mt�`� Date Scheduled ��. I�' — `� Time )/� Fee Pd.,l `<
Soil Suitability Assessment for Sewage Disposal
Performed By: GUIV 0% /Orley/iyG�; Witnessed By:
LOCATION&'GENI';RAL INFORMATION
Location Address 4_% a L A t 4 6 �) Z� Owner's Name
Address
Assessor's Map/Parcel: Z'4-, - 1 f S/ Engineer's Name eqlz%/y s �oWe, 1`4r
NEW CONSTRUCTION V' REPAIR Telephone#
Land Use Slopes(%) D' 3 Surface Stones /L1
Distances from: Open Water Body N/� ft Possible Wet Area It Drinking Water Well
Drainage Way Mill 11 Property Line R' Other Il
SKETCH:(Street name,dimensions f lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes)
t,r�ll
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L/
9b a
f
o
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Parent material(geologic) Depth to Bedrock
Depth to Groundwater: Standing Water in Hole: dr/f,**ff Weeping from Pit Face
' 1
Estimated Seasonal High Groundwater N �V [411,e leil,
DETMINATION�`OIt SEASONAT�HIGI�'VVATEIt TABLE
ER
Method Used lrvun�aa COrlfDvh/'/aj�
Depth Observed standing in obs:hole: /Y/101- in. Depth to soil mottles: in.
Depth to weeping from side of obs.hole: I%AII in. Groundwater Adjustment (t•
Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level_
PERCOLATION::>TEST: Hate i9 9�'l ime
re�e f errcr✓ /'-88��
Observation
Hole# Time at 9"
Depth of Perc Time at 6"
Start Pre-soak Time Q Time(9%6")
End Pre-soak
Rate Min./inch
Site Suitability Assessment: Site Passed_� Site Failed: Additional Testing Needed(Y/N)
Original:.Public Health Division Observation Hole Data To Be Completed on Back_j
Copy: Applicant
I
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)
Fhcr b It
/¢ 9.► lcrr /D Y4 61F b le
lr,1 ooa /oyR Y/b �ncrble
a� IWver os!f /o°lo
msi eW-)Av 000eyE
/a y2 46" — Lase
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)
I ;
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color 1 ..Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Consi'stency.%Gravel) .
j
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nS,ii
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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)
Flood Insurance Rate Maw
Above 500 year flood boundary No— Yes V
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
urea proposed for the soil absorption system? e5
If not,what is the depth of naturally occurring pervious material?
Certification
I certify that on lOZ75 (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.
Date
Signature _