HomeMy WebLinkAbout4352 MAIN ST./RTE 6A(BARN.) - Health GA-
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No. 4210 1/3 BLU
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Town of Barnstable P a 1
Department of Health,Safety,and Environmental Services
Public Health.Division Date
Q. 367 Main Street,Hyannis MA 02601 ,
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f6J� `lfo /nuct Date Scheduled Time Fee Pd.
Soil Suitability Assessment for Sewage Disposal'
PerformedBy:�OA,�tCE Witnessed By:-ZDAht/r} 'JIQt2t13TAIGLE 10 H
` I•�OCATIpN& �E�1ER�L INFORIV,[AT�N
Location Address cS7"RE� °er's Name ���•� f E��e y
I Address
Assessor's Map/Parcel' j�M 3 SG/I/4(�C��� O�a Engineer's Name P"J. SW EFE YSr-,f
NEW CONSTRUCTION REPAIR X Telephone# 56b "a -65-3 q
Land Use •)rk)T►A L Slopes(%) Surface Stones
Distances from: Open Water Body R Possible Wet Area.:.N 1 ,R Drinking Water Well
Drainage Way N A R Prope y Line R Other N/ R
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
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Parent material(geologic) ldl`►1 ZV ER. 4'0)qA y(0406E -114U Depth to Bedrock
Depth to Groundwater: Standing Water in Hole: NA Weeping from Pit Face
Estimated Seasonal High Groundwater /
bETIATYO1�ttJltASOALT'UVAT : >> >:
Method Used:
Depth Observed standing in obs.hole: in. Depth to soil mottles: in.
Depth to weeping from side of As.hole: in. Groundwater Adjustment R.
.-Index Well# 'Reading Date:- Index Well level __ Aill.factor Adj.Groundwater Level_
PERC.o -A,Ti+(Il�t TEST :< ate rltue`f _
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Observation �1��OtJ
Hole# ' Time at 9" al� as 9S.;19 �.
Depth of Pere 7J t -84 Time at 6" 5&. S 6 3:
Start Pre-soak Time® o,0G d: 0b Time(9"-6") R•33 3
End Pre-soak /5,00 15,00
Rate Min./inch �V $+' a•�7
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
Conv: Aoalicant
_. . ..
Depthm fro Soil I lorizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) I Mottling (Structure,Stones,Doulderes.
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154unYkOIA4 10V A1 3 rZrR6E
S;WDY 4PIM 10VA/y I (iLE
16 It Ct Nolum S4Nn /61C G (, l� LaosE
�5-c 4 6N9 SAS loy2 7 3 Fkjera E
5G-ISIn`I C3 Aq ROE51, /0Ye 7/3 &6E w AS-300/
GenvE�COWS SroOE5 i1Hf6Ct5
DEEP OBSERVATIOON�IOLIJ LOG
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Depth from Soil Ilorizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Doulderes.
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SANDY LA �Dy�```/� FiIAALF
la n b SAMD-! AoaM asY 7 Fie—)p14>F
J6—IV41 el M/MEDIUM'S1►Nb IaZy � ��SE
yy— Jd,'t C� rYJA4 S'ibJfl 017 S a ^leiAs1-F-
DI ' I#SRA7'1( N Yob' . L.00 ole#'
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Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Doulderes.
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DEEP OIISMATION IIOLE LOG Hale #'
r. ... ...:....>........ . :.:..:. ... ::: ..... .. . .,.
(y Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Doulderes.
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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 througliout the
area proposed for the soil absorption system? YF S
If not,what is the depth of naturally occurring pervious material?
Certification
I certify that on OV 3G )`'33 (date)I have passed the soil evaluator examination approved by the
Department of Environmental and that the above analysis was performed by me consistent with
the require�ig,expe 'se a#d exp fence described in 310 CMR 15.017. ,
Signature . ���e Date �/
TOWN OF IARNSTABLE
�'' ..SEWAGE #
VILLAGE ASSESSOR'S, MAP.& LOT
INSTALLER'S NAME & PHONE NO.�I�� z-,*� ^ 1-3 .3-
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SEPTIC TANK.CAPACITY
' LEACHING FACILITY:(t ) 4E
"NO. OF BEDROOMS � PRIVATE WEI:1?OR PUBLIC-WATER
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BUILDER OR OWNER � �h- d ®�7 e�.✓ J ,,a,
DATE PERMIT ISSUED: .!/
DATE • COMPLIANCE ISSUED: /- 0 .
VARIANCE GRANTED: Yes No
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L0'CATI 'ON SEWAGE PERMIT N0.
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VILLAGE
INSTALLER NAME & ADDRESS
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D U I L 0 E R OR OWNER
DATE PERMIT ISSUED
DATE _ COMPLIANCE ISSUED _lysFd
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` LOCQ,TIoKI Yjell, rye. SEW&CAE PERMIT UO.
IMS-TQLL R 51 Mo ADDRESS I
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BUILDER 5 Q &V AE ADDRESS
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DNTE PERKA T 155U:.E6 —
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D, .TE COKAPLI &QCE' ISSUED : � �!
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