HomeMy WebLinkAbout0058 RUE MICHELE - Health Rue Michele
Barnstable
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Town of Barnstable pit /0
�y�' Department of Regulatory Services
33�_0 �! „� : Public Health Division Date
i, 639.��� 200 Main Street,Hyannis MA 02601
Date Scheduled Time Fee Pd.
Soil Suitability Assessment fog- Sewage Disposal
Performed By: M 101r- W
itnessed By:
LOCATION&GENERAL INFORMATION
Location Address � � Owner's Name
Address 4�! f S6 /2ve !�►��H6�E
Assessor's Map/Parcel: /'+�S, a�7/pnrt c -72/7/' Engineer's Name 1- 5L Ge�Q--P.
NEW CONSTRUCTION REPAIR Telephone# 67&g--77$
Land Use P'l 5 fv r L Slopes(4b) z2 —3 rm Surface Stones N�
Distances from: Open Water Body 71>0a ft Possible Wet Area 1 S'o p ft Drinking Water Well 2 t ft
Drainage Way NA ft Property Line d ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
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� RNLI . .�C�°�r��fr,�✓r- ��s '
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Parent material(geologic) QtA.1,01 L Depth to Bedrock NA
Depth to Groundwater. Standing Water in Hole: /✓'q Weeping from Pit Face
Estimated Seasonal High Groundwater I, a
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used: _D15wt+ OF rfcx-E
Depth Observed standing in obs.hole: in. Depth to soil mottles:
Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft.
Index Well# Reading Date: Index Well level Adi,factor -.� Adj.ftroundwnter Level
/�b$er PERCOLATION TEST' Date 'r1it1C
_.. V \'dti Un = _<
Hole# Time at 9"
Depth of Pere
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Time at 6,.
Start Pre-soak Time @ Time(9"•6")
End Pre-soak
Rate MtnJlnch y
Site Suitability Assessment: Site Passed /` Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on Back-----------
***If percolation test is to be conducted within 100'of wetland,you must first notify the
Barnstable Conservation Division at least one(1) week prior to beginning.
` , /„ Q:ISEPTIMERCFORM.DOC
DEEP OBSERVATION HOLE LOG Hole# /
Depth from Soil Horizon Soil Texture Soil Color Soil. Other t
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders.
Consistency.% rave J
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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,Boulders.
Consistency.%Gravel)
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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,Boulders.
Consi to c Gravel)-
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders-
Consistency,
Flood Insurance Rate May:
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? N e -- I
If not,what is the depth of naturally occurring pervious material? r._
Certification
• t on / 0 Z. (date)I have passed the soil evaluator examination approved by the
I certify tha
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 % ` Date
QA$EPTILIFERCFORM.DOC