HomeMy WebLinkAbout0025 WOODBURY AVENUE - Health ,�. 25 Woodbury
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Town of B kmsta.ble. P# 11 ,713
Department of Regulatory Services •
• Date
Public Health Division
200 Main Street,Hyannis MA 02601
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Fee Pd.
Date Scheduled �v / 'Time
,foil Suitability Assessment for Sewage Disposal
Performed By: Witnessed By:
I-
LOCATION&GENERAL INFORMATION
Location Address'. //u�, Owner's Name r j ewv )c 1101 6 TY
.�� / L�✓ oue i Address G �� 0
Assessor's Map/P4rce1: :3 Q Engineer's Nam 1 ht .0•r'f / S
:NEW CONSTRUj.'l'10N REPAM j Telephone# 6-0 -.2- ,M74 �L°74 ,
71fl-W
Land Use S CB[.GL�i�7GC.I Slopes M ��'y Surface Stones �LOyI IP
Distances from: Open Water Body. ft Possible Wet Area ft Drinking Water Well ft
Drainage Way ft. Property Line __10_ft Other ft
i
SKETCH:($treet name,dimensions of lot,exact locations of test holes&Pere tests,locate wetlands in proxitnity to holes)
. GUooq'�er� /�res�y� •
7o' "�
V4,2-
s ,
/D
i
-70 f
Parent material(gedlogic) IL G a Off' "a-" 1 1 Depth to Bedtoek _
I W in from Pit Face
Depth to GroundwaWr. Standing Water in Hole eeP g
Estimated Seasonal high Groundwater i
ntTER TION FOR SEASONAL HIGH WATER TOLE
Method Used: y
��LrT.,,�� In
Depth db�aved standing in obs.hole: � in. Depth to soil mottles:
Depth toiweeping from side of obs. ole /9 ey t in. amundwitter Adjpiment f .
„ A .fhetor . Adj.droundwattr l evel—Z
htdex Well# Reading Date: index Well level i
Z
PERCOLATION TEST Date
Observation Time at 9"
/
Hole# i } -" �•
Time at6"
Depth of Perc —�-1-- .
start Pre-soak Time.@ (fit - p+A1End Pre-soak
CP jz 7 -
RateMinJlnch n t '
Site Suitability AsscosmenG Site Passed
Site Failed: Additional Testing Needed(Y/N)
OriginnL•.Public Health Division `
Observation
Hole Data To Be Completed on Back
***If percola ibn test is to be conducted within 100'of wetland,You mast first notify the
Barnstable C lservation Division at least one(1)weck prior to beginning•
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistenev.%Gravel)
/Z 14 , L: /14 Z�2 /11
)10
7.
44 G 1X0
DEEP OBSERVATION HOLE LOG Hole# 2--
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistencv.%Gravel)
• gyp '` SG U Z��
, S S-t/
DEEP OBSERVATION HOLE LOG Hole#
Depth from' Soil Horizon Soil Texture Soil Color Soil • Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistenev. Gravel)
DEEP OBSERVATION BOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,%QMvell
f �
0
Flood Insurance Rate May:
- r Above 500 year flood boundary No_ Yes
Within 500 year boundary No'' Yes
Within 100 year flood boundary No—Z Yes
Depth of Naturally Occurrinz 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? —� g
If not,what is the depth of naturally occurring pervious material?
Certification
I certify that on NOV IZZ4 (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 trainin , xpertiis/se//and expert ce described in 3.10 CUR 15.017.
Signature t/ Date 5
Q:%EPTICIPERCFORM.DOC
it
TOWN OF BARNSTABLE
LO^ NA)IATION aft` SEWAGE# 9007'a 30
Vh LAGE ASSESSORS MAP&PARCEL
INSTALLERS NAME&PHONE NO. � � —�/ap-t/��3 y
SEPTIC TANK CAPACITY �M A)P
LEACHING FACILITY:(type) q jt1kA i'e (size) G A i�h xd 67
NO.OF BEDROOMS
OWNER.
PERMIT DATE: COMPLIANCE DATE: LS
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
FURNISHED BY
Ai - -22
d
-G9� V
31'
� 02
57 �.
5.=57`
G- 17 �
7- z5'
96 T'
TOWN OF BARNSTABLE
LOCATION ov SEWAGE #
VILLAGE ASSESSOR'S MAP & LOT 1
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY l O 00
LEACHING FACILITY: (type) (size)
NO. OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: COMPLIANCE DATE: ._
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 f�f leachin c'li ) Feet
Furnished by (�wcd1S �t/lt� �tl�
1
(�. �'__
y �
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No. �.�lA ` ' Fee i
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE, MASSACHUSETTS Yes
2pplication for Di5pogar *pgtem Cow9truction Permit
Application for a Permit to Construct( ) Repair(6 Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components
Location Address or Lot No. S (� �vN �+v 2 Owner's Name,Address,and Tel.No.
4 YOWNI5 t I�c��mes
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 2-'1 tl -t— c'
� s A s v s�oe la3-e S��s
Type of Building: -
Dwelling No.of Bedrooms Lot Size /,6511 sq.ft. Garbage Grinder ( )
Other Type of Building J�nc)),Sp No.of Persons Showers( ) Cafeteria( )
Other Fixtures
^-� Design Flow(min.required) gkJO gpd Design flow provided YZ r gpd
„Plan- Date Number of sheets Revision Date
Title ll
Size of Septic Tank 15M Type of S.A.S. 30,66 X ra,,Aa X &7 &j(j 4 t�h Ifrufo(S
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) ` 1c irA 40P'L Seypi-o 5o44&!N
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Sign Date y
Application Approved by , Date
Application Disapproved by: Date
for the following reasons
Permit No. _ Date Issued
o
No. ` `' Fee
r ,
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: i
PUBLIC HEALTH DIVISION`—TOWN AF BARNSTABLE, MASSACHUSETTS Yes
01ppYication for Mtgpogal 6pgtem Cow5tructton Permit
Application for a Permit to Construct( ) Repair, Upgrade( Abandon( ❑ Complete System ❑Individual Components
-Location Address or Lot No.a S"wcoc)bvy AV Q Owner's Name,Address,and Tel.No.
N yCAMNI� N01m
Assessor's Map/Parcel
)4 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �I
A sso IC11 PS Sa�irt�
Type of Building:
Dwelling No.of Bedrooms 7 Lot Size sq.ft. Garbage Grinder ( )
' Other Type of Building jAtX)e P No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) yin gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
-Title
Size of Septic Tank 1ST Type of S.A.S. I2 )2,. .(, Al'il 4 tk }1CJorS
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) 1 r.��it.l, toQtj !.51p i.t( ctIc'Afts
a
Date last inspected:
` Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore descrih'ed on-site sewage disposal system in
accordance with.the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board o Health.
t
SignoiC -ti Date • ' / "d
s Application Approved by " Date >r
"Application Disapproved by: !' -/ �`'. Date
for the following reasons
` Permit No. Date Issued
—————— —.———.————— ———————————-
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (y Upgraded ( )
Abandoned( )by _ )
at ��. I ip_ nJ N I has been constructed in accordance
with the provisions of Tit e 5 and the for Disposal System Construction Permit No. dated
.Installer 1��CV S A Er;o,,,ir-3 Designer
#bedrooms Approved design flow gpd
The issuance of this permit shall not a con a as a guarantee that the system will f�nctio�fn/(as d
esigned Jr
Date �`� Inspector
r u -
————— ------ ------.— -----`�-----��' --- --r —.
l
No. J � Fee
u, THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS
wigpo5ar 6p5tem Cow5tructiou Permit
Permission is hereby granted to Construct ( ) ,Repair (�O Upgrade ( ) Abandon ( )
System located at �j �t.�'x7�btJiY t)�°_ IYGNN 1
v
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title S and the following local provisions or special conditions.
Provided: Construction must be completed within three years of the date of th's permit.
Date `� '3� ' O `I Approved b
PP Y
r
Town of Barnstable
r
-�` Regulatory Services
'Thomas F. Geiler,Director
fl
1. MASS.[E % Public Health Division
1 y NtAfs+.
\�QOp t634•
\'ornw 'Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
.Installer&Designer Certification Form
Date: 6--49—Q7 Sewage Permit# 20a?—R.7&1 Assessor's Map\Parcel 30 7 9
Designer: Installer: Aa moe'Al
Address: J� L� // Address: 11111d• DEC
�S�w/ ell d90�57v �Dz63L
On 7 d/"_ 111 was issued a permit to install a
(date) (installer)
septic system at 47S based on a design drawn by
l/ (address)
1141 dated 7
(designer)
I er* that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as.lateral relocation of the
distribution box and/or septic tank.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow.
pF ~�q
AW cN
VON HONE
nstailer s Signature) v #ioee 0
9 �
RNt TA0
(Designer's Signature) (Affix Designer's Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF
COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE
RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU.
Q:Health/Septic/Designer Certification Form 3-26-04.doc
t:
N GENERAL NOTES:
LOCUS e�
101.93 W00,DqtjRj/ I. VERTICAL DATUM: Assumed
102 2. MUNICIPAL WATER is AVAILABLE.
co 102,37 102.56 /A V 102.99 3• SCHEDULE 40 PVC PIPE TO BE USED THROUGHOUT SYSTEM
�di r m Edge �• UP/236/3 UNLESS OTHERWISE NOTED.
S S uth St et i 102.64 Of Pavement 102.88 4. ALL PRECAST UNITS TO CONFORM TO
PK/SET AASHTO: H-10& H-20
co
Woo : 102 1�3.01 5. PIPE PITCH-1/4° PER FOOT UNLESS OTHERWISE NOTED.
0) o`�° Area=�0�� 03.03 6. ALL CONSTRUCTION DETAILS TO BE IN CONFORMANCE WITH MA
:' ;: 10,850t S.F. , � ENVIR. CODE(TITLE V)AND LOCAL REGULATIONS.
Ocean Ave. payed::; Map 307 103/24 103. - 102.90 7. CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR TO
LOCUS MAP N.Ts. Drive: ''' Parcel49 G/SHUT--OFF,..•- 103: CONSTRUCTION.
ASSESSOR'S MAP: 307 103,10 x 103,0� 03 24UT-pF LEGEND:
PARCEL: 49 10.4 103 0 103.07 _f
REFERENCE: BK. 154 PG. 127 0,2,` �• ' 4 03.2 BRB/FND ss PROPOSED CONTOUR
�. .', gg PROPOSED SPOT GRADE
FLOOD ZONE: C Town of Barnstable 1 3 08 0` ' .Paved. — 4O EXISTING CONTOUR
�.:
#2500010006 D (7/2/92) � k 103.38 Drive " � - 30.23-- EXISTING SPOT GRADE
4.1
103.21`
a�
�03 0 TEST PIT
102,88 a J
103:20 ® EXISTING WATER SERVICE
103,38`` #25 x 103.33
E�XEm WORK LIMIT LINE
TOF=103.53 1 3, 0
103,30
x 102:08 ic) �� (Assumed) _ .
x 10�
y' �`SMOFMgS9 Qom..
JV`
r�0 °cy AS' AMY tiG
�\ 103,05 TERRY Gs� VON 1 fOhE
\ I ' -I
Crawl _ WARNER N ,➢ #1068 0 �y
103,03 - ;�de�k_ I 103,44 No.38721 SFN/s-T
m �� 103.15 i Off' Ta
-' 10 2.6 5
a 1
x I o
101.05 10 �. . 1.0. . 103.26 7
� ea)
265 c . . � ti 1D 0
BENCHMARK Set: i x F NOTE: This plan is to be used for septic
S E P T�•C%.ti[].N' - ND
Orange paint on 1 ,� -w� x
Conc. Footingsystem purposes only and is not to be
0 0 3,08 102,50
102,53 102.4
EL. 102.82 Assumed considered a property line survey.
( ) 102,45 1 �^ I 7f/2
1 2: 25 WOODBURY AVENUE, BARNSTABLE, MA
1 Garage (0 C.) Pump and Remove Cesspools H
�� and all contaminated soils within PREPARED FOR: Douglas Brown
10 j5' of proposed leach field.� - � associates and
102 6 C TO x SEPTIC SYSTEM DESIGNS
6� 0 102,4o Thomas F. Holmes, Jr.
to v� 102.51 12•8 T9 t 320 Cotult Road
S skade den o 2�, 1D Sandwich,
A02 63 Sara W. Holmes
�e 7o-t 25 Woodbury Avenue
102 Su„Wng by: Hyannis, MA 02601
x 1��'92 101.97 ! Terry A. Warner.P.L.S. ,
Har22 wich"MA 026as DATE REVISED SCALE SHEET NO.
Scale: 1"= 20' x 101,86 (�e) aa2-ssos 04/29/07 1" = 20' 1 of 2
l
T.O.F.(Full/Partial Crawl)' Provide Riser over D-box NOTE:All components to be marked with NOTE:To prevent breakout,final grade
EL. 103.53 to within 6"of final grade magnetic tape or similar prior to final cover. of EL.99.5 to be carried out a minimum
15' beyond edge of leach facility.
F.G. EL:103.0t F.G. EL: 103.0t F.G. EL: 103.0t i Maintain Min.2%slope over leach facility to prevent ponding
Existing ,�- F.G.EL: 102.5t
EXISTING Install risers w covers over inlet and, I Min.2"of 1 8"-3/4"Washed Stone or Geotextile Fabric Inspection Port within 6"to grade
EL. 101.36 a outlet to within 6"of final grade - / Clean Sand Fill
L=10'
4"SCH 40 PVC L=15' ^, L=10'
4"SCH 40 PVC 4"SCH 40 PVC Top of Pefstjoe or Geotextile Fabric EL 99.5
@S=13.6%(2°i6 to.l 14, @S=2.5%(1%MIN)
EL.99.75 s @S=1%(0.5° MIN) ..< ® ® a ® 8"Eff.Depth
Install Gas-Baffle EL. 99.37 EL.99.2
ti:...
Bottom EL.98.5
EL. 100.0 PROPOSED DB 5 EL. 99.1 Use 32 Quick4 Standard Infiltrators
H 10DISTRIBUTIONBOX SEPTIC SYSTEM PROFILE
(Install PVC Inlet&Outlet Tees) (H 2 Field Configuration Fill in 51
PROPOSED 1500 GALLON
H-10 SEPTIC TANK �, N.T.S. (32.66'x 12.82'x 0.6T)
QUICK4 STANDARD INFILTRATOR FIELD DETAIL Bottom ofTH-1
SOIL LOG MOUND FOR PROPER DRAINAGE ` N.T.S. (Adj. Groundwater EL.79.76)
.� DESIGN CRITERIA
................ .
................... GkE (�NktlYl. gGKrl�l T
IN.,H-10 LOAD AREAS
SOIL EVALUATOR: AMY VON HONE,R.S. `\ 6"MIN.,NON-TRAFFIC AREAS Number of Bedrooms: Existing 4 Bedrooms
INSPECTOR: DONNA MORANDI, R.S., BOH Top'.ot Pe istone o.r.Geotexttie FatrdC
DATE: APRIL 27,2007 10:00 AM ®LEAPT, Soil Type: Class I
PERCOLATION RATE: <2 MIN/INCH PERMIT#11713 :12- Design Percolation Rate: <2 min/Inch
�a o
I6"1------34 Daily Flow: 440 G.P.D.
TH- - 1 TH - 2 Design Flow: 440 G.P.D. (Min. Required)
ELg103.08 EL 103.08 ADDITIONAL NOTE.? Garbage Grinder. No
Sandy Loam Sandy Loam 1. Contractor to confim soil suitability prior to installation. Contact.BOH in the event of
10YR3/2 10YR3/2 varying soils from original soil test. Leaching Area Required: (440)/0.74 = 594.59 S.F.
12" 102.08 14" 101.91 Septic Tank Required: 1500 Gallon (Proposed)
B B 2. Failed CESSPOOLS to be pumped and backfilled per Title V specifications.All
Sandy Loam Sandy Loam contaminated soils to be removed within 5'of proposed leach facility, if required. Use 32 Quick4 Standard Infiltrators(H-20)with Clean Sand Fill:
10YR5/8 10YR5/8 • Leach Field Dimensions: 32.66'x 12.82'x 8"
30" 100.58 30" 100.58 3, dater line to be sleeved at any sewerline crossings and within 10'of any septic Per DEP Approval Letter:
Perc F C1 C1 components, as needed, per Water Department requirements.
@ Coarse Sand Coarse Sand Quick4 Standard Infiltrator: 4.72 SF/LF for Field Configuration
54" t om 4. An Quick4 Unit Length =4'x 4.72 SF/LF= 18.88 SF/Unit
2.5Y6/4 2.5Y6/4 y existing Orangeburg pipe to be replaced with Sch;40 PVC pipe back to existing Minimum 594.59 SF required/18.88 SF/Unit=32 Units Required
cast iron or PVC pipe. 32 Units with End Caps =616.62 SF Total Provided
FLOOR PLAN Design Flow Provided: 0.74 616.62 S.F. =456.29 G.P.D.
74" 96.92 72" 97.08 N.T.S. t 25 WOODBURY AVENUE, BARNSTABLE, MA
C2 C2 Bed 1 Living_ V H
Medium Sand Medium Sand Room Bed 4 PREPARED FOR: Douglas Brown .
2.5Y6/4 2.5Y6/4 Bed 3 associates and
144" 91.08 120" 93.08 SEPTIC SYSTEM DESIGNS
PERC RATE: <2 MIN/IN.(Cl&2 Horizons)-<9 inches @12:58 minutes Kitchen 320 Cotuit Road Thomas F. Holmes, Jr.
No Groundwater.Observed in TH-1 or TH-2 Sandwich,MA02563 Sara W. Holmes
Bed 2 ® 508.833.0041
Well MIW-29,April, 2007,zone A, (7.0')=0.9'Adjustment Bath 25.Woodbury Avenue
Adjusted Groundwater calculated using Contour Maps=EL 79.76(290) a u n Hyannis, MA 02601
1,Amy L.von Hone,R.S., hereby certify that I am currently approved by the DEP pursuant to surveying br.
ath ( Terry A. Warner.P.L.S.
310 CMR 15.017 to conduct soil evaluations and that the above analysis has been 22 Long Road
performed by me consistent with the requirements of 310 CMR 15.017. 1 further certify that Harwich, MA 02645 DATE REVISED SCALE SHEET NO.
I have successfully passed the Soil Evaluator's Exam on November,2004. 1st Floor 2nd Floor (508) 432-8309 04/29/07 1" = 20' 2 of 2
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