HomeMy WebLinkAbout0207 WIANNO AVENUE - Health (2) OSTERVILLE207WIANN
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�pl id39.�� 200 Man Street,Hyannis MA 02601
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Date Scl ed6led 1 i itnex ,,� ��
— �, l„f Fee Pd /() , ,,
'1�1 Z�. I'll �1661:z-;:6. .b�!,�6 e I � 4
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Soil ►5 UMbillty Asses)nient for JS`ewa -e Dis oral 6''
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Peiformed By a�/�yah F•.Cl�9i�eedf ap 4 :
�,L(^'r Witnessed By
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I LOCATION& GENERAL INFORMATION" 4` s
Location Address: C,,L
zwU (�IJ�Gt.n �O /9 Y- Owner s Name I MO. I iL icy SIi�11�Q
` yy /
/ p`o i6o. 5G
,0-5 `e )'1 �L Address. 7
r t W 0.�c r)Jlt,,`+�+ dak56
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Assessor's Map/Parcel /:4U� /;i�
4 - Engineer's Name i�fi/fi"'�.C(�:.�'p�iAe�l.n
a `
NEW CONSTRUCTION v REPAIR-• -' Telephone# ,Sdg:,�j/ZB.-.v 3 y
.
/� / , /'
Land User IC�S,c e/1,4, � WO,d Slo es Sa r /o ' o jt _
. P ( ) Surface Stones' A/ �
. ' ; ti i .r
Distances from Open Water BoJy , ft Possible Wet Area ft Drinking Water Well' ft
i y
Drainage Way i . Property l ne Other
ft a 2(y f ft1 a ft
SKETCH:(Street name dimensions of lof,exact locations of test holes.&perc tests,locate wetlands�n pmxirtury to holes) 16.
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/ 4 .1 / 5 1. ..: tee .
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Parent matenai(gcologic)• w `' Depth to Bed roelt}' �a'° *`" '°"`—
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:i .Yj Z .
C-y P
Depth to Groundwater Standing Water in Hole /U Weeping from Pit RnCc 'a$
.,�. _ 7 r Ii
Estimated,Seasonal HJgh dioundwater` .}
_ ". ;
DETERMINATION TOR SEASONAL HIGH WATER-TABL,t♦�
Method Used
Depth..Observed standing in obs hole: - In. Depth to soil i!nottl93,, in. ,F`
Depth to.weepmg from side of obs,hole in ',Groundwater Adjustment I . � t" : ft.
• Index Well# Reading Date. '` Index Well level. , Adj.lhetor .. .�..- . Act;Groundwater Level, I
.
. x :. _
`PERCOLATION TEST , ; atp:'9 )Ylrttne 11';`3 0
Observation ' .
Hole# Timu'at 4"
Depth of Pero } Tlme at G'
,
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C. ��
Start Pre-soak Time @ /'3P Time(9"G") _;�__.� _ '
.
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11 3
. End Pre soak 3 CsA 6 5
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RateMin./Inch � 2r�,n g Gon-e •'.I1 11 s
:;. a,:
Site Suitability Assessment ;Site Passed %Site Failed Additional Testing Needed,(Y/N) j,
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;\SEPTIC�PERCFORM.DOC {
.
DEE,P.OBSERVATION HOLE LOG Hole# 1
Depth from Soil.Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Stnucture;Stones;Boulders. .
�r onsistencv %t3ravel)
11 3 y. /✓ h� .p. /�l. J�AQ� ��!'G /( ale r,T�cf
i
� s
DEEP •B O SER V ATI 2-:O NH OL EL LOG o
Depth from ' Soil Horii6u Soil texture
Soil 1 So Color i i So 1 Othe r
Surface(inJ ;; ; .. . ' (USDA) (Munsell)' :Mottling (Structure;Stones;Boulders.
r oMisten go Gravel)
940eq Y
12_ 3 �-,
.�! .S�g
i 1
DI;EP•OBSERVATION HOLE' LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.).: (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency. a c
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DET♦;P,OBSERVATION HOLE LOG : Hole#.
Depth from Soil Horizon Soil Teztu a Soil Color. Soil other
o Boulders.
uctu e 5 Ones
Surface(in.) (USDA) (Munsell) Mottling (Str r , .t ,
Consistency.
i
Flood Insurance Rafe Man:
Above 500 year,flood boundary No Yes
Within 500 year bOUR ary No Yes
.:
Within l00 year flood boundary'No= Yes
Depth.of Naturally Occurrin>?Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the .
o ho n s stem? -e S
sed for the soil abs Y area ropo rp y
P - _
If not,what is.the depth;of'naturally occurring pervious material'? _
Certification
I certify that on 7 1 o/Z (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 CNM 15.017. `
Signature
Date 9 2'3-fit
Q:WEpTic\PERCFORM.DOC.
10
Ab
DATE:_6L1_4_/_95
x,
PROPERTY ADDRESS:_207 wianno Ave---------- ,¢ 1996
T
osterville,Mass
02655 ,
------------------------
.- i
On the above date, I Inspected the septic system at the above address. �y
This system consists of the following:
A. 2-fx8 block cesspools .
B. 1 -1 04.4__-gallon leaching pit
Packed in stone.
Based on my inspection, I certify the following conditions:
A. Thiis is not a title five septic system.
B. Repairs needed to be done to existing system
A. Reset existing metal covers
B. Pump 92 cesspool . Heavy solids .
C. Raise cover on leaching pit
to meet title five regs. `
SIGNATURE:
N a m e:�I.�.LjacQm>�.e�-ar-------- i
Company:__J_P_Macomber_&—Son Inc.
. Address:_.Bsx_E.C---------------
Centervi 1 l e,M_a s s0 2 6 3 2
Phone:_508_775�3338_________ :..
THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY
JOSEPH P. MACOMBER & SON, INC.
Tanks-Cesspools-Leachflelds
Pumped & Installed
Town Sewer Connectlons
P.O. Box 66 Centerville, MA 02632-0066
775.3338 775-6412
7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ,
Address of property ZOO
Owner ' s name fAAtXAJU-4
Date of Inspection V V u L
PART A
CHECKLIST
Check if the following have been done:
✓ Pumping information was requested of the owner, occupant, and Board of
Health.
None of the system components have been pumped for at least two weeks
and the system has been receiving normal flow rates during that
period. Large volumes of water have not been introduced into the
system recently or as part of this inspection.
As built plans have been obtained and examined. Note if they are not
available with N/A.
The facility .or dwelling was inspected for signs of sewage back-up.
The site was inspected for signs of breakout.
'- All system components, excluding the SAS, have been located on the
site .
The septic tank manholes were uncovered, opened, and the interior of
the septic tank was inspected for condition of baffles or tees,
material of construction, dimensions, depth of liquid, depth of
sludge, depth of scum.
The size and location of the SAS on the site has been determined based
on existing information or approximated by non-intrusive methods.
The facility owner (and occupants, if different from owner) were
provided with information on the proper maintenance of SSDS.
Q _Z56 V"L �o C- CZ, VvV_uvi Gyo 0/0%_T a N5'
'l C CS5 N,onk eoe.��O�Z�� •►o yGT- "07 �`�So►.� TU
1:7At L A-jvq w o zLT1A
_ o -tkP C-OssV-00Z_
/ 0�7 12 � dt Pam.t icZ cc�yes t-c�
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION
FLOW. CONDITIONS
If residential
(_ number of bedrooms 2 `E,41" Lac= L
number of current residents
garbage grinder, yes or no
Yes connected to system, yes or no
seasonal use, ,.yes or no
If nonresidential , calculated flow:
-b NL 05GAGC�f
Water meter readings, if available• J 4 ' S3;000 Z90 6 PP
3-73 6 PD
Last date of occupancy
GENERAL INFORMATION
Pumping records and source of information:
1 V-c-co 1z L r- u ,u P i PJ V : -Tc%e�vo o F -me,
System pumped as part of inspection, yes or no.
if yes, volume pumped
Reason for pumping:
Type of system
Septic tank/distribution box/soil absorption system
Single cesspool
_ Overflow cesspool
Privy
Shared system (yes .or no) (if yes, attach previous inspection
records, if any)
other (explain)
Approximate age of all components. Date installed, if known. Source of
information:
lad""7c�sT ?CT t II'Slp-CL f�—k t979 - ScE c� 2E�o2p
�� Sewage odors detected when arriving at the site, yes or no
9
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION continued j
SEPTIC TANK: �6vjc-
(locate on site plan)
depth below grade :
material of construction: concrete metal FRP other(explain)
dimensions:
sludge depth
distance from top of sludge to bottom of outlet tee or baffle
scum thickness
distance from top of scum to top of outlet tee or baffle
distance from bottom of scum to bottom of outlet tee or baffle.
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles,
depth of liquid level in relation to outlet invert, structural integrity,
evidence of leakage, recommendations for repairs, etc. )
DISTRIBUTION BOX: NON315,
(locate on site plan)
depth of liquid level above outlet invert
Comments:
(note if level and distribution is equal, evidence of solids carryover,
evidence of leakage into or out of box, recommendation for repairs, etc.)
PUMP CHAMBER:
(locate on site plan)
pumps in working order, yes or no
Comments :
(note condition of pump chamber, condition of pumps and appurtenances,
recommendations for maintenance or repairs, etc. )
10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION continued
SOIL ABSORPTION SYSTEM (SAS) :
(locate on site plan, if possible; 'excavation not required, but may be
approximated by non-intrusive methods)
If not determined to be present, explain:
Type
leaching pits and number
leaching chambers and number
leaching galleries and number
leaching trenches, number, length
leaching fields, number, dimensions
overflow cesspool , number
Comments:
(note condition of soil , signs of hydraulic failure, level of ponding,
condition of vegetation, recommendations for maintenance or repairs,etc. )
E
CESSPOOLS (locate on site plan) : 5 E� PC�r�
number and configuration
depth-top of liquid to inlet invert
depth of solids layer
depth of scum layer
dimensions of cesspool
materials of .construction
indication of groundwater .EE
inflow (cesspool must be pumped as
part of inspection)
Comments:
(note condition of soil, signs of hydraulic failure, level 'of ponding,
condition of vegetation, recommendations for maintenance or repairs,etc. )
P ( Gs�s flcc�(_ 7 ` z t�l 7 1 ac))�_s 6CxD P
Wt C. CovrZS
PRIVY: .
(locate on site plan)
materials of construction
dimensions
depth of solids
Comments:
(note condition -of soil , signs of hydraulic failure, - level of .ponding, 'condition of vegetation, recommendations for maintenance or repairs, etc.
11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION continued
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100 ' p�,� AJ \AJA,
g
L
INSTl�� 7 i9-79
OLD
'b►!L2��'+W
L G5S Poo(_ C' es5 �GY�L K
2 Cov E25; M c=T-A
Rkvu6S 3' 50L os ',FQ C> Pr,
'Yv1 c�C.. Gov�2
I
• 4 j
/� � 'mac ✓l, v'l9 C`J ��
DEPTH TO GROUNDWATER
30 depth to groundwater
method of determination or approximation:
US&S Tb � 17 � lti 3S
F- L
12
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C 1
FAILURE CRITERIA
Indicate yes, no, or not determined (Y, N, or ND) . Describe basis .of.
determination in all instances. If "not determined" , explain why not)
KO Backup of sewage into facility?
LoDischarge or pond`ing of effluent to the surface of
the ground or
surface waters?
Sta
tic liquid l.�vel in the distribution box above outlet invert?
NO Liquid depth in cesspool <6" below invert .or availabl
e volume< 1/2 day
flow?
Required pumping 4 times or ? --
...� P P g more in the last year.
number of times pumped
Septic tank is metal? cracked? structurally unsound? substantival
infiltration? substantial exfiltration? tank failure imminent?
,( O Is any portion of the SAS, cesspool or privy:
1� below the high groundwater elevation?
within 50 feet of a surface water?
QO within . 100 feet of a surface water supply or tributaryto
water supply? a surface
.
IV6 within a Zone I of a public well?
(IyO
within 50 feet of a bordering vegetated wetland or salt marsh
(cesspools and privies only, not the SAS) ?
within 50 feet of a private water supply pp y well?
less than 100 feet but greater than 50 feet from a private water
supply well with no 'acceptable water quality analysis? If the well
has been analyzed to be acceptable, attach copy of well water analysis
for coliform bacteria, volatile Qrganic compounds, ammonia nitrogen
and nitrate nitrogen. u
TOWN OF AQiA 6TA EL-67 BOARD OF HEALTH
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D - CERTIFICATION
-TYPE OR PRINT CLEARLY-
PROPERTY INSPECTED J
STREET ADDRESS 'ZC`j \jCl 1 fir,, x
ASSESSORS MAP, BLOCK AND PARCEL #
OWNER' s NAME Maureen Carvner
PART D - CERTIFICATION
NAME OF INSPECTOR' :. 0L LA V/PL,1�-Q .
COMPANY NAME L"sOLTF�V\.)T' TO VOSGP-t-j �/i G
COMPANY ADDRESS Box 66Centerville,Mass. . 02632
Street Town or City State ZIP
COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX (790 ) 1578 _
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system a
this address and that the information reported is true , accurate, and
complete as of the time of inspection . The inspection was performed and any
recommendations regarding upgrade , maintenance , and repair are consistent
with my training and experience in the proper. function and maintenance of on
site sewage disposal systems.
Check one:
System PASSED
The inspection which I have conducted has not found any information
which indicates that the system fails to adequately protect public
health or the environment as defined in 310 CMR 15 . 303 . Any failure
criteria not evaluated are as stated in the`',,FAILURE CRITERIA section of
this form. f :*
System FAILED* `/ ra l'e:R
SU['�'.,(rlN }i
The inspection which I have conducted '"IF [-W f►►!yy�����►(}JnJth the system fails tc
Pfll' ��aa
protect the public health and the envi n . ,nt irl, ogrdance with Title
5 , 310 CMR 15 . 303 , and as specifically It `'� , ' : ° C - FAILURE
CRITERIA of this inspection form. ;;;ALt'°" '''
Inspector Signature Date
One copy of this certification must be provided to the OWNER, the BUYER
(where applicable) and the BOARD OF HEALTH.
* If the .inspection FAILED, the owner or operator shall upgrade the system
within one year of the date of the inspection, unless allowed or required
otherwise as provided in 310 CMR 15 . 305 .
partd.doc
13�
SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM
PART D
CERTIFICATION
Inspector : Peter Sullivan PE
Location : 207 Wianno Ave. Osterville
Date :June 6,1995
Certification Statement
I certify that I have personally inspected the sewage disposal system at this address
and that the information reported is true, accurate and complete as of the time of
inspection. The inspection was performed and any recommendations regarding
upgrade, maintenance and repair are consistent with my training and experience in
the proper function and maintenance of on-site sewage disposal systems.
I have not found any information which indicates that the system fails to adequately
protect public health or the environment as defined in 310 CMR 15.303 . Any failure
criteria not evaluated are as stated in the FAILURE CRITERIA section of this form.
Please note the summary of recommendations as presented in this form.
Lastly please note 310CMR:15.302 Criteria for Inspection(1) "The inspection is not
designed to provide information to demonstrate that the system will adequately serve
the use to be placed upon it by the new owner. "
truly yo
O . h OF
eter Sullivan PE - A Fc��
SULLIVAN
No. 29733
Distribution: �V.� ��
Original to system owner �A�
Buyer
Board of Heath