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0019 MARC AVENUE - Health
; 19EMarc•A}�v, enue� { � �` a `b"�g'� talk ` ���, +q'�YGPµ ,- 4 �Hvannis ,� �& 1 !l, a :k � ja.� s�' 3'?''i'b `��5 62.E r.yp i'' A 252 061� "a r 'f.' a k; 1' tl h O G r r l f I 4 L� f No. v�' � J/� Fee Z THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Rpplication for Disposal *pBtrm Construction jhrmit Application for a Permit to Construct( ) Repair(Jf Upgrade( ) Abandon( ) ❑Complete System [✓Individual Components Location Address or Lot No. 19 Mci rc. A✓6 N� `j Owner's Niune,Address,and Tel.No. G ,4a'Tho^y Rocco Assessor's Map/Parcel Z$Z, — c. Ayr Installer's Name,Address,and Tel.No. Lp 7. O G,S 3 Designer's Name,Address, d Tel.No. ry7q. 99 y. 1)1.4 ,(3 EXCaVa-)i on R A V E FLakc r+y rl- ore o o Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building Qcs,.,c^4;cx j No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 13O gpd Design flow provided gpd Plan Date /O-G. J L• Number of sheets Z Revision Date Title ` Size of Septic Tank f 0 0 0 qa.J Type of S.A.S. SOO 5)m Q C �Z Description of Soil Nature of Repairs or Alterations(Answer when applicable) MCIa)L420 .' 00-A Z 500 qo.1 C. 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. 'MSigned @Cgkx.,�_9t Q2rN Date Application Approved by Date A)'7 Application Disapproved by Date for the following reasons Permit No. O Date Issued No. vim' Fee t 00 . i Entered in computer: a THE COMMONWEALTH OF MASSACHUSETTS p PUBLIC HEALTH DIVISION -;TOWN OF BARNSTABLE, MASSACHUSETTS Yes '{ 01pplication for disposal *psteul Construction Permit 'I Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System E Individual Components I Location Address or Lot No. ]q /+'1 a r c. A✓6 N y j Owner's N e,Address,and Tel.No. Assessor's Map/Parcel Z$2, A PJ) �On� (�OCCO - G 1 9 'ARc. AvS Installer's Name,Address,and Tel.No. yc)j- 0 L,S 3 Designer's Name Address,apdTel.No, �t J• 9 9�( ! �'� 13 ,4B EXCa�o•-) on S7AUF . hc l ri I)rpe of Building: Dwelling No.of Bedrooms , Lot Size sq.ft. Garbage Grinder Other Type of Building {Rc_S,Ac nA, a j No.of Persons Showers( ) Cafeteria( ) {` Other Fixtures Design Flow(min.required) 3O gpd 'Design flow provided y$ gpd Plan Date /0 •G J L Number of sheets Z Revision Date Title - Size of Septic Tank JOO 0 Type of S.A.S. T00 ga LI C (-Z:) Description of Soil Nature of Repairs or Alterations(Answer when applicable) N t Lj fJ 20 ,D BOA - Date last inspected: Agreement: l The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in i v j 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. Signed �� ��� Date J 0 • ,7 - J L Application Approved by Date h 7 16:2 Application Disapproved by Date for the following reasons Permit No. d (0 Date Issued f ------------------- ---------------------------------- ------------=------ ------------------------------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certifirate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(✓f Upgraded( ) Abandoned( )by J2 i B E XCa;y o A; O/1 at 19- M A R C. AV C has been constructed in accordance I' l - `l - p with the provisions of Title 5 and the for Disposal System Construction Permit No. d,� dated Installer Designer _D a V C r�)<>A,L r 4 c4 #bedrooms 3 Approved design flow gpd The issuance of this permit shall not be constt�-ued a guarantee that the system will fu trio desi ned. Date V �- L+ 1 01A1 tk Inspector i --- ------ -------------------------- ------------------- -------------------------------------------------- --------------- No ' c� �' S - _ , ,- - _ -Fees° THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS .30isposai 6pstem Construction permit Permission is hereby granted to Construct( ) Repair( v/ Upgrade( ) Abandon( ) System located at 19 ✓•►'1 a R C A V C d4 m_4key c 4i and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completedwithin three years of the date of this permit. L Date �. w Approved by Town of Barnstable Regulatory Services Richard V. Scali Interim Director BARNWABLE 639 1 Public Health:Division FO MAC 6 Thomas.McKean,:Director 200 Main Street,Hyannis,MA 02601 Office: 508=862-4644 Fax: 508-790-6304 Installer. &Designer Certification Form z Date: Z� l Sewage Perm ��"it#� 3S Assessor's Map\Parcel Designer: G "y' Installer: _ �}�C ILj //ll C r Address_ I Address:7-5 ir On G ' �' fJ - was issued:a permit to install a (date) (installer) septic system at _ based on,a design drawn by (a dress) . U'" ✓ dated / . (designer) I certify 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 ank. Strip.out (if:required) was inspected and:the soils were found satisfactory: I certify that the septic system referenced above: was installed with:major changes (i:e: greater than 10' lateral relocation of tire' 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. Strip out(if required)was inspected and:the soils were found:satisfacto ry.. I certify,that the system referenced above was.constructed in compliance with the terms of the IAA approyat letters:(if:applicable) OF DAVIDGN . y (Installer's Signature) FI:AHERTY, JR. in No. 1211 ISTE - (Design r.'s S gnatu V (Affix Desig ere) 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:\Septic\Designer Certification Form Rev 8-14-13.doc Town of Barnstable P# Department of Regulatory Services i I Public Health Division Date 200 Main Street,Hyannis MA 02601 lf[l M1Cl a � . Date Scheduled U L L, Time Fee Pd._ Soil Suitdbiiio Assessment for Sew e Disposal Performed-By: " `T" I J Witnessed By: Tov 4✓l t LOCATION&. ENERAL INFORMATION Location Address A Owner's Name6 , an If Address S v9-vt^-g / Ass ssor's Map/Parcel Engineer's Name NEW CONSTRUCTION REPAIR _ Telephone Land Use )e. . Slopes(%) 0 Surface Stones Distances from: Open Water Body ( l t/v R Possible Wet•Area�ft Drinking VJatcr Well Dtalhage Wey i ft Property Line ,/ y _ft Other {) SKETCH:(Street name,dimensions of lot,exact locations of test holes&pare tests,locato wetlands-in proximity, to holes) IT 1 g� Parent material(geologic) " �y�G" • g ) Depth to Bedrock Depth to Oroundwater. Standing Water In Hole: N Weeping frotr]Pit Pnca _ T Estimated Seasonal High Groundwater 07� DETERMINATION FOR SEASONAL•HICH WATER TABLE Method Used: Depth Observed standing in obs.hole: in, Depth to sell mottles. Del1th to weeping from side of obs,bolo: - In, Groundwater Adjusttdont fk. Index Well- Reading Date: Index Well]oval Adj,•ihotbr,,,,,_.r,r, Adj.Clroundwater•1-evol,,,,_, U.,PERCOLATION TEST lulu 0 hn, 41.1cro Observation Holo# (17 Tlme at 9" ( v Depth of Pow ✓y Time at 6" N Start Pro-soak Time @ V t/ Time(9"•6") r' End Pro-soak Rate Min./Inch Site Suitability Assessment: Site Passed Site Palled: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back---------- ***If percolation testis to be conducted within 100' of wetland,you must first notify the; Barnstable Conservation Division at least one (1)week prior to beginning. Q:ISEPTICVBRCPORM.DOC /w Vv DEEP.OBSERVATION HOLE LOG Hole# Depth from Sall Horizon Sail Texture Shcl Color Sall• Other Surface(in.) (USDA) (Munsell) Mottling (Structum,Stone,Boulders. • � rsistency.96't3ravel) ' CO V . + `Z Gf V4 , DEEP OBSERVATION HOLE LOG Hole# Depth from Sall Horizon Soil Texture Soil Color Sall Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders., 0-10 �— lairlli - L- S Olr 3 ?0 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Sall Color Sall Other Surface(In.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, Consistency.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Sall Horizon Soil Texture Soil Color Sall Other Surface(in.) (USDA) (Munsell) Mottling (Structure,SRopes;Boulders, t Flood Insurance Rate Man: Above 500 year f lood boundary No.I l Yes Within 500 year boundary No.= Yes„ r Within 100 year flood boundary No-4 Yea Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious mtiterlal exist in all areas observed thrpughout the area proposed for the soil absorptibn system? '- S If not,what Is the depth of naturally occurring pe vious material's .____._....�. Certicatt°n I certify that on rl 2 (date)I have passed the soil evaluator examination approved by the Department of Envir n ntal Protection and that the above analysis was performed by me conslstent with . the retluired tralnin ,expo se d x rien described in�10 CW 15.017. Signature ' Datts Q:WHVTlC RRCFORM.DOC TOWN OF BARNSTABLE 18 LOCATION. SEWAGE # � hEy/a- VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NOK: .��� SEPTIC TANK CAPACITY rJ/V® Q LEACHING FACILITY:(type) Dcc) (size) —:2"�— 5;lolt�. NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUE . VARIANCE GRANTED: Yes No L TIN J.` r�' No—SLI16- Fizz THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....... . .....:........................OF.......................................................................................... Appliratinn for Disposal Works Cfnnstrur#inn "rani# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: y -------•------------------- _......--.........._.................•-•-- L lion-A,yddress� .. or Lot No. .....:.. ................................................ ......... ... .... W Owner Add re .................. ............................................ ...................... .... Installer Address Type of Building Size Lot.J54! 4!...._Sq. feet Dwelling- o. of Bedrooms. .................:....................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons-_.--__-_._.-_-__---_--.-_. Showers ( ) — Cafeteria ( ) Q' Other fixtures .................................. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacityJA04gallons Length................ Width................ Diameter................ Depth................ x Dispos l Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.6-Y..V..... Diameter.................... Depth below inlet....6............ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -- -- - --- - - --- -- O Description of Soil --------------------------------------------------•-•----- x W -------------------- -------------------------------•----------------------------------------.._....--------- -- VNature of Repairs or Alterations—Answer when applicable... ; .' ........... -----------------------------------------------------------------------------------------------------•----------------------------•--------...----------------------------------------•-----•.....---. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL% 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued the board f ealth. Signed---- ---------------- •.....--••-...... .--•---••......._----------•- �1 ..... " Date Application Approved By.........� . ---------------------------- .......... L.'�,.�.. Date Application Disapproved for the following reasons---------------•--.....---.......------------------------------------------------------------------.......---••- ......--•---------------•--.....------------......------.....................-•---------...-•---....---------------------•-------•---------•-----......---------•------------------------------•--------- Permit No...........Q �" 1 Issued_` . � c' Date._.._. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....... ..........................--.....O F.......................................-----------......----............................-- Appliratiun for Eliipuiittl Works Tomitrurtiun Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Systt w i ... - - ! --•• ......................................................... •---••-•-............ .................. A g tic n-Address or Lot No. -•----•-----......-•----. .............................................. ................. ....._..... 1, .. Owner Vie Addr s '.A��.. . �f W w`r .....Q-G f�.......L.... Installer Address d Type of Building _ Size Lot.f3.- '.......Sq. feet U Dwelling LI"'-No. of Bedrooms.='................... .....Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of persons............................ Showers — a YP g -------------------••---.... p ( ) Cafeteria ( ) a' Other fixtures ...............................................------------------------------•------------------ W Design Flow............................................gallons per person per day. Total daily flow............._........._.................... gallons. WSeptic Tank—Liquid capacity/. gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length..................... Total leaching area....................sq. ft. Seepage Pit No:2.X___d'`_... Diameter.................... Depth below inlet...P?............ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ x -- -- .. ............ Descriptionof Soil ........................................... .....••--•-------..............---....._....-•----••-•--. x W ----••-------------------- -------------------------------------------•-------•--.........-------•------ �... ...: UNature of Repairs or Alterations—Answer when applicable.~_ � �-� �'�:..�.�....�.....-�2 :_1:. • --------•--------------•-------•----...........------------•------------=--...........-------------•-----•-•----------------------------------------........................------------•---•-....---••- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI.1 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board f ealth. Signed....... . '` .... - a Date Application Approved By........ ------•------------------••-- .........11'--�-?:.r_.Y.s. Date Application Disapproved for the following reasons-------------•-----................----------•---------•----------•---------------........--••-•---•--••-•-----_ ........----•---•-•---•------------------------------•-•-----------•---•------...........---...-•----•--•--••-•---•--.....__......_..........-----............-••••-•.....----•-------.....-••---....._ GG _ Permit No..........n.••�.............. ............_ Issued....------/-?• --y-s _- -Date ...» Date --_THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........... ......OF................ 1,1.1...�14�` ..................... Tlertifiratr of Tumtrlittnrr THIS IS TO CERTIF5, That the Irldividual Sewage Disposal System constructed ( ) or Repaired by 7 ;• ........................ ......... .............•--... •---.._ Installer at.......................... - ••. • ------------------ ^z. -----•---------------••-----------• -------•--•--.-.---- has been installed in accordance with the provisions of TITL`Fof The State Sanitary Code as described in the application for Disposal Works Construction Permit No..........................r 1..!;--.. dated.............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............. •-�----••--••--..........••-•...................... Inspector.................... =' ................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH�/f ......OF............ ..c _��: 11j11 .......................... No...�U.. .. Fim.. ........ Disposal Works Tomitrnrtiun f rrmit � Permission is hereby granted.......... .... .... - v? .-:..................................._.... to Construct ( ) or Repair (k) an Individual Sewage Dispospl Syst atNo........ C. ..-s ce 9.4 t.............' 'Al .......--•---..........--•---•--•----..........---............... Street c�j/ -- as shown on the application for Disposal Works Construction Permit No�. .... Dated.......................................... .......................•---..... ... �--- -- -.-........................................._ DATE. --� �.• r Board of Health FORM 1255 A. M. SULKIN, INC., BOSTON AsBuilt Page 1 of 2 TOWN OF BARNSTABLE LOCATION ,}� � .C2C� �/�� SEWAGE#� VILLAGE ASSESSOR'S MAP & LOT — INSTALLER'S NAME & PHONE NO, SEPTIC TANK CAPACITY///JL`} Q �� r LEACHING PACILITY:(type) Dcx� (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER 0 / DATE PERMIT ISSUED: ' DATE COMPLIANCE ISSUE VARIANCE GRANTED: Yes No http://issgl2/intranet/propdata/prebuilt.aspx?mappar=252061&seq=1 9/14/2016 _ COMMONWEALTH-OF MASSACHliSETTS 1 ExECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS F- DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE t<Z\TER STREET. BOSTON K-1 0210c t617, 292-550v TRUDY COaE Secreta.� ARGEO PALL CELLUCCI DAVID B STR'_7.HS Governor Cotnmissione- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART`A CERTIFICATION Property Address: 19 Marc Ave . , Centervilleamneofowner Robert Gonella p, Address of Owner: Date of Inspection: Name of Inspector:(Please Print)Wm. E . Robinson Sr. I am a DEP approved system!inspector rsuant to Section 15.340 of Title 5(310 CMR 15.000) companyNam,e: Wm. E . Robinsoneptic Service Mailing Address: PO BOX 0 9, Centerville . IV1A ` Telephone Number: CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site se disposal systems. The system: _ Passes _ Conditionally Passes Needs Further Evalu tion By the Local Approving Authority Fjails` inspector's Signature: Date: W The System Inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within thirty (30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS p 3 1999 tat JF TOWN -,H[)EPT. LE rev; sed 9/2/9E Page Iof11 N t q �r:n?ed on Rea•ned Panr, ..a " SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM _ PART A f CERTIFICATION(continued) 'rop"Address: 19 Marc Ave . , Centerville Owner: Hobert Gonella Date of Inspection: INSPECTION SUMMARY: Check 8, C, o/ D: A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. TEM CONDITIONALLY PASSES: 0 e or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon c pletion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes, no, or not determined (Y, N, or NO). Describe basis of determination in all instances. If "not determined', explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20)years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked,structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipels) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed 4. revised 9/2/98 Page 2ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Icorrtinued) Prop"Address: 19 Marc Ave . , Centerville owner: Robert Goneella Date of Inspection: C. FU THER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: C ditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the pu lic health, safety and the environment. 1) SYS WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS N T FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) S STEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS NCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER , revise^ .9 ,2 98;,. ;. Page 3of11 g SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) - Fo Property Address: 19 Marc' Ave . , Centerville Owner: Robert Gonella Date of Inspection: D. SYSTEM FAILS: You mu indicate either "Yes" or "No" to each of the following: I ave dermined that one or more of the following failure conditions exist as described in 310 CR 15.303. The basis for this d terminatite M on is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No _ Backup of sewage into facility-or system component due to an overloaded or-clogged SAS or cesspool. _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. _ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any portion of a cesspool or privy is 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 organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: he following criteria apply to large systems in addition to the criteria above: he system serves a facility with a design flow of 10,060 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(interim Wellhead Protection Area- IWPA) or a mapped Zone II of a public water supply well) The ow er or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office f the Department for further information. revised 9/2/98 Page 4of11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART B CHECKLIST Property Address: 19 Marc Ave . , Centerville Owner: Robert Gonella Date of Inspection: �J�`g 9 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No / Pumping information was provided by the owner, occupant, or Board of Health. Wit/ _ 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 system does not receive non-sanitary or industrial waste flow. (/ _ The site was inspected for signs of breakout. ✓ _ All system components, excluding the Soil Absorption System, 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 Soil Absorption System on the site has been determined based on: 7/ _ Existing information. For example, Plan at B.O.H. _ Determined in the field(if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) 11.5.302(3)(b)] _ The facility owner (and occupants,if different from owner) were provided with information on the proper.maintananrj�-0f SubSurface Disposal Systems. - „ revis.en-- 9/2'/98 . . Page sorlt LSUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Y I _ PART C SYSTEM INFORMATION Irop"Address: 19 Marc Ave . , Centerville Owner: Robert G one Gl,la Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: -0g.p.d./bedroom. Number of bedrooms(design): 7--> Number of bedrooms(actual): Total DESIGN flow Number of current residents: /�✓fj Garbage grinder(yes or no): D Laundry(separate system) (yes or no)/IQ; If yes, separate inspection required Laundry system inspected (yes or no) Seasonal use (yes or no): /-6 Water meter readings, if available (last two year's usage (gpd): 1998 63 , 000 gal. Sump Pump(yes or no):�i6 1997 51 , 75o gal Lest date of occupancy:[ COM RCIALANDUSTRIAL: Type of stablishment: Design fl w: qpd ( Based on 15.203) Basis of sign flow Grease tr p present: (yes or no)_ Industrial aste Holding Tank present: (yes or no) Non-sanit ry waste discharged to the Title 5 system: (yes or no)_ Water m ter readings, if available: Last dat of occupancy: OTHE : (Describe) Last t of occupancy: GENERAL INFORMATION PUMPING RECORDS nd source of information: System pumped as part of inspection: (yes or no) If yes, volume pumped: gallons Reason for pumping: TYPE OF YSTEM 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) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed lif known) and source of information: Sewage odors detected when arriving at the site: (yes or no) d revised 0/2/91 Page 6(if 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM KART C SYSTEM INFORMATION(eontinued) 'roperty Address: 19 Marc . Ave . , Centerville Owner: Robert Gonella Date of Inspection: yJ BUILD' SEWER: (Locate on site plan) Depth belo grade:_ Material of construction:_cast iron_40 PVC_ other(explain) Distance rom private water supply well or suction line Diameter Comm ts: (condition of joints, venting, evidence of leakage,-etc.) SEPTIC TANK:_ (locate on site plan) I L Depth below grade: Material of construction: toncrete_metal_Fiberglass _Polyethylene_other(explain) If tank is metal,list age_ Wage confirmed by Certificate of Compliance_ (Yes/No) Dimensions: (/_ C*, �. 1�e Sludge depth: Distance from top of sludlge to bottom of outlet tee or baffle: Scum thickness: I 3 I'' Distance from top of scum to top of outlet tee or baffle: 65r 1 Distance from bottom of scum to bottom pof outlet tee or baffle: How dimensions were determined: O fC%h- ;omments i (recommendation for pumping, condition of inlet and outlet tees or baffles depth of liq iid level in relation to outJ et invert, structural integrity, evidence of leakage, etc.) �r 6 o- cd D �� �`- �� T ��/,6 e Y GREA E TRAP: (locate n site platy Depth b low grade:_ Materia of construction:_concrete_metal_Fiberglass _Polyethylene_other(explain) Dimen ons: Scum ickness: Dista a from top of scum to top of outlet tee or baffle: Dista ce from bottom of scum to bottom of outlet tee or baffle: Dat of last pumping: Co ments: (re ommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evi ence of leakage, etc.) revised 9 2 98 " � Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM , PART C SYSTEM INFORMATION(continued) Arop"Address: 19. Marc Ave , Centerville owner: Robert 'Gone la Date of Inspection: TI T OR HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection) Ilocat on site plan) Depth elow grade:_ Materi I of construction:_concrete_metal_Fiberglass_Polyethylene_other(explain) Diman ions: Capaci y: gallons Desig flow: gallons/day Alarm resent Alarm level: Alarm in working order: Yes_ No_ Date f previous pumping: Com ents: (con ition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: /V v Comments: (note if level and distribution is equal, evidence of solids.carryover, evidence of leakage into or out of box, etc.) PUMP HAMBER:_ (locate n site plan) Pumps(local working order: (Yes or No) Alarms i working order(Yes or No) Comme ts: (note c dition of pump chamber, condition of pumps and appurtenances, etc.) revised 9/2/98 Page8orll SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 'rop"Address: 19 Marc Ave . , Centerville Owner: Robert G one lla Date of Inspection: 1 f 1—q 7 SOIL ABSORPTION SYSTEM(SAS)1/ (locate on site plan, if possible;excavation not required,location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits; number: leaching chambers,number:_ leaching galleries, number:_ leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool, number:_ Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of ve etati n, etc.) 6t�-c) ,b') �R��L A 3 J` I ,]d �A-d Cl G a 9 Q.�� � Ull CES OOLS:_ (locate on site plan) Number and configuration: Depth-t of liquid to inlet invert: Depth of solids layer: )epth of cum layer: Dimensio s of cesspool: Materials f construction: Indicatio of groundwater: inflow (cesspool must be pumped as part of inspection} Comm ts: (note ondition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRI _ (loc a on site plan) Mate ials of construction: Dimensions: Dept of solids: Com ents: (not condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) revise: 9/2/96 Page 9ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) NopertyAddress: 19 Marc Ave . , Centerville )wrier: Robert Gonella Date of Inspection:1//_C,e7 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) vim' b G 1� �3 36 J L revised Pagcloof11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) rop"AddfeSs: 19 Marc Ave . , Centerville 01Mf1 ; Robert Gonella Date of Inspection: ��.-��,-7 NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater�-6Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site(Abutting property, observation hole, basement sump etc.) etermined from local conditions 6---Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators, installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) revise:: Page 11of11 TOWN OF BARNSTABLE LOCATION 19 Marc AVE SEWAGE# ZO/G ' 3Sy VILLAGE J4gQ nn i S ASSESSOR'S MAP&PARCEL ZSZ •01,1 INSTALLER'S NAME&PHONE NO. B*,B EXcc►yaAj oN S08- y77- UG53 SEPTIC TANK CAPACITY 1000 40,1 LEACHING FACILITY:(type) s DOood &.1 c.C"Z) (size) 13z 2.5 n 2- NO.OF BEDROOMS 3 OWNER An*Nnntj ROCC0 PERMIT DATE: D • `j- f L COMPLIANCE DATE: U. .�.k 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 Al - al /0 AV a aZ- A3 -3® ' 4 ,q EM�PL` Q3.3® M- 33 REAR 0 � A a 0 . ,f. 3 0 COVERS BE AND TIGHT • TOP OF FOUNDATION BROUGHTOTO W THINR6" OF F NAL GRADE SEPTIC SYSTEM' PROFILE Flaherty Environmental Services EL. 56.0' EL. 55.0' (not to scale) INSP. PORT W/I 3'' OF GRADE CLEAN SAND P.O. BOX 81,. _ Z" of e" to d" DOUBLE WASHED EL. 54.0 r Yarmouth Port, MA 02675 4" CAST IRON or EQUIVALENT PEAS ' GEOTEXTILE -�` 508.362. FO 1657 FILTER FABRIC MIN. PITCH 1/4" PER OT 4' SCHEDULE 40 PVC PIPE 4" SCHEDULE 40 PVC PIPE ; %,,,,,,,,,, •` FLOW LINE I Z° VENT IF REQUIRED (first Zito be level)17 �. 10' 18%—�.- _'„" 5' EL 51.7,'t o o e o e o •e;• 4. ' •• o0 o e e o0 0 0 ooe o0 III L.EXIST. 14" } ---� �'Q p p Q•: e '~ 'p i—i9q Oo0o0°O°c EL, EXIST —� °o°o°o°o°oo ° p p p p p' 000°o°o°c EL 52.5' `'" o 0 0 0 0 0 � o 0 0 00 0 0 0 0 �Q ®� o 0 0 o c 0 0 0 0 0 0 0 0 0 0 0 L 50.53' o 0 0 0 0 o p po 0 0 o c 0 0 0 00 0 00 0 0 0o00000 0000c2.0 GAS BAFFLE E 0, EL, 50,5' °000000000°000000 p' © p p p•po0000000c—, c �c� aE rp .O OO OO O O O •a•.. °00000000 0000°O m O°O°00000 / ... „ H-20 G e': o 0 0 0 EL.48.5' t// (o-BOX) SOIL ABSORPTION SYSTEM "1"'":�<.`.;,• 6"CRUSHED STONE OR INSTALL INLET TEE 1000 GALLON SEPTIC TANK MECHANICALLY COMPACTED 1"ABOVE OUTLET INVERT 7 (2) SOOr GALLON H-20 CHAMBERS 5.0' (DATUM: ASSUMED) (EXISTING) 3i 11 WITH 4 STONE AROUND IN A 4 to 1, DOUBLE WASHED STONE 12,83W X 25.0'L X 2'D CONFIGURATION EL. 43.5' } BOTTOM OF TEST HOLE EL. 43.5' LOCATIONMAP USGS ADJUSTMENT: N/A GROUNDWATER ELEV: N/A N TH "ARC A VEIVC/p Rl. 132 ' 75,00, c Mato Ave 54 LOT 25 . 7,500 SFt t LOCUS MAP 252 LOT 61 Midway Dr, I G NTS o ' EXISTING �ytH o � OF ss L 3 BR DWELLING o BENCHMARK: ��� D y c TOP OF FNDN H t EL. 56.0'r R -, DECK P 2 54 �C/STE?- EXIST, S.T. O 23,5' S�Nt A PN SHED SHED O ' 0' 10, DATE. 101612016 REVISED: 75,00'TH-I .• • rH-2 � SITE AND SEWAGE PLAN 10' FOR B & B EXCAVATION, INC./. ' ANTHONY ROCCO, .19 MARC AVENUE I' SCALE : 1 �� s. 301 BARNSTABLE, MA REF.*PB 147 PG 73 PAGE J OF2 .......... .................. ....... ............ .................................................................................................................................................................................................................................................................................................................................. ................................................................................................................... ........................................... M -GENERAL NOTES DESIGN CAL CULA TIONS ' SYSTEM DETAIL Flaherty Environ en6l Services P. 0. Box 81 1. ALL PRECAST COMPONENTS TO BE H-1 0 Yarmouth Port, MA 02675 RATED UNLESS OTHERWISE SPECIFIED, NUMBER OFACTUAL BEDROOMS 3 t 774.994.1166, ALL COMPONENTS WITH ANY ANTICIPATED VEHICULAR TRAFFIC TO BE GARBAGE DISPOSAL UNIT NO H-20 RATED. 2. THE DESIGN OF THIS SYSTEM DOES NOT TOTAL ES TIMA TED FLOW ALLOW FOR THE USE OF GARBAGE ✓ (110 GAUBRIVA YX 3 BR) 330 GAL./DAY GRINDER. REQUIRED SEPTIC TANKCAPACITY 660 GAL. 3. MUNICIPAL WATER IS AVAILABLE. 4. ALL CONSTRUCTION TO CONFORM WITH SIZE OF SEPTIC TANK 1000 GAL. (EXI�STING) 310 CMR 15.000 AND ALL OTHER APPLICABLE LOCAL, STATE AND FEDERAL SOIL CLASSIFICATION I 25' CODES AND REGULATIONS. 5. INSTALLER/CONTRACTOR TO REVIEW& DESIGN PERCOLATION RATE <2 MIN./INCH VERIFY ALL ELEVATIONS AND DETAILS EFFLUENT LOADING RATE 0.74 GAL./DAY/FT? AND REPORT ANY DISCREPANCIES TO DESIGNER PRIOR TO CONSTRUCTION OR 12.83' LEACHINGAREA 0 ASSUME ALL RESPONSIBILITY, (2)x(25.01+ 12.83)(29 = 151 SF 6. INSTALLER/CONTRACTOR IS 25.0'x 12.83' =320 SF RESPONSIBLE FOR MAINTAINING SAFE 471 SF x 0.74 =348 GPD WORK AREA, VERIFYING ALL UTILITIES AND NOTIFYING "DIG SAFE" USE(2)500 GALLON H-20 CHAMBERS WITH 4'STONE (1-888-344-7233) 72 HOURS PRIOR TO AS DIAGRAMMED INA 25.0'X 12.83'X2'CONFIGUR4TION CONSTRUCTION. 7. ANY CHANGES TO OR DE VIA TIONS FROM THIS PLAN MUST BE APPROVED IN RESERVE LEACHING CAPACITY NIA' WRITING BY FLAHERTY ENVIRONMENTAL SERVICES AND LOCAL BOARD OF HEALTH, 8. FINISH COVER OVER COMPONENTS IS NOT TO EXCEED 3'PER 310 CMR 15.'000 (NTS) UNLESS SHOWN PER PLAN. 9. ALL ABANDONED SEPTIC SYSTEM COMPONENTS TO BE PUMPED DRY AND SOIL EVAL UA TION FILLED WITH CLEAN SAND OR REMOVED (OF TESTHOLE#1 F#15183 TESTHOLE#2 PW15183 --A ,F AND REPLACED WITH CLEAN SAND. Evaluator Evaluator David D.Flaherty Jr.,RS,REHS David D.Flaherty Jr.,RS,REHS 10.ALL COMPONENTS TO BE PROVIDED SE#2755 SE#2755 BOH witness. David Stanton,RS BOH Witness: David Stanton,RS WITH WA TER TIGHT ACCESS POR TS Date. October 6,2016 Date: October 6,2016 i WITHIN 6"OF FINISH GRADE, FQA 11-ALL SEPTIC TANKS, DISTRIBUTION 7H-I ELEV.54.'0' TH-2 El EV.,54.0' BOXES AND PIPING TO BE INSTALLED 0. WATERTIGHT. -9" FILL 0"-10" FILL 12-NO KNOWN WETLANDS OR WELLS 9"-19" A LS 10YR 312 10"-20" A LS 10 YR 312 WITHIN 100 FEET OF PROPOSED LEACHING. 19"-36" B LS 10YR 616 20"-35" B LS 10YR 616 13.THIS IS NOT A CERTIFIED PLOT PLAN AND UNDER NO CIRCUMSTANCES IS THIS PLAN TO BE USED FOR ZONING OR SITE AND SEWAGE PLAN BUILDING PURPOSES. 7 cel*that on November 12,2002,1 have passed FOR 14.LOT IS SHOWN AS ASSESSORS MAP 252 36"-126" C MS 2.5Y614 , PERC<2 minli"nch 35"-120' C MS 2.5Y614 the examination approved by the Department of B & 8 EXCAVATZON, INC./ raron* /YS/S mental Protection and that the above ana LOT 61 . 5%gvel 5%gravel Environmental has been performed by me consistent with the ANTHONY ROCCO 15.LOCUS PROPERTY IS LOCATED WITHIN required training,expertise,and experience described G.W.ELEV.MA G.W.ELEV. In 3 10 CMR 15.018(2). 19 MARC AVENUE AN AQUIFER PROTECTION DISTRICT (ZONE 11). B67-rom TH-1 ELEV. 43.5' BOTTOM TH-2 ELELEV. 44.0' BARNSTABLE,"MA PAGE 20F2 .......................................... ......................................... ..................... . . . ....... -d........................................ .................................. ................................. ............................. ......................................................- ......................... .......................... ........................... .... ... ........................ ................... ......................................... ............... .... .......... .....................................