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0041 WILTON DRIVE - Health
41 Wilton Drive Centerville A = 208 — 136 5 M EAD Na Z•1=R UPC 1M4 enwd.=m • MW@ In.WA I 30p S JOZ anoN luaO aQ uoll!M lb\ing amin3 jo s3jnl!e3 uo!loodsul o!ldoS sjalla'I\OLLdgS\:i) u1IeaH JO pzeog 3111 Jo TUOOV OHO ` S2H `uea}loW seuzOgl HI'IVHH JO CI HVOff 3HZ JO NHCrdO WHd •uoljov juauzaazoJua aanTnj ul llnsaz Ilim popod aullpuop all uitllim tuals,�s 011dos atll aouldAi/aiudai ol aanlied uor�eotdi�ou s1111 OAiaoaa noX alup 0111 room saua f(Z) omj uttiTim u ;)TSXS aildos atll oovjdai zo zredaa of pa.zapio on,noA '(1'6-09£apoD umoZ.iad) ;alui molaq ,,ZI>`Ianal pinbil u�liu ql!m loodssaa .ao ;id Ouigauarl Ouimolloj atlj of onp (00•S I NWD 0 10 A TULL S66 H JO souilopm2? atll aapun ,sl!u ,, uzalsXs atll juuj pomogs uzalsXs oiidas atll jo uoiloodsui oqj, •siasntlouss-eW jo ajujS oql zoj zoloodsul oildaS A NI'l pa9iPao 'Xoala3w umugS Xq `I£ SIOZ/£Z/OI uo paloodsui sum V-W `al1pualuaD laAu(t uojl!Ac1 It,J-e pajPoOI WOISXs OTIdos Qq L S :I I,LII. `MOD 'IV.LN:IIVNO' IAN:l J,LV.LS HJUM A'IdIVOD 012IJ(RIO Z£9Z0 VW `aiHinaOTUOD anizQ uOjIjAk It, jo ajujsg `INsuiznrl auilned S I OZ `t Z.zaquzanOM t,90L I L6 10000 OM S I OL # rllVW QHIAI LWFfD OHO`UU3NOW-V semogZ b0£9-06L-80S :Xd3 Joloai!Q`!IPOS'A pingO!'d tb9b-Z98-805 :001330 LOOZ I09ZO VW siuuVXH `jaazjS UTeW OOZ UOiSiAiQ ujiivaH ailgnd -601 A,1111 , uatu uda saa�n.�a n � � � Q S o��i �a21 algelsuieg aiaulsujug jo umoZ / TO'WImT OF f1ST P Sc-WADE , ASS.E.SSOIt°S 1vIA t'$i Z(3x lT5TR.3, .EMS-NAME,1 1'�lOt+lE Nm. S1EF'1�C wix.CA' Cl'C`L 160 LEACMIC 1��C1L1`I"Y. 4PIP.) Seprntiunlistaa► le'tv�aeta cl7o' MaxlmumA. justetlGtpuitdatet'ttlatailaecrttorriufLeac;hinl�,nilit�+ piivm4 wata Saoply Wdl aria i,earWrig 24 wty (a.o4 yot9s as s a10.elw oe':wltl7ln 7010 feet of leacW fttcibty) Fxi�rts cy�VVet�an tail Lek ng i~ac tty(� y w ll�+ncl5 exls4 c ep wit{1it130 fc ak let►pHting Puctlry) ct ^^ A 1-07C y LOJ,9 I D � �— �6 ' ;p a� a V OFTNE Tary Town of Barnstable P ° Public Health Division HANHSTAeLE. ' 200 Main Street 9 HAtiS. b �prED MP�P,O Hyannis,MA 02601 Pauline Luzinski, Estate of 41 Wilton Drive Centerville, MA 02632 t <� ' 'r. _` _`�-,�_ i ��, �,� I Mail 6, o alo I _ r--I p. Certified Mail Fee Extra Services&Fees(check box add fee as appropriate) _ O O ❑Return (hanleop� $Q 0 ❑Return Receipt(electronic) $ Postmark O ❑Certified Mail Restricted Delivery $ Here 0 �i M ❑Adult Signature Required $ 0 o ❑Adult Signature Restricted Delivery$ ' O L7 Postage ru 11J f u $ Ln s��� Ln Total Postage and Fees S Ln s Ln Ln Sent_To ra r- rq p O O Street and Apt No.,or PO Box IVo----------------------------------------------------- Ci Z State. IP+4® Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail t ■A unique identifier for your mailpiece. associate for assistance.To receive a duplicate j till ■Electronic verification of delivery or attempted return receipt for no additional fee,present this z delivery. USPS®-postmarked Certified Mail receipt to the _ 5(_} r y V• ■A record of delivery(including the recipient's retail associate. Restricted service,which rovides signature)that is retained by the Postal Service'" delivery P -», - --.-- •- for a specified period. delivery to the addressee specified by name,or i to the addressee's authorized agent f# Important Reminders. -Adult signature service,which requires the ■You may purchase Certified Mail service with signee to be at least 21 years of age(not Y t,,^•e- �, Rrst-Class Mail®,Rrst-Class Package Service®, available at retail). or Priority Mail®service. Adult signature restricted delivery service,which "•a� ■Certified Mail service is notavailable for requires the signee to be at least 21 years of age International mail. and provides delivery to the addressee specified.; ■Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent,I 4-"""" with Certified Mail service.However,the purchase (not available at retail). -� -• of Certified Mail service does not change the ■To ensure that your Certified Mall receipt is insurance coverage automatically Included with accepted as legal proof of mailing,R should bear a' -- *^ certain Priority Mail items. LISPS postmark If you would like a postmark on J T`w Ks + ' •, T ■For an additional fee,and witha proper this Certified Mail receipt,please present your endorsement on the mailpiece,you may request Certified Mail item at a Post Office'for j - the following services: 9 postmarking.If you don't need a postmark on this j _ + -Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply r, You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece. , _",`,:a�.;_ ;�;, electronic version.For a hardcopy return receipt, j • f complete PS Form 3811,Domestic Retum , t Receipt attach PS Form 3811 to your mailpiece; iMPORTAUR Save this receipt for your records. PS Form 3800,April 2015(Reverse)PSN 7530-02-000.9047 SENDER: • e • . ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. X ❑Agent 0 Print your name and address on the reverse ❑Addressee ; so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No 3. Service Type ❑Certified Mail" i]Priority Mail Express' ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑Collect on Delivery 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (transfer from service labeq PS Form 3811,July 2013 Domestic Return Receipt I UNITED STATES POSTAL SERVICE I First-Class Mail I Postage&Fees Paid USPS I Permit No.G-10 i I • Y P Sender: Please print our name,address,and ZIP+4®in this box* I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I ? s Town of Barnstable + HARN3rABLE, + MASS ,�� Regulatory Services Department Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard Scab,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6,-2007 Rev. 7/6/15 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1)YEAR DEADLINE CRITERIA ❑ Static.liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or.cesspool ❑Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑Any portion of the cesspool within a Zone 1 to a public welI ❑Any.portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑Any"conditionally passed systems" (broken cover,relocation of a pipe,relocation f � of a driveway due to H-10 components, etc) C 4 �� ' `• Leaching pit or cesspool with high liquid level, <12"below inlet(per Town Code 60-9.1) OTHER . 1�Sv� ❑ Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments. M 41 Wilton Dr r Property Address Estate of Pauline Luzinski Owner Owner's Name information is required for every Centerville ✓ MA 02632 10-23-15 page. City/Town State Zip Code Date of Inspection • 3 - I_Ur.�l Inspection results must be submitted on this form. Inspection forms may not be altered in an f O way. Please see completeness checklist at the end of the form. A. General Information 1.• Inspector:, Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the i information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ' ❑ Passes ❑ Conditionally Passes ® Fails ❑ ,Needs Further Evaluation by the Local Approving Authority, 10-23-15 I pector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 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 DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Vs t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Rage 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form` Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 41 Wilton Dr Property Address Estate of Pauline Luzinski Owner Owner's Name information is required for every Centerville MA 02632 10-23-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: 0 B) System Conditionally Passes: Q One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for-Voluntary Assessments M 41 Wilton Dr Property Address Estate of Pauline Luzinski Owner Owner's Name information is required for every Centerville MA 02632 10-23-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. f B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipes) or due to.a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N [1 ,ND (Explain below): ` _ ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts ' W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 41 Wilton Dr Property Address Estate of Pauline Luzinski Owner Owner's Name information is required for every Centerville MA 02632 10-23-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and 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 SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. I Method used to determine distance: f I I **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate-"Yes"or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into.facility or system component.due to 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 Y2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 41 Wilton Dr Property Address Estate of Pauline Luzinski Owner Owner's Name information is required for every Centerville MA 02632 10-23-15 - page. City/Town State Zip Code Date of Inspection B. Certification (cont-) Yes No ❑ ® 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 SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of 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 1 of a public well. ❑' ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. s❑ ® 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. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form j � ® The system is a cesspool serving a facility with a design flow of 2000gpd- f. .{ 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The -, , .j, „r , system owner should contact the Board of Health to determine what will be . 74 necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd., For large systems, you must indicate-either"yes"or"no"to each of the following, in addition to the questions in Section D. 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 If you have answered "yes"to any question'in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 r ., Title 5 Official Inspecton Form:Subsurface Sewage Disposal System-Page 5 of 17 y 1 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 41 Wilton Dr Property Address Estate of Pauline Luzinski Owner Owner's Name information is required for every Centerville MA 02632 10-23-15 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? El ® Were as built plans of the system obtained and examined? (if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? Z 0 Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, t dimensions, depth of liquid,'depth of sludge and'depth of scum? ® 0 Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® ' ❑ Determined in the field'(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of.bedrooms (design): .2 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 t t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . 41 Wilton Dr Property Address Estate of Pauline Luzinski Owner Owner's Name information is required for every Centerville MA 02632 1 0-23-15, page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage,grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 2015 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day Y(9Pd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments' M 41 Wilton Dr Property Address Estate of Pauline Luzinski Owner Owner's Name information is required for every Centerville MA 02632 10-23-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? 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) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the 1/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3f13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts , Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments L M 41 Wilton Dr Property Address Estate of Pauline Luzinski Owner Owner's Name information is required for every Centerville MA 02632 10-23-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1970's Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 18"feet Material of construction: • ® cast iron ® 40 PVC ® other(explain): Orangeburg Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: 12"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal Sludge depth: 12" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection -Form Subsurface Sewage Disposal System Form -Not for.Voluntary Assessments . l 41 Wilton Dr Property Address Estate of Pauline Luzinski Owner Owner's Name information is required for every Centerville MA 02632 10-23-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 20" . Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with-baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: 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 Date of last pumping: Date t5ins-W 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form =Not for Voluntary Assessments SVey°� 41 Wilton Dr Property Address Estate of Pauline Luzinski Owner Owner's Name information is required for every Centerville MA 02632 10-23-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons + Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 ' Title 5 Official Inspecton Form:Subsurface Sewage Disposal System•Page 11 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System'Form -Not for Voluntary Assessments 41 Wilton Dr Property Address Estate of Pauline Luzinski Owner Owner's Name information is required for every Centerville MA 02632 10-23-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert N/A Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 41 Wilton Dr Property Address Estate of Pauline Luzinski Owner Owner's Name information is required for every Centerville MA 02632 10-23-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: , ® leaching pits number: 1-64 block pit ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: i I ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Block pit in poor condition with water level and stain lines above inlet invert at time of inspection. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): 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 inflow ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M $V0 41 Wilton Dr Property Address Estate of Pauline Luzinski Owner Owner's Name information is required for every Centerville MA 02632 10-23-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) _ ' Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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, etc.): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 41 Wilton Dr Property Address Estate of Pauline Luzinski Owner Owner's Name information is required for every Centerville MA 02632 10-23-15 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) . Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M SVO,. 41 Wilton Dr Property Address Estate of Pauline Luzinski Owner Owner's Name information is required for every Centerville MA 02632 10-23-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database- explain: You must describe how you established the high ground water elevation: USGS and town maps show groundwater at greater than 20. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 41 Wilton Dr Property Address Estate of Pauline Luzinski Owner Owner's Name information is Centerville MA 02632 10-23-15 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 I, r V Aoecl Town of Barnstable P# EVE Department of Regulatory Services L / U&MIRrABLA : Public Health Division t",, Dat,� l , � 1� r rl p "6,9. �C 200 Main Street,Hyannis MA 02601 � ' rFn nt►�" Date Scheduled Time l O1 Fee Pd._� y U Soil Suitability /Aslssi e'}ssment for S111 e D'sposal Performed V By: !'y '/ �J C� �7 f�!TN V�1/ I� y 1 Witnessed By: ., I.v, fi•.�n ,� f :.00ATION&.GENERAL INFORMATION Location Address '� Owner's Name l PIt( 6d`V r// Address 4( 1.✓l I,I Assessor's Map/Parcel: �j S� Engineer's Name C 1.rtviol ����G1a kd� NEW CONSTRUCTION REPAIR Telephone#' 2j e 1/ V 71;1 OEM Land Use. CIlI U] i/1 Slopes(%) O Surface Stones ✓l 0 1ll: Distances from: Open Water Body `�_ft Possible Wet Area �®0+ ft Drinking Water Well I D L : ft Drainage Way >Q + ft Property Line 1 b + ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) o n . 0 ' o b�t,G4 Parent material(geologic) f D G191 (�U�hlGj s Depth to Bedrock ' `D,��`J Depth to Groundwater. Standing Water in Hole: V e� Weeping front Pit Face V�n O l e Estimated Seasonal High Oroundwater M b ie +f11 q h / ( Vi DETERMINATION FOR SEASONAL HIGII WATER TABLE Method Used: me)+i 160S • R Depth Observed standing in obs.hole: In. Depth to soil mottles: 1 3 Z + In, Depth to weeping from side of obs.hole: _____ In, Groundwater Adjustment ft. Index We1F4 Redding Date: Index Well 1eYCl Adj,-factor � o.� Adj.Groundwater Level v PERCOLATION TEST bate (6�q 15 Tune to 1i M Observation ( �� Hole# t Tine at 9" Depth of Perc D 1 h Time at 6" UI _ Start Pre-soak Time @ V -d D Time(9"-6") End Pre-soak 2, I Rate Min./Inch Vh P h. Site Suitability Assessment: Site Passed Site Failed: /Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data Td 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. VS Q:ISEPTICU'ERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# t Depth from Soil Horizon Soil Texture .Sdil Color Soil. Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones;Boulders. onsistency.%Oravel) O 1Z ( LL DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsi ten % L on e DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, 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 Man: 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? K e 5 If not,what is the depth of naturally oce 'ous material? � Fhfgq,� Certification JDAVID . y� I certify that on `V L I havuassed it evaluator examination approved by the Department of Environmental Pro &MW analysis was performed by me consistent with . the requir ainin expertise' an rience describ d 10 CUR 15.017. S,Ot NS :` 1 Signature Date oC f s 1 Q:\SEFTIC\FERCFORM.DOC TOWN OF BARNSTABLE ,LOCATION y/ GfJj 7-1W f 1 Vif SEWAGE# VILLAGE �fG07?_iV li//lrf— ASSESSOR'S MAP&PARCEL 08 INSTALLER'S NAME&PHONE NO:,sb$-y20—�'7_1 ,/PJ 1// SEPTIC TANK CAPACITY /t)00 t" 01 LEACHING FACILITY:(type)= ,500 �',�l�}6!�l�jl-''/'.3 (size) 2 S"x /3 NO.OF BEDROOMS 2 " OWNER'�it4t� Y' �G/Z//✓�/\ 1 PERMIT DATE:_/� 1.���— �5:: : COMPLIANCE DATE: -..r. 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 .* r�l 1 /�� � � �j � ��� � S � � `' 3 i t� L3 .; ' -/ y 2, �� �,., No. Fee L THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ftPlitatlon for Misposal *pstrm ConstCUttlon 3pPrmit Application for a Permit to Construct(y- Repair(Upgrade Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.Y/ LU[L Tor/ (,/'[}/!= Owner's Name,Address,and Tel.No. 6.,,E Assessor's Map/Parcel 2 p _ 0~/-E Installer's 1jam Ad ess,and Tel.No.SOg- '/10-'?'"g Designer's Name Address,and Tel.No.s'o Type of Building: Dwelling No.of Bedrooms ,'� Lot Size 5D sq.ft. Garbage Grinder( ) Other Type of Building t t No.of Persons Showers( ) Cafeteria( ) is Other Fixtures Design Flow(min.required) 0-0 gpd Design flow provided 3�J(� gpd Plan Date_ll� — - <<j Number of sheets Revision Date Title Size of Septic Tank Y I DDO Type of S.A.S. Q SO 0 Description of Soil i��IAc,-,M '2, X a�l D Ffi Nature of Repairs or Alterations(Answer when applicable) T 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. Signed Date l t — ApplicationApproved by Date It- /3 s f ' Application Disapproved by Date ' for the following reasons Permit No. C�L 6 Y 0 1 Date Issued // ,,3���j i No. v a Fee (()6, ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN,OF BARNSTABLE, MASSACHUSETTS YeS I 01pplitation for Misposal 6pstem Construrtipu Permit Application for a Permit to Construct(v) Repair grade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. /_0//: Owner's Name;Address,and Tel.No. �rs i�11/=d't/;rr/= �!�!°✓//< L �/'Z/�,!/skl Assessor's Map/Parcel Installer's ame,Add ess,and Tel.No.S"OG- y20- �3d / % Designer's Name,Address,and Tel.No.S� Z! lw-cI7 s�U` /II�G's��'s�J r--�>v /s S I.o /� �= /�'�� �'Liv�rsl Type of Building: �t Dwelling No.of Bedrooms 2 Lot Size t sq.ft. Garbage Grinder( ) Other Type of Building 17 t tej ke, �: No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) oZL gpd Design flow provided U gpd Plan Date �(� - - �Lj Number of sheets Revision Date Title _ Size of Septic Tank X I DD® Type of S.A.S. ,SO e C�C�(. .E G t C..1� Description of Soil h ,�c c Y�1 Sl.� ( Z X t n t Nature of Repairs or Alterations(Answer when applicable) 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. Signed �il/ 454- Date i Application Approved by ` Date //� /''y" f Application Disapproved by . Date ' for the following reasons Permit No. ,o ( �j Y 0 Date Issued p- 1 a3- s -------------------------------------------------------------------- ----- ------------------ ---------------------------------------- n 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 L0.5 eoG, at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. d! u dated f 13 Installer Jp> /?� 1/•c -I�Gi�U Designer #bedrooms Approved design w U gpd The issuance of is pe` it shall not be construed as a guarantee that the system ill �clion as esi ed. Date' i I Inspector G1r✓ 2 i --------------------------------------------------------------------------------------------------------------------------------------- No. �) �U y Fee A?0, THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE, MASSACHUSETTS Mistlosal 6pstem Construction Permit Permission is hereby granted to Construct Repair( ter Upgrade( ) Abandon'( ) System located at 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. " "k Provided:Construction must be completed within three years of the date of this permit. Date I `� _ / Approved by ��C' r THIS PLAN IS INTENDED SOLELY FOR INSTALLATION OF THE SEPTIC SYSTEM '^ DEPICTED ON IT. FOR ANY OTHER CHANGES TO THE PROPERTY INCLUDING ----- n-�- _ PLACEMENT OF ADDITIONS. SHEDS. FENCES OR SWIMMING POOLS. OWNER �i uVO�SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR. �VII PQNS�ABLE OGIS DAT� ELEVATION N� VEMENT _� 48. 55 f WILTOE OF PA �- Tpp GP�� OF WATER .<< 49 61.64 ft 48 — 47 46 • ILOTS AREA = 15501 sf+- • PLAN BOOK 146 PAGE.23 / \ PLAN BOOK224 PAGE 61 / GARB ASSR MAP 208 PCL / I T 49I OVAD ` I I 1 THIS IS A 1 COLOR 45 l CO 0 1 PLAN O USE COLOR PLAN ONLY ' INSTALLATION FULL DETAIL IS BEST VIEWED IN O FULL COLOR &® mo o (m� F- 1 �� —0 . / © Zoo I 1 m PROPOSED SOIL ' 1 44 ABSORPTION Wl SYSTEM - SON BACK O 2 Ok�A E PAVED I DRIVE AY 0 20 ft SLAB ft FOUNDA TION - G I �p CONCRETE o LEGEND SEPTIC COMPONENTS G G off l EXISTING ` PATIO loco GAL l SEPTIC TANK0 1 � I EXISTING0 l 1 I a LEACH PW CESSPOOL I 1 I DISTRIBUTION BOX 0 / Q J TEST PIT I UI 0 0 MINIMAL I W GRADING / �—PROPOSED I 48 47 101.64 ft 46 45 44 ELEVA TIONS ELEVATIONS SPECIFIED ARE INVERT JU r#L�§�4E� PLe% N ELEVATIONS (BOTTOM OF PIPE) EXPRESSED IN DECIMAL FEET. -- WATER LINE SCALE: 1 in = 20 ft SEPTIC TANK IN EXISTING WATER GATE O SEPTIC TANK OUT 45.25 GAS LINE &— 0 20 40 D-BOX IN 44.65 ' ^' D-BOX OUT 44.48 OAS GATE O O 10 20 LEACHING SYSTEM IN 44.40 OVERHEAD WIRE off BOTTOM OF LEACHING 42.40 HYDRANT PRINT ON 8-112 x 14 in PAPER FOR PROPER SCALE FALMOUTH ROAD aka ROUTE 28 O _ _ ROAD �N OF Jo SEWAGE DISPOSAL OLD POST. SgCy ky OF Mgssq�y , SYSTEM PLAN g W DADVID G� �o DAVID Gs I 1 -TO SERVE EXISTING DWELLING O t N W D. COUGHANOWR y COUGHANOWR FRANK & P A U L I N E N o No. 1093 No. 461 LUZINSKI O 9�� t �FCGISTE��� 9P 0 •\ l 1995 ( OWNERIS) OF RECORD `a cjA. TO S N soy PROD / . �y ,°, 41 WILTON DRIVE a . SCALE 155 Geo R der Rd s C E N T E R V I L L E. MA PROPERTY ADDRESS CENTERVILLE. MA Chothom, MA 02633 DovidcouOHotmoll.com IDATE. O C T O B E R 9, 2015 LOCUS MAP 508 364-0894 PG.lI2 �oe� ETE-3986 CTO SOL EST LOG PE C* 1144853 9. 2015 (1 DE GN A L}C UL7A aO SOIL EVALUATOR: DAVID D. COUGHANOWR. ASE zI DESIGN FLOW: 2 BEDROOMS X 110 GPD = 220 GPD l WITNESSED BY: DAVID STANTON. HEALTH DEPT. SEPTIC TANK: 220 GPD X 2 DAYS = 440 GALLONS TEST PIT 1 PERC NO AT70InGROUNDWATER2MINIIINCH IN CRED SOILS USE EXISTING 1000 GALLON SEPTIC TANK IF IN ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER SOUND STRUCTURAL CONDITION. IF NOT. INSTALL INCHES HORIZON TEXTURE (MUNSELU MOTTLES NEW 1500 GALLON SEPTIC TANK. 48.05 0-12 FILL DISTRIBUTION BOX: INSTALL UNIT DEPICTED BELOW. 47.05 12-1321 C MEDIUM SAND 10 YR 6/3 1 NONE I LOOSE SOIL ABSORBTION SYSTEM: 37:05 No GROUNDWATER ENCOUNTERED THE LONG TERM ACCEPTANCE RATE FOR A CLASS ONE TEST PIT 2 SOIL WITH A PERCOLATION RATE BELOW 5 MINUTES 2 MN/INCH IN C SOILS PER INCH = 0.74 GALLONS PER DAY PER SQUARE FOOT. ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER THE 24 ft x 12.5 ft x 2 ft LEACHING GALLERY INCHES HORIZON TEXTURE (MUNSELL) MOTTLES 47.95 0-10 FILL DEPICTED BELOW CAN LEACH: 47.12 10-132 C I MEDIUM SAND 10 YR 6/3 NONE LOOSE BOTTOM AREA = (24 x 12.5) = 300 sq. ft. 36.95 SIDEWALL AREA - (24+ + 5+1 .5)x =1 6 so, ft, TOTAL AREA = 446 sq. ft. FLOW CAPACITY = 0.74 x 446 = 330.04 Sol/day INSTALL A 24 ft x 12.5 ft x 2 ft GALLERY AS CONFIGURED BELOW. FLOW CAPACITY = 330.04 gal/dog WHICH EXCEEDS THE 220 gal/dog REQUIRED FOR A TWO BEDROOM DESIGN. 1000 G,gLLOI�I SEf�TIC T/�Nl� • • � r R�S O I L ,� B S O R P 7-1 O I\l TANK TO BE PUMPED DRY AT TIME Of INSTALLATION AND EXAMINED FOR STRUCTURAL INTEGRITY. INSTALL NEW PVC OUTLET TEE EQUIPPED WITH A OAS BAFFLE. • I REPLACE WITH A NEW DRYWELL 24.0 ft I in 1500 GALLON TANK UNIT TAPER IF CRACKED. ROTTED OR OTHERWISE co COMPROMISED. w Lo vz 0 co CV (V O NOT TO STONE co SCALE 3.5 ft 8.5 ft 8.5 ft 3.5 ft a ft-6 a 500 GALLON DRYWELL DIMENSIONS IS DETAIL INSTALL ONE INSPECTION INLET OUTLET RISER TO WITHIN THREE COVER COVER USE INCHES OF FINAL GRADE H-10 8 INDICATE LOCATION 7wi�IN DROP ON AS-BUILT -► FLOW LINE UNI T FROM 10 In - °14 TO �0 33 BUILDING ir, U D-BOX �p�Uq� 0 �SQ� in 48 in ;4 _o�oo'Qb>�o� LIQUID GAS � ofiooroa �00 \� LEVEL BAFFLE i 5$ 102 in b In STONE BASE /F NEW CROSS SECTION VIEW SEPARATION BETWEEN INLET 8: OUTLET INSTALL AN APPROVED GEOTEXTILE TEES NO LESS THAN LIQUID DEPTH FABRIC OVER STONE CROSS SECTION VIEW 0 0 C Fill p- _ �/ a 3/4 In TO m 24 in a 9/4 In TO I J T 11 U I U 0 /l 11 ft` 1�8 1-1/2 In OAAVa I) PT 1-1/2 6► OAAVVa o MENEM- 46 in 58 in 46 in 150 in 12 In c MIN -INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE N STARTING WORK. � —► i -ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM FROM O REQUIREMENTS OF MASSACHUSETTS TITLE 5 SEPTIC N TANK b, b TO CODE (310 CMR 16). 0 D. ^ SAS -INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND T UTILITIES BEFORE EXCAVATING FOR SYSTEM. -ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION \� 6 In STONE BASE E PUMPING FLOW FTHE(SEPTIC TANK.APPLIANCES. AND PERIODIC 21 \ CROSS SECTION VIEW -SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. /n Z S DO NOT PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. TOP OF FOUNDATION RAISE COVERS TO WITHIN ALL PIPE TO BE SCH. 40 PVC EL = 48.22 +- 6 in OF FINAL GRADE- RADE AND TO PITCH AT 1/8 In/ft MIN 48.15 -B0 3, USE H-20 MAX : E� TNG 45.15 EXISTING 1000 GALLON P 0o RECAST o°o�°� aa�oo°o SEp= TANK 44.48 45.25 00�00. DRYWELL o�o�S�aa o a °8° 6 In EXISTING REFER TO DETAIL BOX STONE COL ABSORPTION + 44.65 BASE 44.40 -REFER TO 4- EXISTING 6 !n STONE BASE IF NEW 20 ft 5-12 ft �����" DETAIL BOX �i 42.40 NO GROUNDWATER MOTTLING OBSERVED _ 36.95 SEWAGE DISPOSAL SYSTEM PLAN1141 WILTON DRIVE CENTERVILLE, MA IOCTOBER 9. 2015 ETE-39861 PG 2/2 r, Town of Barnstable Regulatory Services Richard V. Scali,Interim Director BARN$TAOI E SIAS& ,� Public Health Division. 1639. �Qr °rtorAaat> Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-796-6304: Installer&Designer Certification Form Date: �1 ; ��/5: Sewage'Permit# 9bS Assessor's MaplParcel 208/136 Designer: David D. Coughanowr IRS Installer: 1'0�14 ;2 Address: 155 George Ryder Rd South Address:. Chatham, MA 02633 on �13 `/Slt'�V goo was issued a permit to install a (date) (ins(aller) septic system at 41 Wilton Drive based on a design'drawn by (address) David D. Coughanowr dated October 9, 2015 (designer) • X 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 tank. Strip out (if required) was inspected and the soils were found satisfactory: l certify that the septic system referenced above°was installed with major changes (i.e. I0' lateral.relocation of the SAS.or an vertical relocation of an' eoin orient g�t�catct than y Y I? of the septic system) but in accordance with State &Local Regulations. Plan revision or ccrtii'ied as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory, I certify that the system referenced above was constructed in compliance with the tenns of the RA approval letters(if applicable) o OF G ; � ��A OF t.iA DAVID o_ DAl/!Ds D. (I staller's Signature) CQUGHANt3WR CaUGHMOWR No. 1093 tom, . (Designer's Signature) ner's Sta z " PLEASE RETURN TO BARNSIABLE PUBLIC HCAL'I'll 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:AScptie\Designer Certification Form Rev 8,-14-13.doc