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Home My WebLink About0053 ROLLING HITCH ROAD - Health 53 ROLLING HITCH RD, CENTERVILLE A= 192 063 rA// �gECYCIEp' J�/l�l1lG® o �y� . UPC 12534 �a No.2�OR �bsrco�'J HASTINGS, MN I r TOWN OF BARNSTABLE LOCATION SEWAGE#-2b I l S—i6 VILLAGE NArandiASSESSOR'S MAP&PARCEL Iq?•UZ INSTALLER'S NAME&PHONE NOs T —f� SEPTIC TANK CAPACITY LEACHING FACILITY:(type)CZ- g��( t (size) NO.OF BE ROOMS 3 OWNER D PERMIT DATE: /19 COMPLIANCE DATE: r%t'� Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility r 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 lea hi g aft Feet FURNISHED BY Frant'G� . Sux�,r�wt j At-2I $1-3-y A2-25.4 A3- 32 - _ TOWN OF BARNSTABLE LOCATION S3 ro j 1,A$ 1J; CJn 2c! SEWAGE # ' VILLAGE CEATtey,Il L ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY o1' &.5SjQM LEACHING FACILITY: (type) (size) NO. OF BEDROOMS 3 BUILDER OR OWNER Goe- II Oq^ �'rAnk PERMITDATE: - - - " COMPLIANCE DATE: 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 Sur\ roo �3 - 30 to Ina a3 a i No.c / r �Fee `� / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION" WW OF BARNSTABLE, MASSACHUSETTS ftPlication for Misposai Opst>em Construction Permit Application for Permit to Construct( ) Repair( ) Upgrade(\/Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. t 1{� Ed Owner's Name,Address,and Tel.No. Assessor's Map/Parcel °L - � �p Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building S. No.of Persons Showers( ) Cafeteria( ) Other Fixtures p� Design Flow(min.required) `i i l7 gpd Design flow provided c� Y 1 gpd Plan Date S'(i'2�y. Q (( Number of sheets 19 Revision Date Title -A L 0 S Size of Septic Tank Type of S.A.S. 2 SOd uir tc Description of Soil ►� �C (� I,t,�l h.� I7 l( .� 644 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 A tal Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of He lth Si Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. l' Date Issued f. / l/ v`ts'No. � `� Fee s'. THE COMMONWEALTH OF MASSACHUSETTS Entered incomputT r: PUBLIC HEALTH DIVISION rAli11�., OF BARNSTABLE, MASSACHUSETTS Yes 01pplicatioii for 33isposaf 6pstem Construction J)ermit Application for a Permit to Construct( ) Repair( ) Upgrade(Abandon Complete System ❑Individual Components Location Address or Lot No. ? Owner's Name,Address,and Tel.No. Assessor's Map/Parcel I wnl Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. a J4=jiIsR(_a=i wyli as k) :71 e of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building cT-H No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) Z 3o gpd Design flow provided 3 G gpd Plan Date , Number of sheets Revision Date Title—d c ! S S Size of Septic Tank� �� Type of S.A.S. �QA (_jA(f e f Description of Soil bit K4 Nature of Repairs or Alterations(Answer when applicable) 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 I vir ntal Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of H Ith. { Si Date Application Approved by Date MOM Application Disapproved by {} Date for the following reasons t A \j Permit No. Date Issued ------------------------------------------------------------------------------------- --------------------------------------- i THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-sits S ge Disposal system Constructed( ) Repaired( ) Upgraded( Abandoned( )by �'�` at V has been constructed in accordance / with the provisions of Title 51and theh.Aor Disposal System Construction Permit N G/9 :35t%O dated Installer011tv"vx % Designer #bedrooms Approved desig ow gpd The issuance of this permit shall not/be construed as a guarantee that the system will functio as ign Date % ' I Inspector ---------------------------------------------------------------------------------------------------------------------------- No. r9 --� �j Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS disposal *pstem ConstTurtio Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( Abandon( ) System located at c 3 ,l I r►�0► G 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 a comp eted within three years of the date of this Cb Date J Approved Town of Barnstable . y o Regulatory Services Richard V. Scali,Interim Director Public Health Division rFQ to 'Thomas McKean,.Director 2001lain Street,Hyannis;MA 02601 Office: 50$-862-4644 Fax: 508-790-6304 Installer& Designer Certification Nor>tn Date: ` �Z�' ty Sewage Permit# �l - 6 6�.,_�Assessor's iti�ap\Parcel 1 c1 Z — 3 N c am.+ee Designer: rr ifl A s lvtt Installer: 0 v�-n vt 3 E� Address: 1 Z Ly Cs Ic1 a, Address: 3`i 13c F;_1ej iglu[� M/ � G zy ty�c,J tri M 9 Q On v,.W,% GA. '_-C epas issued a permit to.install a l e) (installer) septic system at 53 IZQ t(�ny (-�� L. Q C.e L (address) _based on a.design dravim by ,'�eerie 1cs J dated (designer) v 1 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. I certify that the septic system ref`e.renced.aboN, liras installed with major changes (i.e. greater than I W lateral relocation of the SAS or any vertical relocation of ariv compeincnt, 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 satisfactory. I certify that the system referenced above was constructed ti with the terms- �the I1A approval letters(if applicable) ,t► —TOR _ 1( tis aller's Signature) CIVIL 140.351 C (Designer's Signature) (Affix Designe ` ere) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH l)IYISION.. CERTIFICATE OF COMPLIANCE WILL NOT BE-ISSUED UNTIL BOTH THIS FORM AND BUILT CARD ARE RECER'ED B�'THE B,ikRNSTABLI; PUBLIC :HEALTH DIVISIZ)N. TRANTK YOU. `Q esi;nerc rtificwtion FonnRev.&14-13.doc Engineers note.This"certilication is limited to an as-built inspection of system components as installed prior io backf ill,The engineer did not supervise construction of the system.The installer assumes responsibility for all materials,workmanohlp,beckfilling to specified grades viith proper compaction and setting riserskovers as shown on the design plan. f f Town of Barnstable Barnstable �p SHF TQ� Inspectional Services Department 1111.1 w HARN9TABLL,"�AS�- Public Health Divisions67q. �� 0"A°�e. 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4988 1586 August 13, 2019 MORRISON, HAROLD BRUCE 53 ROLLING HITCH ROAD CENTERVILLE, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 53 Rolling Hitch Road, Centerville, MA was inspected on 07/22/2019 by Scan M. Jones, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Leaching facility with standing liquid level at or above the invert pipe (per Town Code 360-20 h). You are ordered to repair or replace the septic system within two (2) years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH ean, R. ., HO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\53 Rolling Hitch Road Centerville.doc Town of Barnstable + BARNSfABLE. �p 6 9 A Inspectional Services Department Tf4 MA'S Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/26/19 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 ❑ Structurally unsound septic tank or SAS 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 well ❑ 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 of a driveway due to H-10 components, etc) '4 of Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:ISEPTICIDEADLINES TO REPAIR FAILED SYSTEMS.doc i Commonwealth of Massachusetts /9a 3 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 53 Rolling Hitch Road Property Address Harold Morrison Owner Owner's Name information is Centerville Ma 02632 7/22/2019 required for every page. CitylTown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information 0Z3 on the computer, Sean M. Jones use only the tab key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection use the return Company Name key. 74 Beldan Lane r� Company Address Centerville Ma 02632 Cityrrown State Zip Code 774-248-4850 smjonestitle5@gmail.com, S14522 sean@smjonestitle5.com License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section.15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my in and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ® Fails 7/22/2019 Inspector'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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 53 Rolling Hitch Road Property Address Harold Morrison Owner Owner's Name information is required for every Centerville Ma 02632 7/22/2019 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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: 2) System Conditionally Passes: ❑ 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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 r Commonwealth of Massachusetts �a Title 5 Official Inspection Form 1a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 53 Rolling Hitch Road Property Address Harold Morrison Owner Owner's Name information is required for every Centerville Ma 02632 7/22/2019 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)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 ❑ 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): 3) 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. a. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 53 Rolling Hitch Road Property Address Harold Morrison Owner Owner's Name information is required for every Centerville Ma 02632 7/22/2019 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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**. Method used to determine distance: **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. c. Other: 4) 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments V 53 Rolling Hitch Road Property Address Harold Morrison Owner Owner's Name information is required for every Centerville Ma 02632 7/22/2019 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ❑ 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 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 water supply 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. [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.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ® ❑ 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 system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to i15,000 gpd. For large systems, you must indicate either"yes or"no" to each of the following, in addition to the questions in Section CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 53 Rolling Hitch Road Property Address Harold Morrison Owner Owner's Name information is every Centerville required for eve Ma 02632 7/22/2019 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes" to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: 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? ® ❑ 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? ® ❑ 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, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts i� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 53 Rolling Hitch Road Property Address Harold Morrison Owner Owner's Name information is required for every Centerville Ma 02632 7/22/2019 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts x Title 5 Official Inspection Form In Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 53 Rolling Hitch Road Property Address Harold Morrison Owner Owner's Name information is required for every Centerville Ma 02632 7/22/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form F' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M � 53 Rolling Hitch Road Property Address Harold Morrison Owner Owner's Name information is required for every Centerville Ma 02632 7/22/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. 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 I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: original system 1971 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M., 53 Rolling Hitch Road Property Address Harold Morrison Owner Owner's Name information is required for every Centerville Ma 02632 7/22/2019 page. City/Town State Zip Code Date ofInspection D. System Information (cont.) 6. Septic Tank (locate on site plan): Depth below grade: 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: 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 How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 53 Rolling Hitch Road Property Address Harold Morrison Owner Owner's Name information is required for every Centerville Ma 02632 7/22/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. 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 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 n Commonwealth of Massachusetts 1. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 53 Rolling Hitch Road u Property Address Harold Morrison Owner Owner's Name information is required for every Centerville Ma 02632 7/22/2019 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date cif last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts e Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 53 Rolling Hitch Road Property Address Harold Morrison Owner Owner's Name information is required for every Centerville Ma 02632 7/22/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. 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. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ® overflow cesspool number: 1 ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 53 Rolling Hitch Road Property Address Harold Morrison Owner Owner's Name information is required for every Centerville Ma 02632 7/22/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Overflow block cesspool was found full to inlet elevation resulting in a failing inspection 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 1 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 Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Main cesspool was located but not excavated. Overflow is full resulting in a failing inspection. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .u 53 Rolling Hitch Road Property Address Harold Morrison Owner Owner's Name information is required for every Centerville Ma 02632 7/22/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts (e Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 53 Rolling Hitch Road Property Address Harold Morrison Owner Owner's Name information is Centerville required for every Ma 02632 7/22/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. 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 I `> A Li 30• 2,3 sZ t5insp.doc-rev.7/26/2018 Tide 5 0ffidal won Form:Subst0boe Sewage D4wsal Syetwn•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 53 Rolling Hitch Road Property Address Harold Morrison Owner Owner's Name information is Centerville required for every Ma 02632 7/22/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 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: Groundwater elevation was not established Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments u 53 Rolling Hitch Road Property Address Harold Morrison Owner Owner's Name information is Centerville required for every Ma 02632 7/22/2019 page. Cltyfrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 Commonwealth of Massachusetts Executive Office of Environmental Affairs �c/)' Department of Environmental Protection ro JR One Winter Street, Boston MA 02108 (61.7)292-5500 OXE etary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 53 Rolling Hitch Road, Centerville, MA Name of Owner: Gordon Frank Address of Owner: Same Date of Inspection: October 6, 1999 Name of Inspector: (Please Print) James M. Ford I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: James M. Ford Mailing Address: P.O. Box 49, Osterville, MA 02655-0049 Map: Telephone Number: (508)862-9400 Parcel: 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 sewage disposal systems. The system: ✓ Passes Conditionally Passes _ Needs Further Eval By the Local Approving Authority _ Fails Inspector's Signature: Date: October 7 1999 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 revised 9/2/98 Page Iof11 Printed on Recycled Paper + SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM • PART A �'?1 CERTIFICATION (continued) Property Address: 53 Rolling Hitch Road, Centerville, MA Owner: !'`. Gordon Frank Date of Inspection: October 6, 1999 INSPECTION SUMMARY: Check A, B, C, or 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. SYSTEM CONDITIONALLY PASSES: _ 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. Indicate yes,no,or not determined(Y,N,or ND). 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 pipe(s) 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 revised 9/2/98 Page 2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 53 Rolling Hitch Road, Centerville, MA Owner: Gordon Frank :6 ` Date of Inspection: October 6, 1999 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 the public health, safety and 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 THE PUBLIC HEALTH AND 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. • 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 AND SAFETY AND THE ENVIRONMENT: ; i The system has aseptic tank and soil absorption system(SAS)and the.SAS is within 100 feet to.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 1 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 revised 9/2/98 Page 3of11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 53 Rolling Hitch Road, Centerville, MA Owner: Gordon Frank Date of Inspection: October 6, 1999 D. SYSTEM FAILS: You must indicate either "Yes" or"No" as to each of the following: _ I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination 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'/z 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.l 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 coliforrn bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either"Yes" or"No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: _ The system serves a facility with a design flow of 10,000 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 owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 53 Rolling Hitch Road, Centerville, MA " _.`• Owner: Gordon Frank Date of Inspection: October 6, 1999 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. ✓ _ 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. n/a 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. -7- ✓ The septic tank manholes were uncovered, opened,and the interior of the septic tank was inspected for conditions 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: ✓ 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) [15.302(3)(b)]. _ The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Subsurface Disposal Systems. revised 9/2/98 Page 5of11 I i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM , PART C SYSTEM INFORMATION Property Address: 53 Rolling Hitch Road, Centerville, MA Owner: Gordon Frank Date of Inspection: October 6, 1999 FLOW CONDITIONS RESIDENTIAL: Design flow: n/a g.p.d./bedroom. Number of bedrooms(design): n/a Number of bedrooms(actual): 3 Total DESIGN flow n/a Number of current residents: 2 Garbage grinder(yes or no): Yes Laundry(separate system)(yes or no): No ; If yes, separate inspection required Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings,if available(last two year's usage(gpd): 1998-112 000 Qals. 1997-125,000 Qals. Sump Pump(yes or no): No Last date of occupancy: Currently occupied. COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: and(Based on 15.203) Basis of design flow Grease trap present: (yes or no) Industrial Waste Holding Tank present: (yes or no) Non-sanitary waste discharged to the Title 5 system: (yes or no) Water meter readings,if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: Never pumped-per owner. System pumped as part of inspection(yes or no): No If yes, volume pumped: gallons 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) _ 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(if known)and source of information: Unknown_ Sewage odors detected when arriving at the site: (yes or no) No revised 9/2/98 Page 6ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 53 Rolling Hitch Road, Centerville, MA Owner: Gordon Frank Date of Inspection: October 6, 1999 xl; __ •.. . BUILDING SEWER: _ (Locate on site plan) Depth below grade: Material of construction: _cast iron _40 PVC _other(explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting,evidence of leakage, etc.) SEPTIC TANK: None (locate on site plan) Depth below grade: Material of construction: concrete metal _Fiberglass _Polyethylene _other(explain) If tank is metal,list age_ Is age confirmed by Certificate of Compliance_(Yes/No) 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: How dimensions were determined: 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,etc.) s GREASE TRAP: None (locate on site plan) Depth below grade: 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: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, integrity, evidence of leakage,etc.) revised 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 53 Rolling Hitch Road, Centerville, MA Owner: Gordon Frank Date of Inspection: October 6, 1999 :g TIGHT OR HOLDING TANK: None (Tank must be pumped prior to; or 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/day Alarm present: Alarm level: Alarm in working order: Yes— No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches, etc.) DISTRIBUTION BOX: None (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, etc.) PUMP CHAMBER: None (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order: (Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) revised 9/2/98 Page 8of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 53 Rolling Hitch Road, Centerville, MA Owner: Gordon Frank Date of Inspection: October 6, 1999 arc; SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan, if possible;excavation not requited, 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: I Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.) The overflow cesspool (6' W x 5'T)was dry. The bottom to grade was 8'6" There were no signs of failure. CESSPOOLS: ✓ (locate on site plan) Number and configuration: I with overflow Depth-top of liquid to inlet invert: 1'6" Depth of solids layer: 6" Depth of scum layer: 1" ` Dimensions of cesspool: 6' W x 5' T Materials of construction: Cesspool block Indication of groundwater: None inflow(cesspool must be pumped as part of inspection). Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.) The bottom to grade was 8'6" The liquid level in the cesspool was 1'6"below the outlet pipe. PRIVY: None (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.) revised 9/2/98 Page 9ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 53 Rolling Hitch Road, Centerville, MA Owner: Gordon Frank Date of Inspection: October 6, 1999 ; .. s.. Map. Parcel. 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) 5uv\ roo a Al f31 ' 3 o Ida:- a3 revised 9/2/98 Page 10of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 53 Rolling Hitch Road, Centerville, MA Owner: Gordon Frank Date of Inspection: October 6, 1999 .., 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 35 +/- Feet 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.) Determined from local conditions ✓ Checked with local Board of Health Checked FEMA Maps Checked pumping records Check local excavators, installers ✓ Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) Using the Barnstable Topographic map and the Water Contours map, the maps were showing approximately 35' +/- to groundwater at this site. Using the Cape Cod Commission Technical Bulletin, the high groundwater adjustment for this site (SDW 252, Zone D, 9/99) was 4.8'. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. revised 9/2/98 Page 11of11 7 Commonwealth of Massachusetts Executive of Environmental Affairs DEPr : Department of Environmental Protection } : a 9� a0 , Q co SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM� PART A � CERTIFICATION - Property Address: 53 R oiling H itch R d. Centerville, M a. Address of Owner: Leonard & Louise Francis (if different) Date of Inspection: 06/25/96 Name of Inspector: Michael D eD ecko Company Name, Address and Telephone number: Atlantic Environmental P.o Box 2384 - M ashpee Ma 02649. Tel : (508) 4771420 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 sewage disposal systems. The system X Passes ---- Conditionally Passes ---- Needs further evaluation by the local Approving Authority ---- Fails r Inspector 's ft—OW V,0 Date: 06/28/96 The system Inspector shall submit a cop} of this inspection report to the Approving Authority 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 or the Department of Environmental Protection. The original should be sent to the system owner and copy sent to the buyer, if applicable and the approving authority. r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 53 R olling H itch R oad. Centerville, M a. Owners : L. Francis Date of Inspection : 06/25/96 INSPECTION SUMMARY: Check A, B, C, or D A) SYSTEM PASSES: have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CM 15.303. Any failure criteria not evaluated are indicated below B) SYSTEM CONDITIONALLY PASSES: ---- One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determinate (Y,N, or ND). Describe basis of determination in all instances. If "not determinated", explain why not. ---- The septic tank is metal, 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 conforming 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 pipe(s) 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 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address : 53 Rolling Hitch Road. Centerville, Ma. Owner : L. Francis. Date of Inspection : 06/25/96 C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: -- Conditions exist which require further evaluation by the Board of Health in order to de- termine if the system is failing to protect the public health ,safety and the environ- ment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: ---- Cesspool or privy is within 50 feet of a surface of water ---- Cesspool or privy is within 50 feet of a bordering vegetated wetland or a small marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNC- TIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT. --- The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. ---- The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. ---- The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. ---- The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analy- sis 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 notrogen is equal to or less than 5 ppm. D) SYSTEM FAILS: -- I have determined that the system violates one or more of the following failure criteria as defined in 310 CM 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to cor- rect the failure. --- Backup of sewage into facility or system component due to an overloaded or or clogged SAS or cesspool SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 53 R oiling H itch R oad. Centerville, M a Owner: L. Francis Date of Inspection : 06125/96 D) SYS T E M FAI LS (continued) -- 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 over- loaded 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 NO T 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 cesspool or privy is within 100 feet of a surface water supply ortributary 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 ana- lysis. 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. i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 53 R offing H itch R oad. Centerville, M a. Owner: L. Francis Date of Inspection : 06/25196 E) LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above : The design flow of system is 10,000 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 : --- 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 I I of a public water supply well. The owner or operator of any such system shall bring the system and facility into full compli- ance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please, consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 59 R olling H itch R oad. Centerville, M a. Owner: L. Francis. Date of Inspection: 06/25/96 Check if the following have been done : -x Pumping information was requested of the owner , occupant and Board of Health. --x None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during the period. Large volumes of water have not been introduced into the system recently or as part of this inspection. --x As built plans have been obtained and examined. Note if they are not available with N/A. --x The facility or dwelling was inspected for signs of sewage back-up. --x The system does not receive non-sanitary or industrial waste flow. --x The site was inspected for signs of breakout. --x All system components, excluding the Soil Absorption System, have been located on the site. ---x The septic tank manholes were uncovered, opened and the interior of the sep- tic tank was inspected for conditions of baffles or tees, material of construc- tion, dimensions, depth of liquid, depth of sludge, depth of scum. - x The size and location of the Soil Absorption System on the site has been deter- mined based on existing information or approximated by non-intrusive methods - -x The facility owners and occupants if different from owner were provided with information on the proper maintenance of Subsurface Disposal System. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 53 Rolling Hitch Road. Centerville, Ma. Owner: L. Francis Date of Inspection: 06125/96 RESIDENTIAL: Design flow : gallons Number of bedrooms : 03 Number of current residents: °L Garbage grinder (yes or no) :N Laundry connected to system (yes or no): Seasonal use (yes or no) : Water meter readings, if available: Last date of occupancy : COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow : gallons/day Grease trap present: (yes or no) Industrial waste holding tank present (yes or no) : Non-sanitary waste discharged to the Title 5 system (yes or no) : Water meter readings, if available : Last date of occupancy Other: (Describe) .................................:.......................................................................... Last date of occupancy: GENERAL INFORMATION PUMPING RE,CO DS and source,of`information System pumped as park of inspection(yes or no):...Nr ............ if yes, volume pumped: .................... gallons Reasonfor pumping :............................................................................................................ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 53 R olling H itch R oad. Centerville, M a. O wner: L. Francis. Date of inspection: 06/25/96 TYPE OF SYSTEM --- Septic tank/distribution box/soil absorption system --- S Ingle 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) and source of information .....r........�- CS'..... Y.iiT..........�r'r ............................�: .�. ........................................................... ................................................................................................................................................ ................................ Sewage odors detected when arriving at the site: (yes or no).............. SEPTIC TANK: ...W....... (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, etc.)...................... ................................................................................................................................................ ................................................................................................................................................ ................................................................................................................................................ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PAR T C SYSTEM INFORMATION (continued) Property Address: 53 R olling H itch R oad. Centervillle, M a. Owner. L. Francis. Date of inspection: 06/25/96 GREASE TRAP : ....... ...... (locate on site plan) Depth below grade: ............... Material of construction: ........concrete.........metal........FR P........other(explain).... .......................................................................................................................................... Dimensions:............................... Scum thickness:........................ Distance from top of scum to top of outlet tee or baffle:....................................... Distance from bottom 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,etc.)........................ ................................................................................................................................................ ................................................................................................................................................ TIGHT OR HOLDING TANKS:.. D...... (locate on site plan) Depth below grade:............... Material of construction:........concrete........metal.........FRP..........other (explain).......... ................................................................................................................................... Dimensions:............................ Capacity:....................gallons Design flow:...............gallons/day Alarm level:............................. Comments: (condition of inlet tee, condition of alarm and float switches, etc.) . ................................................................................................................................................ ................................................................................................................................................ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 53 R ailing H itch R oad. Centerville M a. Owner: L. Francis Date of inspection: 06/25/96 DISTRIBUTION BOX:...N.� (locate on site plan) Depth of liquid level above outlet invert:................... Comment: (note if level and distribution equal evidence of solids carryover, evidence of leakage into orout of box, etc.).................................................................................................................. ................................................................................................................................................ ................................................................................................................................................ PUMP CHAMBER:.....:.0 6.. (locate on the site) Pumps in working order: (yes or no)............... Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.).................... ...............................................................:................................................................................ ................................................................................................................................................ 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, number: .................. leaching chambers,number:........ leaching galleries, number:........... leaching trenches,number , length:..................... leaching fields, number, dime lions:................... overflow cesspool,number:.!. ski.4. Comments: (note condition of soil , signs of hydraulic failure,level of ponding, condition of vegetation, etc.)..<.... r�r, . 4d'4t....�D�..YAt..:::.::C,�P£:� �..�t:tc`� •� ,EI �E'�C�.?A, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property address: 53 Rolling Hitch Road. Centerville Ma. Owner: L. Francis Date of inspection: 06125196 CESSPOOLS:........ . (locate on site plan... Number and configuration: ....... ....G..... Depth-top of liquid to inlet invert: .....a`f Depth of solids layer: ....... `.................... ..... Depth of scum layer: ®° Dimensions of cesspool: ... .h. .......... Materials of construction: ... ccY Indicator of ground water: ...r:1^........... inflow (cesspool must be pumped as part of inspection) 5... ................................................................................................. Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) r � . read- -... :. rS �.11`> ,'r_;•4 f`�r r[1`.� �y. ........ ...........................I ..::..r1q PRIVY . ...... `.' . (locate on the site) Material of construction: ................................... Dimensions: ...................... Depth of solids: ................ Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.). A ................................................................................................................................................ ................................................................................................................................................ 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address : 53 R ailing H itch R oad. Centerville, M a. Owner: L. Francis. Date of inspection: 06125/96 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate at wells within 100' k 2z- �JNQODv� C DEPTH TO GROUNDWATER: Depth to groundwater: .�.�Q..Peek Method of determination or approx1im\akive: _ V.•AS..�Cfll.c�.C�.�..C�..l.`t.`.�_:..1 ti'tu'Q:1 '� �"�:��.....srAa��:":.�,o.•r.:.-::di......r4..!....�...�..... ................................................................................................................................................ x -- 97--EXISTING CONTOUR x 100.98 EXISTING SPOT GRADE Co n Crosb Rd N I. EXISTING WATER SERVICE �a WRDLLING HITuriI-�0AD G EXISTING GAS SERVICE 0-- ooPen �n -�//, y},<-OVERHEAD WIRES A°� Posth tng i CURRENT TEST PIT ��° °�t os y MOStheoy Ln edge t 98.54 98.75 °f Povement)9.31 99.31 BENCHMARK \ 9927 ® 99.92 LEGEND of �a � , �100.00 ry a 0 _i �SP1IGl< N 44*10'30" E 100.00 100.26 0 3 o\\cA + 99.63 q� Ap �r LOCUS Z 2 p 100.07 100,46 p- x ��. LOCUS MAP 100.78 NOT TO SCALE /-GENERALOTES: 100,09 100.35 100.17 x 100,30 0 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL ~/ x 100,19 Q BOARD OF HEALTH AND THE DESIGN ENGINEER. 99.81) 9.96 2• ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS x 100.43 a OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE ? LOCAL RULES AND REGULATIONS. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR ° TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. EXISTING DRII%EWAY;:; . .; ':..` :. o 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING z ° HOUSE&53) EXISTING FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN T.O.F.=f00.5t ENGINEER BEFORE CONSTRUCTION CONTINUES. W / p.* N''' 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. CD EXIST; SEWS 100.31 y 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF O ° EXIST., SEWER INV_g8.4t 100,4 p THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF WO O00 INV.=98.4f 100.37 0) L • HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. BH AI- LA WN /RR/GA T/ON ' P K S E T t S NROOM 100,53p�' t� SYSTEM /N PLACE o 0 100.38 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. PATIO 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. 99,67 x �. "r..7'T CROP. S.A.S..;: 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE C� ✓ x 1 0,09 ,..:�DO 100.42 DIRECTED BY THE APPROVING AUTHORITIES. 0 0 0 7 .`.'; 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY 0+ 100,01 • P'.;ZT THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING 099.32 -ADD CLEANOUT 2 100 43 CONSTRUCTION. 0'.4 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS 99.82 99 86 clearing. ' J IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND 0 0p REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 99.24 edge • °f 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE BENCHMARK INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. PROPOSED 000R./BULKHEAD 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND ' SEPTIC TANK EL.=100.53 NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. 142.5a 14. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC S 3315'32" W EXISTING CESSPOOLS SYSTEM COMPONENTS NOT SHOWN ON THE PLAN L WITH SAND & ABANDON PARCEL ID: 192-063 �F M ��P�� gssgcti� PROPOSED SEPTIC SYSTEM UPGRADE PLAN o PETER T. McENTEE --4 53 ROLLING HITCH ROAD, CENTERVILLE, MA CIVIL No. 35109 Prepared for: Harold Morrison, 53 Rolling Hitch Road, Centerville, MA y ALE DRAWN JOB. NO. OWNER OF RECORD Engineering by: SCALE "=20' P.T.M. 231-19 E MORRISON, HAROLD BRUCE Engineering Works, Inc. 53 ROLLING HITCH ROAD 12 West Crossfield Road, Forestdole MA 02644 DATE CHECKED SHEET NO. CENTERVILLE, MA 02632 (508) 477-5313 8/26/19 P.T.M. 1 Of 2 NOTE: TO PREVENT BREAKOUT, FINAL GRADE SEPTIC TANK SHALL NOT BE AT, OR BELOW, EL.=96.5 _ INSTALL RISERS & COVERS OVER INLET & FOR A DISTANCE OF 15' FROM THE EDGE OUTLET AND SET TO 6"-.F FINISH GRADE PROPOSED D—BOX OF THE PROPOSED S.A.S. INSTALL RISER & COVER PROPOSED S.A.S. 1 SET TO 6" OF GRADE INSTALL RISER & COVER OVER ONE CHAMBER AND T.O.F=100.5t SET TO 3" OF F.G. TO'SERVE AS INSPECTION PORT F.G. EL.=100.Of F.G. EL.=100.0f F.G. EL.=100.2f F.G. EL.=100.3t ff MAINTAIN 2% SLOPE OVER S.A.S. EXISTING L = 32' 3'(max.) L = 30' HOUSE(#53) EXISTING ® S=1% (MIN.) p S=1% (MIN.) ® S=1%5(MIN.) T.O.F.=fOO.Jrf 4"SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC 2" LAYER OF 1/8" TO 1/2" T:L6^ DOUBLE WASHED STONE t0"I n Ba $ r (OR APPROVED FILTER FABRIC) t4" 1 s 2' EFF. 00Baeaa INV.=97.32 48" LIQUID DEPTH Baaaaea --g/4" TO 1-1/2" DOUBLE BN �i 2�6+. LEVEL ADD INV.=96.77 PROPOSED 4' 4.8' 4' WASHED STONE SUNROOM INV.=96.60 GAS BAFFLE D—BOX EFFECTIVE WIDTH = 12.8' — �� 1 am A�m Jim INV.=97.07 3 OUTLETS 29'7� INV.=96.50 54.6' 9-500 GALLON LEACHING'CHAMBERS ' N PROPOSED SEPTIC TANK SURROUNDED WITH STONE AS SHOWN 33 4, 56.1' PROPOSED i OD CONNECT TO EXISTING SUITABLE SEWER PIPE/S H-20 RATED S A S AT HOUSE, AT OR ABOVE, INV.=98.4t(verify) TOP CONC. ELEV.=97.6f �__25'�"—'� NOTES: BREAKOUT ELEV.=97.00 INV. ELEV.=96.50 aaBee SEPTIC LAYOUT 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPES & a99aaaaOaaa=1 INVERTS EXITING HOUSE, PRIOR TO INSTALLATION. BOTTOM ELEV.=94.50 aaaBBaaaaaa 2) SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND H 2 x 8.5' _ 17.0' 4' TRUE TO GRADE ON A MECHANICALLY COMPACTED 4' OF NATURALLY OCCURRING EFFECTIVE LENGTH = 25.0' SIX INCH CRUSHED STONE BASE, AS SPECIFIED PERVIOUS MATERIAL IN 310 CMR 15.221(2). 5' (MIN.) ABOVE G.W. LEACHING SYSTEM SECTION 3) INSTALL INLET & OUTLET TEES AS REQUIRED. BOTTOM OF TEST PIT, EL.=90.0 — 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE EST. HIGH G.W. EL.=70.0 _ ®®®®®® ® ®®®® 37" AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. ® Z ®�®® N ®® ® ®®®® G SEPTIC SYSTEM PROFILE 102" DESIGN CRITERIA SOIL LOG 4" KNOCKOUT NUMBER OF BEDROOMS: 3 BEDROOMS DATE: AUGUST 19, 2019 (REF#TPT-19-115) 20" DIA. COVER SOIL EVALUATOR: PETER WENTEE PE(SE#1542) SOIL TEXTURAL CLASS: CLASS I (LOADING RATE=0.74 GPD/SF) WITNESS: DAVID STANTON R.S. HEALTH AGENT DESIGN PERCOLATION RATE: <2 MIN/IN ELEV. TP- 1 DEPTH ELEv. TP-2 DEPTH 4" KNOCKOUT 4" KNOCKOUT 58" DAILY FLOW: 330 GPD 100.4 A 0" 106.5 A 0" 0 DESIGN FLOW: 330 GPD SANDY LOAM i SANDY LOAM GARBAGE GRINDER: NO—not allowed with design 99.9 B 10YR 4/2 6" 100.0 B 10YR 4/2 61, 4" KNOCKOUT LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF SANDY LOAM SANDY LOAM 97 9 10YR 5/6 30 97 9 10YR 5/6 31 500 GALLON CAPACITY, H-20 LOADING 74 GPD/SF C F C CHAMBERS PROPOSED SEPTIC TANK: 1500 GALLON CAPACITY PERC PROPOSED D—BOX: 1 INLET, 3 OUTLET (MINIMUM), H-10 RATED 30"/48"1 N.T.S. USE 2-500 GALLON LEACHING CHAMBERS IN SERIES M-C SAND M-C SAND PROPOSED SEPTIC SYSTEM UPGRADE PLAN SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES 2.5Y 6/6 2.5Y 6/6 53 ROLLING HITCH ROAD, CENTERVILLE, MA SIDEWALL AREA: 2(12.8' + 25.0') X 2 = 151.2 S.F. BOTTOM AREA: 12.8' x 25.0' = 320.0 S.F. I Prepared for: Harold Morrison, 53 Rolling_ Hitch Road, Centerville, MA Engineering by: SCALE DRAWN JOB. NO. DESIGN FLOW PROVIDED: 0.74 GPD/SF(471.2 SF) 473 8.7 GPD PERC RATE <2 MIN% 0 126 Engineering Works, Inc. N.T.S. P.T.M. 231-19 TOTAL AREA:.................... ... .. . . .. . 90.0 126" 91N. "C" HORIZON 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET N0. NO GROUNDWATER', ENCOUNTERED (508) 477-5313 8/26/19 P.T.M. 2 Of 2