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HomeMy WebLinkAbout0593 RIVER ROAD - Health 593 RIVER ROAD Marstons Mills A = 043 - 012 f i � C30�c a�k TOWN OF�ARNSTABLE c LOCATION SEWAGE# Q� Cl J t,YILLAGECI(S S�t,f ASSESSOR'S MAP&PARCEL �� �• U I INSTALLER'S NAME&PHONE NO. &sA n :Or�54 0001 01 SEPTIC TANK CAPACITY cs c�L LEACHING FACILITY:(type) (size) (a X(. iN Sr6 n,& NO.OF BEDROOMS OWNER S c.v PERMIT DATE:=6i C1 COMPLIANCE DATE: /® 11 , 097 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 Ate as A 713 � s aL p Z s 2�i Q 3 3" A �4 No- f 3n Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for misposal *pBtem Construction Permit Application for a Permit to Construct( ) Repair("jUpgrade( ) Abandon( ) ❑Complete System P Individual Components Location Address or Lot No. .Yci 3 kN CX @ 3 Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 01 c2 MAhn Maw LJ Installer's arne,Address,and Tel.No, Designer's Name,Address,and Tel.No. SC(Dt 1 c^V n•.ou S(\ �- 2LCN POPE Type of uilding: Dwelling No.of Bedrooms 1✓ Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided MIA gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 5C S �`t c i t C!r\ tsn, r1•ew Qk:�� t"6 fib t&N (PLC Ste, ((Q LZam 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 to q Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued P i, Fee THE COMMONWEALTH OF MASSACHUSETTS -.. Entered in computer: Yes - 1� PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for Misposal 6pstPm Construction Permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. Sq kgxr 2 Owner's Name,Address,and Tel.No. Assessor's Map/Parcel ...� M(^{'Shn/+1i III t— Sc\vMS� Installer's Name,Address,and Tel.No. J Designer's Name,Address,and Tel.No. \13 G\4*16.r MUU �- 1 n_ Type of uilding: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided A TILA gpd Plan Date Number of sheets Revision Date Title 1. Size of Septic Tank Type of S.A.S. F Description of Soil �41 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. v Signed r r r i; Date Application Approved by Date Application Disapproved by _ Date for the following reasons Permit No. ( �� Date Issued --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of CompliantP HIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded( ) Abando ed( )by at C'G� :V V n . M6"r g kri^M�`13as been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. cZ dl slated 6 y�q Installer C: ch Designer A design /SJ jJ /�#bedrooms p� �� Approved gn flow gpd The issuance of this permit shall not be construed as a guarantee that the system wil functio kdesigne Date i Inspector l� (� --------------------------------------------------------------------------------------------------------------------------------------- No. a Fee 2!5 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS misposaf �p4tP onstruction Permit Permission is hereby granted to Construct( ) . Repair( Upgrade( ) Abandon( ) ' V ystem located at��Cj�����p{��������� M 1`��' i S and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. c Date U Approved by } I KIE Town of Barnstable Inspectional Services BARNb'TABL£, 3 Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL#7015 1730 0001 4988 1173 October 2, 2019 W11,N]INGTON SAVINGS FUND SOCIETY FSB TRUIS C/O Rt.JS.[.[Nl(.)R.E LOAN M(.,M'tl SERVICE 15480 LAGUNA CANYON RD S'l I E, 100 IRVINE, CA 92618 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 593 River Road, Marstons Mills, MA was inspected on 09/20/2019 by Sean M. Jones, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of 1995 TITLE V (3 10 CMR 15.00) due to the following: 0 The distribution box is rotted. You are ordered to replace the distribution box within one (1) year 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 Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SFPTIC\Title V Inspection Report Letters Mai I ing\Conditioiial ly Passes Letters\593 River Road Marstons Mills.doc r , Town of Barnstable + + BARNS[ABLE, b 9 ,�� Inspectional Services Department .orED 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) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTWER Zile) Repair deadline: G Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusett d Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r t P 593 River Road Property Address Wilmington Savings Fund Society, Rushmore Loan Management Service, Carlsbad Funding ? Owner Owner's Name information Is required for every Marstons Mills....................... Ma 02648 9/20/2019 page. Cityrrowm State Zip Code Date of Inspection r, 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:out f rms A. Inspector Information / tilling out forms on the computer, Sean M. Janes 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 p _ key. 74 Beldan Lane UM Company Address Centerville Ma 02632 Citylrown State Zip Code ray 774-248-4850 smjonestitle5@gmail.com, S14522 sean@smionestitle5.com License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 16.340 of Title 6 (310 CMR 16.000); 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 inspection; 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. ED Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 9/20/2019 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. #tiinap:doo-rev:7126mia TtUe 5 Official Inspadion Form^Subsurface Sewage Disposal System•Pop 9 of IS . r r Commonvtrealth of Massachusetl Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 593 River Road Property,Address Wilmington Savings Fund Society, Rushmore Loan Management Service, Carlsbad Funding. Owner Owner's Name information is Marstons Mills Ma 02648 9/20/2019 required for every _._._._.._.�.. page. City/Town 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. 0 Y ❑ N ❑ NO(Explain below): 151r"A c•ray..7/20=15 TIUe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments " 593 River Road Property Address Wilmington Savings Fund Society, Rushmore Loan Management Service, Carlsbad Funding Owner Owners Name information is M required for every arstons Mills Ma 02648 9/20/2019 page. Co Town State Zip Code Date of inspection C. Inspection Summary (cons.) 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): Distribution box was found rotted at water level ❑ 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)(ti)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7126=18 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 593 River Road Property Address Wilmington Savings Fund Society, Rushmore Loan Management Service, Carlsbad Funding owner Owner's Name ___.__. _._. information is Marstons Mills Ma 02648 9/20/2019 required for every _....__ page. City/Town 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 1.00 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•roe'7/211 018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 593 River Road Property Address Wilmington Savings Fund Society, Rushmore Loan Management Service, Carlsbad Funding Owner Owner's Name information is required for every Marstons Mills Ma 02648 9/20/2019 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 Y:day flow ❑ ® Required pumping more than 4 times in the last year NOTdue 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 forma ❑ ® 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 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 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 If of a public water supply well tSinsp.doc•rev.7/26=18 Tide 5 Mist inspection Form:Subsurtaoe Sewage Disposal System•Page 5 or 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 593 River Road Property Address Wilmington Savings Fund Society, Rushmore Loan Management Service, Carlsbad Funding Owner Owner's Name rnq required is every Marstons Mills re wired for eve Ma 02648 9/20/2019 _ page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cost.) If you have answered"yes"to any question in Section C.5 the system is considered d 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 shout y d contact the appropriate regional office of the Department, P 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)) Mnsp.doc•ray,7/26/2018 TWO 6 Official InSpeGion Form Subsurface Sewage Disposal Syslem•page 6 of 18 Commonwealth of Massachusetts IVTitle 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 593 River Road Property Address Wilmington Savings Fund Society Rum_ shmore Loan Management Service, Carlsbad Funding Owner Owner's Name information is Marstons Mills Ma 02648 9/20/2019 required for every page. Citylrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 gpd Description: Number of current residents: 0 9 Does residence have a garbage arba a cinder? ❑ 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 (3 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: unknown Date 15insp.doc•rev.7126=18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments, 593 River Road Property Address Wilmington Savings Fund Society, Rushmore Loan Management Service, Carlsbad Funding Owner Owner's Name information is Marstons Mills Ma 02648 9/2012019 required for every page. CitylTown 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 g ( ) 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.712W2018 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,. 593 River Road Property Address Wilmington Savings Fund Society, Rushmore Loan Management Service, Carlsbad Funding Owner Owner's Name information is Marstons Mills Ma 02648 9/20/2019 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (coot.) 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/Altemative 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: system installed 12/3/1990 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 4.5 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.): Joints in good condition, no leakage, vented through roof. trinsp,dac•rev.712 612 0 1 8 Title 5 official Inspedion Farm Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 593 River Road Property Address Wilmington Savings Fund Society, Rushmore Loan Management Service Carlsbad Funding Owner Owner's Name information required for every Marstons Mills Ma 02648 9/20/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 4 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 gallons Sludge depth: 5" —.- Distance from top of sludge to bottom of outlet tee or baffle 3 Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 7° Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? Opened covers and took measurements 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 needs to be pumped now and again every 2 years for proper maintenance. water level was even with outlet, tank was not leaking and was structurally sound t5inap,doc•rev.7l26WS Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Pape 10 of 18 ,y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 593 River Road Property Address Wilmington Savings Fund Society, Rushmore Loan Management Service, Carlsbad Funding Owner Owner's Name information is Marstons Mills Ma 02648 9/20/2019 required for every 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: El concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: --- Capacity: gallons Design Flow: gallons per day t5inep.doc•rev_7P1512018 Title 5 Official Inspection Form:Subsurface Sawago Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 593 River Road Property Address Wilmington Savings Fund Society, Rushmore Loan Management Service, Carlsbad Funding Owner Owner's Name information is required for every Marstons Mills Ma 02648 9/20/2019 page. City/Town State Zip Code Date of inspection D. System Information (cont.) 8. Tight or Holding Tank(cant.) 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 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.): Distribution box was found rotted at water level and needs to be replaced t5lnsp.doc•rev.7126=18 We 5 Official Inspection Form.Subsurface Sewage Dlaposal System•Page 12 of 10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 593 River Road Property Address _w Wilmington Savings Fund_Society, Rushmore Loan Management Service, Carlsbad Funding Owner Owner's Name information is required for every Marstons Mills ... Ma 02648 9/20/2019 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): I 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: 1 ❑ leaching chambers number: leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number. ❑ innovative/alternative system Type/name of technology: t5lnsp.acc•rev.7r2WM18 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection. Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 593 River Road Property Address Wilmington Savings Fund Society, Rushmore Loan Management Service, Carlsbad Funding Owner Ownees Name information is Marstons Mills required for every Ma 02648 9/20/2019 page. Cityfrown State Zip Code Date of Inspection D. System Information (coat.) 11. Soil:Absorption System(SAS)(cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach pit was dry at time of inspection with no obvious signs of past hydraulic overloading. Cover is on a riser. 12. 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 Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doe•rev.7126QOIS Titla 5 QflIMI Inspodion Form:Subourfoco a Disp osal poael System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 593 River Road Property Address Wilmington Savings Fund Society, Rushmore Loan Management Service, Carlsbad Funding Owner owner's Name information is required for every Marstons Mills Ma 02648 9/20/2019 page. Cityrrown 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.): i tblesp.doc.rev.MAM118 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 593 River Road Property Address Owner Wilmington Savings Fund Society, Rushmore Loan Management Service Carlsbad Funding information is Owner's Name Marstons Mills required for every Ma 02648 9/20/2019 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 FC)-i� AZ 2.cr b ,� Z .2-9 A3 37 �3 31 Aj-( 3sr t5insp.doc•rev.7fAM18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 or 98 f Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 593 River Road Property Address Wilmington Savings Fund Society, Rushmore Loan Management Service, Carlsbad Funding Owner Owner's Name information is required for every Marstons Mills Ma 02648 9/20/2019 page. Cityrrown 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: 12+ 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 was established by accessing town of Barnstable groundwater contour maps. Before filing this inspection Report, please see Report Completeness Checklist on next page. 15insp.dw-rev.7126/2ota Title 5 Officie!Inspection Form:Subsurface Sewage Disposal system-Page 117 of 1s Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 593 River Road Property Address Wilmington Savings Fund Society, Rushmore Loan Management Service, Carlsbad Funding Owner Owner's Name rnequire for is every MarstonS Mills required for eve Ma 02648 9/20/2019 page. Citylrown 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 t5insp.doc•rev..7IM2018 Title 5 Official Inspection Fo=Subsurface Sewage Disposal System•Page r8 of I rep_ we w"fl��! y -I� role v eoo aS STD " ',&,PU U S,p d U C w1" Commonwealth of Massachusettsc3� ,3 Title 5 Official Inspection Form IIb Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 593 River rd v Property Address WILMINGTON SAVINGS FUND SOCIETY FSB TRUS Owner C/O RUSHMORE LOAN MGMT SERVICE information is Owner's Name required for every page. Marstons Mills Ma 02648 _ 9/5/19 Cityrrown 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 A. Inspector Information S( l�fl3[o filling out forms on the computer, use only the tab Michael DiBuono key to move your Name of Inspector cursor-do not DiBuono Sewer And Drain use the return Company Name key. 35 Content Lane r� Company Address Cotuit Ma 02635 City/Town State Zip Code 508-364-9587 S113522 Telephone Number 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 inspection; 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 9/6/19 F.spector'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 I-aspection. If the system has a design flow of J.0;000ggpd or greater, the inspector and the system owner shall submit the report to the appropriate .' egional 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 15insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 19 i c Commonwealth of Massachusetts Title 5 Official Inspection Form to Subsurface Sewage Disposal System Form - Not for Voluntary Assessments /L 593 River rd u Property Address WILMINGTON SAVINGS FUND SOCIETY FSB TRUS Owner C/O RUSHMORE LOAN MGMT SERVICE information is Owner's Name required for every page. Marstons Mills Ma 02648 9/5/19 CitylTown State Zip Code Date of Inspection in the future under the same or different conditions of use. 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: System contains a 1000 Gallon septic tank as well as a concrete distribution box and concrete leach pit. SYSTEM IS IN FAILURE. Staining and sludge in Dbox indicate push back and carry over. Levels higher than normal. System is 31 years old 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 19 I , Commonwealth of Massachusetts IF Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 593 River rd Property Address WILMINGTON SAVINGS FUND SOCIETY FSB TRUS Owner C/O RUSHMORE LOAN MGMT SERVICE information is Owner's Name required for every page. Marstons Mills Ma 02648 9/5/19 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 19 I Commonwealth of Massachusetts Title 5 Official Inspection Form io Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 593 River rd Property Address WILMINGTON SAVINGS FUND SOCIETY FSB TRUS Owner C/O RUSHMORE LOAN MGMT SERVICE information is Owner's Name required for every page. Marstons Mills Ma 02648 9/5/19 Cityrrown State Zip Code Date of Inspection 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: 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 19 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form to Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 9 p Y rY 593 River rd Property Address WILMINGTON SAVINGS FUND SOCIETY FSB TRUS Owner C/O RUSHMORE LOAN MGMT SERVICE information is Owner's Name required for every page. Marstons Mills Ma 02648 9/5/19 Cityrrown State Zip Code Date of Inspection You must indicate "Yes" or"No"to each of the following for all inspections: Yes No Backup of sewage into facility or stem component due to overloaded or ❑ ® p 9 tY Y p 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 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 '/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 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 15,000 gpd. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 19 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 593 River rd Property Address WILMINGTON SAVINGS FUND SOCIETY FSB TRUS Owner C/O RUSHMORE LOAN MGMT SERVICE information is Owner's Name required for every page. Marstons Mills Ma 02648 9/5/19 Cityrrown State Zip Code Date of Inspection 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 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: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 19 I Commonwealth of Massachusetts Title 5 Official Inspection Form to Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '•u 593 River rd Property Address WILMINGTON SAVINGS FUND SOCIETY FSB TRUS Owner C/O RUSHMORE LOAN MGMT SERVICE information is Owner's Name required for every page. Marstons Mills Ma 02648 9/5/19 Cityrrown State Zip Code Date of Inspection ® ❑ 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)] S I D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: Number of current residents: Vacant 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 Z No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Detail: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 19 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments . � 593 River rd Property Address WILMINGTON SAVINGS FUND SOCIETY FSB TRUS Owner C/O RUSHMORE LOAN MGMT SERVICE information is Owner's Name required for every page. Marstons Mills Ma 02648 9/5/19 Citylrown State Zip Code Date of Inspection Sump pump? ❑ Yes ❑ No Last date of occupancy: Date 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 r ?treatment unit resent. P ❑ 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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 19 c Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 593 River rd Property Address WILMINGTON SAVINGS FUND SOCIETY FSB TRUS Owner C/O RUSHMORE LOAN MGMT SERVICE information is Owner's Name required for every page. Marstons Mills Ma 02648 9/5/19 Cityrrown State Zip Code Date of Inspection 3. Pumping Records: Source of information: Not Provided Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: 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: 31 Years Were sewage odors detected when arriving at the site? ❑ Yes ® No l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 19 Commonwealth of Massachusetts Title 5 Official Inspection Form la Subsurface Sewage Disposal System Form - Not for Voluntary Assessments g p Y rY 593 River rd Property Address WILMINGTON SAVINGS FUND SOCIETY FSB TRUS Owner C/O RUSHMORE LOAN MGMT SERVICE information is Owner's Name required for every page. Marstons Mills Ma 02648 9/5/19 CitylTown State Zip Code Date of Inspection 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.): D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 4feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1000 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Sludge depth: 3 Distance from top of sludge to bottom of outlet tee or baffle 24" Scum thickness 3" t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 19 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 593 River rd Property Address WILMINGTON SAVINGS FUND SOCIETY FSB TRUS Owner C/O RUSHMORE LOAN MGMT SERVICE information is Owner's Name required for every page. Marstons Mills Ma 02648 9/5/19 City/Town State Zip Code Date of Inspection Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 30" How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 4 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 19 Commonwealth of Massachusetts - Title 5 Official Inspection Form la Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 593 River rd Property Address WILMINGTON SAVINGS FUND SOCIETY FSB TRUS Owner C/O RUSHMORE LOAN MGMT SERVICE information is Owner's Name required for every page. Marstons Mills Ma 02648 9/5/19 Citylrown State Zip Code Date of Inspection 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 D. System Information (cont.) 8. Tight or Holding Tank (cont.) 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 9. Distribution Box (if present must be opened) (locate on site plan): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 19 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 593 River rd �u Property Address WILMINGTON SAVINGS FUND SOCIETY FSB TRUS Owner C/O RUSHMORE LOAN MGMT SERVICE information is required for every Owner s Name page. Marstons Mills Ma 02648 9/5/19 Citylrown State Zip Code Date of Inspection 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.): 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): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 19 Commonwealth of Massachusetts ,rp Title 5 Official Inspection Form JSubsurface Sewage Disposal System Form - Not for Voluntary Assessments 593 River rd Property Address WILMINGTON SAVINGS FUND SOCIETY FSB TRUS Owner C/O RUSHMORE LOAN MGMT SERVICE information is Owner's Name required for every page. Marstons Mills Ma 02648 9/5/19 Cityrrown State Zip Code Date of Inspection If SAS not located, explain why: Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments n( ote condition of soil, signs of hydraulic(allure, level of ponding, damp soil, condition of vegetation, etc.): 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 19 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments � 593 River rd Property Address WILMINGTON SAVINGS FUND SOCIETY FSB TRUS Owner C/O RUSHMORE LOAN MGMT SERVICE information is Owner's Name required for every page. Marstons Mills Ma 02648 9/5/19 City(rown State Zip Code Date of Inspection 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.): 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.): l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 19 r c Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 0 593 River rd Property Address WILMINGTON SAVINGS FUND SOCIETY FSB TRUS Owner C/O RUSHMORE LOAN MGMT SERVICE information is Owner's Name required for every page. Marstons Mills Ma 02648 9/5/19 Cityrrown State Zip Code Date of Inspection I 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 15insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 19 coo, Commonwealth of Massachusetts Title 5 Official Inspection Form to Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 593 River rd Property Address WILMINGTON SAVINGS FUND SOCIETY FSB TRUS Owner C/O RUSHMORE LOAN MGMT SERVICE information is Owners Name required for every page. Marstons Mills Ma 02648 9/5/19 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 l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 19 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 593 River rd u Property Address WILMINGTON SAVINGS FUND SOCIETY FSB TRUS Owner C/O RUSHMORE LOAN MGMT SERVICE information is Owner's Name required for every page. Marstons Mills Ma 02648 9/5/19 Cityrrown State Zip Code Date of Inspection 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: TBD At time of perc Before filing this Inspection Report, please see Report Completeness Checklist on next page. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 19 Commonwealth of Massachusetts —, Title 5 Official Inspection Form I a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 593 River rd V Property Address WILMINGTON SAVINGS FUND SOCIETY FSB TRUS Owner C/O RUSHMORE LOAN MGMT SERVICE information is Owner s Name required for every page. Marstons Mills Ma 02648 9/5/19 Cityrrown State Zip Code Date of Inspection 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 19 of 19 9/6/2019 Assessing As-Built Cards TOWN�OF/�BARNSTABLE i LOCATION JRi QC,(- ICJ. SEWAGE � r VILLAGE&r&U M wc ASSESSOR'S MAP& LOT INSTALLER'S NAME& PHONE NO. JC)(LvA S SEPTIC TANK CAPACITY f t)Or> ! 4/. . LEACHING FACILITY:(type) (size) xA NO.OF BEDROOMS PRIVATE WELL OR PUBLIC WATER_ BUILDER OR OWNER S�eUGi` n6) DATE PERMIT ISSUED: I/rap- 9D DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No l� AC K Z6r �Z 2q 3q 3> 36 �9 57 https:/Itownofbarnstable.us/Departments/Assessing/Property_Values/HMdisplay.asp?mappar=043012&seq=1 1/2 TOWN OF BARNSTABLE V LOCATION SEWAGE VILLAGE ��� �� i�t ASSESSOR'S MAP Sz LOT INSTALLER'S NAME & PHONE NO. J� �vv !�C't�� y77 SEPTIC TANK CAPACITY 00O 9.41 LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER S�eCX4,,% DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: :�, 9a y 'V VARIANCE GRANTED: Yes No !� 3c�a II 36 37 / 00 * OLTHOF FRs......3PAW THE COMMONWE MASSACHUSETTS �� BOARD OF HEALTH p ' TOWN OF BARNSTABLE C?jAlica Appliration for Disposal arks Tonstr inn rruti# C%=, tion is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal -. - -------------- -----••--•--•---------•• --- ........... ---------- -- Locatio ddr o. t' O ner Address x,f Q ... ... Y_�......---•--•. ...._3... ........1 �4'.- ws ... c .. .... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of -------- Bedrooms...... ....................•. Expansion Attic ( ) Garbage Grinder ( ) `4 Other—Type of Building No. of persons............................ Showers — Cafeteria P4 Other fixtures -----------------••--------------•-••-- . W Design Flow....... ......................gallons per person per day. Total daily flow............................................gallons. W Septic Tank—Liquid capacityl.O°�.gallons Length..........._.... Width________________ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No..l.15N2—__-- Diameter..�r k.ctt...... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------------------------------------------------------------------------- Date........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit.------............. Depth to ground water........................ G% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O Description of Soil----- --r/��j � 4� ........... f ��------.9Y' -s,•�/9 r------ .. ...................................................................................... 3----�-Z�---•�'t... W UNature of Repairs or Alterations—Answer when applicable______________���'lf�`C.......r�_�/_5................................... ..------•---------------------------------------------------------------------------------••--•---------.....----------------------------------------•-•-•......-•--•-......••••-•-•-••••-•---.......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Co —The undersigned furthe agrees not to place the system in operation until a Certificate of Complianc has en issue b e b rd alth. Signed---- � ' �e - ............................... D .__........... ate--'-"---------- Application Approved By .... . ...... -� ----------------- --------------------------- Dace Application Disapproved for the following reasons- ------------------------------------------------------------ ----------------------------------------------------------------- -------------------------------------------- - ..........-...------------------------......---- -- --------------------- . ---.......------.. ..---------......----................... Date PermitNo. ..... --- .......... Issued ----------------------------------------------------------------- Date � & No.. •-=- . FE$...... —`� THE COMMONWE LTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE � Applir#tion for Disposal parks C�nnatrnrtiurt rrutit Ap�ltcatton is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sy" < at-9_4 .............. _. s � :..._.... -----------•------------ �s I .___. ............... .........._------..---.•-•--------• - Location�Addresg t o t :5 ,....- • ........................................................ .........._ ........t�..`.. / Address w �'c ►tee Q .....................3 -�.. ........ Is `�- Installer -.- -•--.-�-••-•---•--Address Type of Building Size Lot--__-_--------------------Sq. feet �-t Dwelling—No. of Bedrooms....................................•___-___Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers a YP g ---------------------------- P ( )--- Cafeteria ( ) dOther fixtures -----------------------------------------------•------•--•------•---------------------..__...---••-••--•-----•---- ----••.... W Design Flow....... ......................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity.!Pe��gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No..J.. a -__-- Diameter.._ ..... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 1.4 Percolation Test Results Performed by.......................................................................... Date........................................ ,.a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P+ --•-•--•-•-•-----------------•-•-••••-•--------•••-------•--••----•---••......-----........-•-••-••......................................................... Description of Soil .. n y r �''x .�ar --•-•-----------------•-------------------------------.......--------- x t/ c.� ---------------------------------------C '�!` �" �N _�_. d� yr- --------------------...................................................--------------------------------------------------- ------------------------------ ----------------- - ----- .......................................------------------------. V Nature of Repairs or Alterations—Answer when applicable_______________�Jal ....... �! 5-- -�------- � !"...__.___._.._.__... ---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Ce—The undersigned furt i agrees not to place the system in operation until a Certificate of Compliance his Deen issued b the board ,� ,alth. a Signed ---- c� -�------------------ -- --- - ---------- -----.-----------------...... , -----1.;.................... Application Approved By ---- _-----�-=^ �- � b Date �.-..... ---------------------------------------- Date Application'Disapproved for the following reasons- -------------------------------------------------- ------ - --------------- --------------------------------------------------- - - ----------------- -----------------------..__------------------------- -........................................... ................ ----------- ------ (� Dare Permit No. / J..- Issued ------------------ -'--'------...---..-.. —----- - ----.-.......... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C9ex#tft. ate of (fans sltttnce THIS TO C R F),Y, That the-Individual Se =age isposal System constructed ( ) or Repaired O - 4"' F at -------------------------------` --- -/-��-1-- -----��.� ���---------------------.............. ............................... has been installed in accordance with the provisions of TITLE�5 of The-State Environmental Code asdescribed in the application for Disposal Works Construction Permit No. _! `� ?..v. -. dated .... ...Nq f)------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE., -.... ...... Inspectors.. . -- ✓�` -------------- THE COMMONWEALTH OF MASSACHUSETTS 4T t BOARD OF HEALTH TOWN OF BARNSTABLE No.....................:... FEE.... .............. Uisp anal nrk. dun trnrtuan rrntit , Permission is hereby granted✓........... < -- ('•------------------------------•--••----------------------- ........... .-..................-...... to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at No..................... /� � etc - k)n A i1 ) M - r;.. .>--------------•---------r•-••-- ---------- ----- ------------- r ............... as shown on the application for Disposal Works Construction jPe,nit tNo..;! ..... .. _..31t d... ....................� 1� r _ -------------- -oard --_ -_ ...__............_ • Board of�flealth DATE.............................. - --------•-•-•-••-•----.••••=- FORM 3850E HOBBS Q WARREN.INC.,PUBLISHERS AsBuilt Page 1 of 1 TOWN OF BARNSTABLE LOCATION SEWAGE N VILLAGE rp,,, ��_ ASSESSOR'S MAP 6 LOT INSTALLER'S NAME 6 PHONE NO. J�GA SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) bX,4 NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER_ BUILDER OR OWNER §eUCt,,_ ` o I DATE PERMIT ISSUED: 1L2 DATE COMPLIANCE ISSUED: /zo 9' v/ VARIANCE GRANTED: Yes No !� C z . z9 37 36 37 5/ http://issgl2/intranet/propdata/prebuilt.aspx?mappar=043012&seq=1 4/19/2018