Loading...
HomeMy WebLinkAbout0056 EVERGREEN DRIVE - Health 56 Evergreen Drive Marstons Mills i 1 10-IU7 Town of Barnstable Barnstable Regulatory Services Department 1 wicaC j MAS& 1� Public Health Division a 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7006 0810 0000 3524 7441 October 22, 2012 Mr &Mrs Stanley Macklis P 0 Box 456 Marstons Mills, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 56 Evergreen Drive,Marstons Mills MA was last inspected on 10/10/2012,by Sean M. Jones, a certified septic inspector for the State of Massachusetts. i The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • I • Septic tank is not constructed of heavy duty loading (II20) and is not designed for vehicular traffic; however, it is located beneath the driveway. i You are ordered to do one of the following, within two (2) years) from the date you receive this notification: a.) replace the septic system component with a new component relocated into another area of land which is not beneath any parking area or driveway, and properly abandoning the discovered H-10 component, or by b.) replace the septic system component with an H-20 component beneath the parking area or driveway,and properly abandoning the discovered H-10 component, or by c.) relocating the parking area or driveway in such a way that no vehicle will have access or the ability to drive over the existing H-10 septic system component. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH I � • Thomas McKean, R.S., CHO Agent of the Board of Health I I Q:\SEPTIC\conditionally passed\Template for H10 driveway.doc f c � Health Complaints 12-Sep-02 Time: 11:15:00 AM Date: 9/11/02 Complaint Number: 3708 Referred To: DAVID STANTON Taken By: Rita Complaint Type: Septic Odor Article X Detail: Business Name: Number: 56 Street: Evergreen Lane Village: Marstons Mills Assessors Map Parcel: 126076 Complaint Description: Strong septic odor-thinks it's coming from the house to his left. What can he do? , Actions Taken/Results: DS VISITED SAID LOCATION. THERE WERE �v 1� NO SEPTIC ODORS PRESENT. SPOKE U C WITH HOMEOWNERS, AND THEY HAVE �� S NOT NOTICED AND SEPTIC ODORS, NOR HAD ANY PROBLEMS WITH SEPTIC/ PLUMBING. AS I WAS DRIVING AWAY, THE ` LADY CHASED ME DOWN THE DRIVEWAY TO SAY THAT SHE HAS SEEN AND SMELLED SKUNKS LATELY, AND THAT MAY BE THE ODOR THEY WERE SMELLING. I TOLD THEM THAT SHOULD THEY HAVE PROBLEMS WITH THEIR SEPTIC, THEY WILL BE REQUIRED TO REPAIR THE PROBLEM. Investigation Date: 9/12/02 Investigation Time: 9:45:00 AM 1 Town of Barnstable Assessors Division Page 1 of 3 ,perim- fr y a our oca ion . Home : Town Departments : Administrative Services : Assessors Division : Property Resul s`" <<Back -Forward>> Thursday, September 12,2002 Assessors Division- Property Results Data is based on Fiscal Year 2002 Assessor's Fiscal Year 2002 Assessed Values database and is provided for information Tax Information purposes only. Sales History Land and Building Description <<Search Again Construction Details Out Buildings& Extra Features Building Sketch 56 EVERGREEN DRIVE Map/Parcel/Parcel Extension: Mailing Address: 126/076/ MACKLIS, STANLEY L&GLORIA Owner of Record: MACKLIS, STANLEY L&GLORIA P O BOX 456 Property Location: MARSTONS MILLS, MA 02648 56 EVERGREEN DRIVE Parcel ID:126076 OW' Fiscal Year 2002 Assessed Values ^Top Appraised Value Assessed Value Building Value: $ 199,100 $ 199,100 Extra Features: $2,700 $2,700 Outbuildings: $ 700 $ 700 Land Value: $ 70,000 $ 70,000 Totals: $ 272,500 $ 272,500 Tax Information ^Top Town Tax $2,523.35 Tax Rates (per$1,000 of valuation) C.O.M.M. FD Tax $ 376.05 Town 9.26 Fire District Rates Land Bank Tax $ 75.70 Barnstable 2.61 C.O.M.M 1.38 Cotuit 1.69 Total: $ 2,975.10 Hyannis 2.54 W. Barn. 1.54 —Total does not include special assessments— Other Rates http://www.town.barnstable.ma.us/ComeOnIn/Departments/Administrative_Services/FinanceDi 9/12/02 c, �, __---- -`__ _._� .� Town of Barnstable Assessors Division Page 2 of 3 Land Bank 3% of Town Tax Due to rounding differences these values are approximate. Sales History "Top Owner: Sale Date: Book/Page: Sale Price: MACKLIS, STANLEY L &GLORIA 3/15/1993 C129575 $ 275,000 SYLVESTER, CARL C & DEBRA J 1/15/1993 C129033 $260,000 STEELE, VERNON H & MARIE E 3/15/1986 C105676 $275,000 IAFRATE, JOSEPH D 5/15/1984 C96454 $ 27,000 PHILBRICK, GARY C81542 $ 0 Land and Building Description ^Top Land Building Lot Size(Acres): 1 Year Built: 1985 Appraised Value:$ 70,000 Living Area: 2863 Assessed Value: $ 70,000 Replacement Cost: $221,277 Depreciation: 10 Building Value: $ 199,100 Construction Details ^Top Style: Cape Cod Interior Walls: Drywall Model; Residential Interior Floors: Hardwood Grade: Average Grade Heat Fuel: Gas Stories: 1 1/2 Stories Heat Type: Hot Air Exterior Walls Wood on SheathWood Shingle AC Type: Central Roof Structure: Gable/Hip Bedrooms: 3 Bedrooms Roof Cover:Asph/F GIs/Cmp Bathrooms: 3 1/2 Bathrms Total Rooms: 7 Rooms Outbuildings & Extra Features ^Top Code Description Units/SQ FT Appraised Value Assessed Value FPL2 Fireplace 1 $2,700 $2,700 SHED Shed 90 $ 700 $ 700 Building Sketch ^Top http://www.town.bamstable.ma.us/ComeOnIn/Departments/Administrative_Services/FinanceDi 9/12/02 Town of Barnstable Assessors Division Page 3 of 3 p y' ro �j �ft ���Map Sketch Legend BAS First Floor, Living Area FST Utility Area (Finished Interior) UAT Attic Area (Unfinished) BMT Basement Area (Unfinished) FTS Third Story Living Area (Finished) UHS Half Story (Unfinished) CAN Canopy FUS Second Story Living Area (Finished) UST Utility Area (Unfinished) FAT Attic Area (Finished) GAR Garage UTQ Three Quarters Story (Unf FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story (Unfi FHS Half Story (Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story (Finished) .. .y. Back- 's Home Departments I Town Information I Contact Town Hall Website Developed and Maintained internally by the Town of Barnstable Information Systems Department Town Hall-367 Main Street- Hyannis,MA-02601 -508-862-4000 DISCLAIMER: Although we strive to provide accurate information,we are only human. Please consult directly with the appropriate department if there is a question of accuracy. Copyright 2001©Town of Barnstable. All Rights Reserved http://www.town.bamstable.ma.us/ComeOnIn/Departments/Administrative Services/FinanceDi 9/12/02 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Evergreen Drive Property Address MACKLIS, STANLEY L&GLORIA Owner Owner's Name required for every required Marston Mills Ma 02545 10/1012012 page. Cky/rown State Zip Code Date of InspeWon Inspection resuks must be submitted on this form.Inspection forms may not be altered in any way.Please see completeness checklist at the end of the forth. Im fillft portant A. General Information �---- on the computer. use only the tab 1. Inspector key to move your -cursor-do not Sean M.•Jones use the return key. Name of Inspector C y e Enterprises Company Name 153 Commercial St Company Address Mashpee Ma 02649 Ckf/rown State Z p Code 505-477-8877 S14522 Telephone Number Liranse Number B. Certification I certify that 1 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 the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 1&340 of Tine 5(310 CMR 16.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Atthority 10/10/2012 Inspedors Signature Date The system inspector shall submit a copy of this inspection,report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner -..J -".L- U.-*,-,p r., If-r.r.49w.. U.-..rr.W.I..V Vw.l.v.l%): ****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. ,sme•,,,,o Togo 5 Of W%pomw fwm Ik"ilaee sewage Disposal sratem•Pape 1 et 17 I ( � 0 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 56 Evergreen Drive Property Address MACKLIS, STANLEY L & GLORIA Owner Owner's Name information is required or every Marstons Mills Ma 02648 10/10/2012 n page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The dwelling located at 56 Evergreen Dr Marstns Mills is served by a Title V septic system consisting of a 1500 gallon septic tank, distribution box and 2 1000gallon pre-cast leaching pits. The system was found to be in proper working condition at the time of inspection. 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. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 1- i r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 56 Evergreen Drive Property Address MACKLIS, STANLEY L & GLORIA Owner Owner's Name information is Marstons Mills Ma 02648 10/10/2012 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed 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): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ ' Cesspool or privy is within 50 feetof a bordering vegetated wetland or a salt marsh l5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 56 Evergreen Drive Property Address MACKLIS, STANLEY L & GLORIA Owner Owner's Name information is required for every Marstons Mills Ma 02648 10/10/2012 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. 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. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow l5ins•I m 0 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 56 Evergreen Drive Property Address MACKLIS, STANLEY L& GLORIA Owner Owner's Name information is required for every Marstons Mills Ma 02648 10/10/2012 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® 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 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 56 Evergreen Drive Property Address MACKLIS, STANLEY L & GLORIA Owner Owner's Name information is required for every Marstons Mills Ma 02648 10/10/2012 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ 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)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3+ Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 949.9 gpd provided t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 56 Evergreen Drive Property Address MACKLIS, STANLEY L & GLORIA Owner Owner's Name information is required for every Marstons Mills Ma 02648 10/10/2012 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: 2010= 141,000 total = 386 gpd 2011= 113,000 total = 310 gpd Sump pump? ❑ Yes ® No Last date of occupancy: vacant Date 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 Industrial waste holdingtank resent? Yes No p ❑ ❑ Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 56 Evergreen Drive Property Address MACKLIS, STANLEY L & GLORIA Owner Owner's Name information is required for every Marstons Mills Ma 02648 10/10/2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 56 Evergreen Drive Property Address MACKLIS, STANLEY L& GLORIA Owner Owner's Name information is required for every Marstons Mills Ma 02648 10/10/2012 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: original system installed 1985 per town records Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints ok, no leakage, vented through roof Septic Tank(locate on site plan): Depth below grade: 1.5 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: 1500 gallons Sludge depth: 6" t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts ; Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 56 Evergreen Drive Property Address MACKLIS, STANLEY L & GLORIA Owner Owner's Name information is required for every Marstons Mills Ma 02648 10/10/2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 3' Scum thickness 0" 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? opened covers, 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 does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. Outlet baffle was intact and in good condition. Water level slightly below outlet invert, most likely due to evaporation. Tank was structurally sound. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 56 Evergreen Drive Property Address MACKLIS, STANLEY L &GLORIA Owner Owner's Name information is required for every Marstons Mills Ma 02648 10/10/2012 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 56 Evergreen Drive Property Address MACKLIS, STANLEY L & GLORIA Owner Owner's Name information is required for every Marstons Mills Ma 02648 10/10/2012 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" 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 in good condition, no major rot at the water line. Cover is 2' below grade. 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form � Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 56 Evergreen Drive Property Address MACKLIS, STANLEY L & GLORIA Owner Owner's Name information is required for every Marstons Mills Ma 02648 10/10/2012 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2x1000 gallons ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): System consists of 2 pre-cast leach pits. Both pits were inspected with a camera from the distribution box and found to be dry with no signs of past hydraulic overloading. 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 l5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 f Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 56 Evergreen Drive Property Address MACKLIS, STANLEY L& GLORIA Owner Owner's Name information is required for every Marstons Mills Ma 02648 10/10/2012 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note,condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonweakh of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessment cvergreen unve Property Address MACKLIS, STANLEY L&GLORIA owner Owners Name - - rnforrrw equiretion is Marstons Milts Ma 02W 10/10/2012 required for every City/'rown page. State Zip Code Date of Inspection D. System Information (cunt.) 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 TAN►r 1 00 .A-I: 13- 1= 326" c- no 0-Bob • , 'II•. 3 31 6'' s v'c A (_Egcrt I? iTs Plr A-Y 13-Y = Mb .- r >3-S: 17 ' ftw•1 tno Tdb 5 0ffi l VdPedm Fww.&Audaw Swwga Dbpoew Syaem-Pap 15 or w Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 56 Evergreen Drive Property Address MACKLIS, STANLEY L & GLORIA Owner Owner's Name information is required for every Marstons Mills Ma 02648 10/10/2012 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 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: Design plan on file at Town of Barnstable Board of Health states that groundwater was not observed at 144" and system is designed to have 54 seperation between bottom of s.a.s. and adjusted high groundwater elevation. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M •y'' 56 Evergreen Drive Property Address MACKLIS, STANLEY L &GLORIA Owner Owner's Name information is required for every Marstons Mills Ma 02648 10/10/2012 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 0 CAT ION Se SEWAGE PERMIT NO.� ' � erg men) ( � ' 7 VILLAGE INSTA LLER'S NAME i ADDRESS S U I L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �5 i r 33 �l l q Gp Y7 f �i RE. 7�T � NOAR3.�i,..�...� ..1 FEB....a, ... ..... �\ o THE COMMONWEALTH OF MASSACHUSETTS d BOAR® OF HEALTH TOWN ................OF...BARNSTABLE ---- -- Appliratiun for Disposal Works Tonstrnrtlun Frrulit Application is hereby made for a Permit to Construct (X ) or Repair ( ) an;Individual Sewage Disposal System at Lot 42 Evergreen Dr. Marston Mills .................................................................................................. --------•-•-------............----•-------------------------------•-------........................ Lo io -Addr ss p� Lot o. Joseph _�talrate P 0 Box 2048 NLno'erville --•-------------------•------...... .......-----..........-----------•....................--------------------......---------......... Owner Address w J P Morin West Barnstable ,-� ........................................ .......................................... -•...-•---------...•---•-•--•--•---••------................... ...............-----------.---... Inst .... a lle r Address ............................43 ,560 q � Type of Building Size LotS feet Dwelling—No. of Bedrooms___........................................Expansion Attic (XX) Garbage Grinder X) a`4 Other—T e of Building No: of persons............................ Showers — YP g ---•--•--------------•-----• P ( ) Cafeteria ( ) dOther fixtures -----•------------------------------------------------•------•----•-----------------•.........-----•---•--••-• w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacit�_5QP..gallons Length................ Width................ Diameter-------_........ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..-_2______________ Diameter...6..__....._.... Depth below inlet.................... Total leaching area.3?9!.8:..sq. ft. Z Other Distribution box ( ) Dosing to k ( ) e Jone s /Murra 2 //6 80 a Percolation Test Results Performed byNy...................1-------..----•.Y............................. Date......1-._1..._.................... Test Pit No. 1.__.-_-2 _Qninutes per inch Depth of Test Pit.... ........ Depth to ground water..Norte 93:4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------------------------------ -- &7 .........-•----.....----•---.........--•--- Description of Soil...0-4__L6am & subsoil.... . Il•-12'__ sandy gravel & medium sand. x w UNature of Repairs or Alterations—Answer when applicable.................................................................................:.............. ----------•--------------•--•------------------------------------------------.....------.....-------•------ ------------------------------------•----------------------------••-•------.....-•--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provis-ons of TITLL 5 of the State Sanitary Code—The undersig d further agrees not to place the system in operatio tilft C t` o .Compliance has b n issued b bo f h Signed... .. .. 12/26/84 Date Ap lication pproved By..... • • ----- ... •....-- -----•- . -•-•-•- • -------•---k4r� ). 42 Date Application Disapproved for a following reasons:................................................................................................................ •--------------------------------------------•-------------------------...----------------•---------------------�----------------•---•------- y ^� -.Date Permit No... ... ! `................... Issued_.......... � .-----2 -........... Date - u ^a. THE COMMONWEALTH OF MASSACHUSETTS ; BOARD OF HEALTH TOWN BARNSTABLE OF Appliraffo t for Uiop)asal Works Tonstrurtiurt ami# ., Application is hereby made for a Permit.;"to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at: Lot 42 Evergreen Dr. Marston Mills ..........................-..................................................................... .....•-•----...------•---------------•-----••--------•-----•••------------......------....._------ Jose phl"°Ttahra`ee P 0 .W J P MorinWner West Barnstable Address .................................................... = ..................... ................•-•-----------.........--••--------.......... ...---........-..--------•-•----•- ,4 Installer Address 43 560 UType of Building Size Lot---------------------------Sq et �-, Dwelling—No. of Bedrooms......3...................................Expansion Attic �X) Garbage Grinder X( ) aa Other—Type of Building ---------------------------• No. of persons____________________________ Showers ( ) — Cafeteria ( ) Otherfixtures -----------------------------------------------------------••-------•••--•-•-•--•-•-••-••••-•-••---••--••...--•--_..-- W Design Flow_____________________________________ ____gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid'capacit�_5_99---gallons Length................ Width................ Diameter................. Depth................ Disposal Trench—2No_____________________ Widt!.............___:_.• Total Length.................... Total leaching area_. _,_--__8..--sq. ft. Seepage Pit No____ _______________ Diameter___._.__._._.____.__ Depth below inlet.................... Total leaching area.........'........sq. ft. Z Other Distribution box ( ) Dosing tapk ) Percolation Test Results Performed b ye 102 a 4/Murray Date a --2.nn 1 -•-•--.....•-------••• None-_...-••-- ,� Test Pit No. 1______________'.minutes per inch Depth of Test Pit...__........._..... Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ r •------- 0 Descriptiori of Soil_.0-_ Lff &._Su�JBO 1 -i2 sandy gravel & mec lum sanii. x -------------------- -----•• -•-•••-•••-•--••------••-•--_..•••--••--•-----•-•-•-•-----•.._._..-•-•--....-•-••---•- V -------•-•---•-----•-•--------------------------------•-----------•-•-••-•---------..., W •----------------------------------------------•--------•------------------------------------•--••--•-•••-••••-----------`-••-•••--•-•-•--•-•-•-•••••--•-•--•-•-••-----••-••-••-----••._.....•----•--- U Nature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ --------------------------------•-•---------------•--------•-------••-------------------•---.......-----------------------------------•--------------------------------------•-••--••-•-----•--•-••----- Agreement: The undersigned agrees to install the aforedescribed Individual.Sewage Disposal System in accordance with the provisions of TITIE 5 of the State Sanitary Code— The undersig ed further agrees not to place the system in operation until a erti' at of`Compliance has ben issued b bob r of h tiJ 12/26/84 Signed... • ----- -------------------- -- ----------- --- -------••--•-•-------• ................................ Appli ationqAproved By.___. _.___ ------------------------ l.- ate 7•� a ;_.... .. Date ? Application Disapproved for he following reasons: ............... ------------- .................•--•---•--------------••-•-•--•-....•-•--•---••---••-••------•-•••-•---.....•--------•--•-•---•--..___...-•--•-••--••••---••-•-•••---•---•-•--•••••----•-•--••-------••-•-•----------- ._.... L� Date Permit*No._ + .............. IssuecL:_.__:_�.4�.__'�� . " s�. f� -----......�......�_ Date-•---••-•--------` ------•---- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TQ ......... .OF...... . .ka TA dL6............................. Tntifiratr of f omplittttrr e Individual Sewage Disposal System constructed ( ) or Repaired ( ) by THIS IS TO CE IF That th- -�-- -staller at------------- t - ............ F 4 L r=... has been i ailed in accordance with th provisions o I= 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No_________________________________________ dated................................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO STRUED AS A GUARANTEE THAT THE SYSTEM WILL FUN TION SATISFACTORY. DATE.............. ••.�.. . -_5................ ......... .lb THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 116 7 .............t.�.W.k.1... ....OF._...-Vic"`('1�.:_-.- A. �"'�_...._....._....._._......._.... No...- ..-....-'..I. . Permission is hereby granted...................'-=•.'-"-....:---. - -•------•�.. -.................................................. to Construct (�') or\Repair ( ) an individual Sews ge Disposal System , atNo........................................................... j------••-------------•--- _ Streei 4 as shown on the application for Disposal Works Construction Permit No.��' _��. Dated_ __1_ .....a:._ ._..�...?......... DATE. 1_ _ oard of Health FORM 1255 A. M. SULKIN, INC., BOSTON � 3 a ,q0 2 43 0" D 3 � r o°• O 48'± r�P•a•L-. �.o F'ub EL s Q I=61lo1'w 0' -5.-r 41,s N ko` 14i / 1 r N �U i p� Z 24' ;i 77 L.P w �r v 14' IA' G i Q ?s}r _ � r III+ r7 -r � ,CIO., y _ T 10 OF MASS9 J0 G c R RT No.29874 �OISTgF' ——� — �� Fig D �NO S UA OF R�F'y -��y ✓� DAVID �y �X IS`Tl F.IG EL�VATIOfJ Sc c ,(/tL, �!U i! U. m P r{� �- PL4w t cQo�D MLEVA71c�.! ei CMUMM p- U ° �". 2.9976 A GlV/LO 4�2 - � J r � �,�• 2 5 0 �U~1 S'T ess/ONA t u APPDo.�ED: �hRD cF' 14EAL-r-,1 n<+ A�seNr 'SALE: I = 40 DA"TI: 1121 8 4- r-I E f2♦=$Y Tt GLII-sUT: gM/V IOW � SAT ?t-�lr= caR T=- LL15 � T1-4uLIU I C . R ED -M4I S-ba rJ° : 54.1�8 F� �RcnorJ oti 4-7a Q=�Ljia �r rs L= A-rED I&..t r-A-rrOr.I To DR,pY: J.�.�. 'fNe a<I->T IW unn�fan Sr-brvhl. 1=AST SAt...1D�,�/Ic�--a , M A • , 02537 DATE RECI'STERED LAUD �!b✓E-o(2 Io FT. MIu. - _ r L.EAC�i••- iwe=I PIT A-P--= 744At_l 2 Beu=w CSRA-At= , A 24"ptAtAe=r>=2 c =,�P_ ' x r< SHALL f'.5E E�> DPtvEwAYS ccL Ic R>✓-rE / 4" P./G P 1 Pl=- Q�r ,1 P�- Au 1_XTRA H EAvY D�cAr�r- I QcD-j , cat=Rs r/ pE R. FT. \� _ CIF�4ti1--SAQ D\ G � i� UScD ►t-I f�GKa t L LIG?OID "/''+ •� 7 cAsT / 2 Pn5 \ fo IRC►--t PlIPE• i iSoo GAL. o e G.h,MFIL .� wAs+ ar_> 'sTz=uE' M I u. P17C44 ° Y4" PEP- 1=r. _PrIG TAr-1IC. FIST. ► o ° ° e , �rtE:L>w BoX•Sct•mo. L10 D.V,G• LorkM - S_6-S L ° r ° DEPr>_ r r WPSI4ED Sint..=- I_7S.4 x ^C.S = 43`l.B G-,l � o ° . e e e e e o 0 o e r _ PREc�cS'T -5E1=.PA6c llJ�/EQT �LE�/AT101 IS (S3."I x I.o IS'!).9 L-�/D o r r o o ° o e e r PIT oQ F v>art� cA-PAc17--r 2 ( 59 3.'1 ez.,-D ) ° ° - 1=L IQ\/EQ-T AT BL.)ILDt"e=) 99.5 PT. � ' �I1 �o Pr D/AM. -res rA t3-7 4 I i . 4 v/D " I iJ LET 5>=PTIG TAI-!I:�_ 9q.O FT• _ 34-q.G ,-/D J4- FT. DIAM. C�g� TABut-ATIOE.J) a JT LTcT SE Prl C TA"4. 9 8.$ FT. 2s 770 �-I fNLET D1 IPxJilor-t �X 98.0 FT• G2aul�D WA7r- P- Ti4BLT_r- 2S::. �TLE'f D ,aLjv -1 Lox 9'1. 8 PT. r I F IULET LEAci-}te�6 PIT G-7:3 FT. Sa�/�/AG� D ISP=Sr4L Sti(ST�M n nP,7 L�AcI-�l►-�6 P r DES16IJ C K I-fi- A I/s}" = 1 r a .. DIME►J7tot�i A �3 FT. D I maw..510,-1 8 4 FT. ti1uM F 2 -F aeDac n5 4-" LD I M Eu SIotJ C 4-_ FT. G,4(2BAC_,E DtSRfiAL cat--j-r YES '5�1 L LOG ToT-A L ESf7 M ATI=D Fl oW 44C> 6AL. lDA,- so t L TEs-r t-J_ I So I L TP�T IJ'='L puMBE•P_ of (EAe.-It,je. Prr, 2 L= 1v I.3 ML = SIDE LEAGHI/16 PER- AIT I-75.9 �. FT. L4"fi= oP 5o►L'TEST a2 •ate• 80 +, . EbTTZDM LEACHtub PeP-AT 153.9 �, .FT — PI_Sc�LTSGAR�D LoA M QATE t.1= 1 •'['OT/{L L�Act--1 t ti16 r4 P->=A 3'L9, 8 SG�. F T'. _ o-�i-� 5"�,t...�.L ''��� � --�'� PE RLt�LAT O i-+ 2"�TE �t"- 2 --- ,r PFE51E�-E,VE LEA_1-Iru6 AL-LA 724. S '5�. PT j' DAVID. P �tH OF S'�• c¢ 1i" NoFi25 76 q 4-,L_ at o JOH N .Ut=O1-*A o G/3TE� �`" /`/� �S;'®l�1 Vl ! LS o Is H /ON v 29874 O i=L L►S Pc Thi v l_t+-! t t 1 G . ENO Rq [�t,lo GRcxxaD w T�2Euc�r-rT1=�0 478 SU KanE hA - E.SA�-IDwtctit, MA. o2s 7 ❑ GPovuD wA7F--- T_t_= Gl_t�e tr : 13r�vvt£vr eoQP DATz : I ( • 2� •ad- JoF3 Lie, 84• I-18 St-{ T 2 of 2