HomeMy WebLinkAbout0094 MONOMOY CIRCLE - Health 94 'Monomoy Circle
Centerville
A = 190 194
IN
No.H10259
163OR
HASTIMAO, VIP
���C��- ?�1�1:�� � •.�. ►?, � ISM i��
►O OO Town of Barnstable P#
Department of Regulatory Services
»MU48TABM : Public Health Division DateMASI
�A 039• ,6� 200 Main Street,Hyannis MA 02601
It
Date Scheduled a t6Time Fee Pd. 1 CId
Soil Suitability Assessment for Se ' Dos v
Performed By: Witnessed-By:
LOCATION & GENERAL INFORMATION
Location Address �'y `f/1o.eOma 64-c Owner's Name
1,� � r') rt h Ka-Ka- � tom
Address " ftmor l'tC4v G✓Z�i
O
Assessor's Map/Parcel: I�O — l f Engineer's r�1 n e Name
NEW CONSTRUCTION REPAIR Telephone# v-� -C— 7 3 7 7
A
Land Use 40 /Slopes —2
p ( ) Surface Stones 1,jO/—,,
Distances from: Open Water Body /A- ft Possible Wet Area A ft Drinking Water Well ,�_. ft
Drainage Way �'r _ft Property Line 1 ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
1 to
DEC 16 g14 pr12:53
0
d0,f-A
-
Mo�a
Parent material(geologic) �' rtiS Depth to Bedrock
Depth to Groundwater. Standing Water in Hole: d n-e— _ Weeping from Pit Race
Estimated Seasonal High Groundwater
2t /
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.hole: In, Depth to soil mottles: in.
Depth to weeping from side of obs,hole: in, Groundwater Adjustment ft.
Index Well# Reading Date: Index Well level Adj,faetor— Adj.Groundwater Level
PERCOLATION TEST Date Time
Observation
Hole# 1 f Time at 4" �
Depth of Perc 3 ) 2 L{ Time at 6"
Start Pre-soak Time @
L 1_5�_ M• "1 Time:(9".6")
End Pre-soak
LZ
Ratei Min.nnch.
Site Suitability Assessment: Site Passed O4 Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on Back-----------
***If percolation test is to be conducted within 100' of wetland,you must first notify the.
Bar' stable Conservation Division at least one_(1) week prior to beginning.
Q:\.SEPTIC;PERCFORM.DOC
DEEP.OBSERVATION HOLE LOG Hole# ._
Depth from Soil Horizon Soil Texture .Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders.
onsistency.% r vel
1,7
�o g c) M -c'54�td `-715-Y l
G z- 15 M S,tvj Z,5 Y7j3
DEEP OBSERVATION HOLE LOG Hole# L
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders.
Consistency.% ravel)
l.o ►e-3-A
y to )5 cz r s�t�� Z.5'( '/3
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA), (Munsell) Mottling (Structure,Stones,Boulders.
Consistency. o Gravel)
DEEP OBSERVATION HOLE LOG Hole# `
Depth from Soil Horizon Soil Texture Soil Color
Soil
Other
P ell Mottling (Structure,Stones,Boulders.
Surface(in.) (USDA) (Mans )
Consist ncy,c
Flood Insurance Rate Map:
Above 500 year flood boundary No— Yes
Within 500 year boundary No Yes
Within 100 year flood boundary No oY Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption sys
tem?. 's
hat is the depth of naturally occurring pervious material?
If not,w p Y ..
Certification
I certify that on �� `�`�� (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with .
the required training,expertise and experience described in 310 CMR 15.017.
Signature Date i l>
Q:\S,EPTIC\PERCFORM.DOC
J
TOWN OF BARNSTABLE
LOCATION l/IC54aYA/ �_/C�t? SEWAGE it
VILLAGE Ge v,4z°w1'l1'e ASSESSOR'S MAP&PARCEL l ctO—
INSTALLER'S NAME&PHONE NO.:�/�� 4 73 w,,U G
SEPTIC TANK CAPACITY XlS�h'S
LEACHING FACILITY: (type) SbOcj IQnt e: (size) _—
NO.OF BEDROOMS
OWNER�e rc. f
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between the: �—
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility g/G 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 BYJ c I!`1j rtT
LYA G tC
11 a�
ILI
ojT^'�e.N,.
37"3'
OU
OUT - I I'
°D - 37
NZ1
2 '�GI
TOWN OF BARNSTABLE
ACATION No n v M a y L"",` SEWAGE #
AGE �214TB/' ,llye ASSESSORS ASAP& LOT
NSTAL.4.ER'S NAME&PHONE NO.
;EMC TA.NKCAPACITY /S/U /
.EACHING PACIILI(TY: (type)
40.OF'BEDROOMS_S_
'ERMIT®ATE: COWL,MCE DATE;
separation Distance Between the:
Aaximum Adjusted Groundwater Table to the Bottom of Leaching Facility
'ivate Water Supply W41 and Leaching Facility (if any tivells exist
_:oat site or within 200 feet of leaching facility) et:E
idge of Wedand and Leaching Facility(If any wellands exist
within 304 feet a lcacDting facility)
,urnishcd by
Lei
0 0
EQ °
•0-971 .8-D-3&'
10
` No. Fee l
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
01ppYication for Misposai bpstem Construction Permit
Application for a Permit to Construct( ) Repair(V/) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.9`/ M o.jc,�Y Ccr-cl � Owner's Name,Address,and Tel.No.
L e v�rer v r 1 l -c. V Assessor's Map/Parcel 0 > I Ci Li
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
�avylc,S A brow J x aC_ -
TP pe of Building:
Dwelling No.of Bedrooms Lot Size � _ Q� sq.ft. Garbage Grinder( )
Other Type of Building a_,J 4 rCIJ No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 5 $b gpd Design flow provided S (y(`� gpd
Plan Date Number of sheets ;;L-- Revision Date
Title
Size of Septic Tank X&4-i,•r e Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) [sJS�'41� 6 &)eui bCM Ct A)C)
S 00 ►umbeFs W L{-L�, 41 6(w? 12 --5 )t All X �L
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 Application Approved Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. oxel-)t Date Issued _ ^
-------__._------------------W�
No. do 1 S- O �� 1's ' _ Fee (" I
* '4 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:V
Yes 'I
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
01pprication fovloisposar 6pstem Construction Permit
Application for a Permit to Construct( ) atRepair( Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.90 �ItA o e-t t c Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel v - cS L-1
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
t�o�51G5 A 13Fawa Z aL _ �.,
Type of Building:
Dwelling No.of Bedrooms Lot Size T n sq.ft. Garbage Grinder( )
'Other Type of Building ( jor,1 to J 4 c, No.of Persons Showers( )TGafeteria( )
Other Fixtures
Design Flow(min.required) .5 gpd Design flow provided S L gpd
Plan Date - ^a i -I q-' Number of sheets .,. Revision Date
Title `
Size of Septic Tank E X r.+ ry c Type of S.A.S. �,1 I4,i n1 C k_rj„Antq F S
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) j NktC:. j bay fL O H
S OO G 1/�.J /"\6 P CS l II� !I( Sj 6MP
,.r+t
~ ^Datebl 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
Application Approved by �S �^t;' Date
Application Disapproved by Date
for the following reasons
Permit No. r O 1 5-- 363 Date Issued r
_.,---------------------------------_-__-----------__-__----------___----------__-_-------_____--------_____--------_-_----------____----
THE COMMONWEALTH OF MASSACHUSETTS
r
BARNSTABLE,MASSACHUSETTS
1, (Certificate of Compliance
THIS IS TO CIRTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(�� Upgraded( )
Abandoned( )by � u t
at � 1-1 M�,a 6 /-.,,.,4 Rai-`u has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction-Permit No ke'01 S 363 dated
Installer 1: X,0 S K(tj._�,J Z" ,..JC Designer ,o
#bedrooms S Approved design flo &,1,,��� gpd
The issuance of t s pe it shall not be construed as a guarantee that the system will funet'onias ,esigne
Date q /J ( Inspector �'
NO. dqeA
Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Bisposal *pstem onstrnction Permit
Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( )
System located at M o ay, a lair C f
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.
�-^ t
Provided:Construction must be completed within three years of the date of this permit! �
Date �� �-' r� Approved by /
1
1
Town of Barnstable
�¢IKE TphyO� Regulatory Services
�g Richard V. Seali,Interim Director
in BARNSTABLE,
90 MASS; ,O�Q Public Health Division
��ArF°►AP'�a Thomas McKean,Director
i
200 Main Street,Hyannis,MA 02601
1
0 lice: 508-862-4644 Fax: 508-790-6304
I Installer&Desiener Certification Form
D;�te: 9 Gl i 5' Sewage Permit:# 2D/S'303 Assessor's Map\:Parcel_.�10 011
D Wgner: U10 r-Lt 5 I0.C Installer: RA , Fib-00 G% L
A ldress: M W . C," s s-p oA R-o Address:
l a rQ_s Mu4 Q z yy Cevt�-e.y,l lam. _bi 02`3 z
I
n I_.*57was issued a permit to install a
(installer)
se`)tic system at 14 moyLo ✓h.o-4 ortL,_ (fen-+-, based on a design drawn by
(address)
g`� n, Wins it,, � dated 1 31
(designer)
1 certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Strip out (if required) was inspected and the soils
were found satisfactory,
.1 certify that the septic system .referenced above was installed with major changes (i.e.
greaten than 10' lateral relocation of the SAS or any vertical relocation of any component
of the-septic system) but in accordance with State cC Local Regulations. Plan revision or
certified as-built by designer to follow. Strip out(if required)was inspected and the soils
were found satisfactory;
I certify that the system referenced above was constricted in cony liance with the terms
of the I\A approval letters (if applicable)
Mgs�9��G
o PETER T,
all e6_9ign—atu McENTEf_
' S CIVIL `^
No. 35109
IFS tt��
( esigner's Signature) (Affix Desig Her
sj—
P ,EASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CER`Il'IFICATE
,O COMPLIANCE WILL NO1' BE _ISSUED UNTIL BOTH THIS FORM AND AS-
B 7.1:LT. CARD ARE RECEIW,D BY THE BARNSTABLE PUBLIC JJEALTH 11,WISION.
pj -x�&
T1 IANK YOU.
Q; eptic\Designer Certification Form Rev 8-14-13.doc
i -
Town of Barns
J1, 0D 0� P#
Department of Regulatory Services
2�1�� f
s�wardet� : Public Health Division Date I (I
� >`�.
A ibl9 `be°' 200 Main Street,Hyannis MA 02601 \• ±
P /
Date Scheduled ( U�
Time Fee Pd.
Soil Suitability Assessment for Se ' p s
IPerformed By:_ �. t�C.5n-�-2� - C '
I °C. Z Witnessed Y:
i
LOCATION & GENERAL INFORMATION
Location Address �.7 ��11iJf�2Pa� Owner's Name
` �JC Ci 0� V�tr-vq \_
Address YL1CvlA rat G y Cr`2�t i.
l2
Assessor's Map/Parcel: l p(� f ,
C '� / �f L% Engineer's Name ,---
NEW CONSTRUCTION REPAIR _ Telephone# _5 60— 7 3
Land Use
_2.
I Slopes(%) / — Surface Stones
I Distances from: Open Water Body0—ft Possible Wet Area ft Drinking Water Well
Drainage Way_ 1, ft Property Line _ft Other ft
f
i S,KETC'H:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands in proximity to holes)
i
Dr 11
9.
CL
. i
n aj,-A
�a,rip r-l� Dy c,;2
Parent material(geologic) Depth to Bedrock
I
Depth to Groundwater: Standing Water in Hole: kJ e n-R _ _ Weeping from Pit Pace ✓�o/�IL
tl
Estimated Seasonal High Groundwater �-
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used: _
Depth Observed standing in obs.hole: ,,,In, Depth to soil mottles; In.
Depth to weeping from side of obs.hole: In. Groundwater Adjustment
Index Well#„ _ Reading Date:- Index Well I'evel,. � Adl,factor— AdJ,Orountlwater bevel o
PERCOLATION TEST Date Time
Observation
Hole# l I Time at Y" W„
f Depth of Pero 3 �2 ' Z �( rj� u n} ` Time at 6"
i Start Pre-soak Time @ ►5 M • "1 Time(9",6")
End Pre-soak _
Rate Min,/Inch.
Site Suitability Assessment: Site Passed _ Site Failed:_ Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on Back-----------
***If percolation test is to be conducted within 100' of wetland,you must first notify the
Barnstable Conservation Division at least one (1) week prior to beginning.
Q:\SEPT'IC\PERCFORM.DOC
I
DEEP.OBSERVATION HOLE LOG Hole#--4-- i
Depth from Soil Horizon Soil Texture .Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders,
Consistency,%Gravel)
>
Z'5' -Y _
�.
DEEP OBSERVATION HOLE LOG Hole#_'2
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Mottling Structure Stones,Boulders.
Mo ,
Surface(in.) (USDA) (Munsell) g
Cons' tency.%%Gravel)
0
G
0 ►
(o —)3 C
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
i Consistency,T,Gravel)- _--
i
_ i
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in,) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
• i
I
t Flood Insurance Rate Map:
Above 500 year flood boundary No, Yes
Within 500 year boundary No Yes
Within 100 year flood boundary No`� Yes
Depth of Naturally Occurring Pervious Material
v
Does at least four feat of naturally occurring pervious diaterial exist in all areas observed throughout g the {{
. I
area proposed for the soil absorption system? _
"S
depth of naturally occurring pervious material? .
If not, what is the p Y g
s
4
Certification r.
I certify that on t� ````t� (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with .
the required training,expertise and experience described in�10 CMR 15,017.
Signature - --- - ! `?—--'_._` Date_
I
� t
i
Q;4SEPT(C\PBRCFORM.DOC
1
I
Commonwealth of Massachusetts
w u Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�M 94 MONOMOY CIRCLE
Property Address
DEUTSCHE BANK
Owner Owner's Name
information is required for CENTERVILLE MA 02632 04-02-2013
every page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When filling out A. General Information
forms on the
computer,use 1. Inspector: (�
only the tab key \\I
to move your CHRIS NARDONE
cursor-do not Name of Inspector
use the return
key. BRIDGE HOME AND SEPTIC INSPECTION SERVICE
Company Name
27 TIFFANY CIRCLE
Company Address
WEST BRIDGEWATER MA 02379
f01 City/Town State Zip Code
508-580-0465 SI 571
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the ipection. TL6 insertion
was performed based on my training and experience in the proper function and,Q1'ntenance1of on site
sewage disposal systems. I am a DEP approved system inspector pursuant toy ection 14F1340 x j
Title 5(310 CMR 15.000). The system: r
® Passes ❑ Conditionally Passes ❑ Fails,:
❑ Needs Further Evaluation by the Local Approving Authority r.>
�o
04-02-2013
Inspector's S)IK1ture Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins-11/10 Title 5 Official on Form:Subsurface Sewage Disposal System-Page 1 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
•�y< 94 MONOMOY CIRCLE
Property Address
DEUTSCHE BANK
Owner Owner's Name
information is required for CENTERVILLE MA 02632 04-02-2013
every 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:
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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
94 MONOMOY CIRCLE
Property Address
DEUTSCHE BANK
Owner Owner's Name
information is required for CENTERVILLE MA 02632 04-02-2013
every page. City/Town State Zip Code Date of Inspection
B. Certification (cons.)
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):
El distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
94 MONOMOY CIRCLE
Property Address
DEUTSCHE BANK
Owner Owner's Name
information is required for CENTERVILLE MA 02632 04-02-2013
every page. Cityrrown State Zip Code Date of Inspection
B. Certification (cost.)
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 %day flow
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
w . Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
wM . 94 MONOMOY CIRCLE
Property Address
DEUTSCHE BANK
Owner Owners Name
information is required for CENTERVILLE MA 02632 04-02-2013
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® 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
r ,
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 94 MONOMOY CIRCLE
Property Address
DEUTSCHE BANK
Owner Owner's Name
information is required for CENTERVILLE MA 02632 04-02-2013
every page. CitylTown 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): 3
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330
t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17
Commonwealth of Massachusetts
w W Title 5 Official Inspection Fora'
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
, t 94 MONOMOY CIRCLE
Property Address
DEUTSCHE BANK
Owner Owner's Name
information is required for CENTERVILLE MA 02632 04-02-2013
every page. Cityrrown State Zip Code Date of Inspection
D. System Information
Description:
SEPTIC TANK , D-BOX AND LEACHING SYSTEM
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
Seasonaluse? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d AVER 140 GPD
9 ( Y 9 (gP ))�
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: UNKNOWN
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 holding tank present? ❑ Yes ❑ No
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
1
i
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
wM '( 94 MONOMOY CIRCLE
Property Address
DEUTSCHE BANK
Owner Owners Name
information is required for CENTERVILLE MA 02632 04-02-2013
every page. Citylrown 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: NO RECENT PUMPING
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-11I10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
94 MONOMOY CIRCLE
Property Address
DEUTSCHE BANK
Owner Owner's Name
information is required for CENTERVILLE MA 02632 04-02-2013
every page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
2002
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 2.5
feet
Material of construction:
❑ cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well or suction line. 20
feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
NOT ACCESSIBLE
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: 1 OFT L-5FT W-51FT D
Sludge depth: 15 IN
rains•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17
. Commonwealth of Massachusetts
a W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
94 MONOMOY CIRCLE
Property Address
DEUTSCHE BANK
Owner Owner's Name
information is required for CENTERVILLE MA 02632 04-02-2013
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle 20 IN
Scum thickness 3 IN
Distance from top of scum to top of outlet tee or baffle 4 IN
Distance from bottom of scum to bottom of outlet tee or baffle 14 IN
How were dimensions determined? PROBE
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 SOUND LIQUID LEVELS PROPER ALL TEES IN PLACE
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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
94 MONOMOY CIRCLE
Property Address
DEUTSCHE BANK
Owner Owner's Name
information is required for CENTERVILLE MA 02632 04-02-2013
every page. City/Town 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 d Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M ' 94 MONOMOY CIRCLE
Property Address
DEUTSCHE BANK
Owner Owner's Name
information is required for CENTERVILLE MA 02632 04-02-2013
every page. Citylrown 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.):
BOX SOUND AND LEVEL SCUM LINE AT BOTTOM OF OUTLETS NO SIGNS OF BACK UPS
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 Forth:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
�M �1 94 MONOMOY CIRCLE
Property Address
DEUTSCHE BANK
Owner Owner's Name
information is required for CENTERVILLE MA 02632 04-02-2013
every page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
® leaching chambers number: 5
❑ 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.):
DUG HOLE IN FIELD SOIL AND GRAVEL CLEAN AND DRY
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
w Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
94 MONOMOY CIRCLE
Property Address
DEUTSCHE BANK
Owner Owner's Name
information is required for CENTERVILLE MA 02632 04-02-2013
every page. Citylrown 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
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
94 MONOMOY CIRCLE
Property Address
DEUTSCHE BANK
Owner Owner's Name
information is required for CENTERVILLE MA 02632 04-02-2013
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
❑ hand-sketch in the area below
® drawing attached separately
t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts
_ Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
94 MONOMOY CIRCLE
Property Address
DEUTSCHE BANK
Owner Owner's Name
information is required for CENTERVILLE MA 02632 04-02-2013
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
® Check cellar
❑ Shallow wells
Estimated depth to high ground water: 7 +
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:
TEST PIT RECORDS
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
.�t 94 MONOMOY CIRCLE
Property Address
DEUTSCHE BANK
Owner Owner's Name
information is required for CENTERVILLE MA 02632 04-02-2013
every page. Citylrown 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17
4/1/13 ` Assessing As-Built Cards
J TOWN OF BARNSTABLE G
LOCATION (�t` '°z�o L��It SEWAGE#
VI-LAGE G 0^— ASSESSOR'S MAP&LOT - qJ
INSTALLER'S NAME&PHONE NO. 2 7
SEPTIC TANK CAPACITY
LEACHING FAC]Lr Y: (type) L Ci (size) 1.2.-�L 2
NO.OF BEDROOMS
BUILDER OR OWNER L S V
PERMITDATE: &— T`" ® ` : COMPLIANCE DATE:L—
Separation Distance Betweee the:
Maximum Adjusted Groundwater Table t/Fility
ttom of Leaching Facility Feet
Private Water Supply Well and Leachin (If any wells exist
on site or within 200 feet of leaching ) Feet
Edge of Wetland and Leaching Facilitywetlands exist
within 300 feet of leaching facility) Fat
Furnished by
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NAME OF OFFENDE . � �. BAR 7 0 86 5
I� TOWN OF ADDRESS OF OFFEND
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BARNSTABLE CITY.STATE.21P CODE rn D `1(O
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TIME A ATE F 1 LATI _ CA ION OF VIOLATION LZL1
NOTICE OF ( .M P. N 20 c7
VIOLATION SIGN'TU OF NFORMgG S PT. ItENSI G BADGE NO. LU
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�I OF TOWN I HE KNOWLE RECEIPT OF CITATION X LU
ORDINANCE Unable to obtain ignature of offender. THE NONCRIMINAL FINE FOR THIS OFFENSE IS Z •� W ?"
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Date mailed w
OR YOU HAVE THE FOLLOWING ALTERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL °- �'
DISPOSITION WITH NO RESULTING CRIMINAL RECORD. Lu
REGULATION a
(1)You may elect to pay the above fine,either by appearing in person between 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted, W :..
(I before:The Barnstable Clerk,200 Main Street,Hyannis,MA 02601,or by mailing a check,money order or postal note to Barnstable Clerk,P.O.Box 2430, d
Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE.
(2)If you desire to contest this matter in a noncriminal proceeding,you may do so by making written request to DISTRICT COURT DEPARTMENT,FIRST
BARNSTABLE DIVISION,COURT COMPOUND,MAIN STREET,BARNS TABLE,MA 02630,Attn:21 D Noncriminal Hearings and enclose a copy of this
citation for a hearing.
(3)If you fail to pay the above offense or to request a hearing within 21 days,or If you fail to appear for the hearing or to pay any fine determined at the
I! hearing to be due,criminal complaint may be issued against you.
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!l; ❑ 1 HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$
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Certified Mail#7006 0810 0000 3525 0106
�afrtl�e r Town of Barnstable
Regulatory Services
nnRr�srAa '# Thomas F. Geiler, Director
MAM g,
Public Health Division
Thomas McKean, Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Maria Farias May 30, 2007
75 Hemeon Drive
W. Yarmouth, MA 02673
NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II
- MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE
TOWN OF BARNSTABLE CODE CHAPTER 170.
The property owned by you located at 94 Monomoy Circle, Hyannis, was inspected on May 5,
2007 by David W. Stanton R.S.,Health Inspector for the Town of Barnstable because of a
complaint. The following violation of the State Sanitary Code was observed:
105 CMR 410.450: Means of Egress: Adequate egress was not provided in the basement
dwelling unit per the Massachusetts State Building Code.
The code reads specifically:
"105 CMR 410.450: Means of Egress: Every dwelling unit, and rooming unit shall have as
many means of exit as will allow for the safe passage of all people in accordance with 780 CMR
104.0, 105.1, and 805.0 of the Massachusetts State Building Code."
However, it is noted that the correct reference to the Massachusetts State Building Code for
egress is 780 CMR 102, 103, and 1010.
You are reminded that the basement cannot be used for sleeping purposes. You were also
notified by the Building Inspector that the basement cannot be used for living space as the stairs
to the basement were not to building code. In the current condition, the basement may only be
utilized for storage purposes.
The following violation of the Town of Barnstable Code was observed:
170-4 of the Town of Barnstable Code: Owner's Responsibility to Register Rental Unit.
The unit is not currently registered with the Town of Barnstable Health Division.
You are ordered to correct the violation listed above within Five (5) days of your receipt of
this notice, by registering your rental unit with the Town of Barnstable Health Division.
QA Order letterMousing violations\94 Monomoy Circle.doc
You may request a hearing before the Board of Health if written petition requesting same is
received.
Non-compliance will result in criminal complaint being issued against you.
ZRDER OF THE OARD OF HEALTH
nAcKean, R.S.
Director of Public Health
Town of Barnstable
QA Order letters\Housing violations\94 Monomoy Circle.doc
I
oFtHE r°�ti Town of Barnstable
* swnxsena�.e,
Department of Health, Safety, and Environmental Services
'""SS.
039n• Public Health Division
��
ArED"A°�A 367 Main Street, Hyannis MA 02601
Office: 508-790-6265 Thomas A.McKean
FAX: 508-775-3344 Director of Public Health
March 16,2005
Ms.Maria Farias
94 Monomoy Circle
Centerville,MA 02632
and
Donna Maria Dorlesa
94 Hemeon Road
West Yarmouth,MA
NOTICE TO ABATE VIOLATIONS OF THE S I ATE SANITARY CODE,CHAPTER 2. 105 CMR
410.00, THE STATE ENVIRONMENTAL CODE, TITLE 5 AND THE TOWN OF BARNSTABLE
RENTAL ORDINANCE,ARTICLE 51
The property owned by you located at 94 Monomoy Circle, Centerville, MA. was inspected on March 16,
2005 at 9:51 a.m. by Thomas McKean, Health Agent for the Town of Barnstable because of a complaint
regarding the garage, overcrowding, and parking. The following violations of the State Sanitary Code, 105
CMR 410,00, 310 CMR 15.000 State Environmental Code, Title 5 and of the Town of Barnstable Rental
Ordinance,Article 51 were observed:
105 CMR 410.300 and 310 CMR 1'5:06:'There were a total of six(6)bedrooms observed in this dwelling;
three were observed on the firsf''floor,'one',in'the garage; and`two:-were observed.within the basement.,
However,the existing septic system was not designed for only five bedrooms.
105 CMR 410.450: Two separate private sleeping rooms with beds observed within the basement without
any emergency egress provided(no second means of egress)within each of the two bedrooms.
105 CMR 410.481: Posting of Name of Owner: Name, address and telephone number of owner not
posted on a twenty(20)square inch sign outside the dwelling adjacent to the main entrance.
The home is restricted to five bedrooms. You are therefore ordered to remove one or more
bedrooms by removing the bed(s);removing door(s) to the sleeping area, and by opening all door-
way entrances by partially removing walls to the room(s) to minimum of five feet wide openings
within thirty(30)days of your receipt of this letter.
If you intend to provide a sleeping area in the basement, you are ordered to either provide
adequately sized emergency egress window within the sleeping area or relocate the sleeping area to a
location where are two means of egress are provided within thirty (30) days of your receipt of this
letter.
p' In addition, you are ordered to post your name, address and telephone number on a twenty (20)
square inch sign outside the dwelling adjacent to the main entrance within thirty days of your receipt
of this letter.
You may request a,hearing before the Board of Health if written petition requesting same is received within
seven(7)days after the date the order is served.
Non-compliance will result in the issuance of non-criminal ticket citations of$100.00 each. Each day's
failure to comply with an order shall constitute a separate violation.
PER ORDER O THE BOARD OF HEALTH
Th�sA.� ean,R ,CHO
Director of Public Health
Cc: Pedro Silva, tenant
- y
w ,y 'M THE COMMONWEALTH OF MASSACHUSETTS
FORM 30 �I&w I-IOBBS 8 WARREN
BOARD OF HEALTH
CITY/TOW N
bt.c.
a DEPARTMENT
c _ 20-0 �iin _ ann1S r A
c1a ADDRESS
E70 9 old 2
p f TELEPHONE
Address_.-M_ 0n0MO lcC_ a4W,v l�ccupant-
Floor Apartment'N�__._ No.of Occupants
No. of Habitable Rooms __. No.Sleeping Rooms
No.dwelling or rooming units_ _ No. Stories _
Name and address of ownerct�-zL_ 1—a�� +4 S __ Cd 3(a 0-�JM�`�
!/atndJLC% Remarks Reg. Vio.
YARD Out Bld s.: Fences:
Garbage and Rubbish
Containers'--
Drainage
Infestation Rats or other:
STRUCTURE EXT. Sto,s•,-tS,1 s, Porches:
("Dual Egress.and Obst'n.:
❑ B ❑ F ❑ M moors,Windows:
Roof
Gutters, Drains:
Walls:
Foundation:
Chimney:
BASEMENT Gen.Sanitation:
Dampness:
Stairs:
Li htin :
STRUCTURE INT. Hall,Stairway:
Obst'n.:
Hall, Floor,Wall,Ceiling:
Hall Lighting:
Hall Windows:
HEATING Chimneys:
Central ❑ Y ❑N Equip. Repair
TYPE: Stacks, Flues,Vents:
PLUMBING: Supply Line:
❑ MS ❑`ST ❑ P Waste Line: S�S`fp.�.� vja!Q nnl. ll/) V
H.W.Tanks Safety'and Vents "t;,p(� c,o.Y+� A ,.,02,,,,E
ELECTRICAL Panels,Meters,Cir.:
❑ 110 ❑ 220 Fusin ,Grnd.: -
AMP: Gen.Cond. Distrib. Box:
Gen. Basement Wiring:
DWELLING UNIT
Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks
Kitchen *
Bathroom
Pantry
Den
Living Room
Bedroom 1
Bedroom 2
Bedroom 3
Bedroom 4
Hot Water Facil. Su .Ten.,Gas, Oil, Elect.:
Stacks,Flues,Vents,Safeties:
} Kitchen Facilities Sink
Stove
Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.:
Wash Basin,Shower or Tub:
Infestation Rats, Mice, Roaches or Other:
(_E re s Dual and Obst'n: No serewl nroc"% o�� or resS pr,)xj:&„cQ ilin q4D
GeneraI Building Posted., at ga-k$n fie Sop"4- IM i
Locks on Doors: L">1)1A nnr'C n�-MP c4sos.S 1,_ n 10Ili y�
ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH
MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY, AND WELL-BEING OF THE
OCCUPANT AS DETERMINED BY 105CMR 410750 OF THE CODE OR THE
AUTHORIZED INSPECTOR.(See Over)
"THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND
PENALTIES OF PERJURY."
INSPECTOR nnc? TITLE `01 tit
DATE Ir► 'chl a� 1�a s TIME ?I l _ P.M.
A.M.
THE NEXT SCHEDULED REINSPECTION --SO � 1/S` P.M.
r
410.750: Conditions Deemed to Endanger or Impair Health or Safety
The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or
impair the health, or safety and well-being of a person or persons occupying the premises.This listing is composed of those
items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the
occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for
human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so
in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that
other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local
health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to
include affect the legal obligation of the person to whom the order is issued to comply with such order.
(A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary
needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer.
(B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as
prohibited by 105 CMR 410.200(B) and 410.202.
(C) Shutoff and/or failure to restore electricity or gas.
(D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting.,in com-
mon area required by 105 CMR 410.254.
(E) Failure to provide a safe supply of water.
(F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR
410.150(A)(1)and 410.300.
(G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object,
including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452.
(H) Failure to comply with the security requirements of 105 CMR 410.480(D).
(1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar-
bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests
or otherwise contribute to accidents or to the creation or spread of disease.
(J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public
Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.)
(K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or
other dangers or impairment to health or safety.
(L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating,
gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352,
so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety.
(M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release
of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105
CMR 410.353.
(N) Failure to provide a smoke detector required by 105 CMR 410.482.
(0) Any of the following conditions which remain uncorrected for a period,of five or more days following the notice to or
knowledge of the owner of said condition or conditions:
(1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven
or,any defect that renders either inoperable.
(2) `Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any °
defect which renders them inoperable.
(3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of
generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard.
(4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as
required by 105 CMR 410.503(A)and 410.503(B).
(5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550.
(P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con-
dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner
to remedy said condition within the time so ordered by the Board of Health.
FORM30 HxW HOBBS&WARREN'M THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
CITY/TOWN
W ��bloc 4-kat 11 _
b DEPARTMENT
ADDRESS
��n r•�L ���"�7i�0iA/1\S D r�Ic�
ADDRESS �
G1M SV 9 y`0� E-0 l/ ACw Z
TELEPHONE
c T
Address 9 mDnOMO i° r - dxccupant
Floor A artment�
No.of Occupants
No.of Habitable Rooms No.Sleeping Rooms
No.dwelling or rooming units �_ No.Stories
Name and address of owner_I r►Gl��_�— F�5 ( O- `��`/
RS 4P A 12a Wp a/n0,� Remarks Reg. Vio.
YARD Out Bld s.: Fences:
Garbage and Rubbish
Containers:
Drainage
Infestation Rats or other:
STRUCTURE EXT. S s, Porches:
Dual E ress.and Obst'n.:
❑ B ❑ F ❑ M ows:
Roof
Gutters, Drains:
Walls:
Foundation:
Chimney:
BASEMENT Gen.Sanitation:
Dampness:
Stairs:
Li htin :
STRUCTURE INT. Hall,Stairway:
Obst'n.:
Hall, Floor,Wall,Ceiling:
Hall Lighting:
Hall Windows:
HEATING Chimneys:
Central ❑ Y ❑ N Equip. Repair
TYPE: Stacks, Flues,Vents:
PLUMBING: Supply Line:
❑ MS ❑ ST ❑ P Waste Line: was
H.W.Tanks Safet and Vents ant
ELECTRICAL Panels, Meters,Cir.:
❑ 110 ❑ 220 Fusing,Grnd.: , t6 Ct4,Wfl -�
AMP: Gen. Cond. Distrib. Box:
Gen. Basement Wiring:
DWELLING UNIT
Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks
Kitchen
Bathroom
Pantry
Den
Living Room
Bedroom 1
Bedroom 2
Bedroom 3
Bedroom 4 11 / - ya
Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: uAA
Stacks, Flues,Vents,Safeties: ,,� y
Kitchen Facilities Sink
Stove
Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.:
Wash Basin,Shower or Tub:
InfpsWion Rats, Mice, Roaches or Other:
E ress' Dual and Obst'n: No s c,ress rw.cb Aq y-Sa
eneral Building Poste v�- g .,an-}- c{
Locks on Doors:
ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH
MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE
OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE
AUTHORIZED INSPECTOR.(See Over)
"THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND
PENALTIES OF PERJURY." I \) rH
INSPECTOR S JM GP�� TITLE
A.
DATE O 1 200-'S TIME_ I"G�r 5� P.M.
A.M.
THE NEXT SCHEDULED REINSPECTION � ��/S P.M.
410.750: Conditions Deemed to Endanger or Impair Health or Safety
The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or
impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those
items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the
occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for
human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so
in every case and therefore is not included in this listing. Failure to include shall in no way be construed'as a determination that
other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local
health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to
include affect the legal obligation of the person to whom the order is issued to comply with such order.
t
(A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold,to meet the ordinary
needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer.
(B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as
prohibited by 105 CMR 410.200(B)and 410.202.
(C) Shutoff and/or failure to restore electricity or gas.
(D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com-
mon area required by 105 CMR 410.254.
(E) Failure to provide a safe supply of water.
(F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR
410.150(A)(1)and 410.300.
(G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object,
including garbage or trash,which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452.
(H) Failure to comply with the security requirements of 105 CMR 410.480(D).
(1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar-
bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests
or otherwise contribute to accidents or to the creation or spread of disease.
(J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public
Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.)
(K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or
other dangers or impairment to health or safety.
(L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating,
gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352,
so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety.
(M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release
of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105
CMR 410.353.
(N) Failure to provide a smoke detector required by 105 CMR 410.482.
(0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or
knowledge of the owner of said condition or conditions:
(1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven
or any defect that renders either inoperable.
(2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any
defect which renders them inoperable.
(3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of
generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard.
l (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as
required by 105 CMR 410.503(A)and 410.503(B).
(5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550.
(P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con-
dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner
to remedy said condition within the time so ordered by the Board of Health.
0
a
F TOWN OF BARNSTABLE
LOCATION A/V"j0wo!, c.ty-,11_ SEWAGE # O - ✓�+ �'
VII.L:AG ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. r�.�.+. o If' 9 27 L
SEPTIC TANK CAPACITY 1L)6 'U
LEACHING FACILrrY: (type) i!r—L. (size)
NO_OF BEDROOMS
BUILDER OR OWNER L 4 V
PERMTrDATE:-& g` O 2- COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table t/Fcility
ottom of Leaching Facility Feet
Private Water Supply Well and Leachin (If any wells exist
on site or within 200 feet of leaching ) Feet
Edge of Wetland and Leaching Facilitywetlands exist
within 300 feet of leaching facility) Feet
Furnished by
m o
h h �
q4A;
No.
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
0[pplication for 30iopool Opotem Con!gtruction Permit
Application for a Permit to Construct( )Repair(x:kUpgrade( )Abandon( ) K7 Complete System ❑Individual Components
Location Address or Lot No.9 4 Monomoy C i r. Owner's Name,Address and Tel.No.
Assessor's Map/Parcel Centerville Laura Skalsky
M 1 90 P1 94
Installer's Tame,Address,and RL No. Designer's Name,Address and Tel.No.
Win E, roinson Septic Servic DArren M. Meyer
P.O. Box 1089 43 Vine St.
Centerville MA 02632 Duxbury MA 02332
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building residential No.of Persons Showers( ) Cafeteria( )
Other Fixtures
i
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank ( Type of S.A.S. S
Q 5f
Description of Soil;
Nature of Repairs or Alterations(Answer when applicable) we will install a new Title-5
septic system to the plans of Darren Meyer dated 10/29/02.
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
g 8r g P Y
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issu by ' B d of He
Signed Date
Application Approved by Date
Application Disapproved for the following reasons
Permit No. Date Issued 2-
Fe�ciO , n0
' THE COMMONWEALTH OF;MASSACHUSETTS ' Entered in computer: ✓ll/
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
'Zipprtcation for Migool bpotem Conotruction Permit
Application for a Permit to Construct( . )Repair(X:�.Upgrade( )Abandon( ) ®Complete System ❑Individual Components
Location Address orZot N0.94 Monomoy Sir. Owner's Name,Address and Tel.No.
Assessor's Ma /P f9 eI Centerville Laura Skalsky
if 0 P194
Installer's W.A,s :ss,and a No. Designer's Name,Address and Tel.No.
`T'm. �. rog�inson Set)Ptc Designer's
DArren M. Meyer
P.O. Box )089 43 Vine Stir "
Eenterville MA 02632 1 Duxbury MA 02332
Type of Building:
Dwelling No.of'Bedrooms Lot Size sq.ft. Garbage.Grinder( )
Other Type of Building re s identAILAL No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons:"
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank I S U Type of S.A.S.
Description of Soil \
Nature of Repairs or Alterations(Answer when applicable) we will i n s tgil l annew Title-5
septic system to the plans of Darren Meyer dated 10/29/02.
Date last inspected:
4 Agreedient:
- 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 Certifi-
cate of Compliance has been issu d by B ofid of Hea o.
Signed / Date _25�'O
, Application Approved by Date fit-f-U
' Application Disapproved for the,following reasons
d
J
y Permit No. )d,)�)-Sad Date Issued I �-
Htahisky THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired(xx)Upgraded( )
Abandoned( 1 by Wm. E. Robinson Septic Service
994 Monomoy ir. , Centerville
at has been constructed in accordance
with the pr vision of Title 5 and the for Dis Designer posal System Construction Permit No. 2 On 2- 5-21 dated i I�k/0 2
Installer
Vim. . Robinson Sr. Darren Meyer
The issuanc�j$ft s permit shall not be construed as a guarantee that the sy will function as design, ed.
Date i i b Inspector J n
------=--- -- ' ——————————--- ——
No, a U 0) Fee 5 0.0 0
Skalsky THE COMMONWEALTH OF MASSACHUSETTS
- PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS
Migo!aY *pZtem .Congtructton Permit
Permission is hereby granted to Construct( )Repair(X)Upgrade( )Abandon( )
System located at 94 Monomoy girl Centerville
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes 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.
Date: 1/�f �� Approved by D.�.� ' a y`1-----
TOWN OF BARNSTABLE 9
LOCATION _
+�.^,ovoyr Gr✓1'o SEWAGE #
VILLAG ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. Tit'rb
SEPTIC TANK CAPACITY 25 6
LEACHING FACILITY: (type) L (size) 0-
NO.OF BEDROOMS
BUILDER OR OWNER
PERMTTDATE;. COMPLIANCE DATE:
Separation Distance Between the:. .
Maximum Adjusted Groundwater.Table t/FFcility
ottom of Leaching Facility Feet
Private Water Supply Well and Leachin (If any wells exist
on site or within 200 feet of leaching ,) Feet
Edge of Wetland and Leaching Facilitywetlands exist
within 300 feet of leaching facility) Feet
Furnished by
1,
G�
�b
_ I
i
a _
LOCUTIONA SE E ERMIT U0.
VILLAGE
w E -I- S
BUILD 5 1`l E . AD EF— S — — —
DATE PERIv�1T ISSUED .•— — — _ — — — —
DATE COKAPLI W aCE IS-SUED;
i
{ f
wx
. �3`
}
r
v
— 101——EXISTING CONTOUR N
x 100.98 EXISTING SPOT GRADE
W EXISTING WATER SERVICE
G EXISTING G SERVICE
H.J+L—OVERHEAD WIRES v
TEST PIT a
a
BENCHMARK bib
o
�Pr'
LEGEND
y j �
o
r m t; a
c o
= o,
r o
z o
c
0
Stoney
�� Lr
s
R LOCUS
LOCUS MAP
NOT TO SCALE
N 27*34'17" E
00' s ockode fence
+ 101:74 x 100,
—1 8 \ x 99,65 UD
101.65�
00 (b
110' rh TP 2 42• SHED \
;.4- ;7:� R_QPOSED S. . T-..
EXISTING S.A.S. 0 0\
(PER RECORD AS-BUILT) O O O .:
TO BE ABANDONED _ F`
— — — — —� � t EXISTING SEPTIC TANK X F
INV.(OUT)=97.5t
BENCHMARK SET 101.14 X 100.43 I I (FIELD VERIFY)
OUTSIDE COR.OF PATIO
EL.=102.23 _40 J I
f� M
r O� _
� I
O STd 0.61 I N
N 101.0 100.60 o
0
ADD'N ON X 100.78 X _ m
z I / PATIO soNorueEs bQ
� Sn�. t
I + 101.36 EXISTING
HOUSE(#94)
T.O.F.=101.5f '
I
I 100.9
� 100,67
101.11 100.92
+ WALK + 00.56
\ 101,z2 LOT 36
15,000 ±SF 1
100,68 MBL 190-194D A6
J DRIVEWAY::
101B .x 11.55 10 .0 �WSO
100,14 �g I
7_344� 100,16
�j 0.00
POLE
PK SET 99.84 edge of pavement 99,66 99.47
100.27 100.00
MONOMO Y CIRCLE
o PETER T. PROPOSED SEPTIC SYSTEM UPGRADE PLAN
McEN
CIVIL E 94 MONOMOY CIRCLE, CENTERVILLE, MA
No. 35109 Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632
o EGlS1� �� Engineering by:
SCALE DRAWN JOB. No.
9p ��.
SSIO NG OWNER OF RECORD 1"=20' P.T.M. 268-14
VIERA, ROXANA E Engineering Works, Inc.
94 MONOMOY CIRCLE 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO.
CENTERVILLE, MA 02632 (508) 477-5313 1 1/31/15 P.T.M. 1 Of 2
NOTE: TO PREVENT BREAKOUT, THE PROPOSED
FINISH GRADE SHALL NOT BE < EL:97.74
FOR A DISTANCE OF 15' AROUND THE
SEPTIC TANK PROPOSED D-BOX PERIMETER OF THE S.A.S.
INSTALL RISERS & COVERS OVER INLET &OUTLET AND SET TO 6" OF FINISH GRADE INSTALL RISER & COVER PROPOSED S.A.S.
SET TO 6" OF GRADE INSTALL RISER & COVER OVER ONE CHAMBER AND
T.O.F.=101.5t SET TO 3' OF F.G. TO SERVE AS INSPECTION PORTS
F.G. EL.=100.8f F.G. EL.=100.6t F.G. EL=101.0t F.G. EL.=101.0(max.)
VENT
L = 36' L = 23'
® S=1% (MIN.) ® S=1% (MIN.)
4"SCH40 PVC 4"SCH40 PVC 2" LAYER OF WASHED
T 1E
s"� DOUBLE WASHED STONE
10"I " s aBaSBaa (OR APPROVED FILTER FABRIC)
1 4" BB99B69
EXISTING 48" LIQUID
aaeaaaa -�-3/4" TO 1-1/2" DOUBLE
LEVEL ADD �� . PROPOSED INV.=97.64 INV=97 47. 4' 4.8' 4' WASHED STONE
GAS .
D-BOX EFFECTIVE WIDTH = 12.8'
INV.=98.0f 3 OUTLETS INV.=97.24
EXISTING
EXISTING SEPTIC TANK 4-500 GALLON LEACHING CHAMBERS
SURROUNDED WITH STONE AS SHOWN
H-10 RATED
TOP CONC. ELEV.=98.0t
NOTES: BREAKOUT ELEV.=97.74
1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INV. ELEV.=97.24 000
INVERTS, PRIOR TO INSTALLATION. eaaa aaeaaa �'
2) D-BOX SHALL BE SET LEVEL AND TRUE TO BOTTOM ELEV.=95.24 :
GRADE ON A MECHANICALLY COMPACTED SIX 4' 4 x 8.5'=34.0' 4'
INCH CRUSHED STONE BASE, AS SPECIFIED 4' OF NATURALLY OCCURRING TIVE EFFEC LENGTH = 42.0'
IN 310 CMR 15.221(2). PERVIOUS MATERIAL -
3) INSTALL INLET & OUTLET TEES AS REQUIRED. 5' (MIN.) ABOVE G.W. LEACHING SYSTEM SECTION
4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE BOTTOM OF TP, EL.=90.6
AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. (NO GROUNDWATER)
SEPTIC SYSTEM PROFILE
SOIL LOG
DATE: JANUARY 5, 2015 (REF#14,605)
I 42 _ _ ' SOIL EVALUATOR: PETER McENTEE PE(SE#1542)
T - -- - WITNESS: DONNA MIORANDI R.S. HEALTH AGENT
00 ELEV. TP-1 DEPTH ELEv. TP-2 DEPTH
N ROPOSED S.A.S.
1 101.7 A On 101.E A 0
SANDY LOAM SANDY LOAM
10YR 4/2 10YR 4/2
100.9 B 1 p" 100.9 B g" ,
N
SANDY LOAM SANDY LOAM
8) �oQ7 10YR 5/8 10YR 5/8
Cp' 99.2 30" 99.1 30"
C1__ PERC --- C1• ..r
3. Lox M-C SAND M-C SAND
OR N �O 94.7 2.5Y 6/6 84" 94.4 2.5Y 6/6 86"
O` p_ C2 C2
N
F-M SAND F-M SAND
2.5Y 7/3 2.5Y 7/3
91.2 126" 90.6 132"
PERC RATE <2 MIN/IN. - NO GROUNDWATER ENCOUNTERED
ADD'N ON
. .
SONOTUBES
GENERAL NOTES:
1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL
BOARD OF HEALTH AND THE DESIGN ENGINEER.
EX/ST/NG 2• ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS
HOUSE(#94) LOCAL RULESAD ENVIRONMENTAL TOS ODE, TITLE V, AND ANY APPLICABLE
T.O.F.=101.5t 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR j
TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE y
DESIGN ENGINEER. ti
4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING I
FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN
ENGINEER BEFORE CONSTRUCTION CONTINUES.
5. ALL ELEVATIONS BASED ON ASSUMED DATUM.
/�
6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF
S.A.S. LAYOUT THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.
7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE.
DESIGN CRITERIA 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S.
9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS a
NUMBER OF BEDROOMS: 5 BEDROOMS AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE
DIRECTED BY THE APPROVING AUTHORITIES. �
SOIL TEXTURAL CLASS: CLASS I (LOADING RATE=0.74 GPD/SF) 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY
DESIGN PERCOLATION RATE: <2 MIN/IN THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING
CONSTRUCTION. ?
DAILY FLOW: 550 GPD
11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS
DESIGN FLOW: 550 GPD IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND
GARBAGE GRINDER: NO-not allowed with design REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3).
550 GPD = 743.2 SF 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE
LEACHING AREA REQUIRED:
( ) INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL.
.74 GPD/SF 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND
EXISTING SEPTIC TANK: 1500 GALLON CAPACITY NOT CONSIDERED TO BE A PROPERTY LINE SURVEY.
PROPOSED D-BOX: 1 INLET, 3 OUTLET (MINIMUM), H-10 RATED PROPOSED SEPTIC SYSTEM UPGRADE PLAN
USE 4-500 GALLON LEACHING CHAMBERS IN SERIES 94 MONOMOY CIRCLE, CENTERVILLE, MA
SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES
SIDEWALL AREA: 2(12.8' + 42.0') X 2 = 219.2 S.F. Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632
BOTTOM AREA: 12.8' x 42.0' = 537.6 S.F. Engineering by: SCALE DRAWN JOB. NO.
TOTAL AREA:..............................................................756.8 S.F. Engineering Works, Inc. N.T.S. P.T.M. 268-14
12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO.
DESIGN FLOW PROVIDED: 0.74 GPD/SF(576.8 SF) = 560.0 GPD (508) 477-5313 1/31/15 P.T.M. 2 of 2
ASSESSORS MAP: TEST HOLE LUGS NOTES:
a /�
4 PARCEL: 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH
FLOOD ZONE: �,,.
SO I L' EVALU TOR : L/��•geao ►"`i fUI� E� �•S . HIS PLAN, 1995 MASSACHUSETTS TITLE V & TOWN OF
WITNESS : _T 4�( BOARD OF HEALTH REGULATIONS.
REFERENCE: DATE: 6(, 0F,g12 2 2.00'2- 2) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES,
PERCOLATION RATE: G ��'`� NW SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO
r � �d y
CLASS -1 Sc�1(. L'iW12. 0;7 ( /�. INSTALLATION.
oil TH-_ .6 TH-2 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION
ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE
A 5ftN-Ol DETERMINATION.
(0 b5 4) ALL PIPING TO BE 4" SCHEDULE 40 @ 1/8 "/ FOOT. (UNLESS
SPECIFIED OTHERWISE)
LOCATION MA P(N•► -S) J S 6 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A
GARBAGE DISPOSAL. .
MaDl Um
6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED)
SAN D b G MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON
A
BASE OF 6"OF CRUSHED STONE.
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00.o ' � SEPT 1 C SYSTEM DESIGN �)��aw./y�.�./_✓�����u..��U��.S_c.�'o�__ ��c� ____
\ FLOW ESTIMATE /0. t
\ s BEDROOMS AT Ito GAL/DAY/BEDROOM - SSa GAL/DAY
I S \ SEPTIC TANK
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USE ( -ALLON SEPT I C TANK ,vOv
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SOIL ABSORPTION SYSTEM
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BOTT(%M AREA:
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- � sG SITE AND SEWAGE PLAN
2 - 3/y'� /�Z t' /Jav6/� LOCAT ION : �� kle)itIOMOy C'I� C&E
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PREPARED FOR :
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DARREN M. MEYER, R.S. SCALE:
43 VINE STREET DATE: /Cj Z D
DUXBURY, MA 02332
DATE HEALTH AGENT (781) 585-0293