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HomeMy WebLinkAbout0020 MONIZ CIRCLE - Health 20 Moniz Circle Marstons Mills A= 121 - 018 ' I COMMONWEALTH OF MASSACHUSEYrS ExECUTIYE OFFICE OF ENVIRONMENTAL AFFAIRS - DEPARTMENT OF ENVIRONMENTAL PROTECTION r - TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM-CORM PART A CERTIFICATION Property Address• Qt�l'Z rns g D Owner's Name: (; ►�1I-)t-t t`'�C��-`-�-•�— � = " ' Owner's Address: �L[QL "2.ci t l Date of Inspection: Name of Inspector.(please print) W i 1 1 ' to F_ .Robinson Sr. Company Name: William E. Robinson Septic Service_ Mailing Address: P O Box 1089 ' Centerville. MA Telephone Number:" (5081 775-877-5 CERTIFICATION STATEMENT 1 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 tine of the inspection_The inspection was performed based on my training and cxperience in the proper function and maintenance of on site sewage disposal systems_I am a DEP approved system inspector pursuant to ection I5340 of Title 5(310 C141R 15.000). The system: Passes , Conditionally Passes , Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: ��/ J Dnte: 1'-1 ,�•"' The system inspector shall submit a copy of this bispccuost report to the Approving Authority(Board of Heatth yr ' 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 shalt submit the report to the appropriate regional office of the DEP_The original should be sent to the system owner and copies ient to the buyer,if applicable,and the approving ' authority. Notes and Comments "'*This report only describes conditions at the time of inspecti"and under the conditions a se at t1fav tithe_This inspection does not address how the system will perfirm"iti the future under the sa a or difkKent ' conditions of use_ ZZ Z CD Title 5 Inspection Form 6/152000 page I L � Page 2ofII OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: N1L �Z C.,J&koa - Owner. SUP- Date of laspectloo; s, inspection Summary; Check A,B.C,D or E!ALWAYS complete all of Section D A. 7Systc,,,Passe=e not found assy information which indicates that any of the failure criteria described in 310 CiviR I5_303 or in 310 CM 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_ Answer yes,no or not determined(Y,N,P1D)in the for the following statements_if Mat explain_ g. determined"please 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 cxfulration or tank failure is itumkwn�SySiEm will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board cif Health_ `A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate ofCompliaruce indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due twbroken or. Obstructed pipe(s)or due to a broken,settled or uneven distri-bution box.System will F�in approval of Board of Health): , , • - spection if(with broken pipe(s)are replaced obsitttction is removed distribution box is leveled or replaced ND explain: The system required pumping more than:4 times a year due to bn)krn or obstst�rscd gas)-7 system will Pass inspection if(with approval ofthe Board of Health)- broken pipe(s)are replaced obstructiafn is;icmoyed ND explain: Fagc 3 ol•1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE-SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: QO co SAe.r✓,i t le_ Owner: t Date of Inspection: C. Further Evaluation is-Required by the Board of Health: - Conditions exist which require further evaluation by the Board of H lttt�orderto 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 15303(t)(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 Y 2. System will fait 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,l 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.front 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form_ ri Y - t 3. Other: 3 r Page 4 of 1 l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: ©S �t «4e Owner- 5v� =�• �• Date of Inspection: i D. System Failure Criteria applicable to all systems: You must indicate"-yes"or"nd'to each of the following for all inspections: ` Yes Nod- _:7$ackup 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 j clogged SAS or cesspool Static liquid level in the distribution box above.outlet invert due taan overloaded or clogged SAS or _✓cesspool /Liquid depth in cesspool is less than 6"below invert or available volume is less than%day flow J.Re wired pumping more than 4 times in the last year NOT due to clo logged or obstructed i e s .Number — — q P P g y gg PP ( ) of times pumped . Any portion of the SAS,cesspool or privy is below high ground water elevation. _ 1/Any portion of cesspool or privy is within 1001eet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone I.of a public well. _ Any portion of a cesspool or privy is within 50 feet of a private water supply weft: 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.IThis system passes if lice well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this forma I A (Yes/No)The system fails.I have determined that one or more o(the above failure criteria exist ai� described in 310 OAR 15.303.therefore the system fails.The system owner should coritact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: ✓ To be considered a large system t e system must serve a facility with a design flow of 10,000 gpd to 15,000 gPd- You must indicate either'y- es"or"no"to each of the following: (77ue following criteria apply to large systems in addition to the criteria above) 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—I WPA)or a mapped Zone I of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threa4 or answered "yes"in Section D above the large system has failed The uwnar 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. 4 Page 5 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY-ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: f�IL�� Z r(j SACX J i t e_ Owner. S u e- L i n�i�Cve-1�. Date of Inspection: Check if the following have been done.You must indicate`Yes"or"no"as to each of the following— Yes No/ z _ _✓ 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(lows in-the previous two week period? ' Nave large volumes of water been introduced to the system recently or as part of this inspection?. v _ Were as built plans of the system obtained and examined?(If they were not-available note as NIA)' Was the facility or dwelling inspected for signs of sewage back up Was the site inspected for signs of break out? Y Were all system components,excluding the SAS,located on site? ' x � t _ _ 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 od: •• . Yes/no . � ♦ • 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 distatice ' k is unacceptable)[310 CMR 15.302(30)] , 5 Page 6 of 11 r - OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 0�0 �� i_Z Ede - Property S 4 kt)L.tl Date of Inspection: 6 aPDi - - FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):.3 Number of bedrooms(actual): 3 - DESIGN flow based on 310 CMR 15103(for example:110 gpd x It of bedrooms): .�3� bP� Number of current residents: 3 Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no):A-�O jif yes separate inspection required] Laundry Ys stem inspected(yes or no):—�1R Seasonal use:(yes or no):_L'-'O Water meter readings,if available(last 2 years usage(gpd)). 6206� ��"(I �? Sum r : U P Pump(yes o no)__ d©O 7 �� �n Last date of occupancy.. G�.irc - COMMERCL41AKDUSTRUL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/personsfsgft,etc.): Grease trap present(yes or no)-._ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings,if available: Last date of occupancy/use: OTHER(describe)-. GENERAL INFORMATION . Pumping Records Source of information: Was system pumped as part of the inspection(yes or no): /--,Izl If yes,volume pumped:^gallons—How was quantity pumped determined? Reason for pumping: T�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) _Tigbt tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no): 6 1'aE,c 7 of I I OFFICIAL INSPECTION FOIIA14—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C r SYSTEM INFORMATION(continued) , . p , Property Address: �o �`�.Z C", rCt� T_ vik1e- Owner: t \C, Dote of Inspection: BUILDING SEWER(locate on site plan) Dcpdi below grade. (e Materials of construction:_cast iron --"40,PVC _oUtcr(explaut): ' Distance Gom private water supply well or suction fuze: Comments(on condition of juutts,venting,evidence of leakage,etc.): SEPTIC TANK:_(locate on site plan) Depth below grade: Matcrial of construction:_✓concrete_rectal fiberglass_polyedlylcne _odtcr(cxplain) — " lf tank is rectal list age:_ is agc confuntcd by a Ccnifrcatc of Compliance O-cs or no):_(attach a copy of ! certificate) Dimensions: C'��ws Sludge depth: _ , Distance from top of sludge,to bottom of outlet Ice or bafllc: 3'g Scum thickness: d Distance from top of scum to top of outlet tee or baffle: � Distance Gom bottom of scum to bonor t of outlet tee or baffle. 1 low sccrc dimensions determined: 0'e-^c0 lours +.,ou r•�r`ri Comments(on pumping recommendations,inlet and oullct tee or bafllc condition,structwal integrity,liquid levels as related to oullc(invert,evidence of leakage,etc.): 2- k-)L 4 d ets f J�47,c-i-. ter- /e I f 6a t5b.ti Ut/�•"ftf` /�C- �^�c SHO>! r�L -- C�C�.rt�all St»ti Gn� a �r 1. GREASE TRAP:_ ocalVin (c plan) Ucp0i below grade: Material of construction:_concrete_metal_fiberglass,___polyethylene other (explain): Dimensions: Scum thickness: . . Distance from top of scum to top of outlet tee or baffle: Distance Gom bottom of scum to bottom of outlet tee or baffle: Date,of last pumping: Continents(on pumping reconmtendations,utlel and outlet tcc or bafllc eonditiu:r,structwal integrity,liquid levels as related to outlet invert,evidence of leakage,c(c.): 7 8ofII ' OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) perty Address: d h0l' t Z_ (2,- cc'i c.it �lc n t r- Got~ r--,^ct t of lospectlon: PUT or HOLDING TANK: tank must be pumped at time of inspection)(locate on site plan) ith below grade: aerial of construction: concrete metal fiberglass__polyethylene othet(explain): rcnsions: tacit): _ nations .ign Flow: gallons/day nn present(yes or no): rm level: Alarm in working order(yes or no): ,c of last pumping: mmcnts(condition of alarm and float switches.ctc.): STIUBUTION BOX: (if ptesent must be opcned)(locate on site plan) pth of liquid level above outlet invert: nuncnts(note if box is level and distribution to outlets equal,any evidence:of solids carryover,any evidence of kagc in no or out of box,ctc.): # .a aO(�L� of Jk1P CHAMBER: � Jvc�on site Ian imps in working order(yes or no): lames in working order(yes or no): xmmcnts(note condition of pump cllambet,coodition'of pumps and appurtenances,dc.)_ Page 9 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: aC) M8-n k z C rC we— Owner: (Z3ye_ �G(\C, the uv,_ Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type _leaching pits,number_ ✓ leaching chambers,number. 014 leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number innovative/alternative system Typetname of technology. Comments(note condition of soil,signs of hydraulic failure,level of pondin„damp soil,condition of vegetation, etc.): , 5a.1 Jr> S4,___«r 44c�iz %cr 1. • CESSPOOLS: (cesspool must be pumped as part of inspectionxlocate 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 or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY': N '(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.): 9 Page 10 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: mot Zi?-C Vie. Owner• Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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. A_l 73 r�-a R -3 y7 ' O a� i � J _ 13-a 13~3 3 ` 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:�20 N1Cm\z � e- kE�� Owner. Sic- Date of Inspection: SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water DAD Meet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-1f checked,date of design plan reviewed: 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_ �6,-ovec, —4tr (1o��,i� A,-I'- 11 � fie�� � FORM 30 Caw H088S8 WARRENTM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H TH CIT /TOWN q� � o E RTMENT DRESS GIN SyOy`ey i TELEPHONE Address °� — Occupant % � ��WI n Floor Apartment Np. No.of Occupants_ I ,� No. of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming units_ No.St o ies e Name and address of owner Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: ` Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: A 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: H..W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 0220 Fusing,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. Sup.Ten.,Gas,Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities in e Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted 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 EP RT IS SIGNED AND CERTIFIED UNDER THFE PA AND PENAL S4W-)PER RY " INSPECTOR TITLE A. DATE TIME A.M. THE NEXT SCHEDULED REINSPECTION P.M. i 4 410.750: 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. THE COMMONWEALTH OF MASSACHUSETTS FORM 30 \ I� HOBBS 8 WARREN M BOARD OF HEALTH CITY/TOWN Z F c DEPARTME T 'o ADDRESS TELEPHONE Address -- - --------___---Occupant - � Floor Apartment No.— -- No. of Occupants a— No. of Habitable Rooms— - No.Sleeping Rooms—* _ __ No. dwelling or rooming units—WAL No.S"tories___ -f- Name and address of owner -_ emarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage / Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,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 E ui . Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,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 -�3 Bedroom 3 L. Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: S)jAQks, Flues,Vents S ties: Kitchen Facilities Si ove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin, Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted 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 I SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY." INSPECTOR TITLE rP,_ ') A.pG� DATE v TIME � f — A.M. THE NEXT SCHEDULED REINSPECTION / P.M. r 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shali be deemed conditions which may endanger or impair the heaith, 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. Crocker, Sharon . To: Miorandi, Donna Cc: McKean, Thomas Subject: BOH Feb Meeting Item -20 Moniz Cir Donna, Tom's out and asked me to check with you on 20 Moniz Circle, Marstons Mills. He would like to know if you have the following information for him to use at the meeting: 1) Number of people allowed vs amount of people currently living in there. 2) Do you have any calculations on what the square footage allows for occupants. Thank you. 1 Town of Barnstable IIARNS'rABLE. = Regulatory Services Department y MASS. g 1639. `` Public Health Division 'OjFa MA'S' 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO C69-Tir 7,0 04)-oa6�_�ysP3s�g February 27, 2006 Susan L. Kingman 29 South Street Osterville, MA 02655 Re arding: 20 Moniz Circle, Marstons Mills, MA Dear Ms. Kingman: You are scheduled to appear before the Board of Health at the next meeting scheduled on March 14, 2006, at 3:00 pm at the Town Hall, Selectmen's Conference Room, located at 367 Main Street, Hyannis. This hearing is being held due to your written appeal dated January 25, 2006. Sincerely, T omas A. McKean _ Director Public Health Division J:\LETTERS\Let_Kingman_20MonizCir 2-27-06.doc February 24, 2006 In regard to the Board of Health meeting scheduled for February 28, 2006, I cannot attend this meeting because of previous vacation plans. I will be leaving February 2, and will return March&h. Please reschedule me for this very important meeting. Thank you, C-S&— P, Sue Kingman f r :T JrC7 ! eP N � MC Management Company, LLC PO Box 457 221 Rt. 149 Marstons Mills, MA 02648 Phone and Fax: 508-428-8888 E-mail: mpgrilio wComcast_nei FAX COVER Date: r� To: 1 a ul of Company: Q e-d C ' ►f e From: Sent by: r2 Number ofpages included ; T 'd 8888-8Z�-80S DIIITJS Taeyq W e0c =0T 90 trZ qaj CENTERVILLE-OSTERVILLE-MARSTONS MILLS FIRE DISTRICT ( DEPARTMENT OF FIRE-RESCUE&EMERGENCY SERVICES 1875 Route 28•Centerville, MA 02632-3117 1926 508-790-2380•FAX: 508-790-2385 John M. Farrington,Chief Martin O'L. MacNeely, Fire Prevention Officer Craig E.Whiteley,Deputy Chief Francis M. Pulsifer, Fire Prevention Officer January 10, 2006 Mr. Jeff Lauzon- Building Inspector Town of Barnstable 200 Main Street Hyannis, MA 02601 Dear Inspector Lauzon: Pursuant to MGL Chapter 148 Section 28A, I am making you aware of and request your interpretation of a suspected un-permitted finished basement apartment at: 20 Moniz Circle Marstons Mills, MA 02648 Secondary to a fire related incident at this address, Fire Prevention was called to the scene to evaluate the smoke detection system. The residence has a combination of battery operated and hardwired smoke detectors. All but two detectors had been disabled or were inoperable and placement of the detectors did not appear to be up to code. Additionally, the finished basement has a kitchen, two baths, and furnished bedrooms, which the owner states was never permitted through the Building Department. As an immediate temporary solution to this issue, the owner has been instructed to install battery- operated smoke detectors. Additionally, the owner was instructed not to allow sleeping quarters on the lower level until an evaluation could be completed by the Building Department. I would like to coordinate a site visit at this address with the Building, Health, Electrical and Fire Department to find an acceptable solution to this issue and remedy any existing code violations. Please let me know the availability of your department for a site visit. Please feel free to contact me with any questions you have relative to this incident. Sincerely, Francis M. Pulsifer Fire Prevention Officer Cc: Health.Department "Commitment to Our Community" �n Health Complaints 11-Jan-06 Time: 9:03:00 AM Date: 1/11/2006 Complaint Number: 18615 Referred To: DONNA MIORANDI Taken By: JOAN AGOSTINELLI Complaint Type: CHAPTER II HOUSING Article X Detail: ILLEGAL OPERATIONS Business Name: Number: 20 Street: MONIZ CIRCLE Village: MARSTONS MILLS Assessors Map_Parcel: Complaint Description: A suspected illegal apartment in the basement. Problen with inoperable fire detectors. There is a kitchen, two baths, and furnished bedrooms which were not permitted by the building department of the TOB. Owner was instructed that there were to be no sleeping quarters in the basement. Site visit is to be coordinated with Fire, Building and Health. (See Jeff in building). See attached letter. Actions Taken/Results: Investigation Date: Investigation Time: 1 Y'ST. CENTERVILLE-OSTERVILLE-MARSTONS MILLS FIRE DISTRICT ( DEPARTMENT OF FIRE-RESCUE&EMERGENCY SERVICES 1875 Route 28•Centerville, MA 02632-3117 1926 508-790-2380•FAX: 508-790-2385 John M. Farrington,Chief Martin O'L. MacNeely, Fire Prevention Officer Craig E.Whiteley,Deputy Chief Francis M. Pulsifer, Fire Prevention Officer January 10, 2006 Mr. Thomas Perry- Building Commissioner Town of Barnstable 200 Main Street Hyannis, MA 02601 Dear Commissioner Perry: i Pursuant to MGL Chapter 148 Section 28A, I am making you aware of and request your interpretation of a suspected un-permitted finished basement apartment at: 20 Moniz Circle Marstons Mills, MA 02648 Secondary to a fire related incident at this address, Fire Prevention was called to the scene to evaluate the smoke detection system. The residence has a combination of battery operated and hardwired smoke detectors. All but two detectors had been disabled or were inoperable and placement of the detectors did not appear to be up to code. Additionally,the finished basement has a kitchen, two baths, and furnished bedrooms, which the owner states was never permitted through the Building Department. As an immediate temporary solution to this issue, the owner has been instructed to install battery- operated smoke detectors. Additionally, the owner was instructed not to allow sleeping quarters on the lower level until an evaluation could be completed by the . Building Department. I would like to coordinate a site visit at this address with the Building, Health, Electrical and Fire Department to find an acceptable solution to this issue and remedy any existing code violations. Please let me know the availability of your department for a site visit. Please feel free to contact me with any questions you have relative to this incident. Sincerely, Francis M.Pulsifer Fire Prevention Officer Cc: Health Department "Commitment to Our Community" Certified Mail#7005 1160 0000 0191 0829 ¢,ca�` Town of Barnstable 5y'A Regulatory Services Thomas F. Geiler,Director M^S& 039. Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 January 19, 2006 Ms. Susan L. Kingman 29 South Street Osterville, MA 02655 NOTICE TO ABATE VIOLATIONS OF 310 CMR: 15.000 THE STATE ENVIRONMENTAL CODE TITLE V• MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY SEWAGE AND VIOLATIONS OF 105 CMR 410.000 STATE SANITARY CODE U-MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE. The property owned by you located at 20 Moniz'Circle, Marstons Mills, was inspected on January 12, 2006 by Donna Z. Miorandi, R.S., Health Inspector for the Town of Barnstable, because of an incident response from the C-O-MM Fire Department. The following violation of the State Environmental Code was observed: 310 CMR 15.214: Nitrogen Loading Limitations: 7 Bedrooms were observed in a Zone 2 Wellhead Protection Area with .49 acres of land on said lot. You may have no more than 3 bedrooms total at said location. You are directed to immediately cease and desist occupancy of the fourth bedroom on the main floor and the three bedrooms in the basement. All furniture must be removed from these four bedrooms. 105 CMR 410 400• Minimum Square Footage: (A) Every dwelling unit shall contain at least 150 square feet of floor space for its first occupant, and at least 100 square feet of floor space for each additional occupant, the floor space to be calculated on the basis of total habitable room area. (B) In a dwelling unit, every room occupied for sleeping purposes by one occupant shall Q\Order-letters\Sewage violations\20 Moniz Circle.doc /! contain at least 70 square feet of floor space; every room occupied for sleeping purposes by more than one occupant shall contain at least 50 square feet of floor space for each occupant. 105 CMR 410.452: Safe Condition: The owner shall maintain all means of egress at all time in a safe, operable condition. Egresses were blocked by furniture in the bedrooms. 105 CMR 410.501:Weathertight Elements: (A) A window shall be considered weathertight only if: (1) all pane of glass are in place, unbroken and properly caulked. Bedroom window pane is broken. The following violation'of the Town of Barnstable Codification Rental Ordinance was observed: § 170-7 of the Town of Barnstable Code: Owner\Property Manager's name, address and telephone number were not posted. § 170-7 of the Town of Barnstable Code specifically reads as follows: An owner of a dwelling which is rented for residential use, who does not reside therein and who does not employ a manager or agent for such dwelling who resides therein, shall post and maintain or cause to be posted and maintained on the exterior of such dwelling within five feet of the main entrance or within five feet of the mailbox(es), at least four feet and not greater than six feet above ground level, a notice constructed of durable material, not less than 20 square inches in size, bearing his/her correct name, address and telephone number. If the owner is a realty trust or partnership, the name, address, and telephone number of the managing trustee or partner shall be posted. If the owner is a corporation, the name, address, and telephone number of the president of the corporation shall be posted. Where the owner employs a manager or agent who does not reside in such dwelling, such manager's or agent's name, address, and telephone number shall also be included in the notice. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance could result in a fine of up to $100.00 per violation. Each day's .failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH m s A. McKean, R.S. Director of Public Health Town of Barnstable Cc: Jeff Lauzon, Building Inspector FPO Frank Pulsifer, COMM Fire Department QAOrder letters\Sewage violations\20 Moniz Circle.doc Ln uI •. • m eZ wLn u I-r) .�'•....vo- Postage $ �5. + , C3 O Certified Fee O Postmark O` O Retum Reciept Fee r } (Endorsement Required) Restricted Delivery Fee cO (Endorsement Required) r=1 Total Postage&Fees ASPS / m CO Sent To + O N ------------------� _._..._... -��- ---- -------------------•- Street,Apt.No.; lJ or PO Box No. City,State,ZIP+4 �pZ/ Certified Mail Provides: o A mailing receipt (asianea)ZooZ eunr'000c Wjod Sd o A unique identifier for your mailpiece n A record of delivery kept by the Postal Service for two years Important Reminders: e Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. e Certified Mail is not available for any class of international mail. e NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811).to the article and add applicable postage to cover the fee.Endorse mailpiece'Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. a For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted-Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete I'm item 4 if Restricted Delivery is desired. 1 ❑Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. Received b. (Printed e) C. Date of D livery ■ Attach this card to the back of the mailpiece, , 3 or on the front if space permits. �� D. Is delivery a d differe&jfrom item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery addeess below: ❑ No LC.Sr�f/l/ /! i / t t3 1 W 3. Service Type G �/ O�P� Certified Mail ❑ Express Mail Registered ❑ RetuW-Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delive ?(Extra Fee) ❑Yes z. Article Number 7003. 1660 D 40 4 5458 3565 (transfer from service label) PS Form 3811,August 2001 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LISPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • `76_�OA) of ��Le_ ,,] IJi????3i?�?31??i�E?????if3{'.3��{t?3114??!}�?�ff339�?s;.?:�=�i� p QS� t Thomas A. McKean,R.S. January 25, 2006 Director of Public Health ' Town of Barnstable , CD r �20 N�o�%� C'�n�� r� r- w M I am filing this letter of appeal with the Public Health Division of the Town of Barnstable in response to a letter I received on January 24,2006, stating violations concerning a rental property that I own located at 20 Moniz Circle in Marstons Mills, MA Assessor's Map 121 Parcel 018. Violation 310 CMR 15.214 : This states that there are 7 bedrooms at this property. This is not true. The inspector included rooms located in the basement,none of which have closets in them,nor are there people sleeping in these rooms. The basement is used only for storage by the tenants living on the first floor and by me. The tenants are also allowed to use the bathrooms in the basement area. In August, 2003, I signed a lease with Mrs. 011yce Gardner for tenancy of herself and 4 other people in the main floor of this dwelling. Since that time, another adult relative has become a tenant, and 3 babies have been born. Two adults sleep with their baby and infant in one bedroom. The second bedroom is occupied by two adults and their baby. And the third bedroom is occupied by a male adult and a child. The fourth room,a so- called bedroom, is actually used as a den. Violation 105CMR 410.400: This states the minimum square footage for each occupant. The Gardner families are good,hardworking,responsible,Christian people. They are not living on welfare,nor do they receive any state aid. They are professional,tax paying adults who appreciate comfortable,clean, safe, and affordable housing. I do not want to evict any of these tenants. Housing is very expensive on Cape Cod and I am able to give them a home at a rent they can afford. And,as a single parent with 2 children of my own, I need this income to provide for my family. My proposal is to make this a 4-bedroom home rather than a 3-bedroom,allowing extra space for this family which is now living there. It has 2.5 baths and a 1500 gallon septic system. Violation 170-7 of the Town of Barnstable Code: This states that I must put my name and address on the exterior of this dwelling. I am a single woman with 2 young children and I feel this violates my right to privacy. My tenants and anyone directly involved with this property are able to contact me anytime. Also,I have a permanent restraining order against my ex-husband,Timothy E.Kingman, who once lived and worked at 20 Moniz Circle. He has been arrested and incarcerated on numerous occasions for assault and battery, sexual assault, and for possession of illegal firearms. I consider the people with whom he associates dangerous and do not want my personal information published for all to see. I feel that displaying my name, address and phone number on the exterior of this house would jeopardize the safety and well-being of my family. Both Violations, 105 CMR 410.452 and 105 CMR 410.501,are now in compliance. Please note that both of these violations occurred on January 9, 2006,as a result of a fire in the dryer which caused smoke to fill the house. The occupants opened windows to clear the air and in the process a window was broken. To prevent cold air,animals,birds, etc. from entering the home,the occupants temporarily put a dresser in front of the window until it could be fixed. These incidents happened only three days before the health inspector came to the house so they had not yet been addressed. Your thoughtful consideration of these matters on behalf of me,my family, and the tenants at 20 Moniz Circle, would be greatly appreciated. Sincerely, Susan L. Kingm ' MM DD YYYY ❑Delete NFIRS _ A 101920 U 01 10 2006 12 106-0000096 000 ❑Change Basic 1 FDID * State* Incident Date * Station Incident Number * Exposure ❑No Activity chect this box to Indicate that the address fox this incident is provided on the wildland Fire Census Tract I BLocation* ❑Module In section B "Alternative Location Specification". Use only fox Wildland fires. ®Street address 20 I I IMONIZ CIR U U ❑Intersection Number/Milepost Prefix Street or Highway street Type Suffix ❑In Front of I� ❑Rear of IMARSTONS MILLS 1U 1102648 1 � Apt./Suite/Room City State Zip Code ❑Adjacent to ❑Directions L Cross street or directions, as ao licable C Incident Type El Date & Times Midnight is 0000 E2 Shift & Alarms 100 (Fire, Other I check boxes if Month Day Year Hr Min Sec Local Option dates are the Incident Type same as Alarm ALARM always required 14 ( `+OM2 3 Aid Given or Received* Date. Alarm * O1 10 2006 I08.:58:06 D Shift or, Alarms District Platoon ARRIVAL required, unless canceled or did not arrive 1 ❑Mutual aid received ❑ U U �I Arrival * O1 10 2006 09:03:18 � E3 2 ❑Automatic aid re CV. Their FDID Their State CONTROLLED Optional, Except for wildland fires Special Studies 3 ❑Mutual aid given I I I "4 ❑Automatic aid given I " I ❑Controlled I I I I Local Option 5 ❑Other aid given Their LAST UNIT CLEARED, required except for wildland fires I II Incident Number Last Unit Special Special N ONone ❑ Cleared U 1 101 120061 EL.1-5:41 I Study IDa Study Value Actions Taken 7k Gl Resources G2 Estimated Dollar Losses & Values ❑ Check this box and skip this LOSSES: Required for all fires if known. Optional section if an Apparatus or 11 Extinguishment by fire I Personnel form is used. for non fires. None U Primary Action Taken (1) Apparatus Personnel Property $1 1 , 000 , 0001 ❑ Suppression U 0003 Contents $1 , 000 , 000 12 (Salvage & overhaul I ❑ Additional Action Taken (2) EMS I U PRE-INCIDENT VALUE: Optional 33 (Provide advanced life I Other 10 Property $1 � , 000 1 000 ❑ Additional Action Taken (3) ❑ Check box if resource counts $1 , � ,� ❑ include aid received resources. Contents 000 000 Completed Modules Hl*Casual ties❑None H 3 Hazardous Materials Release I Mixed Use Property O ®Fire-2 Deaths Injuries N None NN X Not Mixed Fire 10 Assembly use X❑Structure-3 ( f 1 ❑Natural Gas: slow leak, ne ewaeation or Hauat a.tien: 20 Education use Service I 0 Civil Fire Cas.-4 2 []Propane gas: <21 lb. tank (a, in home HHQ gzill) 33 Medical use ❑Fire Serv. Cas.-5 CivilianL_____j 1 001 3 ❑Gasoline: vehicle feel tank or portable container 40 Residential use GEMS-6 � 4 ❑Kerosene: feel burning equipment or portable ,forage 51see Row of stores Detector 53 Enclosed mall ❑HazMat-7 Required for Confined Fires. 5 ❑Diesel Fuel/fuel oil: enicle feel cam or portable 58 Bus. & Residential ❑ Z wildland Fire-8 ❑Detector alerted occupants 6 [-]Household Household solvents: home/office spill, cleanup only 59 Office use QApparatus-9 7 ❑Motor oil: from engine or portable container 60 Industrial use OPersonnel-10 2E)Detector did not alert them Paint: from 63 Military use 8 om paint sans totaling< 55"gallons 65 Farm use ❑Arson-11 U❑Unknown 0 ❑Other: special Hx,M t action,required or spill>55ga1., 00 Other mixed use Pleae let. the H.r t form J Property Use* Structures 341❑Clinic,clinic type infirmary 539 ❑Household goods,sales,repairs 342❑Doctor/dentist office 57 9 ❑Motor vehicle/boat sales/repair 131 ❑Church, place o£ worship 361❑Prison or jail, not juvenile 571 ❑Gas or service station 161 ❑Restaurant or cafeteria 419®1-or 2-family dwelling 599 ❑Business office 162 ❑Bar/Tavern or nightclub 42 9❑Multi-family dwelling 615 []Electric generating plant 213 ❑Elementary school or kindergarten 439❑Rooming/boarding house 629 ❑Laboratory/science lab 215 ❑High school or junior high 449❑Commercial hotel or motel 700 []Manufacturing plant 241 ❑College, adult education 459[]Residential, board and care 819 ❑Livestock/poultry storage(barn) 311 ❑Care facility for the aged 4 64❑Dormitory/barracks B82 ❑Non-residential parking garage 331 ❑Hospital 519❑Food and beverage sales 891 ❑Warehouse Outside 936❑Vacant lot 981 ❑Construction site 124 ❑Playground or park 938 ❑Graded/care for plot of land 984 ❑ Industrial plant yard 655 ❑Crops or orchard 946 ❑Lake, river, stream 669 ❑Forest (timberland) 951 ❑Railroad right of way Lookup and enter a Property Use code only if g y you have NOT checked a Property Use box: 807 ❑Outdoor storage area 960 [-]Other street Property Use 1419 919 ❑Dump or sanitary landfill 961 ❑Highway/divided highway 931 ❑Open land or field 962 ❑ 11 or 2 family dwelling [:]Residential NFIRS-1 Revision 03 1l F9 I9 COMM Fire District 01920 01/10/2006 06-0000096 s K1 Person/Entity Involved I I 1508 - 428 - 8484 Local Option Business name (if applicable) Area Code Phone Number I IOLLYCE [GARDNER I U ®Check This Box if Mr.,Ms., Mrs. First Name MI Last Name Suffix same address as incident location. 120 I �� IMONIZ I CIR L_J Then ship the three duplicate address Number Prefix Street or Highway Street Type Suffix lines. IKINGMAN, SUSAN L IMARSTONS MILLS I Post Office Box Apt./Suite/Room City U 102648 I-1 State Zip Code ❑More people involved? Check this box and attach Supplemental Forms (NFIRS-1S) as necessary K2 Owner Elsame as person involved? Then check. this box and skip I I 508 - 428 - 1946 The rest of this section. Local Option Business name (if Applicable) Area Code Phone Number �J ISUE L—J I KINGMAN I u OCheck, this box if Mr.,Ms., Mrs. First Name MI Last Name Suffix same address as incident location. 129 I U LSOUTH I ST Then skip the three duplicate address Number Prefix Street or Highway Street Type Suffix lines. I I I J IOSTERVILLE � Post Office Box Apt./Suite/Room City U I02655 I-1 State Zip Code L Remarks Local Option Caller Name : ALICE GARDNER Caller Phone : 428-8484 Caller Address : SAA OIC : TAVARES/T. MISKIV/PULSIFER Pats. . 1 lmotte 2006/01/10 09:03:18 - 321 AT EVENT MANNING IS 1 lmotte 2006/01/10 09:04 :16 - 303 AT EVENT MANNING IS 3 lmotte 2006/01/10 09:08:16 - 304 AT EVENT MANNING IS 3 lmotte 2006/01/10 09: 18:44 - 324 AT EVENT MANNING IS 3 lmotte 2006/01/10 09:44 :36 - 328 AT EVENT MANNING IS 1 911 ; 2006/01/10 08:58:06 Time of Call RESD 08:57 01/10 Phone Number (508) 428-8484 COID=VERIZ Caller Name GARDNER, D & V Street Number : 20 Street Name : MONIZ CIR Service Municipality : MARSTONS MILLS ESN ESN=509 MTN:508-428-8484 lmotte 2006/01/10 08: 59:41 PAST DRYER FIRE lmotte: ; 2006/01/10 09:04 :52 L Authorization 18480 I ( TAVARES, JOHN M. ( ILT 1321 I1 011 I10 I 2006 Officer in charge ID Signature Position or rank. Assignment Month Day Year t Boxcif© 18480 I (TAVARES, JOHN M. I ILT I 1321 I L-011 110J 2006 same Position or rank Assignment Month Day Year as Officer Member making report ID Signature in charge. COMM Fire District 01920 01/10/2006 06-0000096 MM DD YYYY 1 01920 U L11 1 101 1 2006 1 2 1 06-0000096 1 000 complete FDID State Incident Date Station Incident Number Exposure Narrative Narrative: Caller Name : ALICE GARDNER Caller Phone : 428.-8484 Caller Address : SAA OIC : TAVARES/T. MISKIV/PULSIFER Pats. : 1 lmotte 2006/01/10 09:03:18 - 321 AT EVENT MANNING IS 1 lmotte 2006/01/10 09: 04:16 - 303 AT EVENT MANNING IS 3 lmotte 2006/01/10 09:08:16 - 304 AT EVENT MANNING IS 3 lmotte 2006/01/10 09:18:44 - 324 AT EVENT MANNING IS 3 lmotte 2006/01/10 09:44 :36 - 328 AT EVENT MANNING IS 1 911 • 2006/01/10 08:58 :06 Time of Call RESD 08 :57 01/10 Phone Number (508) 428-8484 COID=VERIZ Caller Name GARDNER, D & V Street Number : 20 Street Name : MONIZ CIR Service Municipality : MARSTONS MILLS ESN : ESN=509 MTN:508-428-8484 lmotte ; 2006/01/10 08:59:41 PAST DRYER FIRE lmotte ; 2006/01/10 09:04:52 321-SNGL STRY W/SMOKE SHOWING, START 2ND ENG lmotte ; 2006/01/10 09:05:01 321-FIRE IS OUT, INVESTIGATING lmotte ; 2006/01/10 09:07:26 321-COMMITTING BOTH CO'S ON LOC lmotte ; 2006/01/10 09:09:30 STA 3 COV-DAVERN,HENSON,SCHNECKLOTH lmotte ; 2006/01/10 09: 14:37 321-WILL NEED THE RESCUE lmotte '; 2006/01/10 09:23:52 324 COMMITTED, STA 1 COV-LONG,OMELIA,OSGOOD lmotte ; 2006/01/10 09:28:18 321-WILL NEED 328 HERE lmotte ; 2006/01/10 09:29:37 328 ETA 10-15 MINS 01/10/2006 18:36:31 jtavares Received the call for above, upon my arrival I found a single story wood frame occupied home with moderate smoke showing from the main front door, with occupants still within the home. I immediately ordered the home evacuated and requested a second company. There was an attempt by an occupant (the victim transported) to extinguish the fire with a 2.5 lb ABC dry chem extinguisher. Fire was contained to the lint screen and vent area of the dryer. The fire was completely extinguished by us with a 2.5 gallon PW. COMM Fire District 01920 01/10/2006 06-0000096 MM DD YYYY 01920 U 1 11 1 101 1 2006 1 2 1 06-0000096 1 1 000 complete FDID State Incident Date Station Incident Number Exposure Narrative Narrative: The occupant attempting to put out the fire was experiencing some respiratory symptoms and an ambulance was requested for evaluation and transport. PPV was established the alpha side. There was no way to remove to dryer to the exterior due to the basement being finished around the washer and dryer, we assured complete extinguishments. Other issues found included but not limited to, inoperative, unmaintained, and removed fire detection system, an altered electrical panel of questionable workmanship in the basement, and 10 occupants in a residential home of this size. With the previous items found I requested FPO Pulsifer to assist with the investigation and to follow up as he sees necessary and agencies he feels necessary. FPO Pulsifer and I spoke to the home owner regarding the issues previously mentioned. 01-10-06 Recieved call to respond to 20 Moniz Circle, Marstons Mills for a past appliance fire, OIC Lt. Tavares requesting fire prevention. Responded 328 from Hyannis and arrived w/o incident. Briefed of incident detail by Lt.Tavares. - Structure is a single story wood frame residential building. Structure has a double electrical meter socket with a single meter in place. Entered structure to find 1st floor and basement with finished construction. Multiple smoke detectors had been removed from service and/or found to be faulty. Lt. Tavares stated that post incident,companies on scene removed one SD, in the fire area that would not immediately restore to normal. All others were found as stated at the time of the incident. A total of one battery operated SD on the first floor level and one hardwired SD on the basement level were operational. All SD's found on the first floor are battery operated and all SD's and HD's found on the basement level are hardwired. Some locations of devices are not in the correct locations according to code requirements. Additionally, four rooms on the first floor are being used as bedrooms and three rooms on the basement level are being used as bedrooms. These seven rooms have furniture and made bedding concurrent with active sleeping quarters. The basement level as well has two bathrooms with cloth atticles as doors, a common living space and kitchen facilities with sink, stove and refrigerator. There are egress issues throughout the structure both on the first floor and basement areas. Access was restricted in many areas by furniture in rooms and a crib in front of a main egress door. Also noted one of the electrical panels in the basement level with taping of circuit breakers. Interviewed owner of the property with Lt. Tavares. Owner is Sue Kingman. home address of 29 South Street, Osterville. Contact numbers are (H) 508-428-1946 and (C) 508-237-5739. Owner is renting the property at 20 Moniz Circle. At the present time, there are ten people living at this address as a permanent residence, including four children. One of the ten is an adult guest and is not using this address as a primary residence. Reviewed incident with Ms. Kingman and stated the concerns with access, egress, electrical and detection issues. When asked, Ms. Kingman stated that she did not believe that the basement was ever properly permitted for residential purposes through the Building Department. Lt. Tavares and myself advised Ms. Kingman that the immediate course of action would be to remove all occupants from the basement level sleeping quarters to the firsty floor level, to restore the smoke detection equipment to acceptable standards based upon the age of the dwelling and number of bedrooms on the. first floor level, and to immediately correct access and egress issues. Also advised Ms. Kingman that notification would be made to the Building, Health and Electrical Inspectors for follow-up action. Ms. Kingman cooperated throughout the investigation and agrees to comply with the above requests prior to anyone sleeping in the residence. COMM Fire District � ,,01920 01/10/2006 06-0000096 MM DD YYYY 01920 U 11 1 101 1 2006 2 06-0000096 1 000 complete FDID State Incident Date Station Incident Number Exposure Narrative Narrative: Upon walk-through with Ms. Kingman, she stated that her ex-husband, Timothy Kingman, had done the work to the basement. Ms. Kingman has since lost contact with him and has no contact information available. Ms. Kingman advised her tenants of the urgency and importance of immediate compliance to the above issues. Advised Ms. Kingman that I would be in contact with her regarding a follow-up site visit with the appropriate departments. Cleared w/o incident. Letter to Town of Barnstable Building Inspector Jeff Lauzon, Cc: Health Department and verbal notification to Electrical Inspector Bill Amara. Site visit scheduled for 01-12-06 at 14 :00 hours. 01-12-06 Site visit at 20 moniz Circle, Marstons Mills. Inspectors present were Inspector Lauzon- Building department, Inspector Amara- Wiring Department, Inspector Miorandi- Health department and Inspector Pulsifer- COMM Fire Department. Issued a Notice of Violation to Ms. Kingman relative to failure to maintain fire alarm equipment, access and egress issues and acceptable temporary course of action to correct. All parties identified to owner, allowed entry to structure. Fire alarm equipment and access issues were resolved satisfactorily, some egress issues with respect to partially blocking windows for secondary egress were noted and owner advised of the same. On the lower level, it appears that the occupants have refrained from utilizing this area as sleeping quarters as ordered. Inspectors on site concurred that there were no permits to establish residential living/ sleeping quarters in the basement. The residence is only allowed three bedrooms by Town of Barnstable regulations. Inspectors on site advised Ms. Kingman of appropriate courses of action to correct including removal of lower level bedrooms and one of the lst floor bedrooms. Ms. Kingman was advised of the permit process and advised to contact respective departments for assistance or clarification. All inspectors cleared w/o incident. Ms. Kingman inquired the status of the structure and it's use group when she and her ex-husband purchased the property in 1998. Ms. Kingman stated that when they purchased the property in 1998, there was the 1st floor living space and a doctor's office on the lower level. After purchasing the property, her husband made the doctor's office into a home office and later renovated it to residential purposes. Researched the permit file to find a 26F inspection completed on October 28, 1998 for the sale and transfer of this property. The certificate indicates a single dwelling with four battery operated smoke detectors at the time of inspection. It is unclear from this information, if the building was ever permitted/ used for buisness purposes, however, statements made by Ms. Kingman indicate that subsequent to this, permits were never in place to create additional living quarters on the lower level after they bought the property. Follow-up will be on an as needed basis. Building and Health Departments to coordinate efforts with Ms. Kingman to ensure compliance. Case is closed pending any further requests from Building and Health. 01/12/2006 16:42:07 fpulsifer COMM Fire District 01920 01/10/2006 06-0000096 COMPLETESENDER: COMPLETE THIS SECTION • ON DikLIVERY ■ Complete items 1,2,and 3.Also complete . ure I item 4 if Restricted Delivery is desired. N. 1 ❑Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. Received by(P)rnt ame) C. Dat f Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 1?. ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No b 3. Se ice Type ❑ Certified Mail Express Mail Se �tReturn Receipt for Merchandise El Insured Mail 10 C.O.D. I 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (transfer from service label) • z .° 7 0 5, 116 0191 8 2 9 2 PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540!. I I" UNITED STATES POSTAL SERVIC --t First-Class Mail Postage&Fees Paid .A USPS rPermit No.G-10 I • Sender: Please prrant yoar Ka/me, address,.�.and-ZiP+4in-t+iis box*" I � - I A00 i� I racy IIIIIII till till III I►„1,111I1 till It lilt M11111!{t1111111lilt J ,Y Certified Mail#7005 1160 0000 0191 0829 Town of Barnstable Regulatory Services Thomas F. Geiler,Director t+�nss. 1.A'� Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 January 19, 2006 Ms. Susan L. Kingman 29 South Street Osterville, MA 02655 NOTICE TO ABATE VIOLATIONS OF 310 CMR: 15.000 THE STATE ENVIRONMENTAL CODE TITLE V: MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY SEWAGE AND VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II-MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE. The property owned by you located at 20 Moniz Circle, Marstons Mills, was inspected on January 12, 2006 by Donna Z. Miorandi, R.S., Health Inspector for the Town of Barnstable, because of an incident response from the C-O-MM Fire Department. The following violation of the State Environmental Code was observed: 310 CMR 15.214: Nitrogen Loading Limitations: 7 Bedrooms were observed in a Zone 2 Wellhead Protection Area with .49 acres of land on said lot. You may have no more than 3 bedrooms total at said location. You are directed to immediately cease and desist occupancy of the fourth bedroom on the main floor and the three bedrooms in the basement. All furniture must be removed from these four bedrooms. 105 CMR 410.400: Minimum Square Footage: (A) Every dwelling unit shall contain at least 150 square feet of floor space for its first occupant, and at least 100 square feet of floor space for each additional occupant, the floor space to be calculated on the basis of total habitable room area. (B) In a dwelling unit, every room occupied for sleeping purposes by one occupant shall QAOrder-letters\Sewage violations\20 Moniz Circle.doc l - contain at least 70 square feet of floor space; every room occupied for sleeping purposes by more than one occupant shall contain at least 50 square feet of floor space for each occupant. 105 CMR 410.452: Safe Condition: The owner shall maintain all means of egress at all time in a safe, operable condition. Egresses were blocked by furniture in the bedrooms. 105 CMR 410.501:Weathertight Elements: (A) A window shall be considered weathertight only if: (1) all pane of glass are in place, unbroken and properly caulked. Bedroom window pane is broken. The following violation of the Town of Barnstable Codification Rental Ordinance was observed: 170-7 of the Town of Barnstable Code: Owner\Property Manager's name, address and telephone number were not posted. § 170-7 of the Town of Barnstable Code specifically reads as follows: An owner of a dwelling which is rented for residential use, who does not reside therein and who does not employ a manager or agent for such dwelling who resides therein, shall post and maintain or cause to be posted and maintained on the exterior of such dwelling within five feet of the main entrance or within five feet of the mailbox(es), at least four feet and not greater than six feet above ground level, a notice constructed of durable material, not less than 20 square inches in size, bearing his/her correct name, address and telephone number. If the owner is a realty trust or partnership, the name, address, and telephone number of the managing trustee or partner shall be posted. If the owner is a corporation, the name, address, and telephone number of the president of the corporation shall be posted. Where the owner employs a manager or agent who does not reside in such dwelling, such manager's or agent's name, address, and telephone number shall also be included in the notice. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance could result in a fine of up to $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH mas A. McKean, R.S. Director of Public Health Town of Barnstable Cc: Jeff Lauzon, Building Inspector FPO Frank Pulsifer, COMM Fire Department QAOrder letters\Sewage violations\20 Moniz Circle.doc �� II Town of Barnstable max ` Board of Health rrs 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Sumner Kaufman,MSPH Paul Canniff,D.M.D. March 22, 2006 Ms. Susan L. Kingman 29 South Street Osterville, MA 02655 Dear Ms. Kingman, On March 14, 2006, the Board of Health voted to uphold the orders from our Health Agent, Thomas McKean, to correct all of the violations observed at 20 Moniz Circle, Marstons Mills on January 12, 2006. The Board also voted unanimously to grant you an extension of time until June 1, 2006, to ensure four of the occupants vacate this property. No more than six occupants maximum are authorized at this property. Also, no more than three bedrooms area authorized at this property. Recall that the following violations were observed: 310 CMR 15.214: Seven(7)bedrooms were observed at this property,which is located in an area where only three bedrooms are allowed (this is a 0.49 acre parcel located within a nitrogen sensitive area). No more than 3 bedrooms total are allowed at this property. 105 CMR 410.400: Ten persons observed residing within this dwelling. No more than six occupants are allowed to reside within this dwelling. 105 CMR 410.452: Egresses were blocked by furniture in the bedrooms., 105 CMR 410.501:: Bedroom window pane is broken. 4 170-7 of the Town of Barnstable Code: The owner or property manager's name, address and telephone number were not posted. You are directed to cease and desist occupancy of the fourth bedroom on the main floor and the three bedrooms in the basement on or before June 1, 2006. All furniture must be removed from these four bedrooms. The violation regarding blocked egresses [105 CMR 410.4521 shall be corrected immediately, upon your receipt of this letter. The remaining violations shall be corrected within ten (10) days of your receipt of this notice. PER ORDER OF THE BO OF H LTH Wayne Miller, M.D. Chairman Q:\Order letters\Sewage violations\20 Mon i ircle2. c .a Bk 21107 PsP212 4WIL3S'413 097Y 06-16-20 H6 Q DEED RESTRICTION WHEREAS, SUSAN L. KINGMAN, Trustee of the SUSAN L. KINGMAN INVESTMENT TRUST, dated March 8, 2001 of 29 South St., Osterville (Barnstable), Massachusetts is the owner of a single family residence located at 20 Moniz Circle, Osterville (Barnstable), Massachusetts, (hereinafter referred to as 20 Moniz Circle) and being shown on a plan entitled uSubdivision of Land in Osterville Bamstab/e Massachusetts, for Manuel Moniz scale 1 in. = 50 ft. date: Oct. 28, 1963 Charles N. Savery, Inc. Registered Engineers and Surveyors Cotuit Falmouth Cape Cod" duly recorded in Barnstable County Registry of Deeds in Plan Book 184, Page 127; WHEREAS, SUSAN L. KINGMAN, Trustee of the SUSAN L. KINGMAN INVESTMENT TRUST, dated March 8, 2001 as the owner of said lot has agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included in any home built on said lot as a pre-condition to obtaining a disposal works construction permit in compliance with 310 CMR 15.000 State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage; WHEREAS, the Town of Barnstable Board of Health, as a pre- condition to granting a disposal works construction permit for a septic system in compliance with 310 CMR 15.200, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, and authorizing the issuance of a building permit for the construction of a single family home on this property, is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on the lot be put on record with the Barnstable County Registry of Deeds by recording this document. NOW, THEREFORE, SUSAN L. KINGMAN as Trustee of the SUSAN L. KINGMAN INVESTMENT TRUST, dated March 8, 2001 does hereby place the following restriction on her above-referenced land in accordance with her agreement with the Town of Barnstable Board of Health, which restriction shall run with the land and be binding upon all successors in title: 20 Moniz Circle, Osterville (Barnstable) Massachusetts may have constructed upon the lot a house containing no more than three (3) bedrooms. SUSAN L. KINGMAN, Trustee of the SUSAN L. KINGMAN INVESTMENT TRUST, dated March 8, 2001, agrees that this shall be a permanent deed restriction affecting the residence located on Map 121, Parcel 018 in the Town of Barnstable, MA, and being shown on the plan recorded in Plan Book 184, Paged 127 at the Barnstable County Registry of Deeds. For the latest and current title of 20 Moniz Circle in Osterville, Massachusetts, seethe following deed: Book 15630, Page 323 at the Barnstable County Registry of Deeds.- E cuted as a sealed instrument this le day of June, 2006. SUlfan L. Kingman, Trustee of the Susan L. ngman Investment Trust u/t/d March 8, 2001 CD 1-M COMMONWEALTH OF MASSACHUSETTS ) ) ss. COUNTY OF BARNSTABLE ) On this le day of June, 2006, before me, the undersigned notary public, personally appeared SUSAN L. KINGMAN, proved to me through satisfactory evidences of identification, which was a Massachusetts driver's license and personal knowledge, to be the person whose name is signed on the preceding page of this document, and acknowledged to me that she signed it voluntarily for its stated purpose. Witness my hand and official seal. My commission expires: November 22, 2007 Charles C. Case, Jr. — Notary Public ' CHARLES C.CASE.JR Notary Public Commonwealth of Massachusetts mm'`,,, DMCoissionExp%Nov72.20D7 V", TOWN OF BARNSTABLE L01ATION 'Z_ O pyt 12- , 9L SEWAGE# Z7 VUAGE f'✓t ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NQ. ,>1 iLlJ�C;t�s� SEPTIC TANK CAPACITY LEACHING FACILITY: (type)'Z 500 (94 C"f3-�S(size) I Z• SX �C NO. OF BEDROOMS OWNER I"'t Iff ��.d► h,��- PERMIT DATE: .- (� -®(- COMPLIANCE DATE: Ca'Z 0C, Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 306 feet of leaching facility) Feet FURNISHED BY _ _ _ �- � I � � r �, `� � - .e t. .;�. . � �S` l! ^// �, Y ., ��b ,� � F �r � � , 33 � J �� s No. . F$1 0.0. 00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pprication for )0igpo!6a[ �&pgtem Construction Verna Application for a Permit to Construct( ) Repair ) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. 4 2 8—1 9 4 6 Sue Kingman Assessor'sMap/parrcellZ 11 21 /1 8 e 29 South. St., Osterville Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No.3 6 4—0 8 9 4 Wm E Robinson Sr Septic Eco—Tech PO Box 1089 Centerville 43 Triangle Cir, Sandwich Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder (10) Other Type of Building f No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) We will install a new Title 5 septic system to plans of Eco-Tech, ETE-2294. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisio s.o e o the Environmental Code and no-to place the system in operation until a Certificate of Compliance has been issue \ fIealth. Si a Date Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. Date Issued aN tC/ Feel (1 Y w ()(�1(1 t G" THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: - Yes PUBLIC HEALTH,DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 1 Application for Mi5pont *pftern Congtruction Permit Application for a Permit to Construct( ) Repair(X) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. 4 2$-1 9 4 6 20 MP 12 1On1Z Cir,/18©s_a �11e Sue Kingman Assessor'sap/ " 29 South. St, Osterville Installer's Name,Address,and Tel.No. 7 7 5-8 7 7 6 Designer's Name,Address and Tel.No.3 6 4-0 8 9 4 Wm E Robinson Sr Septic Eco-Tech PO Box 1089 Centerville 43 Triangle Cir, Sandwich Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder (10) Other Type of Building No.of Persons Showers( ) 'Cafeteria( ) k. Other Fixtures ; Design Flow(min.required) gpd Design flow provided, gpd ~ ` Plan Date Number of sheets Revision Date Title e Size of Septic Tank Type of S.A.S. Description of Soil 1 i Nature of Repairs or Alterations(Answer when applicable) We will install a new Title 5 septic system to plans of Eco- ec , ETE-2294. Date last inspected: Agreement: ` The undersigned agrees to ensure the construction d jiginteriance of the afore described on-site sewage disposal system in accordance with the provisio s-ef-Ti e o the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issue"By h ' f-Flealth. .�. sign J �' /� _ Date Application Approved by / u o A Date Application Disapproved by: �- - Date for the following reasons , J r Permit No. / Date Issued —————= THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Kingman < em (Certificate of Compliance 0-� .3 s THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (X ) Upgraded ( ) Abandoned( )by Wm E Robinson Sr Septic Service at 20 Moniz Circle, Osterville hpbeenc nstruc� accordance [(// � _ with the provisions of Title 5 the for Disposal System Construction Permit No., dated Installer 76Designer ( G' ., -AiA/ XJ#bedrooms Approved design flow ,r gpd The issuance of this permit shall not b on true as a guarantee that the system wi11- cti d si ned. Date rp Inspector ------- - =---------------------------------� -- ---- No. 900 Fee1 Mon iz THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS 1=V9po!9a1 on5truction Permit Permission is hereby granted to Construct 11 Repair (X ) Upgrade"( ) Abandon ( ) System located at 20 Moniz• Cirel`e, Osterville 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: ��Cons` ction must be completed within three years of the date of this pet.�1 Date Approved by i a / t � V , iHe Town of Barnstable oF rqy, :. o Regulatory Services Thomas F". Gciler, Director • BARNSTABLE. y MASS. g t639• Public health llivision �0 Arf01Ap�A Thomas A-IcKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer- & Designer Certification Form Date: �y'Z 0 Sewage Permit#'&_>Db Assessor's MapUlarcel 21 /1 8 Designer: Eco—Tech Installer:Wm E Robinson Sr Septic Address: 43 Triangle Circle Address: PO Box 1 089 Sandwich Centerville - On Wm E Robinson Sr Septtivgs issued a permit to install a ) (date) (installer) septic system at 20 Mon.iz Cir, based on a design drawn by --J 4 _-(address)?- Eco—Tech dated 05-25-06 (designer) I certify that the septic system referenced above was installed substantially according, to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. i I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the' SAS or any vertical relocation of any component of the septic system) but in accordance with State Local Regulations. flan revision or certife as-built by designer 4: A OF sq DAVID D. (Instal er's Signature) COUGHANOWR N No. 1093 STS SgNlTAR1P� (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO 13:UR-NSTABLE PUBLIC HEALTH DIVISION- CERTIFIC-ITE 01: CO�IPLIANiCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM :1iti1) AS-BUILT CARD :\RE RECEIVED BY THE BzUUNSTABLE PUBLIC HEALTH DIVISION. Til NK YOU. Q: Heatt;i:SepticiDesigner Certification Four=-26 {)S.doc Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM, 4 f� �- I, 'h y i o D . COVG HW p„ F�hereby certify that the engineered plan signed by'me dated W 2,9, Z004 concerning the property located at 2C> VAOVIZ CIWGL ... �11 meets all of the following criteria: • Two soil evaluations excavated for detailed examination(no hand augering) and two percolation tests shall be conducted. • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will-be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W. Elevation 17 .0 + adjustment for high G.W. '57 _ 0 DIFFERENCE BETWEEN A and B D SIGNED : �• DATE: May 215, 206 NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. gASeptic\percexcmp.doc TOWN OF BARNSTABLE LOCA_I'ION C SEW��j s�- qua VILLY.GE o f ASSJS VS MAP LOT INSTALLER'S NAME&PHONE NO. M Q r A(2c:S,P SEPTIC TANK CAPACITY 6-D 5% t LEACHING FACILITY: (type) t-�`C P�-•Csize) d?� 1 r�� NO.OF BEDROOMS BUILDER OR OWNER A-� aWAs-\ ./ �a e PERMITDATE: ! —f/qff COMPLIANCE DATE: 7 -- I,Sf d R Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 9� ,re .� ro. i a Sno No. OI FeeVes THE COMMONWEALTH OF MASSACHUSETTS Entered in computer PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for �Digogaf *pgtem Congtructton permit Application for a Permit to Construct( )Repair( )Upgrade(Abandon( ) ;� omplete System ❑Individual Components Location Address or Lot No. C90 V110Pt-GCT Owner's Name,Address and Tel.No. Assessor's Map/Parcel D Q D Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 4-C* SIG Type of Building: Dwelling No.of Bedrooms _ Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow lz.�w gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. t Description of Soil t(Y•�-� SSA�J Nature of Repairs or Alterations(Answer when applicable) Cr-q%A( i SW Yl 1 01,— S�Ia^I C- v 1. u ts� r�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 a Envir mental Code and not place the system in operation until a Certifi- cate of Compliance has been' ued by this Boaz ealth. Signed 00 Date Application Approved by Date Application Disapproved for de fol owin reasons Permit No. Date Issued /No. [OO� 1 Feed THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 01pprication for Mtgogal 6petem Conotruction Permit Application for a Permit to Construct( )Repair( )Upgrade(1.Abandon( ) ;?!�Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel J q i —01 Q Q J )1 sv e Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building 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 6 Cm N-- Type of S.A.S. W t C I r �Description,of Soil • Nature of Repairs or Alterations(Answer when applicable) �� �-`� 1 s�� \(1►" S E'( Y C- ` X cNi4e fIr2uu _ 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 6 5.ef, Envir nmental Code and not place the system in operation until a Certifi- cate of Compliance has been' ued by this Boar ealth. n a Signed I Date Application Approved by Date l6-7e Application Disapproved for K followin reasons ' Permit No. ` Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (fertificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( I� Abandoned( )by i7-C_ r S -- "\ at a2.n �M 0 AJ 1 Z_ C t r c._K;, c [)ST-e e,A has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 9T -601 dated Installer Designer The issuance of this ermit sharp. not construed as a guarantee that the system will function. as designed. Date U � Inspector —— /_ r =,— Fee THE COMMONWEALTH OF MASSACHUSETTS y PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS lwioogar *pgtem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade`f )Abandon( ) System located at VV\O A"r-7_ 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 "�g Approved by < i 10/9197 i. NOTICE: This Form Is To Be Used For the Repair Of Failed - l Septic Systems Only: CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) f ' lu r 1 hereby certify that the application for disposal works - construction permit signed by me dated concerning the property located at ( meets all of the �. . fo wing criteria: 5r � , ,, i • . There are no wetlands located within I do.feet of the proposed leaching facility There are no private wells within 150 feet of the proposed septic system There is no increase•in flow and/or change in use proposed I` There are no variances requested or needed. ' =! 1'f the proposed leaching.facility will be located within 250 feet of any wetlands,the bottom of the a proposed leaching facility will bDJ be located less than fourteen(14) feet above the maximum adjusted a' T : groundwater table elevation. .R Please complete the foh'owingt " w A)Top of Ground Elevation(according to the Engineering Division G.I.S.map) ._ a ` B)Observed Groundwater Table Elevation(according to Health Division well map)( Fa • SIGNED DATE: i ; h !- LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 'IAttach a sketch plan of the proposed System.Also if the licensed installer posesses a certified plot plan, this plan should he submitted). "' a q:hiiilh folder.deft µ M�nA .74<..e+:f I Fc5j a � i TOWN OF BARNSTABLE SEWAGE # N1 �- VIILAGE C' �� ASSESSOR'S MAP & LOT !2j _ a 9' INSTALLER'S NAME&PHONE NO. M i Q r:A(24e-SP P1� ( SEPTIC TANK CAPACITY 1\J 1 S LEACHING FACILITY: (type) size) 4 x d n Z� NO.OF BEDROOMS 3 BUILDER OR OWNER PERMTTDATE: f� —& H COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 7 1 Q-e i o � ,o a j PLAN REFERENCE CONTOURS ® FALMOUTH.r?t7AD 3 w ,C. PLAN BOOK 184 PAGE 127 EXISTING - - - - - - - 5t7 o 0 LOCUS b-ry o b: ASSESSOR'S MAP: 121 FINAL 5m �' 0m� LOT: 18 lu 3 u n 2 w a (nn m �� > oo>_ N BENCH MARK m o0 m cn cn m w m TOP OF CONC BOUND z o z ELEVATION = 59.45 o d w BARNSTABLE GIS DATUM N �" cr (c__ 0 cn Tw OSTERVILLE MA °z3 rLOCUS MAP �z❑ o z ::::;;;.;. e cn o z 58 24 f t x 12.5 Ft x 2 Ft 00 ;_; ., e �mD 56 NOT TO SCALE 54 LEACHING GALLERY zw cr) ':''?`s?; �r'� Owl �� _ 52 51 51 C) :'ri V <N C3 �� 52 24-P 54 NOTES _ 56 N �J Lu~ W I TP-I m _ �f�00p f£ SYSTEM HAS BEEN DESIGNED ON THE BARNSTABLE W W I /II i n� � BOARD OF HEALTH FINDING OF MARCH 22. 2006 THAT W 0_um U _j > 4 56 / �-� TP-2 ��� NO MORE THAN THREE BEDROOMS ARE AUTHORIZED I- w I LEGEND l / ` zao vEly 30 P AT THIS PROPERTY. IT SHALL BE THE RESPONSIBILITY ' < J CD Lq / 1 PIPE LOT 9 OF THE PRESENT AND FUTURE OWNERS. NOT THE x IL❑ I -0 1 RESPONSIBILITY OF THE DESIGN ENGINEER OR THE to LtJ Z EXISTING I AREA = 21390 sF +- �lljn mF U W 1500 GALLON 56 o / _I-56 INSTALLER. TO ENSURE COMPLIANCE WITH THE THREE SEPTIC TANK l �° 1 BEDROOM LIMITATION. lz "ExW zLLJ D-BOX 0 :,: I LL ,,', TEST PIT m / l�l3 w} i;;:;:i::c:. EXISTING LAUNDRY PIT O N l (oUJ I 1 , x O �w X Tc�6 ' kWeTJ ZJ O 1` UTILITY POLEW�� LI /o � C NG 24 P / CONVERSION �? �m o-0 TREE l SL,9e DISTANCES W< < m m l Z FND_ni CHART EL // INCHES TO Z /L.L wo ❑ -NUMBERS.LETTER O DIAMETER ES TPE _ Jreget_ I I DECIMAL FEET TO LEACHING GALLERY ci 0-z O-OAK M-MAPLE P-PINE ' (� I l I In ft ALL DISTANT AND DECIMAL FEET Z S 1 I / NOT 1 FEE D INCHES j U0 .;u CZZL / W / r J 00 C ZpJ (D Cl)07 I ��\ZQ -/ 3 I I 'k 2 �� 1 45.0 4�1 156.6 I W ~' 3 .25 2 33.4 58.9 77.1 W `�� l~ 3 21.3 52.9 72.s4 .33 5 .41 2 6 .50a 1 3 -� ao m �� m 1 7 .58 + z m \� W l 8 .67 A e r, N m �Z , I / 9 75 C _ I (o X wArE� m 10 .83 v w GATE ?e 0 ' 11 .92 W ' /e /_� 1 12 1.0 z � / EDGE�A_ 11 5�T4 w w Z LL z J < ` \ n; z SEWAGE DISPOSAL SYSTEM PLAN 0 3 <m `+—'� E -TO SERVE EXISTING DWELLING � cn � W� JI, ' SUSAN L. KINGMANm ED Wn J m W FLAN ❑ �� 2B MO N IZ CIRCLE OSTERVILLE. MA LS NOFMCn + U) -T, cj� � ECOTECH ENUIRONMENTAL DAVIDm SCALE 1 30 ft � D. 43 TRIANGLE 0 < ? z 30 0 30 60 ; COUG ANOWR N EST. SANDWICH MA 82563E X ; No. 1093 �� 1995 < 508 364-8894 o W w w w e 10 20 30 1 /sTe� ` ONNA� ETE-2294 IMAY 25. 2t/J!/76 1A 1/2 tL IT PN t THIS PLAN IS BASED ON AN INSTRUMENT SURVEY AND IS INTENDED SOLELY FOR INSTALLATION OF THE PROPOSED SEPTIC SYSTEM p DEPICTED HEREON. FOR ANY OTHER CHANGES TO PROPERTY INCLUDING �� OV ct y/ 2-5, 2-00Ci PLACEMENT OF ADDITIONS. SHEDS. FENCES OR SWIMMING POOLS. OWNER SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR. SOIL TEST LOG DESIGN CALCULATIONS DESIGN FLOW: 3 BEDROOMS X 110 GPD = 330 GPD DATE OF TEST: APRIL 21. 2006 SEPTIC TANK: 330 GPD X 2 DAYS = 660 GALLONS SOIL EVALUATOR: DAVID D. COUGHANOWR. R.S. USE EXISTING 1500 GALLON SEPTIC TANK IF IN SOUND STRUCTURAL WITNESS REQUIREMENT WAIVED - NO VARIANCES SOUGHT CONDITION. IF NOT. INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) NO GROUNDWATER ENCOUNTERED DISTRIBUTION BOX: USE 3 OUTLET D-BOX. TEST PIT 1 PARENT MATERIAL: PROGLACIAL OUTWASH SOIL ABSORBTION SYSTEM: A 24 Ft- x 12.5 Ft x 2 Ft LEACHING GALLERY CAN LEACH ELEVATION = 51.60 _ PERC AT 60 in : 2 MIN/INCH IN C SOILS Abot = ( 24 x 12.5 1 = 300 sF + Asdw = ( 24 + 24 + 12.5 + 12.5 ) x 2 = 146 sF Atot = 446 sF DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER Vt 0.74 x 446 = 330.04 GPD (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING USE A 24 Ft x 12.5 Ft x 2 Ft. GALLERY. Vt = 330.04 GPD > 330 GPD REQUIRED 51.60 0-4 O LOAMY SAND 10 YR 3/2 NONE FRIABLENO T TO I Q 4-8 A LOAMY SAND 10 YR 4/4 NONE FRIABLE LEA CHI N G G A LI� L� E 1 \ Y SCALE 48.93 8-32 B LOAMY SAND 10 YR 5/6 NONE FRIABLE USE SHOREY PRECAST 500 GALLON LEACHING DRYWELL (H-10 LOADING) 32-140 C MEDIUM SAND 10 YR 6/4 NONE LOOSE CONSTRUCTION DETAIL 500 GALLON DRYWELL 39.93 DIMENSIONS AND DETAIL NO GROUNDWATER ENCOUNTERED YWELL UNIT TEST PIT 2 PARENT MATERIAL: PROGLACIAL OUTWASH -s-x 4.-10-x 2'-9- STON USE H-10 UNIT 2 MIN/INCH IN C SOILS INSTALL ONE INSPECTION ELEVATION = 52.25 +- z Ft EFF. DEPTH RISER TO WITHIN SIX DR 2 4.0 f t INCHES OF FINAL GRADE cn AND INDICATE LOCATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER ON AS-BUILT PLAN (INCHES) HORIZON TEXTURE (MUNSELLI MOTTLING (.,_ 52.25 � m , Lq 0-4 O LOAMY SAND 10 YR 2/2 NONE FRIABLE N v`` (v Q 33 QO 4-10 A LOAMY SAND 10 YR 4/4 NONE FRIABLE m o00000 0o Q0��) 1ri m oIZIc 0 0000 0000 49.58 10-32 B LOAMY SAND 10 YR 5/6 NONE FRIABLE s.s f't 8.5 Ft L6.5 Ft 5 FE 000000�oOO OQQ �� 32-120 C MEDIUM SAND 10 YR 6/3 NONE LOOSE 24.0 Ft G�8 40.25 102 irk NOTES CROSS SECTION VIEW 1) GARBAGE GRINDER NOT ALLOWED WITH THIS DESIGN 2 in PEASTONE 2 in PEASTONE 2) ALL LINES TO BE 4 in DIAMETER SCH 40 PVC AND PITCH AT 1/8 INCH PER FOOT MINIMUM. 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS o 0 OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15) 28 241n 3/4 in TO EFFECTIVE Min26 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES In 1-1/2 GRAVEL DEPTH 1-11n BEFORE EXCAVATING FOR SYSTEM. 5) EXISTING LEACHING GALLERY TO BE ABANDONED IN PLACE. 6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE 46 1, 58 1n. 46 in 7) LINES EXITING D-BOX TO RUN LEVEL FOR 2'-0- BEFORE PITCHING DOWN 150 1n 8) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTIC TANK 9) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. D_Q, NOT GROUNDWATER ADJUSTMENT SEWAGE DISPOSAL SYSTEM PLAN PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. 101 INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING`'lWORK. EXISTING GROUNDWATER LEVEL -TO SERVE EXISTING DWELLING BASED ON TOWN OF BARNSTABLE 11) SEPTIC S TABLETANKS BASE THATL BE HAAS BEEN MECD LEVEL AND TRUE, TO GR�,DE HANICALLY COMPACTED AND ON TO WHICH GIS DEPARTMENT RECORDS. SUSAN L. KINGMAN SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING INDICATED GW 25.00 20 MONIZ CIRCLE OSTERVILLE. MA ti INDEX WELL SDW-253 12) SEPTIC TANK TO BE PUMPED DRY AT TIME OF SYSTEM .REPAIR AND' CHECKED ZONE c FOR STRUCTURAL INTEGRITY. INSTALL PVC OUTLET TEE, FITTED WITH GAS BAFFLE. REEADING DATE MARCH. 2006 ECO-TECH ENVIRONMENTAL READING 48.4 ADJUSTMENT 3.5 43 TRIANGLE CIRCLE SANDWICH MA 02563 ADJUSTED GW 28.5 ETE-2394 MAY 25, 20061 1212