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Home My WebLink About0170 SEABROOK ROAD - Health NEW 170 SEABROOK ROAD, HYANNIS A 307 027 `S V Town of Barnstable Inspectional Services Department - • MASS Public Health Division.. 1639. 200.Main Street, Hyannis MA 02601 Office: 508-8Q-4644 FAX: 508-790-6304 Thomas.A.McKean,CHO March 2021 Michael Tanghe 170 Seabrook Road Hyannis, MA 02601 RE: SEWER CONNECTION DEADLINE EXPIRED 170 Seabrook Road-,;Hyannis A=307 027 Dear Property Owner, Your sewer connection deadline has passed. Please contact the Public Health Division Office to provide an update relative to the status of property's connection to public sewer (i.e. contractor name, DPW sewer connection permit number, anticipated connection.date.) If you would like to request an extension, such request must be in writing addressed to the Board of Health (200 Main,Street Hyannis, Massachusetts) or e-mail Sharon Crocker at: sharon.crocker@town.Barnstable.ma.us within fourteen(14) days. Sincerely yours, Karen Malkus-Benjamin Town of Barnstable Health Division Coastal Health Resource Coordinator karen.malkus(a-)town.barnstable.ma.us - Town of Barnstable Inspectional Services �'" MMASSS. Public Health Division fp3.(A Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 October 11, 2019 Michael Tanghe 170 Seabrook Road. Hyannis, MA 02601 IMPORTANT NOTICE Map & Parcel 307-027 RE:- SEWER CONNECTION DEADLINE,EXPIRED 170 Seabrook Road, Hyannis' raw Dear Mr. Tanghe, Your December 30, 2018 sewer connection deadline has passed. Please contact the Public Health Division Office to provide an update relative to the status of property's connection to public sewer (i.e. contractor name, DPW sewer connection—permit number, anticipated connection date). If you would like to request an extension, such request must be in writing addressed to the Board of Health (200 Main Street Hyannis Massachusetts)within fourteen (14) days. Sincerely yours, -- LP Thomas A. McKean, R.S., C.H.O. Director of Public Health ' Town of Barnstable Q:\WP\SewerConnectionDeadlineEXPIRED 170Seabrook 2019.docx U.S.POSTAGE>>PITNEY BOWES Town of Barnstable ` Public Health Division '200 Main Street r'• ZIP 02601 6� 0 MASS. "IFONw+ Hyannis,MA 02601 �ti 02 10 0001383424JAN. 13, 2014. 7012 1010 0000-`2651 1715 O 9J qF� O MOVEO J .A p O FO CE 91Rp rp ATrEMgRP/G��AppRE - -� SFN —'1pTF RDFR EXPS O .tiO y ONO SUCH S� ,,O REF gWIV/RFO OINSU FC T JS6 RESS } t1 1! flit j 1 3yt (i t(( li6t s` { i f NOW j I o Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. ❑Agent i i I I n Print your name and address on the reverse X ❑Addressee ! i so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery i a Attach this card to the back of the mailpiece, or on the front if space permits. I D. Is delivery address different from item 19 ❑Yes I 11. Article Addressed to: If YES,enter delivery address below: ❑No , I ! Michael A Tanghe l i 170 Seabrook Road Hyannis, MA 02601 1 3. Service Type ❑Certified Mail ❑Express Mail ❑Registered ❑ Return Receipt for Merchandise i ❑ Insured Mail ❑C.O.D. ` 4. Restricted Delivery?(Extra Fee) ❑Yes f , 2. Article Number 7 012 1010 0000 2851 1715 (Transfer from service labeq I PS Form 3811. Februarv-2004 Domestic Return Receipt. 102595-02-.an-1540 rl rlOF m E Postage $ Q,'\ ru Certified Fee � dt (} q Postmark Return Receipt Fee CM (Endorsement Required) Here' Restricted Delivery Fee (Endorsement Required) �/�,✓ 0o blH t3 Total Postage&Fees s / ra ru o Michael A Tanghe - 9wT . 170 Seabrook Road Hyannis, MA 02601 Certified Mail Provides: 4 o A mailing receipt o A unique identifier for your mailpiece n A record of delivery kept by the Postal Service for two years Important Reminders: a 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. e 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. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 tK�E ram, Town of Barnstable Barnstable AMWW Regulatory Services Department P + RARNSTAULL D 9 MASS. ,� Public Health Division f0N10'�p 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard Scali,Interim Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7012 1010 0000 2851 1715 January13, 2014 Michael A Tanghe 170 Seabrook Road Hyannis, MA 02601 IMPORTANT NOTIC Map & Parcel 307-027 The Department of Public Works informed us that public sewer lines are now available in your neighborhood. According to our records, your property has a septic system. This letter directs you to connect your dwelling, at f170.Seabr000k-Road;"Hyaltnis,MA -� to public sewer on or before 12/30/2018. The old septic system must be either removed or filled in due to future safety concerns. This may be done by the same contractor who connects you to the sewer. Septic Abandonment Permits ($ 25) are issued at the Public Health Division, 200 Main Street, Hyannis. Failure to comply with this Board of Health Order may result in a complaint against you,, in a court of law. For additional information pertaining to the sewer connection, please see enclosure.`- eiz. McKean, R.S., CT.H.0. HEALTH Agent of the Board of Health Enc Q:\SEWER connect\Sample order letters for sewer connection\170 Seabrook Rd Hy Jan 2014.doc Public Health Division March 28, 2013 ADDITIONAL INFORMATION AND REMINDERS FROM OTHER DIVISIONS: SAVINGS AVAILABLE/GRINDER PUMP: A reminder to those of you who need a grinder pump for your connection: Department of Public Works (DPW) sent you a letter in December 2012 stating the town, for a limited time of two years, only from the receipt of the DPW letter, would provide you with the pump at no charge. (This can save you thousands of dollars.) Please note: You must pay the installation cost through your own contractor. Please make your contractor aware of this, if interested. Also be aware: this is a shorter deadline than the Public Health Division's deadline on the reverse side of this page. SAVINGS AVAILABLE/PERMIT FEE: The Town offers a waiver of the residential sewer connection fee of $420.00 for those properties that connect within two years of the receipt of the DPW December 2012 letter. LOANS: For loan(s) available, please see the enclosed brochure, or see the town website: http://www.town.bamstable.ma.us/cdb (under the "CDBG Programs", see "Sewer Connection Loan Program). For loan specific questions, you may contact Kathleen Girouard, Growth Management, at 508-862-4702. CnNTD "CTOD c ' vV1Y i1�11 liU'.` Information on Licensed Sewer Installers is available on our web site at wNvw.town.bamstable.ma.us/PublicWorksTech/sewerinstallers. Contractors, approved to perform sewer connection work in the Town of Barnstable must obtain and file a Sewer Connection Permit with DPW-Water Pollution Control Division, 617 Bearse's Way, Hyannis—contractors, please call Dave Anderson at (508) 790-6244. FOR ANY QUESTIONS /ASSISTANCE: Len Gobeil at the Town Manager's Office is available to provide you with direction you may need in reference to the Stewart Creek Sewer Connections. You may contact him at 508-862-4701. QASEWER connect\Sample order letters for sewer connection\170 Seabrook Rd Hy Jan 2014.doc �2W • i r https://tools.usps.com/go/TrackConfirtnAction.action?tRef=fullpage&tLc=i&text28777=&tLabels-701210100000285117151 English Customer USPS Mobile Register/Sign In Service taus/s-co Search USPS.com or Track Packac Quick Tools - Track Ship a Package Send Mail Manage Your Mail Shop Business Solutions Enter up to 10 Tracking A Find Find USPS Locations Buy Stamps Sc d I �^ TM Customer Service) Loo ul po3� T 1 a C k I n g + Have questions?We're here to help. Ca Hold Mail ...... _... Change of Address Tracking Number:70121010000028511716 Requested label is archived. Restore Archived Details > Product & Tracking Information Available Actions Postal Product: Features: Certified Mail i x#s 4 )February 18,2014', 10:54 am Delivered HYANNIS,MA 02601 L---'---- _. _.....---------...... __.._......... ................ - _ Track Another Package What's your tracking(or receipt)number? Track It - _ . LEGAL ON USPS.COM ON ABOUT.USPS.COM OTHER USPS SITES Privacy Policy> Government Services, About USPS Home) Business Customer Gateway) Teens of Use) Buy Stamps&Shop) Newsroom) Postal Inspectors> FOIA> Print a Label with Postage> USPS Service Alerts> Inspector General> No FEAR Act EEO Data> Customer Service, Forms&Publications> Postal Explorer> Delivering Solutions to the Last Mile> Careers> Site Index> JUtUSPS:Coff 1 Copyright*2014 USPS.All Rights Reserved. https:Htools.usps.com/go/TrackConfirmAction.action?tRef=fullpage&tLc=1&text28777=&tLabels=701210100... 3/12/2014 • i Town ®f Barnstable Barnstable Re9ulat®ry Services Department MAmMIanRY j anxnrseABM t 7 MASS. Public Health Division m 1639• 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard Scali,Interim Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7012 1010 0000 2851 1715 January13, 2014 " Michael A Tanghe 170 Seabrook Road Hyannis, MA 02601 IMPORTANT NOTIC Map & Parcel 307-027 The Department of Public Works informed us that public sewer lines are now available in your neighborhood. According to our records, your property has a septic system. This letter directs you to connect your dwelling, at 170 Seabrook Road, Hyannis,MA, to public sewer on or before 12/30/2018. The old septic system must be either removed or filled in due to future safety concerns. This may be done by the same contractor who connects you to the sewer. Septic Abandonment Permits ($ 25) are issued at the Public Health Division, 200 Main Street, Hyannis. Failure to comply with this Board of Health Order may result in a complaint against you, in a court of law. For additional information pertaining to the sewer connection, please see enclosure. PER ORDzMcKean, BOARD OF HEALTH A. ., C.H.O. Agent of the Board of Health Eric Q:\SEWER connect\Sample order letters for sewer.connection\170 Seabrook Rd Hy Jan 2014.doc Parcel Detail http://issgl2/intranet/propdata/ParceiDetail.aspx?ID=24573 t , Logged In As: Parcel Detail Monday, January 13 2014 Parcel Lookup Parcel Info Parcel��027 ( Developer;LOT B&C&E-1..___.._. ID Lot Pri Location!170 SEABROOK ROAD Frontage I113 Sec __.�_ _ __ ___ ____ _._.... w. ______ Sec Road Frontage' Fire Village IHYANNIS-__ - .e._ District JHYANNIS Town sewer exists at this _ Road addresslNo Index 1453 Asbuilt Septic Scan: Interactive 07027 1 Map Owner Info co- Owner • GHE, MICHAEL A Owner St eetl ,70 SEABROOK ROAD Street2 City,HYANNIs ! State MA Zip;02601 Country Land Info Acres[0 36 j Use jSingle Fa m MDL-01 Zoning Irk Nghbd!0105 Topography Level Road Paved Utilities 1public Water,Gas,Septic Location Construction Info Building 1 of 1 Year � � Roof Ext i1920 ( WWood Shingle Built' Struct jGable/Hip Wall Living r _..____._w_.._ Roof _ __� _.. AC i1006 jAsph/F GIs/Cmp Area Cover Type' q ; ' _� Int. ___. Bed r Style jCape Co Wal Rooms d• 1Drywall 12 Bedrooms l _•�'" '� �� j# Int :_-_..____ _ Bath '. o Model Residential ( FloorPine/Soft Wood Rooms 11 Full r , 77, Heat y Total Grade IAverage ( Type Hot Water 1 Rooms;5 Heat Found- • Stories F.2 Fuel Oil atio-(Conc. Block Gross http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=24573 1/13/2014 COMMONWEALTH OF MASSACHUSETTS 8 3 � EXECUTIVE OFFICE OF ENVIRONMENTAL AFF B DEPARTMENT OF ENVIRONMENTAL PRO ION /! ONE WINTER STREET, BOSTON, MA 02108 617-292-550 �� 2 IPA WILLIAM F.WELD U t+-? TRU} OXE Governor '{ . cretan ARGEO PAUL CELLUCCI l .STRUHS Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - — ' Commissioner PART A CERTIFICATION Property Address: 170 Seabrook Rd., Hyannis Address of Owner: John Diamond Date of Inspection: /019/98 (If different) 174 Bay State Rd Name of Inspector: Wm E Robinson Sr Boston MA I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: Wm E Robinson Septic Service Mailing Address: PO Box 1 089, C -n Pr y; 1 1 e, MA 02632 Telephone Number, 508` 7 7 9—A 7 7 A CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sew ge disposal systems. The system: Passes _.-Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date: ', The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A) SY TEM PASSES: have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below." COMMENTS: B) SY TEM 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. Indic a yes, no: or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not. _ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04/25/97) Page 1 of 10 _ s DEP on the World Wide Web: http:Uwww.magnet.state.ma.us/dep e'j Printed on Recycled Paper • h SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A w .. t.` CERTIFICATION (continued) ��perty Address: �ya 170 Seabrook Rd., Hyannis � Pro . tom' " ner: Diamond. Ow Date of Inspection: ///1 9/98 B] SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed or due to a broken settled or uneven distribution box. The system will ass inspection if(with approval of the pipe(s) Y p Pe PP Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are -eplaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Co itions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the pu lic health, safety and the environment. 1) STEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER HICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYS M WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE YSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVI ONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OT ER (revised 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A -CERTIFICATION (continued) Property Address: 17 Q _9 e abr o oX Rd, Hyanlh i s Owner: Diamond. t Date of Inspection: 1%/Z 9/98 D] SYSTEM FAILS: You m t indicate eir er "Yes" or "No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis or this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct he failure. Yes o Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: he following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes o the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area- IWPA) or a mapped Zone II of a public water supply well) The owne or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirem is of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 170 Seabrook Rd, Hyannis Owner: Diamond Date of Inspection: ,//19/98 Check if the following have been done: You must indicate either "Yes" or"No" as to each of the following: Yes / No Pumping information was provided by the owner, occupant, or Board of Health. _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _ As built plans have been obtained and examined. Note if they are not available with N/A. t/ _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. All,system components, excluding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of constructior, dimensions, depth of liquid, depth of sludge, depth of scum. —The size and location of the Soil Absorption, System on the site has been determined based on: The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. Existing information. Ex. Plan at B.O.H. Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)) (revised 04/25/97) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION r Property Address: 170 Seabrook Rd, Hyann1s' ''i' Owner: Diamond Date of Inspection: •/, '/19/98 4t t FLOW CONDITIONS RESIDENTIAL: Design flow:. ./bedroom for S.A.S. Number of bedrooms: Number of current residents: Garbage grinder (yes or no):_,!�:p Laundry connected to system (yes or no):t,z-S Seasonal use (yes or no):�e) Water meter readings, if available (last two (2) year usage (gptk 10/98 - T 0/07 21 Cljln 'Sump Pump (yes or no):-X, d 10/96 - 10/97 74, 2509 Last date of occupancy: COM ERCIAUINDUST IAL: Type o establishment: Design'low: gallons/day Grease rap present: (yes or no)— Ind u"ri I Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water I eter readings, if available. Last da e of occupancy: OT : (Describe) Last e of occupancy: " GENERAL INFORMATION PUMPING RECORD and source of information: v Syste umped as pan of inspection: (yes or no)1$e6 If yes, volume pumped: .7-go--A-) gallons Reas6n for pumping: TYPE OF YSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Other v APPROXIMATE AGE of all components, date installed (if known) and source of information: Itl rid, . /0 �ZZ7 Sewage odors detected when arriving at the site: (yes.-or no) O (revised 04/25/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 1 PART C SYSTEM INFORMATION (continued) Property Address: 170 Seabrook Rd., Hyannis Owner: D iamond Date of Inspection: /1/19/98 BUI ING SEWER: (Local on site plan) Depth low grade: Materi I of construction: _cast iron _40 PVC _other (explain) Dista ce from private water supply well or suction line Dia ter Co ments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: (locate on Site plan) Depth below grade:, Material of construction: Lfoncrete _metal _Fiberglass _Polyethylene —other(explain) If tank is metal, list age _ Is age confirmed by Certif cate of Compliance _(Yes/No) Dimensions C-i Sludge depth:_ t ' Distance from top of sludge to bottom of outlet tee or baffle: 9 Scum thickness: 8 L Distance from top of scum to top of outlet tee or baffle: 0 1 Distance from bottom of scum to bottom of outlet tee or baffle: How dimensions were determined: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) AL I.;G^,-' �-' 'a "s GREASE TRAP: (locate o site plan) Depth be ow grade: Material f construction: _concrete _metal Fiberglass _Polyethylene —other(explain) Dimensi ns: Scum th ckness: Distanc from top of scum to top of outlet tee or baffle: Distanc from bottom of scum to bottom of outlet tee or baffle: Date of ast pumping: Commen s: (recomm ndation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 04/25/97) Page 6 of 10 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 170 Seabrook Rd., Hyannis Owner: Diamond. Date of Inspection: ///29/98 TIGI TOR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth low grade: Material f construction: _concrete _metal _Fiberglass _Polyethylene —other(explain) Di iensi 5: Capacity gallons Design ow: gallons/day Alarm vel: Alarm in working order_Yes; _ No Date f previous pumping: Co ents: (condit n of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_✓ (locate on site plan) Depth of liquid level above outlet invert: V Comments: (note if level and distribution is al, evidence o solids carryover, evidence of leakage into or out of box, etc.) 6 6 &. PUM CHAMBER:_ (locate on site plan) Pump in working order: (Yes or No) Alarm in working order'(Yes or No) Com ents (not condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 170 Seabrook Rd, Hyannis Owner: Diamond Date of Inspection: ///19/98 SOIL ABSORPTION SYSTEM (SAS):L/ (locate on site plan, if possible,- excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type. leaching pits, number:�-- leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: / (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) CESSPOOLS: _ (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: 14 Depth of solids layer: / ) , Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Comm r (note c ndition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: (locate n site plan) Mat als of construction: Dimensions: Depth f solids- Comme ts: (note c dition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 04/25/97) Page 8 of 10 =' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 170 Seabrook Rd, Hyannis Owner: Diamond Date of Inspection: A 19/98 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within�00'I(Locate where public water supply comes into house) fAl J �v h � P (revised 04/25/97) Page 9 of 10 . w SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 170 Seabrook R d, Hyann-s Owner: D iamond. Date of Inspection: ///19/98 k Depth to Groundwater JI/ Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation. (Must be completed) (revised 04/25/97) Page 10 of 10 V/ ATLANTIC ENVIRONMENTAL P.O.BOX 2384 MASBPEE,MA 02649 RECEIVED ` J U N 1 4 1996 � Attn: Commonwealth of Massachusetts Date: 06/0 /96 rim ; Town-of Barnstable aW rCW� r Board of Healthy,. 367 Main Street �'�`' Barnstable, MA 02601 7 From : Mr Michael DeDeck o Po Box 2384 Mashpee MA 02649 Dear Board of Health Official; / 7v I certify that ave personnally inspected the sewage disposal systems at the following address : I Seabrook Rd. Hyannis, Ma. �7 C) The informations reported are true, accurate and complete as of the time of the inspection. If you have any questions regarding this inspection, please contact me at this number: (508)477-14-20. Thank you. Sincerely, X D . U ` Michael el DeD- o phone 508 477-1420 Commonwealth of Massachusetts Executive of Environmental Affairs DEFT Department of Environmental Protection SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A .1 � 0 CERTIFICATION Property Address: �Qeabrook Road. Hyannis, Ma. Address of Ocaner: Thelma Diamond (if different) 54 B rimmer S treet. B oston,M a 02108 Date of Inspection: 06/05/96 Name of Inspector: Michael D eD ecko Company Name, Address and Telephone number: Atlantic Environmental P.o B ox 2384 - M ashpee M a 02649. Tel : (508) 4771420 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection . The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. The system Passes ---- Coqditionally Passes ---- Needs further evaluation by the local Approving Authority ---- Fails Inspector ' s Signature: JW f2t Date: 06/06/96 The system Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office or the Department of Environmental Protection. The original should be sent to the system owner and copy sent to the buyer,if applicable and the approving authority. r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 107 S eabrook R d. Hyannis, M a. O wners : Thelma Diamond Date of Inspection : 06/05/96 INSPECTION SUMMARY: Check A,B,C, or D A) SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CM 15.303. Any failure criteria not evaluated are indicated below B) SYSTEM CONDITIONALLY PASSES: ---- One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair,passes inspection. I ndicate yes, no, or not determinate (Y,N, or N D). D escribe basis of determination in all instances. If "not determinated", explain why not. ---- The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration , or tank failure is imminent. The system will pass inspection if the existing g p conforming septic tank as approved b septic tank is replaced with a PP y the Board of Health. ---- Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box. The system will pass inspection if (with approval of the Board of Health). ----- broken pipe(s)are replaced ----- obstruction is removed ---- distribution box is levelled or replaced ---- The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): ---- broken pipe(s) are replaced ----- obstruction is removed SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address : 107 S eabrook R oad. Hyannis, M a. 0 wner : T helma D iamond. Date of Inspection : 06105196 C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: ---- Conditions exist which require further evaluation by the Board of Health in order to de- termine if the system is failing to protect the public health , safety and the environ- ment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: -- Cesspool or privy is within 50 feet of a surface of water ---- Cesspool or privy is within 50 feet of a bordering vegetated wetland or a small marsh. 21 SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNC- TIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT. ---- The system has aseptic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. ---- The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well ---- The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. ---- The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analy- sis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate notrogen is equal to or less than 5 ppm. D) SYSTEM FAILS: -- I have determined that the system violates one or more of the following failure criteria as defined in 310 CM 15.303. The basis for this determination is identified below. The Board of Health should be contacted to.determine what will be necessary to cor- rect the failure. --- Backup of sewage into facility or system component due to an overloaded or or clogged SAS or cesspool. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 107 Seabrook Rd. Hyannis, Ma Owner: Thelma Diamond Date of Inspection: 06/05/96 D) SYSTEM FAILS (continued) -- Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. --- Static liquid level in the distribution box above outlet invert due to an over- loaded or clogged SAS or cesspool --- Liquid depth in cesspool is less than 6" below invert or available volume is less than 1}2 day flow. --- Required pumping more than 4 times in the last year NO T due to clogged or obstructed pipe(s). number of times pumped --- Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. --- Any portion of cesspool or privy is within 100 feet of a surface water supply ortributary to a surface water supply. ---Any portion of a cesspool or privy is within a Zone I of a public well --- Any portion of a cesspool or privy is within 50 feet of a private water supply well --- Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality ana- lysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 107 Seabrook Rd. Hyannis Ma. Owner: Thelma Diamond Date of Inspection : 06/05/96 E) LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above : The design flow of system is 10,000 gpd or greater Large System and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist : --- the system is within 400 feet of a surface drinking water supply --- the system is within 200 feet of a tributary to a surface drinking water supply --- the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area - IWPA) or a mapped Zone I I of a public water supply well. The owner or operator of any such system shall bring the system and facility into full compli- ance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please, consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 107 S eabrook R d. Hyannis, M a. Owner: Thelma Diamond. Date of Inspection: 06/05/96 Check if the following have been done : -x Pumping information was requested of the owner , occupant and Board of H ealth. --x None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during the period. Large volumes of water have not been introduced into the system recently or as part of this inspection. --x As built plans have been obtained and examined. Note if they are not available with N/A. --x The facility or dwelling was inspected for signs of sewage back-up. --x The system does not receive non-sanitary or industrial waste flow. --x The site was inspected for signs of breakout. --x All system components, excluding the Soil Absorption System, have been located on the site. ---x The septic tank manholes were uncovered, opened and the interior of the sep- tic tank was inspected for conditions of baffles or tees, material of construc- tion, dimensions, depth of liquid, depth of sludge, depth of scum. ---x The size and location of the Soil Absorption System on the site has been deter- mined based on existing information or approximated by non-intrusive methods ---x The facility owners and occupants if different from owner were provided with information on the proper maintenance of Subsurface Disposal System. SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 107 S eabrook R oad. Hyannis, M a. Owner: Thelma Diamond Date of Inspection: 06/05/96 RESIDENTIAL: Design flow : 330 gallons Number of bedrooms : 6''S Number of current residents:O Garbage grinder (yes or no):00 Laundry connected to system(yes or no):L�,S Seasonal use(yes or no) : ,du Dater meter readings, if available: N Last date of occupancy: 4x.c"�, COMMERCIAL/INDUSTRIAL : Type of establishment: Design flow : gallons/day Grease trap present: (yes or no) Industrial waste holding tank present (yes or no) : Non-sanitary waste discharged to the Title 5 system (yes or no) : Water meter readings, if available : Last date of occupancy: Other: (Describe) ............................................................................................................ Last date of occupancy: GENERAL INFORMATION PU M I N G R E CO R D S and source of information .. .V... 0�.t. ...................:.............................. System pumped as part of inspection(yes or no) :....1.4.......... if yes, volume pomped : .................... gallons Reasonfor pumping :............................................................................................................ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 107 S eabrook R d. Hyannis, M a. Owner: Thelma Diamond. Date of inspection: 06105/96 TYPE OF SYSTEM --- Septic tank/distribution box/soil absorption system --- S Ingle cesspool --- Overflow cesspool --- Privy --- Shared system (yes or no) (if yes, attach previous inspection records, if any) Other (explain)...szllq C .. o }��Qa..Ca-0 APPRO CIMAEE AGE of all components, date installed (if known) and source of information t � . ....... .... 5 . ............................................................................................. ................................................................................................................................................. ................................ Sewage odors detected when arriving at the site : (}yes or no)..... ?�.. SEPTIC TANK : ..... (locate on site plan) Depth below grade: .......... Material of construction: ....... concrete ......... metal ........ FR P ........ other (explain) .......................... Dimensions: .................. Sludge depth :............... Distance from top of sludge to bottom of outlet tee or baffle:.............................. Scum thickness :..................... Distance from top of scum to top of outlet tee or baffle: ....................................... Distance from bottom of scum to bottom of outlet tee or baffle :......................... Comments : (recommendation for pumping , condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.)...................... ................................................................................................................................................ ................................................................................................................................................ SUBSURFACESEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 107 S eabrook R d. Hyannis, M a. Owner: Thelma Diamond. Date of inspection: 06/05/96 GREASE TRAP : ........ (locate on site plan) Depth below grade: ............... Material of construction: ........concrete.........metal........FR P........other(explain).... .......................................................................................................................................... Dimensions:............................... Scum thickness:........................ Distance from tap of scum to top of outlet tee or baffle:........................................ Distance from bottom scum to bottom of outlet tee or baffle:............................... Comments: (Recommendation for pumping condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.)........................ ...............................................................:................................................................................ ................................................................................................................................................ TIGHT OR HOLDING TANKS:....)Q... (locate on site plan) Depth below grade:............... Material of construction:........concrete........metal.........FR P..........other (explain).......... ................................................................................................................................................ Dimensions:............................ Capacity:....................gallons Design flow:...............gallonsiday Alarm level:............................. Comments: (condition of inlet tee, condition of alarm and float switches, etc.) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 107 S eabrook R d. Hyannis M a. Owner: Thelma Diamond Date of inspection: 06/05/96 DISTRIBUTION BOX:..O. (locate on site plan) Depth of liquid level above outlet invert:................... Comment: (note if level and distribution equal evidence of solids carryover, evidence of leakage into orout of box, etc.).................................................................................................................. ................................................................................................................................................ ................................................................................................................................................ PUMP CHAMBER:....N6..:. (locate on the site) Pumps in working order: (yes or no)............... Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.).................... SOIL ABSORPTION SYSTEM (SAS):..... 5......... (locate on site plan, if possible, excavatio not required, but may be approximated by non- intrusive methods) if not determined to be present, explain: ................................................................................................................................................ ................................................................................................................................................ Type: leaching pits, number: ..:'............... leaching chambers, number:........ leaching galleries, number:........... leaching trenches,number ; length:..................... leaching fields, number, dime lions:................... overflows cesspool, number:..! 1i) A Comments: (note ondition of soil , signs of hydraulic failure, level of ponding, condition of vegetation r�1r. 0k.,. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property address: 107 Seabrook Rd. Hyannis Ma. Owner: T helma D iamond Date of inspection: 06/05/96 CESSPOOLS:.L . �.... (locate on site pin) Number and configuration: ........ ..aAv................. Depth-top of liquid to inlet invert: .. b � .... ............ Depth of solids lager: ...bW?\.................................... Depth of scum layer: ..... .. ..................................... Dimensions of cesspool: ..�:.....X..� �a, Materials of construction: .!�I Xvd er... Indicator of ground water: ...90........... inflow (cesspool must be pumped as part of inspection) ..NQ.=.Qnt. .......................................................................... ................................................................................................. Comments: (note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, ................................................................... m PRIVY : ..... ... (locate on the site) Material of construction: ................................... Dimensions: ...................... Depth of solids: ................ Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) ................................................................................................................................................. ar" SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address : 107 S eabrook R d. Hyannis, M a. Owner: Thelma Diamond. Date of inspection: 06/05/96 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate at wells within 100' 41 AI go AZ Q,2- DEPTH TO GROUNDWATER: Depth to groundwater: A.I.5.feet Method of determination or approximative:. _ V.�, 1 h� .�..�k►.�clr!o.l�?s.!-... Nv KA(QvQ.Sr!�a�J.. .1.,. �... .... ..............Jnt ... .. ............................... ................................................................................................................................................ ill TOWN OF BARNSTABLOlu- E t� L,OCATION D J �` C9 R 6 6 SE AGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME.&PHONE NO. h SEPTIC TANK CAPACITY 1- (type)�"/��- l- (size)LEACHING FACII.TTY: .NO..OF BEDROOMS 3 BUILDER OR OWNER 12/A ,ram 13 PERMTTDATE: to-LY COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to-the Bottom o eaching Facility Feet Private Water Supply Well and Leaching Facility any wells exist on site or within 200 feet of leaching facility Feet Edge of Wetland and Leaching Facility(If wetlands exist within 300 feet of leaching facility) Feet . Furnished by 33 J ` o _ i � y TOWN-OF BARNSTABLE LOCATION '��IIts .5 4 V i rL A 6; SEWAGE IT, 2.22 VILLAGE h0 ASSESSOR'S MAP & LOT INSTALLER'S N &PHONE NO.� � / a 3 b 3� 7 S—$7 G SEPTIC TANK CAPACITY LEACHING FACILITY: `w �--"" �-O C (type) � y (size) ,/CS-I'S -NO.OF BEDROOMS BUILDER OR OWNER L✓I PERMTTDATE: ��4L—9 COMPLIANCE DATE: /j rtcl Separation Distance Between the: Maximum Adjusted Groundwater Table to e Bottom of Leaching Facility Feet Private Water Supply Well and Leachi g Facility (If any wells exist on site or within 200 feet of leac g facility) Feet Edge of Wetland and Leaching F ility(If any wetlands;exist within 300 feet of leaching acility) Feet Furnished by i r f C .. <� IL .No. % �c�l ge 0 .0 0 THE COMMONWEALTH OF MA S HUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BAR TABLES MASSACHUSETTS Application for Digpozal *pgtem Construction Permit Application for a Permit to Construct( )Repair(xx)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components , F Location Address or Lot No. Seabrook Rd Owner's Name,Address and Tel.No. 17—2 7—18 8 Hyannis MA John Diamond. 174 Bay State Rd Assessor's Map/Parcel Boston MA 02215 tall is N e.Address,and Tel.No. — Designer's Name,Address and Tel.No. Robinson Septic Service PO Box 1089 Centerville MA Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(n0) 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 Type of S.A.S. Description of Soil sand Nature of Repairs or Alterations(Answer when applicable) Title 5 Septic system consisting_ of 1-500g tank, D-Box, and two H-20 stonepacked leach chambers to accommo a e j bedrooms . Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by thi o of Health. Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued >� .a• No. FAV �+'�! �.e Fee$5 0 .0 0 THE COMMONWEALTH OF MA S CHUSETTS � Entered in computer: s PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,, MASSACHUSETTS Application for Mfgpool *pgterit Congtruction Permit , Application for a Permit to' ( )Repair l )Upgrade( )Abandon( ) El Complete System El individual Components itr9 t"} { PiC Location Address or Lot No. Iyu SeabrookOwner's Name,Address and Tel.No. 617-247-1868 Hyannis MA John Diamond. 174 Bay State Rd. Assessor's Map/Parcel 07 Boston MA 02215 In taller's N e Address,and Tel.No. Designer's Name,Address and Tel.No. V E Robninson Septic Service PO Box 1089 Centerville MA Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(n0) 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 Type-bf S.A.S. Description of Soil sand V I Nature of R pairs or Alterations(Answer when applicable)) Title 5 Septic system consisting ofv �500g tank, D-Box, and two H- 0 s onepac edeleach cham ers o accr .a ommo e bed rooms . ooms . Date last inspected: Agreement: Thejundersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by thi o of Health. Signed g Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS ' '4 Diamond. BARNSTABLE, MASSACHUSETTS - Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( x )ypgraded1( ) Abandoned( )by 170 Seabrook Rd., Hyannis , at mhaasa been constructed in accordan with the provisions of Title 5 and the for pDi5p so al S,stets onstructin Permit No. f ted � Installer W E Robinson Se�,pta.e(�S�rviee Designer The issuance of s permit shall not be construed as a guarantee that the syst m ''ll functi s desig 0 Date / Inspector • ;- ----------===-------------$-- 50-00 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Diamond PUBLIC HEALTH DIVISION - BARNSTABLE,, MASSACHUSETTS Pfpogal *pgtem Congtruction Permit Permission is hereby grant to�Ge a Drat )Repair�x)Upgrade( )Abandon( ) System located at " C1 Hyalmis i .Installer : U9 E Robinson Septic Serlmiax 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 - ..ffiA Date: Xl�Z01 Approved byi d'' °�.. r NOTICE: This Form Is To Be Used For the Repair Of wiled Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ,301 ENGINEERED PLANS) I, William E. Robinson, Sr. ,hereby certify that the application for disposal works construction permit signed,by me dated concerning the property located at 170 Seabrook Road, Hyannis, meets all of the following criteria: /There are no wetlands within 100 feet of the proposed leaching facility. )There p im g ry are no private wells within 150 feet of the proposed septic system. Jhere is no increase in flow and/or change in use proposed. _Z* There are no variances requested or needed. �If the proposed leaching facility will be located with 250 feet of any wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S. map) B)Observed Groundwater Table Evaluation(according to Health Division well map) SIGNED: g z DATE LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 20-1998 (Attach a sketch plan of the proposed system. -Also if the licensed installer posesses a certified plot plan, this plan should be submitted). O r J-T 1 d . TOWN OF BARNSTABLE = a LOCATION D Sr=% O R 6 b�� SEWAGE #=n VILLAGE !'J 1 ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. 1 7 — z r SEPTIC TANK CAPACITY LEACHING FACII.ITY: (type) (size) /h r . NO.OF BEDROOMS I Yer' T ,I Irk t. BUILDER OR OWNER !2/ A ^-1 a n-.c0 S f PERMTTDATE: j I /� 'g ? COMPLIANCE DATE: Separation Distance Between.the: t> Maximum Adjusted Groundwater Table to the Bottom o eaching Facility Feet ; Private Water Supply Welland Leaching Facility any wells exist �fr on site or within 200 feet of leaching facility Feet 4; , Edge of Wetland and Leaching Facility(If wetlands existx within 300 feet of leaching facility) Feet Furnished by to �, #y, P , _ y A/ r li J