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HomeMy WebLinkAbout0088 LAKEVIEW DRIVE - Health 88 LAKEVIEW DR. , CENTERVILLE A= 214=054 m Vil Town of Barnstable Department of Regulatory Services z Public Health Division Date �Ai679 ti+� - 200 Main Street,H nnis MA 026 rEH MAt k 4 Date Scheduled— t, Pd. Time ee t, Soil Suitability Assessment fOr S e z sa . Performed By: Witnessed By: `+ li LOCATION& GENERAL INFORMATION Location Address 8!1 .L l.P Owner's Name LrNTI!IZU/e_L Address J�'�7�6 Ov�J Assessor's Map/parcel: ` 1�-/Q5� "`�-��zz/ ��Z� Engineer's Name NEW CONSTRUCTION V REPAIR ✓ /,9))REPAIR { Telephone Ik �(l -7 S` L a Land Use Rstt1?,4i'g Slopes(96} S Surface Stones .i? Distances t from: Open Water Body ��� $- Possible Wet Area � /' �ft Drinking Water/.,Weil Draihagow-y_ 4/A frt Property Line _ 4_ ft Other-___i//� ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands?n proximity to holes) T. ag �. _ 19*1 zta/ Parent material(geologic) f9 Depth to Bedrgelt - Depth to Groundwater. Standing Water in Hole: Weeping il•otn Pit Idea Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL Method Used: D ]FIIGfft`WA,TE 'l"AeBLE --�"� rG�N� fi7lAj"� 32,4 Depth Observed standing in obs.hole: c� In. Depth to soil tnottids: Dcpth to weeping from side of obs.hole: In. Index Well# Reading Date: index Well level lit' ©rtlundwater Adf uatmont fr. Adj,factor.,,,,m,a Adj.Groundwater Laval � F Observation PERCOLATION TEST - V Hole# __ 3 Tinto at tV Depth of Pero f—2 Time at 6" Start Pro-soak Time @ Time(9"-6") End Pre-soak Rate Min./Inch Site Suitability Assessment. Sito Passed i.-. Site pnllod: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- *If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1) week prior to beginning. Q:\S EP'TICIPERCFORM.DOC DEEPOBSERVATION ROLE LOG Hole# / Depth from l Q Soil Horizon soil Texture ,Sdn Color Soll• Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,.Stoneg;Boulders. • onsistency �i't3raye0 DEEP 013SERVATION MOLE LOG Hole# Z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,% rav D 170 z.5 6 0 0 0 itk •e DEEP OBSERVATION BOLE LOG hole#. Depth from Soil Horizon Soil Texture Soil Color Soil Other •' Surface(in-) (USDA) (Muuscll) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) - t MI 2 jr1 , ]DEEP OBSERVATION ROLE LOG: Bole Depth from Soil Horizon Soil Texture Soil Color soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stories;Boulders, Consistency, tl !d 17 0 /)a ui17 Flood Insurance Rate Map: Above 500 year flood boundary No— Yes Within 500 year boundary No+ Yes T Within 100 year flood boundary No._ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious mliterial exist in ali areas observed throughout the area proposed for the soil absorption system? Y If not, what is the depth of naturally occurring pervious material? Certification N4� I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required tra• ' erdse nd xp ' ce deseribed in 10 CMR 15.017. Signature Date QN9.EPTIC\PBRCPORM.DOC i �O S!No� _ Fee----14- -!-- BOARD OF HEALTH TOWN OF BARNSTABLE Application r Veil Con5truction Permit Application is hereby made for a permit to Construct ( ), Alter ( ' ), or Repair ()i )an individual Well at: Location Address Assessors Map and Parcel -- Owner Address Installer — Driller Address Type of Building Dwelling ------------ ---- Other - Type of Building— --------- No. of Persons-------------------------- Type of Well—�-������:�------------------ Capacity-------------------------------------- Purpose of Well--------- 1/�--=-------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation The undersigned further agrees not to place the well in operation until a Certificate .of Compliance has been issued by the Board of Health. ate Application Approved B —— --——— `5 �� pp pprove date Application Disapproved for the following reasons:--- - - —---— - ---------- - date Permit No. O — Issued------- -� --- -� -- - date BOARD OF HEALTH TOWN OF BARNSTABLE C ertif irate ®f COMPliance THIS IS TO CERTIFY, That the Individual.Well Constructed ( ), Altered ( ), or Repaired ( ) y—— Installer at- -— ------------ -- - ------___ ----- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. -------------Dated---- --------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-------- ----_-- - --- Inspector-- ——-- - - ---------- I c )Q © 4. Fee----No. - -� '::� BOARD -- . OF HEALTH TOWN OF BARNSTABLE "`� ���lication,�or�ell �Congtruction�erinit Application is hereby made for permit to Construct ( ), Alter ( ' ), or Repair ()C. )an individual Well at: Location, Address Assessors Map and Parcel f% Owner -- --------------- Address — --_—_---- Installer — Driller Address i Type of Building DwellingU�?�' _ _- ---- --------------- Other - Type of Building- -- -------- No. of Persons----k---------------------- d l Type of Well Purpose of Well------? Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate .of Compliance has been issued by the Board of Health. / Sig-ned- --- date Application Approved By /��-D--1- date Application Disapproved for the following reasons: date I r p Permit No. \1.3 Issued--- --- - l D-- - --- date f� 4 BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) bY------- -----_--- ---- --- ----- -- Installer at- -- ------------ -- --- - ---- ----has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection I' Regulation as described in the application for Well Construction Permit No. -------------Dated----- -------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE----- -- — - - Inspector-- ------------------------------ BOARD OF HEALTH TOWN OF BARNSTABLE Vell Congtructionpermit — cam -o/ -- No. ---- --- Fee- 4 Permission is hereby granted /�1/11r ---------------------- to Construct ( ), Alter ( ), or Repair ( ) an Individual Well at: street as shown on the application for a Well Construction Permit No.__— -_—----- Dated•- -1 -- -- ---------- -------------------- Lr DATE �` 0 Board of Health — � I ___ 09-11-1997 01r31PM CENT DST FIREDEPT 5087902385 P.01 rnanr appuv-auurr w tvcai rrre uepartmenL Fire Department retains original application and issues duplicate as Permit. _ Vo m m,o�, �a&X A"' a / Y o APPLICATION and PERMIT i for storage tank removal and transportation to approved tank disposal yard in accordance with the provisions of M.G.L. Chapter 148. Section 38A, 527 CMR 9.00, application is hereby made by: • Tank Owner Name(please print) Roger Bond X � �gnatwe A9arymg rot permn Address_ 88 Lakeview Drive Centerville MA 02632 Street City State �P Company Name Envirosafe Co:or Individual Envirosafe Prim IXK Address PO Box 304, Sagamore Bch MA Address PO Box 304. Sagamore Beach Print trot Signat f, p �ng it) Signature(if applying fcr,;,errrtit) CkIFCI Certified Other a IFCI Certified = LSP# Other Tank Location 88 Lakeview Drive,. Centerville, MA Sleet aaoress cjy Tank Capacity(gallons) 1,000 gallong Substance Last Stored #2 fuel Tank Dimensions(diameter x length) 3 x 12 G^ Remarks: • • • rIQ Firm transporting waste Turner Salvage #002 ` P 9 State Lic.# tic Hazardous waste manifes.1 E.P.A. Approved tank disposal yard Turner Salvage Tank yard# i'1002 Type of inert gas Tank yard address Lynn, MA A . . City or Town FDID# Permit# GiHe Date of issue. 9/10/•97 Date of expiration 9/24/97 Dig safe approval number. #973702927 ipo till Toll Free Tet. Number-800-322-4844 Signature/Title of Officer granting permit 11LIL 7� g�,. After removal(s)send Form=?-290R signed b�IF* t.to UST Regulatory Compli ce Unit, One Ashburton Place, Room 1310, Boston,MA 02?08-1618. FP-292(revised 9/961 TOTAL P.01