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Home My WebLink About0014 MAIN STREET (HYANNIS) - Health F ain Street s-029 No-------------------- Fee ------- BOARD OF HEALTH TOWN OF BARNSTABLE Zipplication ifor Well Con0ruction3permit ) Application is hereby made for a permit to Construct Alter or Re air ( )a *individual Well at:r/q 1,1 ,4 0,114if M6 60L ly Location — Address ILI fflot� Assessors Map and Parcel Q,�e- ------- y9m's- ----------0-w r Address Installer Driller Address Type of Building Dwelling Other - Type of Building --- No. of Persons--Z------- Type of Well Capacity------- Purpose of Well Agreement: The undersigned agrees to install the aforid ed M' dividual well in accordance with the provisions of The Town of Barnstable Board of --'th Privat P c ion Regulation — The undersigned further agrees not to I N place the well in operation nti, ti lance has been issued by the Board of Health. Signe ------- date Application Approved By date Application Disapproved for the fcflowing reasons: date Permit No. Issued------- date 2d4 — 0D2 �fr No.----------- •• '--------- Fee-------------------- BOARD OF HEALTH . -TOWN OF BARNSTABLE Zppiicat ion-for Well Conoructionpermit Application is hereby made for a permit to Construct (V), Alter ( ), or Re air ( )an individual Well at: Location — Address Assessors Map and Parcel _ -%(v_�f�r� i s IVA OZ6G/ �— Owner — ` Address Installer — Driller Address Type of Building Dwelling- i �! I �---� Other - Type of Building-=------__------- No. of Persons--7-_.--------_—__-_____.----- Type of Well Capacity ;---- —--- - - --- Purpose of Well __�a��`r=: � t'�ati Agreement: The undersigned agrees to install the aforedescAed ' dividual well in accordance with the provisions of The Town of Barnstable Board of Health Privat fN ff Pro ction Regulation - The undersigned further agrees not to place the well in operation until a 9 ifi a'� �Co Nance has been issued by the Board of Health. Signed ------ --- --- ----- - — - - r date Application Approved By. / RS _ ) /i date Application Disapproved for.the following reasons:---------__________ date Permit No. -- ------ ----- Issued----------------------------------------- F date --------------- BOARD OF HEALTH TOWN OFt BARNSTABLE Certifirate ®f Compliance � e THIS IS TO CERTI ,/That the Individual Well Constructed ( �-), Altered ( ), 6r'Repaired ( ) Installer at has been installed in'accordance with p th rod visions 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-- --------- - -------------------------------------•------------------------------------- ----- - -----= .-..__ --- -----. ... BOARD OF HEALTH -- TOWN OF BARNSTABLE Well Con0ructiott ermit -'- Fee- Permission is hereby granted to Construct ( k"Alter ( ) or Repair ( ) an Individual Well at: Street ----------------------------------------------------- as shown on the application for a Well Construction Permit No.-___ _ Dated 6 Vvi �r Board of Health DATE tv: ;. ry `a J. 18 C�ropek�d w�(( l g' awo. J o � 6t 3 / W h 4 32/G70 + h v N � tJ Q I f �. V� -36'+_!-=- I o N3 i ,+I 27 '-�- /oo.oo , C avrvTy ti/A y - //,/ S7/7 GC�'T ,v� �iGH CERTIFIED BLOT ' 11,42�rzD FGoaD /v ,oc K�tiE �<c ,�}s syocUn/ aA✓ PLAN C°n�m v�✓�y R6A✓Ec.. No, 2-51900/- 000s c /�J,q T� LOCATION �S�/Yj /N ST, �iS/yJf7S5. PZEliiSE'D. AUGvsT /9J /9BS By:F, !yl!J.• . . . . . SCALE . �'... 3. DATE . 9�ZB�oo Nam: 7'ffis Pcrfiu Q.,6,5 �VOT 2� tsSenJT p. PLAN REFERENCE . �1LoPEJ27y L/niE S'UIZvEy viv-7ff��olov�/.�: fI20/Yl�8v771/V!i . . . as,laid Des . . . . . '" I CERTIFY THAT.THEN/NGS�DGrSayDq� • `'� W Ol+t H SHOWN ON THIS PLAN IS LOCATED ON THE GROUND • o.17, O AS SHOWN HEREON • Mo aun�� n r�n�-2�9 Svaveyvs�. DATE .9��8/��. . wEs/-Y/92•ya�r�/ ,ngs . _ Massachusetts Department of Conservation and Recreation Office of Water Resources 149390 TYPE OR PRINT ONLY Well Completion 'Report 1. WELL LOCATION GPtSt(Required) North L ° `,, . / 77 _ West 10! a° ! 70-7, , Address at Well Location: Property.Owner/Client: Jpovi/ s Subdivision Name: Mailing Address: City/Town: � wt7l1 Cityrrown: Assessors Map 3 y? Assessors Lot#: 02 NOTE: Assessors Map and Lot# mandatory if no street addr ss available Board of Health permit obtained: Yes W Not Required ❑ Permit Numbe4—V®/ -V—Z-Date Issued] ' /1 2. WORK PERFORMED 3:-WELL'TYPE 4. DRILLING METHOD 6. CASING Overburden I Bedrock From (ft) To (ft) Type 1 Thickness Diameter 5.WELL LOG OVERBURDEN 'Extra ❑❑❑ Water Loss or Drop in ❑❑❑ LITHOLOGY Bearing Addition Drill Fast or Zone of Fluid Stem Slow 7. SCREEN' From (ft) To (ft) Code Color Comment Drill Rate From (ft) Tb,(ft)', " Type Slot Size Diameter U S Y3 Y / N Y / N F / S / ®® 61 �7 Y / N Y / N F / S El DO . Y / N Y / N F / S ❑❑❑ - - - ' Y / N _Y / N F / S g, ANNULAR SEAL/FILTER PACK/ABANDONMENT MTL. Y / N Y / N F /rS_ , From (ft) To (ft) Material Description Purpose All Y / N Y / N FPS._ Y / N Y / N ' ❑❑ ❑❑ Y / N Y /•N F /.S ❑❑ El El -WELL LOG BEDROCK Extra.- 9. SITE SKETCH .. , Water Drop in'Extra Visible Loss or #of LITHOLOGY Bearing Drill Large Fast or ,`Rust Addition Fracture Zone Stem Chi s Slow Stainingof Fluid er foot From (ft) To (ft) Co ,Comment P `Drill Rate p d' Y / N Y'% N F,/ S Y / N Y / N 53 Y / NY,%'-NF / S Y / N Y / N Y / N Y`/-N F / S Y / N Y / N Y /``NY / N F / S q/ NY / N Y/��N, Y / N F / S Y / N YiNY / N F / S Y / N Y7NY / N F / S Y / N ' r Y / NY1N F / S Y / N Y / N 77 > JY / NY / N F / S NJY Y / N Y;/ N Y / N F / S Y / N Y / N 10. WELL TEST DATA(ALL SECTIONS MANDATORY FOR,PRODUCTION WELLS) 11. STATIC WATER LEVEL(ALL WELLS) Yield Time Pumped Pumping Level Time to Recover Recovery Depth Below G�Date Method (GPM) w(hrs&`min)`] (Ft. BGS) '' (hrs& min) (Ft. BGS) Date Measured Ground Surface (ft) / ✓` Dom' r —; . 4' b�f A3 r 7-6 12. PERMANENT PUMP(IF AVAILABLE) 13.ADDITIONAL WELL INFORMATION Pump Description ❑'❑ ❑ ❑ Horsepower Developed Y / N Fracture Enhancement Y / N Pump Intake Depth - (ft) Nominal Pump Capacity (gpm) Disinfected Y / N Surface Seal Type ❑❑❑ 14. COMMENTS 4° Total Well Depth Depth to Bedrock 15.WELL DRILLER'S STATEMENT This well was drilled, altered, and/or abandone un� y supervision, according to applicable rules and regulations, and this repdrt i m I a ' correct to the best of my knowledge. J Driller: "' i� - _ Supervising Driller Signatur '_s�G '( Registration #: Firm: &� / C.E:�.0 Date Complete: `/ Rig Permit#: I 1�`F 171 NOTE: Well Completion Reports must ee iled by the registered well driller-within-30 days of well completion. BOARD OF HEALCOPY - Well Completion Report Codes A Section 2 Section 3 Section 4 Work Well Drilling Work Performed Type Method Performed Code Well Type Code Drilling Method Code Decommission DC Cathodic Protection CTPR Air Hammer AH Deepen DP Domestic DMST Air Rotary AR Hydrofracture HF Geoconstruction GCON Auger AG New Well NW Geothermal Closed Loop GTCL Cable Tool CT Repair RP Geothermal Open Loop GTOL Casing Advancement CA Replacement RE Industrial INDS Core CR Injection INJC Direct Push DP Irrigation IRRG Drive and Wash DW Monitoring MONT Dug DG Public Water Supply PBWS Mud Rotary MR Recovery RCVR Reverse Rotary RR TW Sonic SN T Test Wells S Section 5 Section 6 Overburden Casing Lithology Overburden Overburden Overburden Bedrock Type Thickness Name (OB)Code Color Color Code Bedrock Name (BR Code) Casing Type Code Thickness (NO CODE) Artificial Fill AF Black BL Amphibolite AM Certa-Lok CTL Schedule 5 Boulders B Bluish Gray BG Basalt BS Fiberglass FBG Schedule 10 Clay CL Brown BR Conglomerate/Breccia CG/BR Galvanized Pipe GLP Schedule 40 Coarse Sand CS Dark Gray DG Diorite DI HDPE HDP Schedule 80 Cobbles C Greenish Gray GG Gabbro GB NSF Coated Steel NCS Schedule 160 Fine Sand FS Light Gray LG Gneiss GN PVC PVC SDR 13.5 Fine to Coarse Sand FCS Reddish Brown RB Granite GR Stainless Steel SST SDR 17 Gravel G Yellowish Brown YB Limestone LS Steel STL SDR 21 Medium Sand MS Marble MA SDR 26 Organics 0 Quartzite QZ SDR 32.5 Sand&Gravel . SG • Rhyolite RH SDR 40 Silt SI Sandstone SS 17# Silty Clay SICL Schist SC 19# Silty Sand SIS Shale SH Silty Sand&Gravel SISG Slate/Phyllite SL/PH Till T Pegmatite PM Section 7 Section 8 Section 10 Annular Seal/Filter Screen Annular Seal/Filter Pack/Abandonment Purpose Method Screen Type Code Pack/Abandonment Material Code Purpose Code Method Code Carbon Steel CST Bentonite Chips/Pellets BC Fill FL Air Blow with Drill Stem AB Continuous Wire PVC CWP Bentonite Grout BG Filter FT Air Lift AL Galvanized Wire Wrapped GWW Cement/Bentonite Grout CB Seal AS Bailing BL Perforated Pipe PFP Concrete CT Constant Rate Pump CR Pre-pack PVC PPP Sand SD Variable Rate Pump VR Pre-pack Stainless PPS Native Material NM Slug SG Slotted PVC SLP Stainless Steel Vee Wire SSV Stainless Steel Well Point SSP Section 12 Section 13 Pump Description Well Seal Pump Description Code Horsepower Surface Seal Type Type Code 2 Wire Constant Speed Submersible 2WSS 1/2 20 Cement CM 3 Wire Constant Speed Submersible 3WSS 3/4 25 Cement/Bentonite CB Constant Speed Submersible Turbine CSST 1 30 Concrete CT Variable Speed Submersible Turbine VSST 1 112 40 None NO Jet JET 2 50 Line Shaft Turbine LST 3 60 Centrifical CENT 5 75 7 1/2 100 10 125 15 150 --- 200. - 04/13/2011 13:14 FAX 508 888 6446 ENVIROTECH LABORATORIES Q 0001/0002 ENVIROTECH LABORATORIES, INC. MA CERT.NO.:M-MA 063 8 Jan Sebastian Drive Unit 12 Sandwich,MA 02563 /5 08J 989-6460 I-800-339-6460 FAX(.408)888-6446 Client Name sage,Paul Location 14 Main Street Address 14 Main Street Hyannis,MA Hyannis, MA 02601 a"tple Date 04/07/11 Collected By Client Sample Time NA Sample Type New Weil Date Received 04/o7/11 Lab Order Number DW-110642 Well Specs NA LocatIont Source' Date Collected T'!me Collected Comme�tts Analysis Requester! Units :ik Recommender!Limits Analysis Result Method jDare Analyzedl Analyzed By PH_...-....__ :. PH units ;.. .,...,. 6.5.8.5 , ;; 5.30 SM4500-H-B 4/7/2011 LL Specific Conductance 1.u - - - - umho /cn 680 -_ EPA- . ---- -._Nitrite-N mglL <0.004 EPA 300.0 4/8/2011 LL .... ._.. .. ... ................... --- Ni#rate-N mg .. '' ::10:0' 3.83 EPA 300.0 4/8/2011 LL _._. -- _._.._...._... _. Sodium m9/L 20.0 106 EPA 200.1 . 4/812U11 MC .. - .._. _ _. ._.. Totallron►r mg/L' .0.3 0.91 EPA200,7 418/20/1 MC -.-- - - -.._::. _ ...... .._._._......-..._.._ . ..... Manganesep mg/L 0.05 0.23 EPA 200.7 4/8/2011 MC Potasaium� mg1L 20.0 i3.9 EPA 200 7 4/8/20 t 1 MC _..._...._.. ..... ...--..------- . .,... - - --.... ..... __ .._ Calcium m /L NIA 17.5 EPA 200.7 4/8/2011 MC MagnesiumQ r<<gIL WA __.. _ ...... _ 6.7 EPA 200.7 4/8/2011 MC Total Hardnessa mg/L 50-200 71.6 EPA 200.7 4/8/2011 MC __..._.._._.. . - - - -- - -.._._ . ._.__._.._. Alkalinity mg/L 200 6.7 SM2320B 4/12/2011 LL Suffate mg/L 250 9.9 EPA 300.0 4/8/2011 LL - . .._ -- ---- Chlonden mg/L 250 208 EPA 300.0 4/12/2011 LL Turbidity NTU 5.0 , :.-8.7 SM2130 8 .4/712011 __.... __. LL _ _..._.... - - --. .._._.. Cotom �.<�-'A PC units , ; 15 N,... :. r ....< 5.0 •SM2120 8 4/7/2011 LL r.,. _ Free CO2 mg/L 50 w -_' 26.6 Giculation 4/7/2011 LL 11 Total Coliform(Presence/Absence) PresenllAbse ' Absent A SM9223B 4/7/2011 IRS Locatlon Source Dale Collected Trine Collected Comme tis B 4/7111 NA. Analysis Requested 'Units Recommended.Limits Analysis Result I Method Date Ana1yzedj Analyzed By Volatile Organic Compounds* ug/L See:comrnent. 149,142* EPA 524.2 4/11/2011 NEC* -- Comments: Sodium indicates possible salt water intrusion or road salt runoff. Iron and manganese are not a health hazard,.but can cause taste,staining and odor problems, Low pH indicates high corrosive characteristics. 2-Butanone and acetone are found in the PVC glue used for well construction. Limits:2 Butanone 350 ug/L,Acetone 3,000 ug/L` Leveis sttrsld dissipiWifter use. F Date ' _. Ro11J. aiLarector BRL=Below Reportable Limits *See 4trgched- Page 1 of 1 ❑Certifieatlon is not available for this analyte for'rtorr po'lable water,saMpias L: 04/13/2011 13:15 FAX 508 888 6446. ENVIROTECH LABORATORIES Z0002/0002 -t. t 5 { e j ,r {''New.England•ChromaChem: ;. '6.NicholsStreet Salem;MA 01970 v978-744-6600 Massachusetts DEP Lab.MA-072 ' r; , Sample Information EPA Method 524,2 Rev 4.1 Volatile Organic Compounds in Water Client: Envirotech Laboratory,Inc. ' Lab ID: 104022 Client ID: DW-110542 14 Main Street, Hyannis MA State: ..,Liquid Date Received: 04/11/11 Date Analyzed: 04/11/11 Date Sampled: 04/07/11 MCL Regulated VOC's Results(ug/L) (ug1L) Unregulated VOC's Results(ug/L) Benzene ND S:" y Acetone, 149 Carbon Tetrachloride ND 5 ;','_': Bromobenzene ND 11-Dichloroethene ND 7 7. ` Bromochloromethane ND 1,2-Dichloroethane ND Ai Bromodichloromethane ND 1,2 Dichlorobenzene ND.:: 600 . f,}Bromoform ND 14-Dichlorobenzene ND 5,1 Bromomethane ND Trichloroethene ND 5 2=Butanone 142 1,1,1-Trichloroethane ND 200" "'`'' .;" N-Bu! (benzene ND Vin I Chloride "' ND 2 Sec-But (benzene ND Chlorobenzene ND 100 Tert-But (benzene ND cis-1,2-dichlorcethene ND _.' 70..:. Chtoroethane.. ND trans-1,2-dichloroethene ND ':.`- 100 Chloroform- ND 1,2-Dichloro ro ane.. - ND .5. Chloromethane ND Eth (benzene ND,'. 700. 2-Chlorotoluene ND Styrene ND:;_ ;100 m 4Chlorotoluene ND Tetrachloroethene ND.,_ 5. _' ' Dibromochloromethane ND Toluene ND . _ 10007 1 2-Dibromo-3-Chloro ro ane ND X lens Total ND 10000,w 1 2-Dibromoethane . ND Methylene Chloride ND 5 Dibromomethane ND 1 2 4-Tiichlorobenzene ND 70 , ,,: , 1 3-Dichlorobenzene . ND 1,1 2-Trichloroethane IND 5 : . '- Dichlorodifltioromethane ND 1,1-Dichloroethane ND r , 1 3-Dichloro ro ane ND x ' Z131chloro ro ane ND T10chloro r ene ND Hexachlorobutadiene ND lsopropylbenzene ND. F, P-1so `ro (toluene ND Methyl-fert-butyl ether ND t x 3� f" Na hthalene. ND f t ° N-Pro (benzene ND r a' 1 1 1 2-Tetrachloroethane ND w•. r k 1,1 2 2-Tetrachloroethane ND ? ` 1,2,3-Trichlorobenzene ND .r 1"2 4-Trichiorobenzen6 ND ' Triciilorofluoromethane ND 12,3 Tricfilaro ro ane ND . _ 1 1 2'4-Trimeth tlbenzene ND 1'3,5-Trimefh"1benzene' ' ND Analysis Detection Limit=0,5 u /L Recoveries of Internal Standards Benzene-d8 99' ' 80 u 1,2-Dichlorobenzene-d4 98 Method Detection Limit ... 4-Bromofluorobenzene. 85' MCL TTHM s it 0.5 ug1L Analysis.performed per 31OCMR42 Electronically signed and approved by Mr.Bruise A,Bomatein Lab girector,"`: , Date: 0.2/2011 Martin, Cynthia From: Martin, Cynthia_ Sent: Thursday, November 10, 2011 11:42 AM To: 'therese.d ayian @state.ma.us' Cc: McKean, Thomas Subject: 14 Main St., Public Water Supply Terry, Per your request following is the information,regarding the well at 14 Main Street, Hyannis, which serves three separate buildings consisting of a total of fourteen bedrooms per Town of Barnstable Assessor and Building Department records. On November 2, 2011, Hans Keijser, Water Supply Division (WSD) contacted the Public Health Division (PHD) regarding the well at 14 Main Street possibly serving between twenty-five and thirty-five people. The Application for Well Construction Permit, filed March 3, 2011 with the PHD, indicated the well was to serve seven people. However, since that time the WSD, upon property owner request, disconnected service to the address and removed the water meters. The Plumbing Division has verified that the three buildings on site are served by the well. Please direct further request for information to Thomas McKean, Director of Public Health. Sincerely, Cindy Hazardous Materials Specialist Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 Tel.•5OB-B624645 Fax 508-790-6304 1 YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $30.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L. - it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1st FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) and 200 Main Street Offices at the Licensing counter. DATE: Fill in please: x APPLICANT'S YOUR NAME: l say v� o�Os a� a � BUSINESS YOUR HOME ADDRESS: Aq Ma:.. S}. ��l4NY\ s r11�4 es�bo i " f TELEPHONE # Home Telephone Number: Soli: - 7A-6 - bo-/'t NAME OF NEW BUSINESS �sf ,k� �irs TYPE OF BUSINESS IS THIS A HOME OCCUPATION? YES NO Have you been gwen approval from'the bu�ld�ng division? YES NO ADDRESS OF BUS';INESS c�cn o MAP/PARCEL NUMBER' When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature" COMMENTS: 2. BOARD OF HEALTH This individual has beeriinfor= permit requirements that pertain to this type of business. Autho ized Si nature*" COMMENTS: U eS llCA 3. CONSUMER AFFAjhas oe ' ING AUTHO Y) This individual rmed of the lie g quirements that pertain to this type of business. gnature** COMMENTS: Date: / /z/ 0 4, T � TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS:___ BUSINESS LOCATION: 14 PA Al 0, N& : INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: SOk - `l ck o - CONTACT PERSON: �a Kr S e= EMERGENCY CONTACT TELEPHONE NUMBER: So i - 7a(o - 6o y 7 MSDS ON SITE? TYPE OF BUSINESS: c K 4_ INFORMATION/RECOMMENDATIONS: 64 UsesFire District: Waste Transportation: Last shipment of hazardous.waste: Name of Hauler:— Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) _ Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Pln t Motor Oils Pesticides V` NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor&furniture strippers I Other products not listed which you feel Metal polishes ,�,may be toxic or hazardous (please list): Laundry soil & stain removers USe-S CLU ��uc,�2_ (including bleach) u►m,�� 61b rr4,1�� (j �1.._l�_�h Spot removers &cleaning fluids (V„� (dry cleaners) Other cleaning solvents I �, Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS COMMONWEALTH OF MASSACHUSETTS z EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS + d DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON, MA 02108 617-292-5500 e ARGEO PAUL CELLUCCI BOB DURAND Governor Secretary JANE SWIFT LAUREN A.LISS Lieutenant Governor Commissioner Public Water System Determination (Year 2000 Printing) Effective Date: 10-8-96 Policy, SOP or Guideline#88-11 Program Applicability: Supersedes Policy,SOP or Guidance# Approved by: Arleen O'Donnell Background and Rationale Massachusetts Regulation 22.02 defines a public water system as a system serving an average of at least 25 people daily at least 60 days per year and/or having 15 or more service connections. This policy is adopted to provide a standard conversion for calculating residential population served when given information on number of bedrooms and/or service connections to determine whether a water system is a public water system. Policy . It is the policy of the Division when determining whether or not a residential facility for collection, treatment,storage,or distribution of water constitutes a public water system as defined by 310 CMR 22.00, to calculate the number of persons served by either multiplying the number of bedrooms by 2,or by multiplying the number of service connections by 1.67. The PWS determination shall be based on the higher population if both numbers.can be calculated. Date: 10-8-96 Adopted: 10-8-96 Effective: 10-8-96 Arleen O'Donnell,Assistant Commissioner Bureau of Resource Protection :T7& 8811-1 LOC&.T10 5EW6,C4E PERT 1J0. Coo VILLAGE ItilST�I..�ER•5 IJ�,ME � ADDRESS BUILDER 5 Q LAME- P, DDRE SS D NTE P E R 1 M 1T SSUE D - -� - - - - - D ATE COMPLI &&ICE. ISSUED : y 9- ��- D� 1 a76 I ° I I II III l � II Ii III I w t I I I t a I I � 3 I I wo Iw I o w I lo �,i � � I w Lo � lol IQII . � I �) wI ui 0 'u N a cr- I I o J � ( Iw o �- Ia � Q�toWl a a � o I ,,, W 4uj _j I ? I�I � I l o d 2 hl LOCATION SEWAGE PER IT p0. .�� VILLAGE INSTALLER'S NAIVE A ADD Ill ES S � GUILDER OR OWC3EECI Cam- DATE PERMIT ISSUED DATE C 0 M P L I A N C E ISSUED a .. 4 f . i �(`•- � 8- �� t J No..T9....�°`�..... FEE-35.110.......... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .................. ...Town.........OF.......BArnstable Appliratiou for Bi4p.aiittl Workii Tons rurtilart ramit Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal System at: 14 Main St Q_,�__,Hyannis_Nfa,� 02601 ...................---•••-•- -•-•••••••--•-••--•••-•----••------•--...••---•----------•-.......-.._.-_....--------•••••- L ati n-Address or Lot No. Erica__Ambeel _d757a- Hyannis Realty 14:_Main• St-4-_, H�ranni ,� Mai 02601 Owner Address a .......B. Cesspool_..Service __••_••• •••-•-•-•-.----•. 128•-Biehops•••Terrace,� Hyannis: Mag Installer Address d Type of Building Size Lot.......................j•Sq. feet V Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )�+ P4 Other—Type of BuildingA a:rtment__•• No. of persons_____________________ ( ) ( )Showers — Cafe4eria Otherfixtures ......-0118 E-•••••• •---••••----••---•-----•--...-•----••••-•---•--------------•-----...-•--•-••--••••••••••-•••••-•••......................... W Design Flow............................................gallons per person per day. Total daily flow-----------_........... ....................gallons. WSeptic Tank—Liquid capacity____._..___gallons Length-------_--_-- Width---------------- Diameter._.------------- Depth................ x Disposal Trench—No...................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date...-.................................... 04 Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water................._...... 44 Test Pit No. 2................minutes per inch Depth of Test Pit____________________ Depth to ground water.-_____________________- P4 -------- - ODescription of Soil--------------------�3ri ---•••...•••••••••-••••••••-•••••••••---•--•---••----•---•----•--•----•-••---•---------••--•-•••-•-•••---•-•-------•-•--- V ••••••••-••••••--•-•----••••-•---•-•-••--•••••-••••••-••••••-••--••••-••-••••••••••-----------------••-•-••••••----••-•••••••-•-•---•---•-••---••-••---•••••-•--••-••••••••••••••-•----••••••••--•- ------------------ ------------•---------------------------------------------------•---•------• ------------••----- --------•-••••-------•-•--••---------•-•._...--••••••. .................. U VatureofPRepairs or Alterations—Answer when applicable__],y_QQ04---e3j-14C)n---stone---packe�---�J�t�D�-►Gast leach••-••---•-----•-------------•---•--•••-•-•---••••••••-••••-••--•-••••••-•--•-•-------•---=---•••_•••--•••••_...__....-----------•----•-•--•-••-•-------•--------•-•-••-•• .............................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TTTL p 5 of the State Sanitary Code— The undersigned further agrees not to-place the system in operation until a Certificate of Compliance has been dby the board Ith. fined.... ---•---•--- -....A-- •--•••••••. ._F131162 - Date 8 ---7 V 7.9_........ / -/4` Application Approved BY---•`.----------- •- - ..-/-ti-.1/1..--- ••-------------- -----------Sf----7/7-9--------- Date Application Disapproved for the following reasons--------------...............................----............................................................... Date Permit No...79p............................................. Issued-....-----81.... •7179•.......---•---•-••••--- Date No.79-:.:�.�S. Fms... . .�.{}�......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ` ........... ._-------T.own__......OF........Barnstable---- .................................... Appliration for Bi-gVus al Works Tomitrnrtinn rrntit 'Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System 14.....14ia ? ..S ........ .................................................................................................. Erica Amb : � Lo atf-Address or Lot No. y i -----•---.....-•--------e � ... � t s nnia.}.--Ma•--..42.6Q1------- Owner. Address a ..................................... , hoA _... . x . yanni-s.,... i .. Installer Address Type of Building Size Lot............................Sq. feet �-, Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) p.l Other—Type of BuildhigApart?1 ent... No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Other fixtures . ..HOUBG____________________________________ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity..._........gallons Length..........:..... Width................ Diameter---_---_-___-_- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No----------_--------- Diameter.........__.._-..... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) "'Dosing tank ( ) Percolation Test Results Performed b Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water-.--_--_-_______--__---. LT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ----------- anG�- ............................ -- •- - ------------._._.-•-------------._........---•-----------•--,.....---•-------•---.._..........---- D Description of Soil----•----------------S - x -------------------•---------------------------•-----------------------------...----...------------.-----------------------...------------. W U ature of e airs or Alterations—Answer when applicable.-.1_ .00Q-__-maj_l-an---_g_�-o-ne---paekr�-___pr-e-east leach R i pt, Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i-Tl..' p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued,by the board of health. �.; 1gned._ :%✓1i /.. --!r --� ...... .... z P '�f ` =� ter` / D e i9 ----- Application Approved BY ` .�-CaGw - /;�� ' t- ...---------a/----7/fig -- Date Application Disapproved for the following reasons------------------------------ ---.....-•--------------••--•---•----••----•-----••---•-•--••----....._._... •---------•---------••------------------------------------•-------•-------------••----- Date Permit No....79=............................................... Issued...........S/---717.9........................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable ....................... ................OF..................................................7................................. THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or}.Repaired ( X) by....A...&_..B.... :eaans.s.l...S.erYice.,__.128...Ushops...Tarrace.,...Hyannia.....5A....... 1--_----- Installer at.. .4---Main... t...9--- ----Exi-ca---Ambae-1..d-/-b-/.a---Hyannis....Re_a1ty `has been installed in accordance with the provisions of TITLE; 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..79.-_---, _AJ` ':._.____-_. dated,..........8/_...7.17.9--_---_--____-. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE:,_ 8 .n?l.?.9... f . .. ,: Inspector -.. . ---- -- x la z,----- THE,COMMONWEALTH OF MASSACHUSETTS 'Ag, BOARD OF HEALTH Town Barnstable 7 _ ...........................................OF..................................................................................... No..?9. .............. �� t'EE..... � Rapnsal Workii �nnrUan �erntif Permission is hereby granted..A...&...B---C.es.spAA1...Service ----------Hyannis.....Ma.....Q2.6.01........... to Construct ( ) or Repair (X ) an Individual Sewage Disposal S stem at No.14..��ain---St._.,....Hyarmi.s...-...Erma...Ambeel_..Jf /..a_.Hy nni.s...Realty-------------------------- Street as shown on the application for Disposal Works Construction P it No/_�- Dated---- /_..�./7q.. ...... .. DATE 8� ��7g BB_ Ht ............................................................. FORM 1255 HOBBS & WARREN. INC., PUBLISHERS