HomeMy WebLinkAbout0905 MAIN STREET (COTUIT) - Health �905�Main-St��,�,�t �:5�•���--^:---�L
Cotuit Oil Co.
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THE COMMONWEALTH OF MASSACHUSETTS THE in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
2ppYitation for BisposaY fndon(t�_
truttion ertnit
Application for a Permit to Construct( ) Repair( ) Upgrade( Complete System ❑Individual Components
Location Address or Lot No. ^J 65-y0Q Wl S 0 fvl 1 ame,Address,and Tel.No. .36 7 !1' l i t S f
Assessor's Map/Parcel 03_57 09ff �
5o'T -�ba-yo38
Installer's Name,Address,and Tel.No. o?o( (4 h S f— Designer's Name,Address,and Tel.No.
F—novowmeia�I fi�n" �v1t4
� d9 Yd—
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided. gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
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 Eqykwinigntal Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of t .
d Date 3. b
Application Approved by _ Date
Application Disapproved by Date
for the following reasons
Permit No. Date Issued
No. Fep�
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
•, r
21pplitation for Disposal 6pbandon
onstrUttion VPrmit
Application for a Permit to Construct( ) Repair( ) Upgrade( (: • Complete System ❑Individual Components
i
Location Address or Lot No. ?Q J— 0101� S 7� CQ fV) ame,Address,and Tel.No. -Vj'7
Assessor's Map/Parcel
Map ~"rf
Installer's Name,Address,and Tel.No. o�G( ��GG h S Designer's Name,Address,and Tel.No.
Type of Building:
Dwelling No.of Bedrooms , Lot Size sq.ft. Garbage Grinder( )
Other Type of Building / 5t A4 No.of Persons Showers( ) Cafeteria( )
Other Fixtures IL
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
i
Nature of Repairs or Alterations(Answer when applicable)
a 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 En ' ental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Hp t .
fg)n,d i DateApplication Approved byDate
Application Disapproved by Date
for the following reasons
Permit No. Date Issued
---- ---- - --- - --- - -------------------- - - - --- - - ------------ -
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certifitatr of Compliance
-TFHS-TS\TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( )
Abandoned( �)-bJy
t•--1�/ Gl(2<' iA/1�. r P�,; has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No01*701-1
dated
Installer Designer
#bedrooms Approved design flow gpd
The issuance of t•is permit shall not be construed as a guarantee that the systemcto fu ction as des'gned.
Insper fist; 9
----------—----------------------------------------------------------------------_-=__------ --- ----
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Disposal *pstrm Construction Vermit
Permission is hereby granted to Construct( ) Repair( ) Upgr de( ) Abandon(X)
��A A System located at� � / i \
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Cons ction ust be completed within three years of the date of this permi
Date Approved by /
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ad lat amt�tcl i rem- oxat and dispas of appmx6fintoly 1 0 bwea, I:e*t f.0prn�#����.�t�.�h
� c �P u stern-p,a bmated at 905'Main Svm in C.14111M MA. �
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Massachusetts Department of Environmental Protection
Bureau of Waste Prevention •Air Quality 10 1102809
Ll
BWP AQ0wDecal Number
hV
Notification Prior to Construction or Demolition
Important: A. Applicability
When filling out `'
forms on the
computer,use
only the tab key A Construction br Demolition,operation of an industrial, commercial, or institutional building, or
to move your residential building with 20 or more units is regulated by the Department of Environmental Protection
cursor-do not
use the return (DEP), Bureau of Waste Prevention-Air Quality Control Regulations 310 CMR 7.09. Notification of
key. Construction or Demolition operations is required under 310 CMR 7.09(2)ten (10)days prior to any
work being performed.The following information is required pursuant to 310 CMR 7.09.
B. General Project Description-
1. a. Is this facility fee exempt-city, town, district, municipal housing authority, owner-occupied
Instructions residence of four units or less?D Yes ❑ No
1.All sections of b. Provide.blanket decal number if applicable:
this form must be Blanket Decal Number
completed in order '
to comply with the 2. Facility Information:
Department of TOWN OF BARNSTABLE
Environmental
Protection a.Name
notification 1905 MAIN ST
requirements of b.Address
310 CMR 7.09
BARNSTABLE MA 02661
c.Ci /Town d.State e.Zip Code
5088624749
f.Tele hone Number area code and extensio a.E-mail Address(optional)
2144 1
h.Size of Facility in Square Feet i.Number of Floors
j. Was the facility built prior to 1980? ✓ Yes ❑ No
k. Describe the current or prior use of the facility: -
FORMER GAS STATION
I. Is the facility a residential facility? ❑ Yes Q No
=o m. If yes, how many units? Number of units
-O 3. Facility Owner:
TOWN OF BARNSTABLE
�o a.Name
-0 1367 MAIN ST -
b.Address __
BARNSTABLE MA 02601
-� i
0 5088624749 '
f. I Number nE-mail
_a ALISHA STANLEY
�Q h.Onsite Manager Name
ag06.doc•10/02 BWP AQ 06•Page 1 of 3
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention .Air Quality 100102809
( 4 BWP AQ 06 Decal Number
i
Notification Prior to Construction or Demolition
General Statement:If B. General Project Description (cont.)
asbestos is found
during a 4. General Contractor: _
Construction or
Demolition ID B ENVIRONMENTAL
operation,all
responsible parties a.Name
must comply with 1201 MAQUAN ST
310 CMR 7.00, b.Address
Chapter
and HANSON NA 02341
Chapterer 21 E of the
General Laws of c.Cit !Town d.State e.Zip Code
the Commonwealth. 17812944285
This would include, f.Telephone Number area code and extension .E-mail Address(optional)
but would not be DALE DENNISON
limited to,filing an
asbestos removal h.On-site Manager Name ,
notification with the
Department and/or
a notice of
release/threat of C. General Construction or Demolition Description
release of a
hazardous
substance to the 1. Construction or demolition contractor:
Department,if
applicable. ID B ENVIRONMENTAL
a.Name
201 MAQUAN ST
b.Address F _
HANSON MA ��� 02341 —�
c.Citvrrown d.State e.Zip Code
7812944285
f.Telephone Number area code and extension) E-mail Address(optional)
DALE DENNISON
h.On-site Manager Name
2. On-Site Supervisor:
DALE DENNISON
On-Site Supervisor Name
3. Is the entire facility to be demolished? ✓[� Yes ® No
N
0 4.' Describe the area(s)to be demolished:
0 ENTIRE 1 STORY FORMER GAS STATION
N
=0 5. If this is a construction project, describe the building(s)or addition(s)to be constructed:
N/A +
0
C7
ag06.doc•10/02 BWP AQ 06•Page 2 of 3
Massachusetts Department of Environmental Protection ■
Bureau of Waste Prevention .Air Quality 1100102809
Decal Number
BWP AQ 06
Notification Prior to Construction or Demolition
C. General Construct Demolition Description (cont.)
WP,
6. a. If this is a demolition projec, were th structure(s)surveyed for the presence of asbestos
containing material (ACM)?
❑Q Yes ❑ No ~
If yes,who conducted the survey?
NEW ENGLAND SURFACE MAINTENANCE
b.Survevor Name B
AC00196
c.Division of Occupational Safety Certification Number
7. Construction or Demolition: (S/22/2010 ~� 4/1 512 0 1 0
a.Start Date(mm/dd/yyyy) b.End Date(mm/dd/yyyy)
8. a. For demolition and construction projects, indicate dust suppression techniques to be used:.
❑ seeding Q paving
❑ wetting ❑ shrouding b. If.other, please specify:'
❑ covering ❑ other
9. For Emergency Demolition Operations,who is the DEP official who evaluated the emergency?
NA
a.Name of DEP Official
NA
b.Title
1/1/2010
c.Date mm/dd/ of Authorization
NA
d.DEP Waiver Number
D. Certification
I certify that I have examined the JDALE DENNISON
=o above and that to the best of my a.Print Name
-o knowledge it is true and complete. JDALE DENNISON `
The signature below subjects the b.Authorized Signature
-N signer to the general statutes PROJECT MANAGER
=o ` regarding a'false and misleading c.Positioni I itle
�o statement(s). ID B ENVIRONMENTAL
d.Re resentin
3/16/2010
e.Date(mm/dd/yyyy)
�C) - M
�Q
■ ag06.doc•10/02 BWP AQ 06•Page 3 of 3■'
dcrMassachusetts Department of Conservation and Recreation
nzassa�h,.sexs Office of Water Resources
Well Completion Report - - =�
,05 2JUN-,O 8---1'1:2 0:4 5
WELL LOCATION `r 251676
GPS North: 410 37.0391 GPS West: 700 26.1091
Address:,905;,AMain7St Property Owner/Client: c/o Environmental Reclamation -
Subdivision Name-:Cotuit"-"' Mailing Address: 21 Riverbend Drive
City/Town: Barnstable City/Town, State:Natick MA
Assessors Map: Assessors Lot #: Permit Number:
Board of Health permit obtained: N Date Issued:
Work Performed Proposed use Drilling Method Overburden Drilling Method Bedrock
New Well, Monitoring _3.wells ,at-this-,-locatiori7— Auger
CASING
From (ft) To (ft) Type Thickness Diameter
.00 -14.50 PVC Schedule 40 2.00
SCREEN
From (ft) To (ft) Type Slot Size Diameter
-14.50 -39.50 Slotted PVC .010 2.00
WELL SEAL / FILTER PACK / ABANDONMENT MATERIAL
_ From,.=(ft)*,- To (ft') Material Description Purpose
-11.00 -'13-y' Bentonite Chips/Pellets Seal
-13.00 24,-»•= Sand Fill
_ WELL TEST DATA (ALL SECTIONS MANDATORY FOR PRODUCTION WELLS)
Date Method Yield Time'Pumped Pumping Level Time to Recover Recovery
(GPM) (hrs & min) (Ft. BGS) (Hrs & Min) (Ft. BGS)
STATIC WATER LEVEL (ALL WELLS) PERMANENT PUMP (IF AVAILABLE)
Date Depth Below Ground Pump Description:
Measured Surface (ft) Type: Intake.Depth:
05/12/2008 24.5 Nominal Pump Capacity: Horsepower:
WELL DRILLER'S STATEMENT
ADDITIONAL WELL INFORMATION ' Driller: Thomas E Desmond III
Developed: No Fracture Enhancement:No Supervisor: Thomas Desmond III Rig #: 35
Disinfected:No Well Seal Type:None Firm: Desmond Well Drilling Inc.
Total Well Depth: 39.500-Depth to Bedrock:.. Registration #: 764 Date-,complete:05/12/20SW
Comments:
OVERBURDEN
From To Description Color Comment Water Loss/Add Drill Drill
(ft) (ft) Zone of Fluid Stem Drop Rate
.00 22.00 Fine to Coarse Sand .Brown No N/A
22.00 27.00 Fine to Coarse Sand Light Gray ? Yes T N/A
27.00 39.50 Fine to CoarseSand Brown _ Yes N/A
BEDROCK
From To Code Comment Water Drill Extra Drill Rust Loss/ # of
(ft) (ft) Zone Stem Large Rate Stain Add of Frac
Drop per ft
1/1
2008 JUN 28