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HomeMy WebLinkAbout0080 GREAT BAY ROAD - Health 80-_Great Bayt �osterville of 4 - i �i i v TOWN OF BARNSTABLE LOCATION E# �1 VILLAGE V►'I AS ESSOR'S MAP&PARCEL S NAME&PHONE NO. SEPTIC TANK CAPACITY 5'003 I LEACHING FACILITY.( e) ��►eJL M (size) NO.OF BEDROOMS OWNER I6 .� PERMIT DATE: C9b9ddANQk DATE! P. ip Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY I No..--...... - Fxs....�?. .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH SUBJECT TO APPROVA.1, /0(,u.aJ. BARINSTABLE oF.... ' .7�/3G BARNSTABLE coly t.® COiNSER�gqTIo;� IU MISSION Appliration for Uigpu, al Workii C omtrurtion Pumit Application is hereby made for a Permit to Construct 4 or Repair ( ) an Individual Sewage Disposal System at: 9 , .............................. at Lot Address //Aye or of No. .... ......... ..:... •-•_ _ •----------------- --------------------------_- •-••------------------•----•---------------------•- wner Address W a -••.....- t.+----- ------------.7._4-0----------------.---.---. ------_------------------Ad d_` --------------------------------•---...--------- Installer dress VType of Building Size Lot.. ......Sq. fe t dwelling—No. of Bedrooms---•-• __ _ _ ___________________Expansion Attic � Garbage Grinder p, Other—Type of Building --------------•---_----- _ No. of persons____________________________ Showers ( ) — Cafeteria ) Q' Other fixture W Design Flow..................41� .........r......gal lons per person p'or day. Total d?il� ,flow............. �..�..._____._.___ Ions. WSept n • uid capacitv�,S�gallons Length_��.`4.... Widths. ....... Diameter________________ Depth_ ._.. x Disposal No. .__..4 ........ Width..../--•------- Total Length__Z_�j�__........ Total leaching area�.C�-.....sq. ft. Seepage Pit No--------------------- Diameter..:................. Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosin "Qtank �, / -7 Percolation Test Resu Performed by. 1 ..'�.L_r✓lest _:__. .�_: u .._...__ Date.._..Se�'. ._1''. .__.... aTest Pit No. 1____ Z---___minutes per inch Depth of Pit��. ._....... Depth to ground water-�a-_-___--.__.. f%4 Test Pit No. 2................minutes per inch Depth' of Test Pit__-,.0......... Depth to ground water_ .........._... a. *. O Description of Soil••-0f�•-•-�V1�..... 1 ® .._... . ... !U ................................ U -............ -......................................................................... `2.i...-•-=•--••-•--•---------•---••---•••••-•-••----•••--------•-•••••---••••-••--•-•-------•--=-------------- W VNature of Repairs or Alterations—Answer when applicable................................................................................................ -----------------------------------------------•-----------------------------------•--.............---•-----------------------------.--------------•-•-......--••••-------•••--•-•--•-••-------.--••-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TT y g g p y 5 of the State Sanitary Code—The undersigned further agrees not to lace the s stem.in.._.:� operation until a Certificate of Compliance has been iss d b the board of health. Signed.--••- --Y --•-•-• .......----------------•- Date Application Approved B _________________ pp ......._. PP PP y---_---- �� 7 .. �. Date Application Disapproved for thefollowing reasons:................................ --•................................. ................•----- ------...----- ...-------•----------•-••------------------------------------•----------------------•-•-----•------......-•-•---••-•-••-•-•••----•-•••-•-•-•----•-•••-•----------------••••--•-•---------------••••----- Date Permit No_____________________ ........ Issued._. -1 3,. Date "�• THE COMMONWEALTH OF MASSACHUSETTS BOARD Off` .,HEALTH .... ..*.. ..... t ' ,NV Hrutgon for Uhip ig Works Tlin i�rtivn g mit A lication is hereb made for a Permit to Construct ) or Repair PP Y ( r ( ) an IndivduaY"'�:wage,.,psposalY' w, System at: LLof ion-Address or Lot No. Address ..................................A.............................................................. ....._............................................................................................ Installer Address Q Type of Building' ,- Size Lot....... , ...Sq. feet adwelling—No. of Bedrooms....•....'"` - ---•-----._--____--__-_-___Expansion Attic' (" y Garbage Grinder p I Other—Type of Building ........................... No. of persons............................ Showers ( ) — Cafeteria a Other fixtures.-------------------------------- - W Design Flow.:_._ ...... .5 _ ---__gallons per person per,day. Total daily flew .__ 3- _...........gallons. WSeptic Tank—Liquid capacity allons Length---/4.°" ..s Width.., Diameter................ Depth... .. x Disp" Ci ` To........; ------ Width-----. -•----- Total Length....-7e. ._._,�pl Ong area -----sq. ft. Seepage Pit No............ ..�_ Diameter-__--___--- : Depth.below inlet....._.. � ; oaaching area..................sq. ft. � Z Other Distribution box ( Dosin to ( Date... ........ .. a67�Percolation Test Resu Performed by. °-- '• .. ' + .7-- ... . Test Pit No __ minutes per inch Depth of Test Pit __ ........._ Depth to ground water 1`- __---_--.-_ LL, Test Pit No. 2................minutes per inch Depth of Test Pit t P Depth to ground water .ko...__....__.. O Description of:FSoil•��---� --•-- / ._....-_ _ _.. ? d V ---•-- ...--•-----------•--------------------------•••-• ............................................................. W -------------- --------- ---------- x Natur"e"ofµ Repairs or Alterations—Answer when applicable.___......................... ........................----•-------•------•---------------•'-----------------------............------------------------------------------------------------•-------------------------................ Agreement: The undersigned`agrees-�tw>nsiall the aforedescribed Individual Sewage Disposal System in accordance,with the provisions of T T= y g g x p y 5 of the.State Sanitary Code—The undersigned further rees.not to lace the system in operation until a Certificate of Compliance has been issuedby the board of health.k t � ,.:: t;, Signed---------- --- ----- `---------•---•-•----•------•-•----............................................... ................................ Date�M Application Approved BY----•... - -+ - te` •--------- Da Application Disapproved for.the frollowing reasons: - ------ >. 1 T. Date Permit No....... ,-•--•.........::.............. .. Issued =. .... . -^ Date } THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........O F:.....6- .... T IS S TO C RTI That the Individual Sewage Disposal System constructed ( ' or Repaired ( ) by t Installer has been installed in accordance with the.p,�ovlsions -... 1, m, r. j of The Sta KeeSanitary Code.,as;described in the '.. application for Disposal Works•Construction Permit No----- `':: __ -.......... dated._. -r9„a 70f---______________ 4 THE`ISSUANCE OF THIS CERTIFICATE.SHA NOT..BE CONSTRUEd AS A C:UARANTEE THAT THE SYSTEM L ,.UNCTION SATISFACTORY. DATE........ -----•-------- Inspector - , t THE�gO MONWEALTH OF MASSACHUSETTS, BOARD OF EALTH 7 ........ No...... �1� ........... • ;FEES a .. opus rkv Culami rrn rr ti Permiss>on i seby granted_.:_._ 1� . ------------------------- to Construct ( r air ( ) n Individual e gage Dis osal System '4-C 404 o ,�� AVA41 Street as shown on the application for Disposal Works Construction Per` ' o__________?oard ______ Dated.__.__. _--�""� ,....... r: � �� r:... i �.•�., .--..__.-. f ' p (. o �a - DATE... /�--- FORM 1255 HOBBS &' WARREN, INC., PUBLISHERS' NO. Fee----Z3-------- BOARD OF HEALTH TOWN OF BARNSTABLE Zipplicat ion for lVell Con-5tructionpermit Application is hereby made for a permit to Construct Alter or Repair ( )an individual Well at: o4c, op ;30 2- Location — Address Assessors Map and Parcel ial - 13,4-Y R 6 9-0 Owner Address Installer — Driller Address Type of_B ' ' g Other - Type of Building No. of Persons---------.- --- Type of Well I G144 Capacity Purpose of Well..------ Agreement: The undersigned agrees to install the aforidescribed individual well in accordance with the provisions of The Town of Barnstable Board of Ith Private Well Protection Regulation — The undersigned further agrees not to place the well in operation til ertificate of Co hance has issued by the Board of Health. has been iss,, S' Application Approved date Application Disapproved for the following reasons: ------- --------- date Permit No. 0 Issued date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate (Of Compliance THIS,15 TO CERTIFY, That the Individual W 11 Co'ic7td V,, Altered or Repaired by t,4j taller at 111st -------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Frotection Regulation as described in the application for Well Construction Permit Nc,4905k Dated 76 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE Inspector—--------------------------- No.--- ----- Fee----- --------- BOARD OF HEALTH TOWN OF BARNSTABLE ���YicatPion,,�or�er[x�on�tructlo,�terinit Application is hereby made for p' it to Construct ( Cer ), or Repair ( )an individual Well at: ------- -------------------------------- Location — Address — Assessors Map and Parcel — [� -R o'40 --- - 0"" Address Installer — Driller Address Type of2wel c�� �' 6�G - Other - Type of Building---------------------_ No. of Persons-----------==---_____—__—_______ Type of Well `� � � Capacity / 5 �-r 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 th Private Well Protection Regulation - The undersigned further agrees not to place the well in operation u til a ertificate .of o liance has been issued by the Board of Health. Si e co a o� rr da e Application Approved By - --__-__ ___— f date Application Disapproved for the following reasons:-----_____—_—------------—_________________—__—___—__________ ------ --------- ---- - —----------------------- -- - ----- ------ �Q,a � date Permit No. -— -- Issued----- -- - - -- ---— ------------- dat---------------------------------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS tT0 CERTIFY, ThAt the Individual Well Co ct , Alter d ( ), or Repaired ( ) taller at ---.......... 1has 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 -�-'�--0 �'-Dated(P/19 7 4) THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-- _ 13 --------� ---- Inspector--------------------------------------_—_---------- BOARD OF HEALTH TOWN OF BARNSTABLE Ivell Con5tructionVermit No.��©o 6 Fee-! Permission is hereby granted-- to Construct�. �er ), o �p it ) an Indict u el at: j� / Street as shown on-th hc tion for a Well Construction Permit No.- __ ------- Dated - � U --------------------- Board of Health DATE Massachusetts Department of Environmental Management - Office of Water Resources 145918 TYPE OR PRINT ONLY Well Completion Report 1. WELL LOCATION GPS (OPTIONAL) LATITUDE LONGITUDE DATUM Address at Well Location.. �" +`� &22l N8 Property Owner/Client:`- Subdivision Name: Mailing Address: - ' t3 )" fK64-4 m City/Town- �a d`�\ , City/Town: ` �. Assessors Map Assessors Lot#: NOTE: Assessors Map and Lot# mandatory if no street address available Board of Health permit obtained: Yes N Not Required ❑ �Permit NumberVJ� C ate,lssued dZ 2.WORK PERFORMED 3. PROPOSED USE 4.DRILLING METHOD NL New Well ❑ Abandon ❑ Domestic CR Irrigation ❑ Cable @,Auger ❑ Deepen ❑ Recondition ❑ Monitoring ❑ Municipal ❑ Air Hammer—,❑ Direct Push ❑ Replace ❑ Other ❑ Industrial ❑ Other ❑ Mud�Rota " . ❑ Other 5.WELL LOG Water Unconsolidated Consolidated 6. SITE SKETCH (use permanent landmarks with distances) Bearing C - p ro CDOther Ro k Typeca `o 9 From (ft) To (ft) Zones � c) 0 0 m Material Description ®. 7. WELL CONSTRUCTION 8.CASING Total Depth Drilled From (ft) - To (ft) Casing Type'and Material Size I.D. (in) Well Seal Type Date Corpplete " ZA. Nl 4.SCAM'40 c_ s w . -7 5Ie L 9. SCREEN From (ft) To (ft) Slot Size Screen Type and Material i Screen:Diamefer 10. FILTER PACK/GROUT/ABANDONMENT MATERIAL 111.ADDITIONALI WELL INFORMATION Developed? Mi Yes ED No From (ft) To (ft) Material Description-' Purpose Fracture Enhancement? P Yes t�• D No Method Disinfected? N Yes ❑ No 12. WELL TEST DATA(ALL SECTIONS MANDATORY FOR PRODUCTION WELLS) 13. STATIC WATER LEVEL(ALL WELLS) Yield, .'\,Time Pumped Drawdown to Time to Recover Recovery to Depth Below Da s Date Method (GPM)s,. (hi &min) (Ft. BGS) (hrs& min) (Ft. BGS) Date �Measured Ground Surface (FT) jj11 14.PERMANENT PUMP(IF AVAILABLE) ' 15.,NAMEIADDRE,SS OF PUMP INSTALLATION COMPANY Pump Description r" r S'` _ �tS It-} Horsepower ► v s Pump Intake Dept `>~ (ft) Nominal Pump Capacity (gpm) 16. COMMENTS 17. WELL DRILLER'S STATEMENT This well was drilled, altered, and/or abandoned under m supervision, according to applicable rules and regulations, and report' complete and c�'rrec to the best of my knowledge. ^� Driller. t%` 's�f �n r` Supervising Driller Signature: Registration #:I I ' I� Firm: y- 'T- v� ( 1 s 'a� `.` h Date: ` •O Rig Permit#: NOTE. Well Completion Reports must be filed by the registered well driller within 30 days of well completion. Y B . :Y. OARD OFLLHEALTH COP ENVIROTECHLABORATORIES, ING MA CERT. NO.:M-MA 063 8.Jan Sebastian Drive Unit 12 Sandwicly MA 02563 (508)888-6460 .1-800-339-6460 FAX(508)888-6446 Client Name Desmond Well Drilling Location Tocci-80 Great Bay Rd Address PO Box 2783 Osterville MA Orleans MA 02653 Sample Date 07/05/06 Collected By Desmond Well Drilling Sample 7-Ime 12:00 Sample Type New Irrigation Well Date Received o7/06/os Lab Order Number DW-2Ems-2741 Well Specs 3(Y/11Y Locatwn Soarce _ Date Calledert Tire Colteded 3 Lamrrrents Analysis Requested Units Recommended Limits Analysis Resuh I Method jDateAnalyze4 Analyzed By Total Coliform /100 ml 0 0 9222 B 7/6/2006 RS pH pH units 6.5.8.5 5.72 4500-H-B 7/6/2006 MC Specific Conductance umhos/cm 500 191 120.1 7/6/2006 MC Nitr te-N mglL 1.00 <0.004 3M.0 7/612006 MC Nitrate-N mg/L 10.0 <0.01 300.0 7/6/2006 MC Sodium mg/L 20A 31.9 200.7 7/10/2006 MC Total Iron mg/L 0.3 0.1 200.7 7/10/2006 MC Manganese mgrL 0.05 1.90 200.7 7/1012006 . MC Calcium mg/L N/A 1.2 200.7 7/10/2006 RAC Magnesium mg/L WA 2.1 200:7 7/10/2006 MC TDS mg/L 500 122 2540C 7/6/2006 MC Sodium Absorption Ratio 5.0 19.7 Calculation 7/10/2006 MC Electrical Conductivity Miilimhos 0.25-0.75 0.19 Calculation 7/6/2006 MC Comments: Low pH indicates high corrosive characteristics. Sodium level is not a health hazard. Manganese is not a health hazard,but may cause staining and/or give water an odor or taste. Water is suitable for l7M7; tested. Date l Z UL R Laboratory a or BRL=BelowR ortableLinnts P 1 of 1 ep age 'See Attached i BAXTER & NYE, INC. Registered Land Surveyors 32 Wianno Avenue/ Osterville, Massachusetts 02655/ Tel. (617) 428-9131 WILLIAM C.NYE,R.L.S.-President RICHARD A.BAXTER,R.L.S.-Vice President February 10 , 1981 Town of Barnstable Board of Health Town Hall South St . Hyannis , Ma.. 02601 Re : Kenneth Cameron Property Great Bay Rd. Little Island Osterville , Ma. Cent lemen: This is to inform you that the sewage system for the subject project' ha.s been constructed in accordance with the appr.oved. plans . Very truly yours , Villiam C. e , L.S. Alan T4. Jones , P.F. T4CN/AT4J/jn - MEMBERS OF CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS l AMERICAN CONGRESS ON SURVEYING AND MAPPING MASSACHUSETTS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGINEERS LOCATION SEWAG PERMIT NO. VILLAGE - INSTA LLER'S NAME i ADDRESS JOHN A. � C AR�7 i 0 BF,,,KI,OE SERVICE West Barnstable, Mass•02668 ®'UILDE R OR OWNER '. DATE PERMIJ ISSUED 'r`. DATE COMPLIANCE ISSUED 2 _ y_ � �� �� ��" �� j� � .._ ^' �To o , ���� � �'` 1 i � � �' \ �, � 11 i �� o�� � i �co � �-- � \ s 1,.GsCr a i r _a �fAti C.c v w t r Li �lj 41 Nj tO 107 475 ........... . QC�S, t "= 4-0 ` fit..CiV`1 F �mil• ►i>:�?�, • 5� 'Ili �7.1 �'.� c,. H V i A'"ZY: T1 C:. I -T 5= !'_.�.='-'M e-i l TIM 1 I i I , a t 1J G L.� G"la r,l' 1 L.�' -^ +� �jf�`✓'i�'`•r::�J�..l 4' uY 1 k2, u h(^ H c A & L4-_, , 24� �. sp i to-�'7 _.P. l'7^�>A •kc (mod l� ��,r'a. ...--�^""�Y.q� �...,..^..�vc.. �t./ �w iy�'. sa'.r.,r'• .4.t�L ..._....._.•,..Jim v 1 i , M . .r A w yr M / "'"• y� ""''+.. _,.• �� <,,,,/��-.. }... 1�/ ..e�...,,/.,,�,�}'.� ��''•...' y,•1 �--� �` � ��'. �".i �. ,.,,w,,,�.•�,..�.....�.,.,..�.._..._,_.,..._.�.•.�..._...._ .-...�.�. _-_- _ _.r______.�,_,_.�,_ice.}�J. � �.__.�.___._. i