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HomeMy WebLinkAbout0185 CURTIS ROAD - Health 02n—dl(A—Tcx> PARCEL FASSESSOR'S MAP NO 01 a -1 ) 7 CATION _-1 --200 S E W A,,G E PERMIT NO. VILLAGE s . ej elf 6Pi ,,)® sue I N S T A LLER'S NAME ADDRESS R U I L D E R OR OWNER DATE PERMIT ISSUED AV DATE COMPLIANCE ISSUED �, � � � ----__ �: ,, .,�� � �� L_�� � � - � �� i � � � - ,a � � �� � © � �� a ® Fps..No.... +.... - 1 16 Lo . ...................._. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH UZ(o --0k6-_TCC) ................ .....................O F....................................... ..._..._... Appliration for Dispniitt1 Worko Tmitrnrtinn "truth Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ......�.. D .. 1��?.l l ....-C�o ............ ............. .........•-.....--•--•----............------•-----•---------•----•---•----------............_..... cation.Address or Lot No. ©, ---------------------------------- ------� rf.. �,� '"r ----_ -------------------------- Owner Address ot 00 Installer Address UType of Building tf/Do 0 t`t�i¢�1.� Size Lot-___y!.�3..A:_Sq- eet Dwelling—No. of Bedrooms...............�.._........._._._....___....Expansion Attic ( ) Garbage Grinder (*4 `4 Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures ._._._. ------------- ----- ----- --------------••-------•---------- �o•--••-------•-- ------------------ - - w Design Flow....................... '._ .__.___..gallons per person per day. Total daily flow....... ...__._.......gallons. W Septic Tank—Liquid capacity.00..gallons Length.•'`•....... Width... Diameter-_--____-____- p ly.......... .vv Depth x Disposal Trench—No. ......_��_ _._.__ Width.................... Total Length_._.........__.... Total leaching area....................sq. ft. Seepage Pit No..(d P !"Diameter...(Ez.__..__..._. Depth below inlet..__.._......... Total leaching area(0,_:7*_'_.sq. ft. Z Other Distribution box (k< Dosing tank ( ) aPercolation Test Results Performed by......................................................................... Date----------- ............................ a Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water...................... G%, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..................-:_-_- a -••-•-•--•••-----------------•-•-••••-•••-•--•-•.........••-•-•--•••..._•-•-•-......--••....------•--------- ----------- •--------------------•----------- 0 Description of Soil....................................................................................................................---------------------------------------------•-•••- x w UNature_of,._Re airs or Alterations—An�wer when a plica} ee. .&9jeV �Y......ll.'4-P.....C4-&rr®0_ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i T';E 5 of the State Sanitary Co — T nder 'gned further agrees not to place the system in operation until a Certificate of Compliance has been s e y he bo of health. tgn •• :. ................•. --------- -- . r-...-•--•-......•.........••••• Da .............. Application Approved B Date Application Disapproved for the following reasons:-•-•---••-•---•-----•--•----•--•---•--•---•------•-----•--------•-•------------•---------------••••---•--------- .........-•------•-••-••••....---••-••-•••••-•--•-••-•••-•••••-•---••.....----•-•-•................•--•---•--•••-•----•---•--•••-••••-•-•-•••-•-•••------------•--•----••••--••---------•-----•••-•••--- Date PermitNo......................................................... Issued....................................................... Date No.....3.b.: Il l FEs............._............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........... .. ... ....................OF.................... Appliraation for Uhipmal Works Tumitrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ..,.----•---..................................................................................... ............................................... ..._.. •--........... Location-Address or Lot No. --.•-•-•-----------------...------------.............-^............•............................ ......••-------.................................................•••-•---.......................... Owner Address W Instal Ier Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—.Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ------------------------------•---------------.....--'-----------------------------------------------•-•-- 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........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water_--___--_____-__---__--. f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ............................................................................................................................................................ 0 Description of Soil........................................................................................................................................................................ x c.� ---•-------------------------------------•----------•-•-----------------------------------------------------•-----------------------•------------------------------------------------------•------------ ---------- ------ --• ----------- -------------------- - -- --- -------- -••--•• _ ------------------------------------------ ••----------. U Nature of R airs or_Alterations—Answer when ap licakl�._. .t .. . .. _.C� S.SV----00 Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT 5 of the State Sanitary Co e—T' rider igned further agrees not to place the system in operation until a Certificate of Compliance has bee 's e y the bo of hFalth. XSign -•-- •-------........ ........... -- .................................... D to ApplicationApproved By........................................ _........... --••---•-• . --................ ............i 1'1)ate-- Application Disapproved for the following reasons:-------•-----------------•-•----•---------•--------•---•---•---------------••--------------•-•--•••---•--....-- ......................................................-............................................................................................................--•--••------•--••------•-•-•-----••-- Date PermitNo......................................................... Issued....................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Trrtifiratr of`TumpliFanr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired } b ------•-•----------•.•----------------------------•--•------------ ........ at....................... b ti CG r q t Instalte > OC t [� - fA 1 t`1 0 •---•---•----------------------•----••---•••-----•----............. �` 1 has been installed in accordance with the provisions of TILT�I',!� 5 of The State Sanitary Code e rlbed in the application for Disposal Works Construction Permit No.......... _-_��-`r.............. dated- e)� Ci__._............ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE......................... .. ..... . 7 Inspector 0­4� --_- �. .........._ TOO i a -7 — I(. - f o o THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH d 6- P q ...OF........................................................I—........................ . 7 S No......................... FEE........................ Rapimatl 1vorko Ton#rudiora "pan fit Permission is hereby granted--------••�c��................ !.!k.nj.q t0............................................................................... to Construct ( ) or Repair (N) an Individual Sewage Disposal Py�m at No.............................��_Q.••-------••-_. } S• .........r->a .. 1`o'` U Street as shown on the application for Disposal Works Construction Permit No. 6__/1'H... Dated........ �. - ...................... and of Health ATE................... .. .............................................. FORM 1255 HOBBS & WARREN. INC., PUBLISHERS i 1 I ; eA N.K_ 3 /50d �frT� �5b i Tif AZ 6O-Y I i i t � r i 5 F 1 ii TOWN OF BARNSTABLE LOCATION /e� 4 6" / SEWAGE # VILLAGE//AiA�(rX4 VY26 ASSESS 'S MAP & LOT 007 cit,,,V 00 Tom_1S 6?67"Vp S NAME&PHONE NO. SEPTIC TANK CAPACITY 16W&J LEACHING FACILITY: (type) (size) /000 NO.OF BEDR T BUII.DER OWNER PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 o:Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by_� �a G� . (�No. �O� ------ V Fee------ ------------- BOARD OF HEALTH TOWN OF BARNSTAB LE Zipplicat ion,forlVell Congtructionpermit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair (->)an ind* ideal Well at: tlo ���n — 1610 ' Assessors Map an Parceell Owner f Address �'` __5 '� hS / 1 f�✓ ------------ —------------- -------------- —_— — -- -- - - Installer — Driller Address Type of Building Dwelling- ' _1__ Other - Type of Building-- -------__________ No. of Type of Well- --1 /_�� 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. S � date Application Approved __—____— — �3Ilo date Application Disapproved for the following reasons: date Permit No. Issued--3-/ - -----— ——__--— date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate Of Compliance THIS ISS TO CERTIFY, That the I dividual Wejl,Constructed ( ), Altered ( ), or Repaired (v< by LA 7f 1 taller------------------------------------------------------- at has been installed in accordance with the provisio s of the Town of Barnstable Board of Health Private Well Prote tion r1. Regulation as described in the application for Well Construction Permit NC°- Dated --- -- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--___ — ___ Inspector------------__ � J Joao ------- No.---------------- Fee------ ----- BOARD OF HEALTH TOWN OF BARNSTABLE Z(pplication jfor Vell Congtructioupertnit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair (>)an indyidua 1 Well at: ! ------ - ------- Location - Ad�ress Assessors Map and Parcel Owner Address Installer - Driller Address Type of Building Dwelling , S Ic o?f io- -------------------- "- Other -Type of Building-----__-_____________ No. of Persons-------------------------__-____-_____ Type of Well-y r_ � Capacity Purpose of Well a� �� __>-------_—__-- — Agreement: - t' 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. date _ I Application Approved -_-_______—---------- - date - Application Disapproved for the following reasons:------____-_—---_-_____—______ ---date---------- ��(o --CO / J Permit No. --- —---- Issued—__��-1�J `+'' -- - - - - -- ----------------- date '_ -______-_.._______________-___-__-______.-_______..___-__..-_______-___ f BOARD OF HEALTH TOWN OF BARNSTABLE I„ Certificate Of Compliance THIS IS TO CERTIFY, That the I d'ivi 'dual Well Constructed ( ), Altered ( ), or Repaired (1_r, by di4taller_ -- - --—---- ---- ---- at__-'_<9 5 has been installed in accordance with the provisions of the Town of Barnstable tB1oaardof Health Private Well Protection Regulation as described in the application for Well Construction Permit No"�"=��'- Dated-3-)L9J THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. i DATE-------- — - —-- Inspector----------------------------------- k BOARD OF HEALTH TOWN OF BARNSTABLE Vell Con5truct ion Permit No. Fee- _ Permission is hereby granted -'�� �� ���/ `''��//_ r /��✓l____-____ to Construct ( ), Alter ( ), or Repair (4- )"an Individu I Well at: —_ —_ ----- -- -------------- ------------------------------ Street as shownon.the application for a Well Construction Permit bq)� nD9e—d*-eNo. � -----------------— --- --------------- Board of Health DATE /0 -- - -- - --- �J No. BOARD OF HEALTH ''�� Fee---=- ------------._--- C7" � ��,, TOWN OF BARNSTABLE Application-for Uh Lon tructionpermit g cv1�s Eog Application is I ereby made for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: )--�- — � v T�—��-�`� --------------------------------------------P--------------------------------------- ------------------ -------------- -- ------------- Location — Address Assessors Ma and Parcel - ------------------ -------- - Otorl --------------------------------------------------------------------- Owner Address -4-F�,� J T %Off'' G- 13� �_ 1 ______________________-____-� ��__-___ -_-__-_--_____-__---__- _- Installer — Driller Address Type of Building �l Dwelling----------- " --------------------- Other - Type of Building ----------- No. of Persons---------------------------------------------------- Typeof Well— -—- - e-------—----------------- Capacity------------------------------------------------------------------------ Purposeof 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 Certific of Co pliance has been issued by the Board of Health. Signed- —- --------- O date Application Approved By ----------- ------------- date Application Disapproved for the following reasons: -------------------------—------------------------------------------------------------- date Permit No. - - r O Issued --- -�!_ ! �f --— - �`t� -- —— --—------------ f- - date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of 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 Boar of ea h 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--------------------------------------------------------------------------- ,a BOARD OF HEALTH TOWN OF BARNSTABLE,, Cedifitate ®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 Boar of ealth Private Well Protection Regulation as described in the application for Well Construction Permit No.(j), Dated------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. r DATE- --- -----— —-- - — —-- Inspector-------------------------------------------—— ------------ BOARD OF HEALTH TOWN OF BARNSTABLE well Con$tructiouvermit No. o Fee-----�------------ 0 , Permission is hereby granted— - -�----------------------------------------------------------------------- to Con truct Alter ( ), or rir ) an Indivi al We at: N o. --� --� � --[W_ — -�--/�-&�1-1- ` ---------------------------------------- as shown pn the appli ation for a Well Construction Permit No. - - - — Dat - - --- -- ---- --------------------- ----- oar o ealth Bd H DATE— -�r-�_�-��----------------------------- 1 t 1 Sdv�i - .or NO. t -L'l__- `k P i A^?�' ,'• �• ^^�� Fee --. BOARD OF HEALTH -TOWN OF BA,RNBT,ABLE tk y hration-*rUh ructionpermit Application is ereby made for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: -----------—=-=—-----—--------------------—----- ------- —----------------.------------ Location — Address Assessors Map and Parcel Owner 'Address FcA-,,f- -------1-3-a---- Installer Driller .Address � Type-of Building fi Y' g ' x Dwelling-- - - --------------------- Other - Type of Building ------------- No. of Persons-------------------------'--------------------------- `„ v G Typeof Well----------------------�-------------------------------------- Capacity-----------------------------------------------------------------------'- Purposeof Well--------------------------------------------------------------- S 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 ertific .of Co pliance has been issued by the Board of Health. Signed - --- -- -- -- ------------- -- -------- date Application Approved By -- - -B - — -- ------------------ date Application Disapproved for the following reasons:----- --------------------------------------------------------------------------- ------------ -- -- --------- - -- -- - --------------------------- ------------------------------------------------------------------------- J,� ) date - ----------- I Permit No. -�-✓ --- Issued ----1 L-- /1 --- -------- - date - P10hJ 1 4 :51 EN+l I Rl7TECH LABS 509 BBB 6446 P. 01 ENVIROTECH LABORATORIES, INC. MA Cent, No.: M-MA 063 449 Rte. 130 4 Sandwich,MA 02563 (508)888-6460 • 1-800-339-6460 FAX(508)888-6446 CLIENT: Aqua Jet LOCATIONS Curtis Rd. ADDRESS: c/o Bob Glover Barnstable MA SAMPLE*DATE: 11-6-96 COLLECTED BY: Chucky DATE RECEIVED: 11-6-96 TIME: N/A LAB I.D. #: E11085 JOB TYPE: New Well SAMPLE I.D. #: E11085 WELL SPECS. : 44, Deep RESULTS OF ANALYSIS: Parameters Units Recommended Limit Result Coliform bacteria/100m1 (MF Method) 0 0 pH pH units 6.0-8.5 6•77 Conductance 1whos/can 500 110 Sodium mg/L 28.0 10.7 Nitrate-N/Nitrite-N mg/L 10.0 0.05 Iron mg/L 0.3 2.66 Manganese mg/L 0.05 0.102 Volatile Organic Compounds See Attached Report EPA Method 524.2 Chloroform ug/L 100 1.9 Naphthalene ug/L N/A 12.4 Toluene ug/L 11000 14.1 1,2,4- Trimethylbenzene ug/J, N/A 0.5 1,3,5-- Trimethylbenzene ug/L N/A 1.3 Total Xylene ug/L 10,000 0.7 COMMENTS: Iron and Manganese are not a health hazard, but may cause taste, staining, and odor problems. Compounds are probably from glue used in well construction. Y1J5 WATER IS SUITABLE FOR DRINKI OSES FO ARAMETERS TEST x &UDate l �i Cathcart Ch iat LT = Less Than • a - I l '1 1..I1 1 I' I_I F_ 1 I-I 11-I l _ _ U , " �P l',7 ORATORIES,INC. �--. NNVIRONMRNTAI,TUSTINO 50 Hunt Strcet WAST13 WATER DISCHAR011 MINIM). MA 02172 T1=,STING F1 (617)923.0,300 FOOD ANALYSIS 11AX(617)923.0301 CH 13M ICA 1.ANALYSIS FORENSIC TnSTIN0 REPORT LAI3 NO. 567159 Mr, Icon Saari November 15, 1996 ENVIRO'TECH I 13ORATORIES, INC. SampleReoeived: l l/$/9(, 449 Route 130 ChC11 1,1).; Agttll Jet Sandwich, MA 02563 Sarnpfo 1,D.: 01 Curlia Road Telt Results: -^ Valatile.01taniey.ppb(upQ ..�•...__ T Nothod#524.2 13cuzene NU 1,2-Dichloropropsno ND 13romobett�eno NU 0-Diohloropropeno ND Bromoohlowntethano NU 2,2-Dichfol•epmpano ND I3romodioltloroluothttno ND 1,1.Diohloropropono ND Bromoform ND Cit-1,:3.Dichlomprapone ND DretuoIItethano ND I'rona-1,3-f)iohiorepmpcnc ND N•13ut}1113onvcno ND hthylbc>ttto ND S-4311kyl BwAue NI) Hcxeohlorobutadiene Np Terf-Butyl Benzene NJ) Isoptopylbewene NJ) Carbon Tetraovloride NJ) P-Iuoprop)9tohlene NJ) C Chloroh iatto NJ) Methyl Chlorido NU NY) Naphtllalao 12.4 ChllChloroformform 119 N•1%pylbowwo ND Chl ometbAue ND Shrctno ND 2-Cl,Ioratulticnc• ND 1,1,1,2-Tetrachloroothame Ni) 4-Chlorotohreuo NI) 1,1,2,2-'1'ctreuhlori,clltanc NU 1,2-0 bromo•3-cblatvpropauo Ni) ')otraobloroothona ND Uit+roulonletLane ND 1'olofto 1,2-1)icfiloittl,ollzono ND l4:1' 1,3.1)ichk,robonz<alta 1,2,3-Triaorobotme NY) 1,2,4-Tiiohlarahon�ono ND 1,4.11i�}dorob�y�e NI) 1,1,1•'1'richlolXlotllueo Np Dibromoohjoromebano Nl) ],I,2-'1'richlorocthano ND 1,2•Tlybthnw1harto (91)13) NJ) !)iolriorodiiTuoromethano NDrrichlorofluoromdhatte ND 1,I-Diohlarcbthuna 7rrlohlorc,ctbeno NI) i,2-l.)ioLlart>otlrano F,1)C NJ) 1>2,3=1'riohloropropamo ll { ) NJ) 1,2,4-Trimothylb0U0uo N l,i-1)iohiomoAlefc�nd NO 1,3,5-Trttnctllylbagaetto 1.3 Cia-1,2-Diohlor00thyJono ND Vinyl Chlorido - '� ND Total Xvleme N.D. Not 1)ctloctcx] Anstlymitt lato: i i/14/96 MetLad Lm-wion 11mit U, ug/!, 1 1.2-1)iohlar�be17Q1te-O 80 P-131"nnofluorn wnZwo 100 TcSd'19 ` W&4n g Services mes Folttenaarosu,l✓ab Managor for over 30 Years , , , 71d4 Nrc o iR rcndr-witonw.ct upon the conditlaU Ihn1 It Is 1101 W W icproduvod wholly or III pert for adyCrllsing or other porpoaea over nt,r alrnAture or Ut connection eck l'u n4rlle wi1110111 6Mnaal pr1,1111 siorl in willitty„-1b141110101y 1i ihnitod 10 the invoiced nrnounl.11M ri4lga ustrd�elrr only to rcctod,amplca anrllnr npplieahle pnrnracirrs,