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HomeMy WebLinkAbout0710 WAKEBY ROAD - Health ?l 0 WAKEBY RDCO-61 L tS_ A= 012-003. 005 J � ?*WNT1VfA STABLES LOCATION SEWAGE# VILLAGE _ AA ASSESSOR'S'MAP&LOTS i38-•Ob - 08$ INSTALLER'S NAME&PHONE NO SEPTIC TANK CAPACITY ''-LEACHING FACILITY: (type). (size) V X 30 u NO.OF BEDROOMS 6 B TILDER OR OWNER 6 r� �1 I ` WV PERMITDATE: OMPLIANCE DATE: 3, 21, 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 of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by `3 l 4 J H No. � FEE �h Q THE COMMONWEALTH OF MASSACHUSETTS 's !7IVA1 1;-mi'- , MASSACHUSETTS �pyfirafivn fur Tonstxurtiun 11ormit Application is hereby made for a Permit to Construct ( ) or Repair( ) an On-site Sewage Disposal System at: Location Address or Lot No. Owner's'Name,Address and Tel.No. ��-44/vzrz ids, je Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No. of Bedrooms S Garbage Grinder( ) Other Type of Building No. per Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 11P OQlA6�12- gallons per day. Calculated daily flow 3,30 gallons. Plan Date toe, /S,/ J' Number of sheets /' Revision Date Title SS TG/S /rR��' A114 I 4/l e ho/i Z �/zr� 11_ Description of Soil -36`1-Z& Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-site sewage disposal system in accordance wi v'sions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Com " ce has ssue his Board of Health. �31j 3 ^ Si ed Date (,� Application Approved by IS Date Application Disapproved for the following reasons Permit No. / ze — ��]� Date Issued (10- No. '� FEE Q THE COMMONWEALTH OF MASSACHUSETTS MASSACHUSETTS �jajjltrntivn for Bisposal ,§Vs#em (fonstrurttun Ilermit Application is hereby made for a Permit to Construct(�) or Repair( ) an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. "7 Lo; AM- 5- bi ,401 y )Z,v /17,cf/. �� `irz W/�ew;` 4 77-29 2 4- Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No. of Bedrooms Garbage Grinder Other Type of Building No. per Persons Showers,( ) Cafeteria( ) Other Fixtures Design Flow A1a✓0rL� gallons per day. Calculated daily flow -33 a gallons. Plan Date OG 5 /9 J Number of sheets / Revision Date Title f T.Al,Srs✓A�c- Descri tion-of Soil `� Gdf31Yf Nature of Repaik or Alterations(Answer when applicable) Date last inspected: i -Agreement: r The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-site sewage disposal system in accordance witt�.t�lre-p visions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Complia ce has b e 'ssue his Board of Health. -31) -3/0(, Si ed Date Application Approved by r Date — �/-In t Application Disapproved for the following reasons r Permit No. / la — �`7 Date Issued THE COMMONWEALTH OF MASSACHUSETTS #M_oz,_ h � fy. , MASSACHUSETTS � �er#t�t>ctt#e of C�IIzttyIta>tt>ce THIS IS TO CERTIF that the On-site Sewage Disposal System installed Cxj or repaired/replaced( ) on , '/ at 1 - - been constructed in accordance with the provisions of Title 5Tand the for Disposal System Construction Permit No. dated . Use of this system is conditioned on compliance with the provisions set forth below: The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. This Certificate expires on le DATE 1-14 Inspector - q //THE COMMONWEALTH OF MASSACHUSETTS No./�' S `7t�� Pr �� P�f , MASSACHUSETTS FEE 6 r - �ts�IIS�X ��S#eriY �IIrts#r�#tIIrt �exmt# Permission is hereby granted to to construct(,,4or repair( ) an O -s�Sewage System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. All construction must be completed within two years of the date below. DATE — '�X Approved by FORM 1255 Rev.3/95 A.M.SULKIN CO.-BOSTON,MA ENVIROTECH LABORATORIES, INC. MA Cert. No.: M-MA 063 449 Rte. 130 • Sandwich, MA 02563 (508)888-6460 • 1-800-339-6460 FAX(508)888-6446 CLIENT: Fitzpatrick Home Build. Co. ,Inc. LOCATION: Lot 710 ADDRESS:P.O. Box 154 Wakeby Rd. Forestdale, MA 02644 Marstons Mills, MA SAMPLE DATE: 12-11-95 COLLECTED BY: All Cape Wells DATE RECEIVED: 12-11-95 TIME: N/A LAB I.D. #: E12-113 JOB TYPE: New Well SAMPLE I.D. #: E12-113 WELL SPECS. : N/A RESULTS OF ANALYSIS: Parameters Units Recommended Limit Result Coliform bacteria/100ml (MF Method) 0 0 pH pH units 6.0-8.5 7.45 Conductance umhos/cm 500 206 Sodium mg/L 28.0 14.8 Nitrate-N mg/L 10.0 0.42 Iron mg/L 0.3 IT 0.05 Manganese mg/L 0.05 0.02 Volatile Organics See enclosed report. EPA Method 601/602 ug/L None detected. r 'i. Yes No WATER IS SUITABLE FOR DRINKIN POSES R PARAMETERS TESTED. XXX Date Ronald J. E#ari Laboratory Director IT = Less Than GROUNDWATER ANALYTICAL EPA METHODS 601 and 602 Volatile Organics (GC/PID/ELCD) Field ID: E12113 Lab ID: 12401-01 Project: Fitzpatrick/7-10 Wakeby Batch ID: VG3-0479-W Client: Envirotech Sampled: 12-11-95 Cont/Prsv: 40mL VOA Vial/HCl Cool Received: 12-12-95 Matrix: Aqueous Analyzed: 12-12-95 PARAMETER CONCENTRATION REPORTING LIMIT (ug/L) (ug/L) Dichlorodifluoromethane BRL 5 Chloromethane BRL 5 Vinyl Chloride BRL 5 Bromomethane BRL 5 Chloroethane BRL 5 Trichlorofluoromethane BRL 1 1,1-Dichloroethene BRL 1 Methylene Chloride BRL 1 trans-1,2-Dichloroethene BRL 1 1,1-Dichloroethane BRL 1 cis-1,2-Dichloroethene * BRL 1 Chloroform BRL 1 1, 1,1-Trichloroethane BRL 1 Carbon Tetrachloride BRL 1 Benzene BRL 1 1,2-Dichloroethane BRL 1 Trichloroethene BRL 1 1,2-Dichloropropane BRL 1 Bromodichloromethane BRL 1 2-Chloroethyl Vinyl Ether BRL 5 cis-1,3-Dichloropropene BRL 1 Toluene BRL 1 trans-1,3-Dichloropropene BRL 1 1,1,2-Trichloroethane BRL 1 Tetrachloroethene BRL 1 Dibromochloromethane BRL 1 Chlorobenzene BRL 1 Ethylbenzene BRL 1 meta-and para-Xylene * BRL 1 ortho-Xylene * BRL 1 Bromoform BRL 1 ` 1,1,2,2-Tetrachloroethane BRL 1 1,3-Dichlorobenzene BRL 1 1,4-Dichlorobenzene BRL 1 1,2-Dichlorobenzene BRL 1 QC SURROGATE COMPOUND SPIKED MEASURED RECOVERY QC LIMITS a,a,a-Trifluorotoluene 30 29 95 % 87 _ 113 %. 1,2-Dichloroethane-d4 30 31 102 % 83 117 BRL = Below Reporting Limit. * Non-target compound. Method References: Method 601 - Purgeable Halocarbons and Method 602 - Purgeable Aromatics, 40 C.F.R. 136, Appendix A (1986). LOCATION STABLE # 'I VILLAGE SEWAGE MAP& LOT3!1a, tie x� pas INSTALLER'S NAME&PHONE N SEPTIC'TANK CAPACITY f LEACHING FACILITY �- (type) r (size) X 3 0 x �. NO.OF BEDROOMS BUILDER OR OWNER _I � �1 I PERMITDATE:_I i 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) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by Feet G �_� 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 1' FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) and 200 Main Street Offices at the Licensing counter. DATE: y Fill in please: - - APPLICANT'S YOUR NAME: ipl%�iCj 9 BUSINESS - YOUR HOME ADDRESS: iF • :5d 3�- t 7z Teti-� <57 - �� TELEPHONE # Home Telephone Number: NAME OF NEW BUSINESS NEBUSINESS OF BUSINESS IS THIS A HOME OCCUPATION? '"YES —NO J Have you been given.approval from theUbuil g.divisi�?_'YES---NO- ,ADDRESS OF BUSINESS did - 6 ,2!L 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 the Town of Barnstable. This form is intended to assist you in obtaining ,the information you may need. You MUST GO TO 2 of Main St. -.(corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate p - 00 operate your business in this town. y ppro riate permits and licenses required- o eg 1 . BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Si9 nature COMMENTS: 2. BOARD OF HEALTH This individu h info rmd of it requirements that pertain to this type of business. Authorized Signature** MIUSTCOMYNTHALL COMMENTS: HAZARDOUS MATERIALS RtGULATIONS 3: CONSUMER AFFAIRS (LICENSING AUTHORI ) y This individual een inf- h e in uirements that pertain to this type of business. Authorized Signature COMMENTS: Date: TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: - E wiw A Rice.4 L611v,4 c 1EA/,1,r/ BUSINESS LOCATION: 710 - IA14 R INVENTORY MAILING ADDRESS: 114,05L,115 /4/0 - /174 - Od-Lg TOTAL AMOUNT: TELEPHONE NUMBER: L 37 47 ad, CONTACT PERSON: RA TRICIA A/ L 61AIA,. EMERGENCY CONTACT TELEPHONE-NUMBER: C��!2:> 3 6 Z 3 MSDS ON SITE? TYPE OF BUSINESS: C LE�4i✓/�/� INFORMATION/RECOMMENDATIONS: Fire 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 rl NEW USED Cesspool cleaners v Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides 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 A 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 Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers (including bleach) Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS J4 4w;l. rit d e, _r 1 -H Date: TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: PL - l-(.E19iviwc) rPA (?1C1f:; L611t,14 cec-41,-i1fr', BUSINESS LOCATION: 7/0 vJ4 INVENTORY MAILING ADDRESS: 11,41,IDES ,yl/11s - 104 - TOTAL AMOUNT- TELEPHONE NUMBER: C e-j ) Li37 -/7a�_ 7 CONTACT PERSON: RA 12iGIA /L/ L (JA,1,4 EMERGENCY CONTACT TELEPHONE-NUMBER: (�<n�l 3 MSDS ON SITE? TYPE OF BUSINESS: C CEA�✓/�/��tf Fq ' INFORMATION/RECOMMENDATIONS: Fire District: ti e �• 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 �l NEW USED Cesspool cleaners v Automatic transmission fluid / Disinfectants Engine and radiator flushes Road Salts (Halite) I Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides 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) ICaulk/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, iI Misc. Flammables hydrochloric acid, other acids) Floor& furniture strippers Other products not listed which you feel Metal polishes 1 may be toxic or hazardous (please list): Laundry soil & stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS CERTIFICATE OF ANALYSISFREC � a° e:Barnstable County Health Laboratory 2003 �ss�citus�^/ i Y Report Dated: 4/30/2003 Report Prepared For: TOWN OF BARNSTABLE HEALTH DEPT. Order Number: 3-1950 Jose Luna,Jr 710 Wakeby Road Marstons Mills, MA 02648 Laboratory ED#: 0319505-01 Description: Water-Drinking Water Sample#: 19505 Sampling Location: 710 Wakeby Road, Marstons Mills MA Collected 4/24/2003 Collected by: Jose Luna Jr. Received 4/24/2003 Routine ITEM RESULT UNITS MCL Method# Tested LAB: IC Lab Nitrates 1.1 mg/L 10 EPA 300.0 4/24/2003 LAB: Metals Copper <0.1 mg/L 1.3 SM 3111B 4/25/2003 Iron <0.1 mg/L 0.3 SM 3111B 4/25/2003 Sodium 8.3 mg/L 20 SM 3111B 4/25/2003 LAB: Microbiology Total Coliform Absent P/A Absent 309 4/24/2003 LAB: Physical Chemistry Conductance 79 umohs/cm EPA 120.1 4/24/2003 pH 6.8 pH-units EPA 150.1 4/24/2003 Note: Water sample meets the recommended limits for drinking water of all above tested parameters. Approved By: = h `( S ' (Lab Director i t f S �,� ,.tlx.: ,.. .. .,.: ., ,... •'i,_ . .. E Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 VJ i - 60 Gd,l�_ -` -- t . Fee- BOARD ---------- No BOARD OF HEALTH TOWN OF BARNSTABLE v0 0o3la o� Applicat ion,for Vell Construct ion Permit Application is hereby made for a permit to onstruct ( ), Alter (, ), or Repair ( an individual Well at: 0/ Location — Address Assessors Map and Parcel Owrfer Address v{a5-�' .Q, _ ---AiA---C..af>6----WI_X1 ------ -------- ' d I � _ r -- ------- Installer — Driller Address Type of Building ' Dwelling 1#� 1'e ------------------- Other - Type of Building ----- No. of Persons---f=f---------------------— -------- �i Type of Well- - ---—�v '- ----- Capacity- Purpose of Well---�PCS-trA)-Q'1-1-E=--- �'�------ Agreement: of rib individual well in accordance with theprovisionsTh The undersigned agrees to install t o 'describe a ua a of e R I I Town of Barnstable BoarAHeallhP o ell Pro tion Regulation - The undersigned further agrees not to place the well in operatit Com 'ance -been issued by the Board of Health. AA /-WA A Sig - -- - -------- date Application Approved By -- ( - ---`"` -�?d l�'la SS date Application Disapproved for the following reasons:----------------------------------------------------------------------------- - —-- - ---- --- — -- -----------—--- -- -- --- -- _------- n date Permit No. -_—_ �' a _-------- Issued------/P`---6-- -------____—___-_--- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed Y ), Altered ( ), or Repaired ( ) Y- ----- ------1,-=- i 1Y,.__ Installer at- -- -�6 lea- -_ VIA-M 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. -- =--- --DatedTHE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE------------------- -- - ——-- Inspector----------------------------------------—--- ----------- *s.r�.,fc:r^�Y' f,:,.�wri'"��`R"^ Y'^�'S-1�►`y.4 t�_:.sit...'r1}^'^M4.,�7�}l"Y .^Lfi`N.-r•t�tf'r'..'.,. w. J No -,q, BOARD OF HEALTH ,,r-: -TOWN OF, BARNSTABLE 01 � 1 � � - ZppCicat ion for IV ell ,,.pn0truct ion Permit; r Application is hereby maa\de for a permit to Construct ( ), Alter ( ), or Repair ( an individual Well at "! Location—,-Address Assessors Map and Parcel moo-. Owner Address T43 v f Q 6ZA AX ---CAP- ---4 V-----M oZ$3� Installer — Driller ; Address ! Type of Building Dwelling-----� '1 - ------------------- Other - Type of Building -- - No. of Persons----�f----------------- ---------------- ' Type of Well- --4'-— v "' - Capacity ---------- - - --- --—----------- Purpose of Well--��--n'!�—---- -�- - Agreement: The undersigned agrees to install t afc describe individual well in accordance with the provisions of The Town of Barnstable Board of Health P iva�a ell Prot lion Regulation - The undersigned further agrees not to place the well in operation until r fic t Comp 'ance as-been issued by the Board of Health. 1 , t r Sig • ed - ------- - -�Z- ' date Application Approved By - --------r--; ------ - - — ---------- date Application Disapproved for the following reasons:---------------------------------------------------------- - -----' ---------- • /3 � It � �� � date Permit No) Issued=-- - -'�- - -- — ------------- a---- — --____--� date BOARD OF HEALTH r TOWN OF BARNSTABLE (Certificate ®f Comphance THIS IS TO CERTIFY, That the Individual Well Constructed ), Altered ( ), or Repaired ( ) by- -- - A! � -----C� .= __ 4 i A Installer VIA M 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. Dated1�/��- - 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 Ive[C Con5truct ion Permit No. ------- Fee-------------- Permission is hereby granted-�?��- � '�/ -�'f� � !pY--`------------��� _�------- to Construct (�), Alt r ( ), or Repair ( ) an Individual Well at: No. ------------------------------------------------------------------------------- street as shown on the application for a Well Construction Permit ef No. -----------k-- {= -------_—___ - Dated -- --------------------------- ----------- -- G - Board of Health DATE------ — 4 • WAdw Z-5ycSTeM f'i iFilLel� , r�-.JAIZXTI�tW r 44, 9Q.2 CO.v K/SR " X. M 2 Scc�3E FiI✓, �.e.9.cFST NO 1 TEST wo. 2 �D "MAIV, �"M,#,k, ' Iy.�+,1'. 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