HomeMy WebLinkAbout0249 CHURCH STREET - Health Lott 190hurch St. , W. Barnstable
'� A = 153 012 003 �
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No. 4210 1/3 BLU
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ESSELTE
10%
:?�q ahv-ram VSvN OF BARNSTABLE
LOCATION L�Z� G i���/�✓� SEWAGE #
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VILLAGE G✓ �lt/yl5o. � ASSESSOR'S MAP &LOT
INSTALLER'S NAME&PHONE NO. � �
SEPTIC TANK CAPAC= 5'0Z9
LEACHING FACII.TTY: (type) (size)
NO.OF BEDROOMS_.
BUILDER OR WNER
PERMTTDATE: Y 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 of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of le ching facility Feet.
Furnished by rr'. �.
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THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
01ppCication for Zi5pool *potent Construction permit
Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at:
Location Address or Lot No. —j+ ckV" s¢ Owner's Name,Address and Tel.No.
Assessor's Map/Parcel r w-WNW G l ewe Q ;}r.E to(,),� 0 j'"4o� '�
2.n si w
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.of Persons ( Showers( ,Z) Cafeteria( )
Other Fixtures _A J a 16 ,
Design Flow 4 10 gallons per day. Calculated daily flow tf -j— gallons.
Plan Date .3 17 17 C, Number of sheets Revision Date
Title
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 Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issue ardQ
Signed Date
Application Approved b Date2 s-ZZ C
Application Disapproved for the following reasons
Permit No. °rd Date Issued
to. �^ ;! .: Fee
N "�' ' L�)
THE COMMONWEALTH OF MASSACHUSETTS
�- - PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS-_j
0(ppYication for 30i!5pool *p! tem Construction Permit
Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at:
Location Address or Lot No. } t ly U.-r k r,4 Owner's Name,Address and Tel.No.
l 3l��Ll'o9
r g yf c #eprch o .
Assessor's Ma /Pazcel 14fply tJ � G/ �}�1 iv
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
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C 'A.1
" I�r}� � �► rc�►�s� , �dW ti � •
Type of Building: U S t " GA r(-,-5 z
Dwelling No.of Bedrooms Garbage Grinder( )
Other Type of Building - No.of Persons Showers( Cafeteria( ) s
i>
Other Fixtures
C Design Flow y(7 gallons per day. Calculated daily flow gallons.
Plan Date_ 3r�k!G Number of sheets Revision Date
Title
t Description of Soil C&S g /
Z
i
1
Nature of Repairs or Alterations(Answer when applicable)
i
f
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 Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued -oard f Health`- / /
Signed Date ��✓�A
F 01
Application Approved b q Date n
t Application Disapproved for the following reasons
I
^t- Permit No. Date Issued
——————————————————————————.—————————————
THE COMMONWEALTH OF MASSACHUSETTS
R
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed(V/ or repaired/replaced( )on �
Ir by 6A r j,� o e d AJ. Installer .5,Q n,e-
l at has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Constructio rmit No. dated
Date *�' / Inspector
Y
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYS-
TEM WILL FUNCTION SATISFACTORY.
—— % —--——— ———- —— ————————— —
No. —17 9 ——
/ ————Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
Diopozat bpotem Construction Permit
Permission is hereb granted to �" t".,f A-0�7�,
to construct( ' repair( )an On-site Sewage System located at No.#- -R,59 r _
Street
t and as described in the above Application for Disposal System Construction Permit. 461
' No. Date
The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions.
All construction must be completed ww 'n three years of the date below.
Date: A
at � � Approved b
Board<of Health
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BOARD OF HEALTH
f .
TOWN OF BARNSTABLE
- Application,forVell Constructionpermit
�Application is Zree��'by made or a permit to Construct (�, Alter ( ), or Repair ( )an individual Well at:
: ------------ --- - - = -- -- -
Location — Address Asses rs Map and Parcel
CL
--------- ----
Owner Address
- ®' ------ - U�` X � !_ ---------------------
Installer — Driller Address
Type of Building
Dwelling e-f,,)JJov,5r-----------------------------------
Other - Type of Building ------------------ No. of Persons------------- 3--------------— - -
//
Type of Well----,- - -------------------------- --- Capacity �f
Purpose of Well- 1 �C_l� I-d -a= f<`tr`tr� atL? -- fJ
J 1
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 Certificate .of Compliance has been issued by the Board of Health.
Signed f
/ ate
Application Approved By =- � --------- -- - "' �
date
Application Disapproved for the following reasons:-----------------------------------------------------------------------------------------
-------------------------- -----
- ---- - - --- - ------------------------------------
----------------------------------
date
Permit No. -— !`_ � -- ------ Issued ---- -- ---`2 -=------------
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate ®f Compliance
THIS IS TO CERTIFY, That the Individua Well Co structe ( ), Altered ( ), or Repaired ( )
by--------- - ----�-;---- -� --------(y�---------------------------------------- - - -- -r---
,�M7 Installleery
a t-6 (GCE — — — ---------------
---
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protec 'on
Regulation as described in the application for Well Construction Permit No. ----- -----------------Dated- ----w
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE- ---- -- -- Inspector-----------------------------------------------------------'----------
� « "[. ,:.v,,,•s:xivNt�'�: � +iota'�w�f"-:l.e#�'"R-"?iF�"�r!/�'�"' 'ti�w'^'�a�e"ro`er`S"�'�'�`�°�$�ihri� .:+f4,*-la i -V'"�kir!'�'',�li•,,�t�'YoYaceH,.-•.:ilk
F
RD OF HEALTH
TO B-ARN.STABLE
o.
` Yic ott or elY ott trut ton er' it
Application Is hereby made fora permit to Construct;( ; Alter ( ), or Repau ( )an individual Well at:
is Location — Address. Asses rs-Map and Parcel
„w
r LlW- ,- A _ v�%v 4- ---�r -- ---�1____.- ---6 ------------
E Owner — — Address
Installer — Driller "` : -Address
A.
Type.of Building
I
Dwelling--��-uj-t ) -
Other - Type of Building fir.- t�f'�1 No. of Persons -- €P -
3'-Type of Well- ------�--- ---------�--- --- Capacity--- ---
r
Purpose of Well t��f1A1►� C= t +14t�,_ 0----
"Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
j Town of Barnstable,Board of Health Private Well`Protection Regulation - The undersigned further agrees not to
place'the well in operation until Certificate .of .Compliance has been issued by the Board of Health:
Signed - -- --- -- -- --- ---- - ----- . - - ---------
lop $, date
Application Approved B —
r
}� date
Application Disapproved for the.following reasons =---- "-
- ------- -----------------------_-------- --- - - - -
.y _-__________—_____________—_—______—__--__—___—___—__ —.._--____—_____________________-----
_----------
_------------_-------___----—_-------—_-----___________
F date
Permit No. ------------ - Issued-- - ---- -
date
1 BOARD'OF HEALTH
T-OW N : B,ARNTAB LE
f.
�� �:� {�j��� .:�erttfirate��f, �CQm• dance - � -
- f
THIS IS TO CERTIFY That the Individua Well Co structe ( );.Altered ( ), or Repaired ( )
b __ - _ -"----- �--- -
r Y- - ---
v Installer
f
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private ell Protec ion
Regulation as described in the application for Well Construction Permit No 4f.4'-�V1Dated- OV
e;
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A.GUARANTEE THAT THE.WELL
SYSTEM WILL FUNCTION SATISFACTORY..
DATE--------=----— -- -=—- Inspector--- - ------------------- ------------ -
I k ,
;�w. .�.r.: ►: cw.-+t ...� w .ya • ram..
0 •.
r BOARD OF HEALTH
.TOWN . OF BAR-NSTABLE
MrIl. Con�truct ion Permit
No. �!'--=--!�='' � Fee- -----`�
Permission is hereby granted .. - -----•-- --------- -------- -------- ----=----- -----------------------------------
to Construct (`�, Alter ( ), or Re r ( ) n ndi id al Well at.
Street _
'as shown o f application.for a Well Permit
{ ,, _
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No. ------- ------ - r- �------—--- - -------------- Dated-- - ------ --------- -------------------------
led
i Board of Health
DATE
r
Department of Environmental Management/Division of Water Resources
WELL COMPLETION REPORT
WELL LOCATION GEOGRAPHIC DESCRIPTION
Address— _
lleetl (circle)
City/Town A^4' a
Well iSwnerr1!! r'AAr (road)
Address:0 4a' N @S4 E W Of
Imi,in tenthsl fclrcle)
Board of Health permit obtained: yes!❑` no ❑ intersect. w/A (road)
WELL USE WELL DATA
Domestic ❑o"Pu blic❑ Industrial ❑ Total well depth !4A ft.
Monitoring[IOther Depth to bedrock ft.
i Water-bearing rockhrnconsolidaled material:
Method drilled�i��►9�_ n� �/
Date drilled / r ' Description
Water-bearing zones:
CASING 1) From M + To 1h 1)
Type 2) From To
Length,41-04ft. Dia(.I.D.) in. 3) From To
Length into bedrock n ft.
Gravel pack well:YQ dia.
Protective well seal:
Screen: f dia.
Grout.[] Other Slot t+ length—'* from(*;f toy"4
STATIC WATER LEVEL(all wells)
Static water level below land surfaced ft. Date 3CYi*f•
WELL TEST(production wells)
brawdown/ 5 It. after pumping f, hr. min.at .-"h, gptn
How measured4,4112 Recovery ft. after fir. mina
LOG of FORMATIONS COMMENTS
Materials Front To
Driller
G1) AA Firm � �.s
«< t e W
Address � �`) �� A �
- t City/Town
Supervising Driller Reg,$
Si"nature of swervising registered well driller
Pleise Print firmly 4K
- '
BOARD OF HEALTH COPY ,
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 t
,
CLIENT: Glenn Gavin LOCATION: Lot 3
239 Church St.
W. Barnstable, .MA
SAMPLE DATE: 5-29-96
COLLECTED BY: L. Wile Wells DATE RECEIVED: 5-29-96
TIME: N/A LAB I.D. #: E5-541
JOB TYPE: New well SAMPLE., D... #:_,E5-541
WELL SPECS. : 1001/211 static
4" PVC
Flow: 20 G.P.M.
RESULTS OF ANALYSIS:
Parameters Units Recommended Limit Result
Coliform bacteria/100ml (MF Method) 0 0
pH pH units 6.0-8.5 6.47
Conductance umhos/cm 500 75
Sodium mg/L 28.0 9.3
Nitrate-N/Nitrite-N mg/L 10.0 0.03
Iron mg/L 0.3 LT 0.05
Manganese mg/L 0.05 0.004
Volatile Organics See enclosed report.
EPA 524 ug/L
Bromodichloromethane 0.6
Chloroform 5.0
Yes No WATER IS SUITABLE FOR DRIN4Ronald
POSES OR PARAMETERS TEST D.
XXX
LAM% Date L �
J. aari
Laboratory Director
LT = Less Than
LAIPUCK
LABORATORIES, INC.
50 Hunt Street CHEMICAL ANALYSIS
Watertown,MA 02172 BACTERIOLOGY
(617)923-0300 WATER ANALYSIS
FOOD ANALYSIS
SPECIFICATION TESTING
REPORT
LAB NO. 55326 June 21, 1996
Mr. Ron Saari
ENVIROTECH LABORATORIES, INC. Sample Received: 06/06/96
449 Route 130 Client I.D.: L. WILE
Sandwich, MA 02563 Sample I.D.: Lot#3
Test Results:
Volatile Orggn.cs ppb(ug/L)
Method 4524
Benzene N.D. 1,2-Dichloropropane N.D.
Bromobenzene N.D. 1,3-Dichloropropane N.D.
Bromochloromethane N.D. 2,2-Dichloropropane N.D.
Bromodichloromethane 0.6 1,1-Dichloropropene N.D.
Bromoform N.D. Cis-1,3-Dichloropropene N.D.
Bromomethane N.D. Trans-l,3-Dichloropropene N.D.
N-Butyl Benzehe N.D. Ethylbenzene N.D.
Sec-Butyl Benzene N.D. Hexachlorobutadiene N.D.
Tert-Butyl Benzene N.D. IsrpropyIbenzene N.D.
Carbon Tetrachloride N.D. P-Iso
ProPY
ltoluene N.D.
Chlorobenzene N.D. Methyl Chloride N.D.
Chloroethane N.D. Naphthalene N.D.
Chloroform 5.0 N-Propylbenzene N.D.
Chloromethane N.D. Styrene N.D.
2-Chlorotoluene N.D. 1,1,1,2-Tetrachloroethane N.D.
4-Chlorotoluene N.D. 1,1,2,2-Tetrachloroethane N.D.
1,2-Dibromo-3-Chloropropane N.D. Tetrachloroethene N.D.
Dibromomethane N.D. Toluene N.D.
1,2-Dichlorobenzene N.D. 1,2,3-Trichlorobenzene N.D.
1,3-Dichlorobenzene N.D. 1,2,4-Trichlorobenzene N.D.
1,4-Dichlorobenzene N.D. 1,1,1-Trichloroethane N.D.
Dibromochloromethane N.D. 1,1,2-Trichloroethane N.D.
1,2-t3ibrodioe l�acte "EDB)-'" N.D. liane -
Dichlorodifluoromethane N.D. Trichloroethane N.D.
1,1-Dichloroethane N.D. 1,2,3-Trichloropropane N.D.
1,2-Dichloroethane(EDC) N.D. 1,2,4-Trimethylbenzene N.D.
1,1-Dichloroethelene N.D. 1,3,5-Trimethylbenzene N.D.
Cis-1,2-Dichloroethylene N.D. Vinyl Chloride N.D.
Trans-1 2-Dichloroethylene N.D. Total Xylene N.D.
N.D. =Not Detected Analysis Date : 06/10/96
Method Detection Limit =0.5 ug/L
Recoveries of Surrogate-%
1,2-Dichlorobenzene-d4 100
P-Bromofluorobenzene 90
D.E.P. -MA 061 � v
J s Fontenarosa, Lab Manager
Consulting & Testing Services
for over 20 Years...
This report is rendered upon the condition that it is not be be reproduced wholly or in part for advertising or other purposes over our
signature or in connection with our name without special permission in writing.Total liability is limited to the invoiced amount.The
results listed refer only to tested samples and/or applicable parameters.
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SEPTIC TANK: GPD tom_) GALLONS IN r.�'
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BOARD OF EIZALT11
` PREPARED FOR:
- t AF'''ROVED DATE
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— 1996
j SCALE: 3o DATE: ---- -------
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CIVIL:. ENGINEERS � H ,�,� �� �►,E ti`� . :
_-.- LAND _ SURVEYORS ! „
.> a 3�7 PRONE 508-362-4541 l;aruht 1
FAX 508-362-9880 F s►5 +` rYo �vz
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