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HomeMy WebLinkAbout0254 HIGH STREET - Health 254 High St West Bamstable A. = 111 - 032 i I li I p V TOWN OF BARNSTABLE LOCATION ` r SEWAGE # 81dZ*r'1?0C VILLAGE Lt> z]�y,�.s 5 � _ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. CC SEPTIC TANK CAPACITY 45 Cfy LEACHING FACILITY: (type) C'X1i (size) NO. OF BEDROOMS_ BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE:4:Z0 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 #leaWun facility) Feet Furnished by 3� •`t f71` %J C k a No. _l. Fee THE COMMONWEALTH OF MASSACHUSETTS' Enteied id computer: Yes PUBLIC'HEALTH DIVISION -TOWN OF BARNSTAB.LE, MASSACHUSETTS 91ppYication for Miopooal bpotem Conotruction Permit Application for a Permit to Construct( , )Repair( )Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. �,Vj .4 . Assessor's Map/Parcel I✓ *-"�AY Installer's Name,Address,and Tel.No. Designe 's Name;Address and Tel.No. Type of Building: r a,wh o Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other 71}pe of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 416 gallons. Plan Date ��' S N tuber o heets Revision Date Title IL µ e /?Of-rhnMV Size of Septic Tank Type 011 S.A.S. Description of Soil # O ^ f r 4 a s a -446 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 issued by th' of a Cr Signe Date Application Approved by Date ' Application Disapproved for the following reasons Permit No. Date Issued . 3dJ No. Fee `THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PURUC- HEALTH DIVISION s TOWN OF BARNSTABLES MASSACHUSETTS Zipprication for Miopaal bpotem, ctConotructiou Permit Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 4 V S,t r► . Assessor's Map/Parcel L l R y, 14 7f/ Installer's Name,Address,and Tel.No. Designer' Name,Address and Tel No. g 2 f &,qo�� psX4 v 0 SS Type of Building: PS Dwelling No.of Bedrooms _ Lot Size sq.ft. Garbage Grinder( � Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow a _ gallons per day. Calculated daily flow �I L16 gallons. Plan Date s' O Nu ber of sheets Revision Date Title ^t' k ., S Size of Septic Tank Type o A.S. Description of Soil /� Shy �� a a a lid iaM Nature of Repairs o`r 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 aczordance 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 by th�i-s(Ao of Head ' T Signed Date Application Approved by Date Application Disapproved for the following reasons I Permit No. �5 3�G' Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO C FY, at the pn-site Sewage Disposal System Constructed ( )Repaired ( )Upgraded( ) Abandoned( )by Gn{ / _ at 5� NArk5IL has been constructed}'n accordance with the provi ;ons of anal the for Disposal System Construction Permit No. 5 3 dated �9 / 3� Installer cJh^�5 1 Designer 14, The issuance of this permit shall n. be 'o trued as a guarantee that the s n 'o s d tem-rv' esigned. �_.. Date' ,� Inspector - No.— ZF�� --------------------------- Fee ^- THE COMMONWEALTH OF MASSACHUSETTS (� - PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migoat *pe;tem Conn;truction Permit Permission is hereby gran ed to ConsA ct( it( ) r e( )Abandon( ) System located at %y 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 co itiM . Provided:Construction ust b completed within three years of.th date oft s p 1 . Date: Approved f 06/30/2005 18:01 5084296334 MARY SASSING PAGE 06 r CERTIFICATE OF ANALYS"S Pam: , R Barnstable County Health Laboratory juport Dat d: 05al/1999. i For: GM1919 Orftr Number: Bassin$,Henry Henry Besslns 254 Higb St vd west Bemsmble MA'02668 a 9901919-01 ; . _DES waftr=Dri■wos wa ?�4 sty W.lastabie catltnea: WSW" Sample 0: 9191901 �lto4 X ,petted bye Stidd Roar' �L ^� _ Lqpd - r LAB:IC Lab ou1Sn999 1.5 MWL 0.1 10 9PA 300.0 Nitttate . LAB:Metals CQ.1 fWL 0:1 1. SM31118 04116119" Copper 0.1 =911. 0.1 03 SM 3111B 04/1019 Iron 99 13 �- 1.0 it1 siK 311 is 04716/1999 Sodium LAB, Microbiology To#ul Conform Absent P/A 0 Agent PIA 04/15/19" LAB:Physicd!Chee,tk" Conductance 138 EPA 120.1 04n6n"9 PH PH�mita 0 EPA 130.1 04/16i1999 N*W.. Water sample meets the remmmeaded limits for drialdae wetter O RR above tested parameters. Superior Court House, PO.Box 427, Banwtable,. MA 0263o. Ph:SW37S4603 06/30/2005 18:01 5084296334 MARY BASSING PAGE 05 r ' r CERTWICATE OF ANALYSIS per: Z Barnstable County Health Laboratory P itr r• "A Dated- 05/2111999 Bassin? Henry Order Num ,;_ G9901919 gamy Anstng 254 ffi$h stmet West Ba:wtable MA 026U Laboratory ID M. 9901919-02 u &d: Wow-Drnlaoawa w Samples: M8 & 87 Sampling Lesadee: 254 High shvit,W Bmwa CoIIeewds OMISn999 olleetad by: Sdefel ftewdWde p4/lS/i!9! EPA.524.2- Yolatae Organics by GC✓MS yN _ ram mods La. 1,1,1,2 Tetracitloroethane BRL up/L 0.5 1WA S24a 04/281999 1,1,1-Tiiebloroethane BRL up/t. 0.5 EPA 942 04ra81999 1,1,Z,2-Tetracbloroethane BRL uyL 0.5' I'A 5U.2 04/26/1994 i,1,2-Trichloroethmt BRL use. 0.5 10 EPA s24.2 04 v/1999 1,1-Diclltoroethane BRL VWL 0-5 VA seta 04/2V1999 1,1-DiChlOt'oetllelle BRL ug/L 0.5 7.0 EPA 524.2 04/23119" 1,1-D[citlor6paropeue BRL asp 0.5 UA 524.2 otrzen9" 1,2, -Triclilorobenzene B u�y►- o-s !mow su z oanvt 1,2,3-Trichloropropwe BRL, uBfL o.s EPA 52r1a 04/28/1999 I,2,4-Trtddorobenzene BRL- ug/L 0.5 70 RA S242 04/28n999 1,2,4Trimethylbenzene BRL A 0.5 EPA 5242 04129119" 1,2'Dibromo=3-cb1oropr01P2n BRL ug/L o.s 0 BPS 524.2 04/28119" o4ns/19" y,Z-lribromaethane"(EDB) BRIE unit, o s EPA 524.2 i,2-Dichlorobenzene, BRL uWL. 0.5 boo SPA sza a z�1 i,Z-Dlchloroethane BRL ue/L 0.5 5.0 EPA$242 008/1999 1,2-Dichioropropane BRL ug/L 0.5 13PA 524:2 04/="9 i,3,5-TrlmetbylbewP-ne BRL pelt o.s EPA sea z n4Izsn 9�s 1,3-Dichlorobenzene BRL ug/L 0.s BPA s2a.2 04=1"9 1,3-Dichloropropane BRL uriL. 0.5 EPA 524.2 04r28/1999 m---DieWorobenzeue BRL uSIL, 0.5 5.0 SPA Sul 04fi2811999 2,2-'Dicllloropropaue BRL uyt. 0.5 EPA 524.2 009/10" z-Chlocotoluene BRA. �. ul/L. 06 EPA.5242 Q4n8/1999 MChlorotoluene BRL 0.5 EPAS241 0412e1999 Superior Court House, PO.Box 427, Baraatabie, MA 02630 Pb:508.373-"05 06/30/2005 18:01 5084296334 MARY BAS8IHG' PAGE 04 w s CERTIFICATE OF ANALYSIS Page: Barnstable County Health Laboratory RopedDated: OS21/1999 rt massing,��, Order Number: Gp901919 Henry Basing 254 High SUVO West Bamatable MA 02663 II.ab2akry ID#- 9901919-02 w;t-r.Ddata09 Watw $smelt ti: RM & S7 ollaQ k.op �>�� ,w•19stable cbu.dad: 9411S/199! . Rsew.ds OI/13fl494 efloeted by: Sdefe! Benzene BILL u`1L o s s.c 1A SX4 2 oanan Bromobenzene BRL UWL 0.5 EPAU42 04Wn999 Bromochloromethame BRL 0.5 EPA 524.2 04l1811999 BromodichloromethAne BRL u�/i, o.s EPA 5y►� 04l18n999 Rmmoform DRY. us/L o.s EPA 524.2 o41a811999 Bromomethane BRL o s: EPA=42 04128/t999 Carbon tetrachloride BRL udl1. 0.5 5.0 EPA U4.2 04/ &4"9 Chlorobemne BRL Ua O.s too EPA$24.2 MOM Chloroetbane BRL uWL o.5 EPA$24.2 04ng/1999 Chloreform 13 uWL 0s RPA 3242 04128/1999 Chloromethane BRL 0.5 EPA S242 04E811999 eta-1,2,Diddoroethene BRX•. vim. o.s 7o EPA s2u oar n999 cis-1,3-Dichloropropene BRL usti. 0.5 VA 5242 04/asn999 Dlbromochloromethana BRL UA 0.5 ErA$24.2 04/agh* Dibromomethane RRL vim- O.S um 324.2 W28n944 Dichloroditluoromethane )BRLurlc o.s SPAsaa2 oarzsii999 Ethylbenzene BRL vg/l. 0.5 700 EPA 524-2 04/2tili 999 Hemehlorobutadiene BRL 41, os Erb 5za2 oatzui993► Impropylbmene BRL VA 0.5 EPA 5242 Odr231t999 Methyl-tort-butyl ether BRL Ua 2.0 EPA M z. atnsrl9 Methylene chloride BRL 119X 0.5 5.0 EPA 524.2 04izs./10 n-Butylbenzene BRL +W1. 0.3 EPA5243 o4ra�i99� nrPropylbenaene BRIL UWL o 3 EPA szt 2. o4rzeris99 Naphthalene BRL U91L 0.5 EPA 241 04113119" p-Isopropyltoluene BILL 41. os WA 524.2 04J2i4/1999 sec-Butylbenzene DRL ug/L o.S $PA h 41 Wwt999 Styrene BRL uWL o.s 100 I&A$24.2 OQS/19" Supwior Court House, F0.llama 427, Barutfible, � 02630 M gQ8 37&6M 06/30/2005 18:01 5084296334 MR BASSING PAGE 03 CER d H ICA Jl E OF ANALYSIS SIS Page. 4 ' Barnstable County Health Laboratory rt Pre or: > rt a osnl/1999 Bossing,Henry Order tuber: G9901919 Hoary Bassing 234 High Streit West Barnstable MA 02669 Lal�gmtory yam#.. 9901919-02 galwamn.. wow-nflnxhs WOW Sample R: RM & 57 samma ia99aAg w m9h SbVK w.30Ab1* MSAW ageded by: WOW �aed�sd: OU15J19l9 tot-Butylbenzene B$L up/L b.S EPA 524.2 04/28 "O Teo=Woroethene BRL as/L 0.5 S-0 EPA sU 001119" Toluene BRL o.S 200 EPA M2 04 V19" Total xylenes BRL uWL o.s 10000 EPAM4.2 0412VIM trans-1,2-Dichloroethene BRL -ysn a-5 100 EPA sus M811999 trans-1,3-Dichloropropene BRL ug1L 015. EPA 524.2 04WI999 Trichloroethane BRL us(t. 0.5 $.0 EPA 5242 04/Z8Jt9" WehloroIIuoromethane BRL q#L IS EPA$24.2 04128/1999 Vinyl chloride BRL uglL 0.5 2.0 EPA S24.2 OQV19" Now Approved gy; - - ) Sh0/4 Superior Court Horse, PO.Box 427, Barnstable, MA 02630 Plu 5M754W t f 06/30/2005 18:01 5084296334 MARY BASSING PAGE 02 ti r RE N° 11864 Environmental Heai Services From: r . For.(specify service)_ Amount: Signed: Date: C 9AM&TAtlLEOMMW LTHAND BM MNMENTAL DEPOTMEttT r�NphoM superior Court Houu 3624SI1 Bemstaft Ma'".02M Ent.337 - BOARD OF HEALTH TOWN OF BARNS TABLE VdI Congtruction1hrmit No. Permission is hereby granted Z 3nA'"' L624I 1 2-�P JI " 4a-- to Construct (4-f, Al ( or R ( ) divid Well at: No. as shown on I a cation fora Vyell Construction Permit No. "ram s DatedA&= .. .r+ Board of Health DATE // EY r Town of Barnstable o Regulatory Selices Thomas F.Geiler,Director NAM Public Health Division ib Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 - Fax: 508-790-6304 Installer&Designer Certification Forte Date: Designe : Installer: J e /' - 461Cd 1-n% Address: s Address: on !W41 . _was issued a permit to install a (date) (installer) septic system at IN P based on a design drawn by (ad ss) dated �� �O (designer) ", Certify that-the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State& Local Regulations. Plan revision or certified as-built by designer to follow. "OF�,gss9c STETSON y� er's Signature) HALL N No.527 EVALUA ; ,=, esigner ign tune) (Affix D =§"Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTIN THIS FORM'.AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE P LIC HEALTH DIVISION. THANK YOU. Q:Hedth/Septic/Dewper Certification Form TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE. bi 12 .��s �, ASSESSOR'S MAP & LOT. — INSTALLER'S NAME&PHONE NO. 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