HomeMy WebLinkAbout1663 MAIN ST./RTE 6A(W.BARN.) - Health E 1663 Main St.,1" Lutheran Church
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W. Barnstable
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aN_ Massachusetts Department of Environmental Protection
' Bureau of Resource Protection -Drinking Water Program
TRANSIENT NON-COMMUNITY(TNC)VIOLATION
NOTICE OF NONCOMPLIANCE (NON) Enforcement Notice:
M.G.L.c.21A sec.16,310 CMR 5.00
`� s•°���� NON - BO- 085D091
Attention: Owner/Owner representative/Responsible party:
General Information
PWS NAME: FIRST LUTHERAN CHURCH DATE: 5/6/2008
P.O.BOX 157 PWSID: 4020021
CLASS: TNC
WEST BARNSTABLE - MA 02668-0000 CITYITOWN: WEST BARNSTABLE
Location Where Noncompliance Occurred: FIRST LUTHERAN CHURCH
Description of Violations under M.G.L. c. 111 sec. 159-160 and 310 CMR 22.00 and 21.00 and Corrective
Actions to Take and Deadlines for Taking Such Actions:
1. The Department of Environmental Protection(MassDEP),Drinking Water Program(DWP),records indicate that your system is in violation of the
following checked(X)requirements.In order to return to compliance for these violations your system must take the indicated corrective action(s)by
the prescribed deadline(s):
Description ofiV<a/ati ERegcfreal for `Hffre`Actfoan Deadlii►e lor :akfng Suc ction �a �
Failure to submit the 2007Within 30 days of receiving this NON
Annual Statistical report to the You must completely.fill out the attached Annual Statistical report and submit 2 copies of the form to:
Department,as requried by MassDEP/DWP, 1 Winter Street,5th Floor,Boston,MA 02108,Attention Stats Program.You must also
310 CMR 22.15; complete and submit the attached Transient Non-Community Violation Response Form(TNCVRF)with your
Within 30 days of receiving this NON
You must obtain the services of a certified operator of the required certification grade by contracting with a
Massachusetts certified operator and submitting the attached Public Water System Certified Operator
Compliance Notice to the Board of Certification of Operators of Drinking Water Facilities(the Board).You
must submit proof of your notice to the Board by sending a photocopy of the completed notice along with the
attached TNCVRF to:MassDEP/DWP, 1 Winter Street,5th Floor,Boston,MA 02108,Attention TNC
Operating a public water Program. Or
system without a certified Within 30 days of receiving this NON You must apply to the Board fora temporary six-month emergency
operator as required by 310 certification*and submit proof of your application to the Board by sending a photocopy of the completed
CMR 22.11 B 0); application to the Department.You must also complete and submit the attached TNCVRF with your response.
In addition,within 6 months of receiving this NON Your system must be operated by personnel that fulfill
the certified operator requirements as stated in 310 CMR 22.11 B(1)and(2).
*To apply for a temporary six-month emergency certification you must completely till out and mail the
attached Application For Temporary Certification form along with the required fee,to the Board at 100
Cambridge Street,Room 1406,Boston,MA 02202.
Within 30 days of receiving this NON
Failure to submit the a cross You must completely fill out the attached Cross-connection Program Plan Questionaire for Transient Non-
X connection control program Community Public Water Systems and submit 2 copies to:MassDEP/DWP, 1 Winter Street,5th Floor,
plan to the Department,as Boston,MA 02108,Attention TNC Program.You must also complete and submit the attached Transient Non-
requned by 310 CMR 22.22(3) Community Violation Response Form(TNCVRF)with your response
2. If your system HAS COMPLIED with any or all of the requirements listed and checked(X)above,you must submit proof.Examples of proof
include copies of return receipt postcards from the post"office postmarked prior to the deadline(s)..You must submit the proof and 2 copies of
the required information to:MassDEP/DWP, 1 Winter Street,5th Floor,Boston,MA 02108,Attention Stats program.You must also complete
and submit the attached TNCVRF with your response.
Important Information
An administrative penalty may be assessed for every day from now on that you are in noncompliance with the requirements described in this NON.
Notwithstanding this NON,the Department reserves the right to exercise the full extent of its legal authority in order to obtain full compliance with all
applicable requirements including,but not limited to,criminal prosecution,civil action,including court-imposed civil penalties or administrative
penalties assessed by the Department.Contact Information: If you have any questions about this NON please call Damon Guterman at 617-574-
6811:
Certified Mail#:
Date Mailed:
Attachments
cc: MassDEP Boston-Office of Enforcement Dave Terry,Program Director
MassDEP Regional Office-DWP Drinking Water Program
Local BOH Bureau of Resource Protection/Mas§DEP
0 Certified Operator
Massachusetts Department of Environmental Protection
i Bureau of Resource Protection -Drinking Water Program
R TRANSIENT NON-COMMUNITY VIOLATION RESPONSE FORM (TNCVRF)
s
M.G.L.c.21A see.16,310 CMR 5.00
Attention: MassDEP/Drinking Water Program
' General Information DATE: 5/6/2008
PWS NAME: FIRST LUTHERAN CHURCH RE: NON - BO- 085DO91
P.O.BOX 157 PWSID: 4020021
CLASS: TNC
WEST BARNSTABLE MA 02668-0000 CITY/TOWN: WEST BARNSTABLE
Location Where Noncompliance Occurred: FIRST LUTHERAN CHURCH
Description of Corrective Action Taken under M.G.L. c. 111 sec. 159-160 and 310 CMR 22.00 and 21.00:
My public water system has taken the following actions to correct the violations listed in the above referenced NON.(please check all that apply)
LlescrrpSon of Violafron_ � 'E)�escr�fioi�of Gg�cf�v,eI�Cban r�nby" - t.- a Syst� ,� :;: m;�,� �' p�"`�_�_�,�`H
Failure to submit the 2007 Annual My system DID submit the 2007 Annual Statistical report to MassDEP by the required deadline.
Statistical report to the ❑Department,as requried by 310 Within 30 days of receiving the above referenced NON I am submitting this form,two(2)copies of the
CMR 22.15; 2005 Annual Statistical report and documentation that proves that my system submitted this report by the deadline.
❑ My system DID NOT submit the 2007 Annual Statistical report. Within 30 days of receiving the above referenced
NON I am submitting this form and two(2)copies of the 2007 Annual Statistical report.
Operating a public water system ❑ My system HAS the required Certified Operators and DID report to the MassDEP this change in operator status as
without a certified operator as
required by 310 CMR 22.11 B(1); required. Within 30 days of receiving the above referenced NON I am submitting proof to the Department that my
system has the required Certified Operator and had properly notified the Department.See attached
photocopies of the license(s),contract(s),other supporting documentation that proves my system submitted
this information by the deadline and the completed Certified Operator Status Table below.
❑ My system HAS the required Certified Operators but DID NOT report to the MassDEP any changes in operator status
as required. Nithin 30 days of receiving the above referenced NON I am submitting proof to the Department
that my system has the required Certified Operator.See attached photocopies of the license(s),contract(s)
and the completed Certified Operator Status Table below.
❑ My system DID NOT have the required Certified Operator. Within 30 days of receiving the above referenced NON
My system has
❑ Obtained the services of a Certified Operator of the required certification grade and completed and submitted a
Public Water System Certified Operator Compliance Notice form to the Board for verification and signature.See
attached copy of the completed form as well as.the completed Certified Operator Status Table below.
❑ Applied to the Board for a temporary six-month emergency certification. I understand that within six months
of receipt of the above referenced NON my system must be operated by personnel that fulfill the
certified operator requirement as stated in 310 CMR 22.11E(1)and(2).
See the attached copy of my application.
❑ I will report all future changes in my system's Certified Operator status to DEP within 24 hours of such changes.I
will also provide MassDEP with written documentation of the change within 30 days.
Failure to submit a cross-
connection control program plan ❑ My system DID submit a cross connection program plan to MassDEP by the required deadline.
to the Department,as requried by Within 30 days of receiving the above referenced NON I am submitting this form,two(2)copies of the
310 CMR 22.22(3); completed Cross Conection Program Plan Questionnaire for Transient Non-Community Public Water Systems and
documentation that proves that my system submitted this report by the deadline.
t
aMy system DID NOT submita cross connection program plan. Vithin 30 days of receiving the above referenced
NON I am submitting this form and two(2)copies of the completed Cross Conection Program Plan Questionnaire
for Transient Non-Community Public Water Systems.
❑ My system was unable to meet some or all of the corrective action requirements identified in the above referenced
NON.An explanation is attached. I understand that I may be subject to further enforcement action.
GerttfiedOperatorStatus Name/Address/Phone# Licence# Grade Approximate dates of planned routine monthly site inspection
Certified Operator
Owner,Owner Representative,Water Commissioner or other Responsible Party:
Print Name: Title: Phone#:( )
Signature: Date: Email address
cc:MassDEP I DWP Regional Office,Local Board of Health
Please complete and return this response form to: MassDEP/DWP,1 Winter Street,5th Floor,Boston,MA 02108,Attention Stats Program
TOWN OF BARNSTABLE 0J
LOCATION ��o�3 R'r Gl I j dlu`dui S 01 SEWAGE # l
VILLAGE u), cs C DA ta ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. 1'Q, M nr�m 69 C
SEPTIC TANK CAPACITY aOCt5 �
LEACHING FACILITY: (type) (?ivy M1 -C�S (size)
NO.OF BEDROOMS
BUILDER OR 3 L4 ¢yu it C ci
PERMTTDATE: l 2 — 7 COMPLIANCE DATE: '/l
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
1 --
I 1
�ti
r. No. -f /—6 70 Fee $5 0
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
ZippYication for -Mizpozal *pztem Construction Permit
Application for a Permit to Construct( )Repair XX)Upgrade( )Abandon( ) D Complete System ❑Individual Components
Location Address or Lot No. 1663 Route 6 A Owner's Name,Address and Tel.No. 16 6 3 ROUTE 6 A
West Barnstable,Mass. 02668 First . Lutheran Church
Assessor'sMap/Parcel West Barnstable.Mass. 02668
Installer's Name,Address,and Tel.No. 5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. 5 0 8—7 7 5—3 3 3 8
J.PNacomber & Son Inc. J.P.Macomber & Son Inc.
Box 66 Centerville,Mass. 02632 Box 66 Centerville,Mass.02632
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 660 gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank 2000 Type of S.A.S. 4-500 gallon chambers
Description of Soil
Tight sand. Will have a five foot dig r)ut
Nature of Repairs or Alterations(Answer when applicable) Omitting cesspool and adding
4 500 gallon chambers.
Date last inspected: 1 1 /2 9/9 7
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 issu by this oar f He lth.
Signed Date 1 2/1 /9 7
Application Approved by Date 12 -Z-9 7
Application Disapproved for the following reasons
Permit No. !7-7 Date Issued l Z_Z "1 -7
�T -- --- - ---- --- -- — � — — --------------
14-
No. 7-� / Fee $5 0
nA _ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓
f Yes
;t PUBLIC HEALTH DIVISION -.TOWN OF BARNSTABLE, MASSACHUSETTS
Zopfication for Zi5pogar *p!gtem Construction Permit
Application for a Permit to Construct( )Repair(XX)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 1663 Route 6A Owner's Name,Address and Tel.No. 16 63 ROUTE *A +
West Barnstable,Mass, 02668 First Lutheran Church
Assessor'sMap/Parcel West Barnstable.Mass. 02668
_ 7
Installer's Name,Address,and Tel.No. 5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel'No. 5 0 8—7 7 5—3 3 3 8
J.PMacomber & Son .Inc. J.P.Macomber & Son Inc.
Box 66, Centerville,Mass. 02632 Box 66Centerville,Mass.02632
a
_Type of Building:
r Dwelling R No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 660 gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets. Revision Date
Title f
Size of Septic Tank 2000 Type of S.A.S. 4-500 gallon chambers
Description of Soil
Tight sand. Will have a fiii-1 iot dig out
Nature of Repairs or Alterations(Answer when applicable) Omitting cesspool and adding
4 500 ,4allon chambers.
k
Date last inspected: 1 1 /2 9/9 7
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 by this 'oard f He th.
Signed Date': 12/1 /9 7 '
Application Approved by Date"1"I "Z-9 7
Application Disapproved for the'following reasons
Permit No. 7-�o+l r Date Issued f Z -7 a! '7 r
--{---------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired (XX)Upgraded( )
Abandoned( )by
J.P.Macomber & Son Inc.
at 1663 Route 6A West Barnstable,Mass. has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. ? 7 dated Z -2
Installer Designer
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
Date 1 �_ _ 1 A _ "? Inspector +
--p---//-------------.---------------------
No. / 77- (J tq 0 Fee $ 50
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
&5pooal *p.5tem Construction Permit
Permission is hereby granted to Construct( )Repair�X�Upgrade( )Abandon( )
Systemlocatedat 1663 Route 6A West Barnstable,Mass.
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.
Provided:Construction must be completed within three years of the date of this ermit.
Date: Z ' 2-�, Approved by�.
n
10/9/97
NOTICE: This Form Is To Be Used For the Repair Of Failed
Septic Systems Only.
CERTIFICATION OF SKETCH AND APPLICATION FOR A
DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT
ENGINEERED PLANS)
1, Joseph P.Macomber Jr. , hereby certify that the application for disposal works
construction permit signed by me dated 12/1 /9 7 , concerning the
property located at 1 663 Route 6A west Barn-,t-ah"ItafmA meets all of the
following criteria:
/There are no wetlands located within 100 feet of the proposed leaching facility
/There are no private wells within 150 feet of the proposed septic system
/There is no increase in flow and/or change in use proposed
�' There are no variances requested or needed.
/, if the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the
proposed leaching facility will=be located less than fourteen(14) feet above the maximum adjusted
groundwater table elevation.
Please complete the following:
A)Top of Ground Elevation(according to the Engineering Division G.I.S. map)
B)Observed Groundwater Table Elevation(according to Health Division well map) 2 3 '
SIGNED : r DATE: �
LICEN4 SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER
[Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan,
this plan should be submitted).
q:health folder:cert
`a r
1
0;0ip
TOWN OF BARNSTABLE
LOCATION.1�v�i� R'r A 'T G71(1 S �� SEWAGE#
VII I+AGE -I I-a`D S rab1 ASSESSOR'S MAP &LOT
NAME&PHONE NO.
T�
•INSTALLER'SQ� t'tlncl�cn b P t~
SEPTIC TANK CAPACITY C7G� �
LEACHING.FACILTTY: (type) y -rJOL.. Li,u mb fK- (size).s,no qa I
NO OF BEDROOMS
BLIILDER-OR(' E� /— v yevu,
FERMTTDATE: 17..— 2 —L7 COMPLIANCE DATE: Z '/l—g 7
' Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Pri'Vafe 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
:wiiithin 300 feet of leaching facility-) Feet
Fu sihed by"
s• -
).30
TOWN OF BARNSTABLE (� !
f1G11�i i 1 SEWAGE #
L ATION
' I
VILLAGE(, �t tczblrz' ASSESSOR'S MAP &LOT 10 0
INSTALLER'S NAME&PHONE NO.
I !.
SEPTIC TANK CAPACITY o
to sized
LEACHING FACILITY: (type) Lj '1' �
NO.OF BEDROOMS
BUILDER OR �c``S 'F L o `f' C.tvi►
PERMTTDATE: C-Z ~ 2 _ 7 COMPLIANCE DATE:
Separation Distance Between the: Feet
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility
Private Water Supply Well and Leaching Facility (If any wells exist Feet i
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
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TOWN OF BARNSTABLE
LOCATION 1 &6_3 I�IAJN ��, SEWAGE # 9A v 3.Y
VILLAGE W. 13RUST-Rib1 C ASSESSOR'S MAP & LOT f -
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY /3 0d
LEACHING FACILITY:(type) 4 .fir FF1 TqS A,)t S (size)
NO. OF BEDROOMS- PRIVATE WELL OR
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED: - -
VARIANCE GRANTED: Yes No
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OP BARNSTABLE
Appliration for 14spnsal Works Tomitrixrtinn Prrnti#
Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal
System at:
...............................................................................•--............._..
Lo ation•Address r Lot N
� 1
Own ddress
G41n.lak...QV25J. U. r ................................ 13� ` /I��!
Installer '7/7/ S-/74 i Address
d _Type of Building Size Lot___az�.�L'C _-•Sq. feet
�,
U Dwelling—No. of Bedrooms......... .... .. ....................Expansion Attic ( ) Garbage Grinder ( )
`4 Other—T e of Building No. of persons-_________________________ Showers — Cafeteria
Q' Other fixtures -•-----------------------------• -
W Design Flow............................................gallons per person per day. Total dail flow-----------------.......-----_........_•._--gallons.
WSeptic Tank—Liquid capacity./�Q.gallons Length�.... ...._ Width e... .... Diameteit�,a.._. Depth...`i��_�o N
x Disposal Trench—No. .....4 ...._... AA
........ Total Length._S.91.......... Total leaching area.._.i-cov....sq. ft.
Seepage Pit No........ Diameter.......... ------ Depth below inlet...-�........ Total leaching area......"�..._.sq. ft.
Z Other Distribution box (I ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
aTest Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water-___--_______-_---------
�Tq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.........................
a - . ••. .......................... .. ---......
•---
•-----------
------------------
O Descri ion of Soil-------------rC,fz.T- ---P ._._..jo. I.__.."--� 1 1
U
W --•-•------•----------•--•-•--------------------------•-•--•--------•-----•-••----•-•••.........•• ... - ....:- --------------
x
U Nature of Repairs or Alterations—Answer when applicable______ /?c3. �I1 . ........ ....11.2. 1460 ...__.
.._. _ � Sn ........-•••-••••••-•--••-----•-••-••----------------------•-••---•---•-----•-------•-••-•••----.._....--•---
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Complian has been sued by the board,of health. l
Signed --- � = .... —:---------------------------- - �Date9
Application Approved By --------------- -�",. .. --tc .�, ..;.�- .-. ..-., .�...
.......................—'---...-.--......------......-.--....-------.-... Date
Application Disapproved for the following reasons- -------------------------------------- ------------------------------------------------------------------------------- ------------
----------..............................
Date
Permit No. .... .a...-..... Issued -----------------------------------------------------------------
Date
FPO'"'
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliratiun for MoVaiial Works Cfunitrnrtiun ramit
Application is hereby"made for a Permit to Construct ( ) or Repair ()() an Individual Sewage Disposal
System at:
,� , • -
�! Location.Address or Lot No. ,� /
Owner 3 ddress/- �}
W L l`�nr/ , 1_r•JaS I/r//t_ '�. I 4��/ !Qa..... ,�_ ..1 //7L'Gl/IJWI.�,_..... -��r!
........................ t�
Installer i /7� . S/7G Address r
d Type of Building Size Lot... feet
U Dwelling—No. of Bedrooms........-/--------------•--__.-_-----.Expansion Attic ( ) Garbage Grinder ( )
'4 Other—Type of Building .............. No. of ersons.__.._................_..... Showers — Cafeteria
a YP g -------------- P ( ) ( )
QI Other fixtures -----------------------------------
W Design Flow...........................................gallons per person per day. Total daily
x .
flow.._..._...........s.......�.,.................gal`lons.
Septic Tank—Liquid caPacttYJ_ gallons Lenh . Widthr � Diameter __W ... //
Disposal Trench—No. .......... Wdt ..� ........... Total Length._3 R............. Total leaching area......'_2-----sq. ft.
Seepage Pit No....... ".......... Diameter........- Depth below inlet....~ '...... Total leaching area...... ........sq. ft.
Z Other Distribution box (1 ) Dosing tank ( )
.-,Percolation Test Results Performed bY.......................................................................... Date........................................
aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-___--_--____-___-.__.,
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
�.' ----------- .....-•------------------------------------=.........................................................................
- --•-------...-----•------•-••--.--•------ ••-.
O Description of Soil............ 119h.7:____/JArI:e!P .___,.Sn i______-_-, ...
x 9 �' •-•�...:Llnp.._...� )s A_//sue rl`A P (/. �41�t/ r :......
U = - • -. ..
U Nature of Repairs or Alterations—Answer when applicable______-2/5 S 14R.... ........ �/ 5_..__.
Agreement:, (J
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further`agrees,;not to place the
system in operation until a Certificate of Compliance has been issued by the board of health.
C/ r�G �r��I!ZUcTi�� k � ' r7h�&
Signed ------- . �.1 ,... ",. 1 --=.._Y .......... ice ---------
A Application Approved B ,u 7...• .�/. ...;Q'�
PP PP Y Dace
Application Disapproved for the following reasons- ------------------------------------------- ------------------------------- ------ ........-----------
--------------------------------------- --------------------------------------------------------------------------------------------------.......................................................... ...................-- ---------------
e'( Dace
PermitNo. .... c� -.....75-- ------)---------------- Issued ........................................ ...........-----------
Dace
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE r '
&rtifirate of Graptianre
THIS IS TO-CERTIFY, That the Individual Sewage Disposal System constructed ( ) or,, paired( X )
by ..........................
( /). !? % 11c-T C X_...----.. -------------------------_------------_-.----.....-----..---.---..----.--f.....----------....--.------ --
at
..............
................
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ........-..�.�.. .�..... ....... dated ........... .
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT B CONSTRUE AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. '), ` r
r
DATE---------------------------------------------- - --- I ...------.----.-- --- Inspector ..........r.: ------------. '..............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
No.. / .►� .7 FEE.. ............
- �i��u��tl urk� �un��r�rtiun permit
Permission is hereby granted........(_._,IaI'rL,a .....czkd.AA...............................:......•--.....................---........---........ ....
to Construct ( ) or RepairOQ an Individual Sewage Disposal System
C
Street elm ,`
as shown on the application for Disposal Works Construction Permit No. .. .... ... Dated..........................................
....................................
0 $r d o --------------........---•--------•--...........-
: f Health
DATE ¢..:I -
FORM 36508 HOBBS 6 WARREN,INC..PUBLISHERS '1
362-4541
926 main street
yarmouth
mass. 02675 down cope engineefing
civil engineers& land surveyors $
structural design
Arne H.Ojala P.E.,R.L.S.
land court Richard R.Fairbank P.E.
surveys
site planning
March 20, 1986
sewage system
designs
inspections
Mr. John Kelly
Board of Health
permits Barnstable Town Offices
Hyannis, MA 02601
Dear Sir:
This letter is to certify that Down Cape Engineering is preparing
a site plan for First Lutheran Church, West Barnstable.
The present septic system will be studied and inspected
and upgraded according to current Barnstable and State
standards as necessary.
Sinc ely,
Arne H. Oj a, .,
Down Cap E ineering
A HO/1c
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BOARD OF HEALTH
TOWN OF BARNSTABLE
ApplicationArVell Cootruction Permit
Application is hereby made for a permit to Construct (v, , Alter ( ), or Repair ( )an individual Well at:
Location — Address Assessors Map and Parcel
A-) CMU P-CA I G 6 3 Yh_ p J L) 57 VV - R"Al s R:W e-
Owner Address
�E6YI'70 ,Z 7d'3
--------------------------
Type of Building _- --- -
Installer Driller � Address
Dwelling-------- — -----------------------------------------------
Other - Type of Building ------ No. of Persons-------------------------------------------------
/i �� / lrf= -------- Ca
Typeof Well------ --`�----------------------------------- Pacity---------------------------------------------------------- ---
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 unLCertificateof Compliance has been issued by the Board of Health.
Signed dat
Application Approved By
date
Application Disapproved for the following reasons:----------------------------------------------------------------------------------
--------------------------- ------------------------------------------------------------------------------------------------------------------------
/�� `� date
Permit No. -�'1��- � Y------------------- Issued — - -------------- ------------------ ---------------
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
(tertificate ®f (ComPhance
THIS IS TO C RTIFY, That the Individual Well onstructed ( ), Altered ( ), or Repaired ( )
---------------------------------------------------------------------------
Installer
at- l7_ _1 L�,cv y f�.�" �_ � ______L -- ---------------------------------
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.4411�'�` ated-�-'--��''--fa
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE- --- --—-- -- — - - --— — -- Inspector-------------------------------------------- ------------
h-
�/�' T Fee- -� ---------- -----
No. ------------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Application-*rlDrIt CongtructionPermit
Application is hereby made for a permit to Construct ( Alter ( ), or Repair ( )an individual Well at:
----- ------------=-------------- -------------------------
Location Address Assessors Map and.Parcel
�iR•5 i LUT r' PJ --CuU12c,4-- — f4 L -- �,9 L) -57 - -V-- A? APAlSTip43
J` /j?0 1/`J O�nerOr/C.CIA Ac �` ` 7. 3ddre5sO.E'LE/`lILIS 14
Installer Driller Address
Type of Building
tDwelling - - ------------------------------------------- {
Other - Type of Building --- ----------------- No. of Persons----------------------------------------------------
Type of Well---- `�-_ '� ---------------------------------- Capacity-------------------
t
Purpose of Well �1i7 �TF�_ _f'o? .N3L
Agreement:
III
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.
Signed - - -- - - --�0-
------------------- date
Application Approved By ---------------- - -- ------------
- —— date
Application Disapproved for the following reasons:----------------------------------------------------------------------
------ --------
i
-------- -------------------------------------------------------------------------------------
I dale'
Permit No. ---------- Issued --- �/
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BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate Of Compliance
THIS IS• TOgRTIFY, That the Individual Well onstructed ( ), Altered ( ), or Repaired ( )
bY---------- !_� -------- ------------------------------------------------------------------------------- --- --
Installer
�_ '_ �O�,4e � -_a - --- -- -----------
- - -------------------------
t---- - -
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. ----- -- - ated --��-�"-----��-�
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
fDATE-----------------—-— - -- - --- -- Inspector-------------------------------------------——- ------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Vell Congtruct ion Permit
No. �'=---- �- Fee- �'=----
Permission is hereby granted- -- M,le-'-_-""'-------------------
to Construct
► Alter ( ))1LfY�000r.�Repair ( ) an II ddi�idduaI W 11 t: f7
No. - - -
Street
as shown on the application for a Well Construction Permit
No. ---- - ----r-----------------------=------------ Dated---------------------------- ----- ------------------------------------- i
e—,117-7
� Board of Health
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DATE— �� - - - —---— -
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�"t° 4 r1 Chu�c�
TOWN pE' BARNSTABLE
L OC A T14N_l :,[•�1dE.,�..��.-._._��S E W AC;E N - �
VILLAGE ,
�E ASSESSOR'S MAP & LOT_
INSTALLER'S. NAM9 Q PHONZ: NUJ._
SEPTIC TANK CAPACITY��/`�;p�j
LEACIUNG FAC:ILITY:I[ypel Tb 1 �f
,.ems (slze)�}�.��—`�
NO. C)F 13EDROUMS__Y_PRIVATE WELL OR Pb31ct. 1�f '
BUILDER OR OWNER -
DATE PERMIT ISSUED: 7 - .,� ' - .�.�
DATE C 0&fPf.IANCIi ISSUED:
VARIA14CE GRANTED: yes��
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EIVVIROTECHLABORATORIES,INC. �I'J
MA CERT.NO.:M-MA 063 I
449 Me. 130
Sandmcb, MA 02963
508(888-6460) 1-800-339-6460
FAX(508)888-6446
CLIENT: First Lutheran Church LOCATION: 1663 Main St
ADDRESS: c/o Mr Penny W Barnstable MA 02668
1663 Main St The Parsonage
W Barnstable MA 02668
COLLECTED BY. Desmond Well Drilling SAMPLE DATE. 6-21-99
SAMPLE TIME., 8:00
WATER SAMPLE TYPE. New Well DATE RECEIVED: 6-21-99
LAB I.D. #: 996563
WELL SPECS.: 4"x 80'/20'
RESULTS OF ANALYSIS:
Parameters Units Recommended Results Method Date Analyzed
Limits
Coliform bacteria /100ml 0 0 9222 B 6/21/99
pH pH units 6.5-8.5 5.91 4500 H+ 6/21/99
Conductance umhos/cm 500 100 120.1 6/21/99
Nitrate-N mg/L 10.0 0.29 300.0 6/21/99
Sodium mg/L 28.0 8.8 200.7 6/22/99
Iron mg/L 0.3 < 0.02 200.7 6/22/99
Manganese mg/L 0.05 0.010 200.7 6/22/99
COMMENTS: Low pH indicates high corrosive characteristics.
WATER MEETS EPA STANDARDS AND IS SUITABLE FOR DRINKING PURPOSES
FOR PARAMETERS TESTED.
Date, /L
Ron id J. S H
Laborsto Di for
<=less than
>=greater than
TNTC=too numerous to count
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Desmond Well Drilling, Inc.
Cape Cod Test Boring
5 Rayber Road P.O. BOX 2783
ORLEANS, MASSACHUSETTS 02653
(508)240-1000
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Desmond Well Drilling, Inc.
Cape Cod Test Boring
5 Rayber Road P.O. BOX 2783
ORLEANS, MASSACHUSETTS 02653
(508)240-1000
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FIRS' LUTHERAN CHURCH
HIGHWAY 6A
WEST BARNSTABLE, CAPE COD , MASS . 02. 6.68
PHONE 362- 3161
March 20, 1986
Barnstable Board of Health
Att'n. : Mr. John Kelly
367 Main St.
Hyannis, MA 02601
Dear Mr. Kelly:
First Lutheran Church is planning alterations and an
addit}on to our sanctuary structure. Down Cape Engineering is
preparing site plans and evaluating the present septic system.
No additional plumbing outlets are planned and the present
system has been completely satisfactory. In any event, the
septic system will be in accord with legal requirements.
Sincerely, -
.
r•' ,
Leonard tandall,
Building Committee Chairman
cc Mike McDonough,
Down Cape Engineering
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,CJ�►t1 may,
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_ Congregation of the Lutheran Church in America Serving the Cape Cod Area
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