HomeMy WebLinkAbout1753 OLD STAGE ROAD - HealthrEl753 OLD S7A9C-E RD, 19. BARNS7ABLE
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TOWN OF BARNSTABLE
LOCATION Ole L/� mod, SEWAGE#
VILLAGE Gt/ �Q/��-�f�� ASSESSOR'S MAP&LOT 1- Z` '31
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INSTALLER'S NAME&PHONE NO. / oIAI �� / C�/� ���✓Z��
SE PTI TANK CAPACITY
LEACHING FACILITY: (type) ''f (size)
NO.OF BEDROOMS
BUILDER OR OWNER
PERMIT DATE: Y Z 5�e COMPLIANCE DATE: /-7e3�
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
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No. Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
01pplicotiou for Digpont *pgtem Construction Permit
Application is hereby made for a Permit to Construct( )or Repair(bZ)an On-site Sewage Disposal System at:
Location Address or Lot No. Owner's Name,Address and Tel.No.
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Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
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P74 j w4i -"I /e-AD N ��-
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Type of Building:
Dwelling No. of Bedrooms Garbage Grinder N0
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 6 gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Description of Soil
Nature of Repairs o ,Alterations(Answer when applicable) -3 A-Lz bli z- �x.4- f U o o
f>r - LJ/ � Gr WAS -7-0 _ Z4-F_ E-XI n—/lf&-- S 5 L
cS
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction f 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 t ' o d of He lth. /
Signed Date
Application Approved by 4(_
Application Disapproved for the following reasons
Permit No. Date Issued
r
No. Fee
THE COMMONWEALTH OF'MASSACHUSETTS
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS,
pprication for Miquar *pgtem Construction Permit
Application is hereby made for a Permit to Construct( )or Repair(V)an On-site Sewage Disposal•;System at:
Location Addressor Lot No. Owner's Name,Address and Tel.No.
t 7,SZZ 6 t,AA .sib 4i,4 D Ay aJ l EdM.I
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(nJ. .B.��-mil S►_ t�+�M- Ur}-G Lo� i
Installer's Name,Address,and Tel.No. Designer's Name,.Address and Tel.No.
O(�TZll.0lsil�, <�,U►JT_J /WcX7Uti! /^j(_ o
-74—1�b wA4L-"-! A4-eb
Type of Building:
t Dwelling No.of Bedrooms Garbage Grinder
Other l Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 6 gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Description of Soil
I
Nature of Repairs or Alterations(Answer when applicable) 10a0 od
IQ /� '7 fe;X 1ST`/►✓6� S i L
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction f 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-
pate of Compliance has been issued by this He th.
Signed Date /9
Application Approved by
Application Disapproved for the following reasons
Permit No. '"'" Date Issued
THE COMMONWEALTH OF MASSACHUSETTSL '' ---
PUBLIC HEALTH DIVISION- BARNSTABLE, MASSACHUSETTS
Certificate of Compliance -
THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replaced(p4 on
by _20/�'d n r.)
G0J—,7WCT-tVJ for !/---y r10ynlr4.hJ
E
O U6 S��+t rZ 6,AZ t.J . A AW-A-M-r, as been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. ^ dated n+ A' �
Use of this system is conditioned on compliance with the provisions set forth below:
�-^
No. � Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
litpogal *p.5tem Construction Permit
Permission is hereby granted to f-1 I k)G
to construct( )repair( an On-site Sewage System located at / 75.� to S j � /LOAaL) ,
W. 6A.4-j s,A-4 c.E .
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: / """�' /� Approve
CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS)
I, 2�6�e,� �3G✓�o�„ , hereby certify that the application for disposal works
construction permit signed by me dated , concerning the
property located at 175---3 O L4 w / i.meets all of the
following criteria:
v • There are no wetlands within 300 feet of the proposed septic system
`There are no private wells within 150 feet of the proposed septic system
observed groundwater table is 14 feet or greater below the bottom of the leaching facility
�/• There is no increase in flow and/or change in use proposed
`�• There are no variances requested or needed.
SIGNED : DATE:
LICENSED 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].
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CERTIFICATE OF ANALYSIS
y Barnstable County Health Laboratory
Report Prepared For: Report Dated: 01/04/2001
e
Order Number: G0008677
Joan Croft
1753 Old Stage Road
West Barnstable, MA 02668
Laboratory ID#: .008677-01 Description: Water-Drinking Water
Sample#: 08677 Sampling Location: 1753 Old Stage Rd West Barnstable MA Collected: 12/27/2000
ollected by: J Croft Received: 12/27/2000
Test Parameters
ITEM RESULT UNITS MDL MCL Method# Tested
LAB: Microbiology
Total Coliform Positivie CFU/100mL 0 0 P/A 12/27/2000
Note: Exceeds the recommended maximum contamination level for drinking water due to presence of Coliform Bacteria.
Approved By:
(Lab Director)
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Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605
LOCATION -� 11�3 SEWAGE PERMIT NO.
T Srjgx - seal gel- /o Z Z
VILLAGE
INSET/A LL)' ER'S NAME j ADDRESS
6 BUILDER OR OWNER
DATE PERMIT ISSUED e4
CgDATE COMPLIANCE ISSUED S �
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30 �8 -
f�
No. Fmc ��.X=
-------—----
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........._TO.W�...............OF....
Appliration for Roposal Works Touotrurtion "amit
V
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
System at:
.........S;?A.a...aA---�.- ...... ..................................................................................................
0 Location-Address or Lot No.
.............. ........................................,
...........
caner
Address
...... ..1.4.....csa---Of .................. ..................71A...t0v1jai::a ...............
Installer Address
Type of Building Size Lot............................Sq. feet
U
Dwelling—No. of Bedrooms.____- ________________________________.Ex
pansion Attic QJIP)7- Garbage Grinder
aOther—Type of Building ............................ No. of persons._______4................. Showers ( ) — Cafeteria
Otherfixtures ........................................................................... ..............C
Design Flow..................6.145;7...............gallons per person per day. Total daily flow-- ...........*............-gallons.
' *...........
9 Septic Tank—Liquid capacity/.99.0gallons Lengthl.'.� ..S'
Width_�� ......... Diameter________________ Depth___'__!
Disposal Trench—No. .................... Width_____._._.__.__.__._ Total Length__.__._.______..____ Total leaching area--------------------sq. ft.
61 ....... Depth below inlet__._._._____........4!
Seepage Pit No.....).............. Diameter._._.__.-___._.._._. ........ Total leaching area.JY5.15.7...sq. ft.
Z Other Distribution box ( .) Dosing tank
Percolation Test Results Performed by.____.__ ............................................. -Datc/.Q.1.05•&q
Test Pit No. 1..R..4......minutes per inch Depth of Test Pit.....)P..)...... Depth to ground water_____ .....�9Q
fZq Test Pit No. 2................minutes per inch Depth of Test Pit.....IAJ..... Depth to ground water______-.............................................................................................................................................................
0 Description of Soil......A .... .....................................................................................................
=L C.M-1..M.eA....16a__.A.......................................................................................................
---------- ----------"-------------------------*...................................................................................................................... .......................... .....................................................
U Nature of Repairs-or Alterations—Answer when applicable..............................................................................................
........................................................................................................................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE the
5 Co
State Sanitary Code— The undersigned further agrees not to place the system in
operatio Cert cat4 0 nce has been issued by the koarl of health.
Signed..... --------.............
ate
plicati n=Apved y.............. at
................. .. .... ....t .......... ..........L.. f Date
Ap kv7ed
y Application Disapp oved for the following reLasons:._ ..........................................................................................................
........................................................................................................................................................................................................
Date
<
.. . .. . ...
Permit No.__ ..... ................... Issued-........ -------------------
D e,
Oh
No.).:'..�. .�- n FEs�.. ..'`...........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF............
95P(o%') 5'1 Ae3LC
Appliration fear BitivniiFal narks Tonotrurtinn ".truth
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
................__. ............._...._...... •- ..............I----- ........-•----._...•---.._.._......_...----•-....._..----�---------.._........-----....----
Location-Address or Lot No.
.
(�/� wner /� /'J Address
..__________)!.!.!__. _!� .9._�. L.._^._.,�__._. St.i_..Y.�.C___________________ ---------------- _/__j_-DL.... .....................
Installer Address
Type of Building Size Lot............................Sq. feet
�-� Dwelling—No. of Bedrooms........! _________________________________Expansion Attic (111p)_ Garbage Grinder (�P�
Other—Type of Building ............................. No. of persons___._._/.___.____.__...___ Showers ( ) — Cafeteria ( )
Q' Other fixtures _____________________
W Design Flow................. .......................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length________________ Width................ Diameter___(__ !a13epth_______________-
x Disposal Trench—No_____________,t r?c.2 tWidth.................... T•ptal1Length........ !...... Total leaching area................it:sq. ft.
_ Seepage Pit No--------------------- Diameter................_--- Depth below inlet.............. Total leaching area..................sq. ft.
Z Other Distribution!box ( ) Dding tank ( ) G ' `1 ;--
Percolation Test Results Performed by.......................................................................... Date ==-=l= '-------------.._...---
,� Test Pit No. 1________________minutes per inch D'dpth of�Test Pit.................... Depth to ground twat6n4__________________--.
44 Test Pit No. 2._':-.�_/______minutes per inch Depth of Test Pit----J.ri?__'______ Depth to ground water..... 1!'�_
Descriptionof Soil...............................................................................................................................--------------•--•......................
X a.
(� ..................................-•-'------! f? .: = f) .....1.......................................................................................................
U Nature of Repairs or Alterations—Answer when applicable--------------------------------•............................................................
___.
-----------•------------•-----•----••••--._.....•-•----•-•--
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary 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.
Signed ............f.....
ee
-....__.....
e a �
Application Approved By... ................ ............
t Date
Application Disapproved for the following reasons__________________________________________________________________-----•---------•---•---•- --------------
.............................................._....--•••••---...-•--------•---••---•-•-••----•-------_---
----------------------------------------------------------------------------
Date
PermitNo..---` —--------- Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..............................OF.................................................................._..._..............
Tatifiratr of TompliFanrr
THIS IS TQ CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by # -----------
-----------------------------------------------
-----------------
---------------------------------------
----------------
----------------
_ Installer
at.......4rn
,:._ .— -
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No------- dated--------------------------_.....................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE._...__...--•--•-�- _.. ...................................... Inspector....................... •-• ................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
ti, ......................OF...........------.....--_..__..._..R S.. .� as
No.. ..�lU A , . �..�,,/�.4,.t................ FEE.. ...-
�i���a��" nr�� ��an��railan rrani�
Permission is hereby granted t = .........................................................................
to Construct ( ) or Repair ( ) an Individualr,.5f4i, . posaf�'ys em
atNo.................................................................... --------.---``----------------------------------------------•------------------------•--••••--............
Y� Street
PP l-ID£Dis �? ".I���'
as shown on the a h�ton -� � - �i�s�nstructio� nit No_____________________ ated_�1_/_�'�� ......................
�.
DATE. + l e5 Board of Health
------••. ....... .......
L3 .
FORM 1255 A. M. SULKIN, TO
Log Number: Bottle #
G126 Date' 9/2- /64
sa BARNSTABL•E .COUNTY HEALTH DEPARTMENT
SUPERIOR'.COURT.HOUSE
O ''BARNSTABLE, MASSACHUSETTS 02630
w8a DRINKING DATER LABORATORY - i � ,, PHONE: 982.2311
Y� EXT. 331
°: 1+7 ,_` evelo m® Inc :Edward P;` Behan
Client. : F ., 1 � ,,� p t3t� :., � .Co.l:lector t �^3x .: a. ,: �. ,�. , ... .. ,
t
Mailing Address:"I61i i •s �,� ,r� <k ' :fAffi1iation -n,��� ,;f ee an.< e a r _fin
-Ts .:'o i6urr�mi(West bor.o MAimA0.581, rFg,f timer&',.Date,of t ,,;,,.. ���r�� �..
. .17U ,.�_ 1vl. dp'm:�F�Fr: K4 st�.a .: `?� nra• t: l; ollection:,;; �t� , 9/26/84,, , :00t :m.
Telephone: b:,778=4889/473.-9046 :a.' ...,Type off Supply: ,!- •A we water ,,,-x'f3�;.
Sample Location: . Lot 1 'Old 'Stage 'Rd: "" " "' Well Depth:- ,-- • )0
Centerville " Date"of-Analysis: '-'9/27/84
PARAMETER SAMPLE RESULT - RECOMMENDED LIMITS
Total Col,iform -Bacteria ;1.00. ml °'.
H wa�•+y:+. avr va.'7rki.•.• ..-, . •._..,. •. . -.w .+.y,. i,#i ft',,;"; •'�' ti�iw :C.. ,
`5_.9
Conductivity micromhos/cm 59. 500:0
w'1 ti t'S :J .:,t) ru 'i:ka, A ..'7: J"' •.i 5 - _ "s,l # "t`•t ` .
Iron m 0.12 0.3 ,•
Nitrate-Nitrogen m <0.04 10.0
Sodium m) -- 20.0
t.: xi :...•T , ",.,•.� .sr,,.,. •i' YiieR4 ... �t.'t :'7 C:bl3x+btl' °:Flv^'? o-R! i',_ti:tf ¢T� S.--'!: l . e. 'T
L �>:� , =``{: aF;`:34a.�7!S.^ .S't"4�,y'�{ dkr �' �S'�� �"dJ � ��1^r!-.3,^Yc c� .'�? ;}S"T!. @' a Ci J,"?;,.. _"`. •^ +,.c 't,( 4Y ?:
{ L4a< YF +`ei .] �i .P^<5.,f in"-a .}...n•or . =n. 1'A •d
♦ .. :w•- s . .. .. ., • rim!'t 7... ,. ..
I , xx Water sample meets the. recommended `limits for drinkingi. ' �i of all 'abov'r.e• J tested parameters.
II . Based only on "re'sults -of the parameters tested for this sample, the water is . ,
suitable for drinking but may present the problems checked below: =
A. Water sampl e` has''hi AW than "average 'l evel s 'of Ni trate.- Future moni tori ng is
recommended (2-3 times' per year)_ to- establish"any upward •trends.
.. • ,. _ 7 ... .v.. ,
B. The low pH of the water may shorten the useful life of the house's plumbing.
C. Water may present aesthetic• problems (taste,M odor, staining) due to
D. Water 'samPl*e fias"high `l eve l'sIofrsod -Um' i.y,t`=Persons ,on low sodium diets should
consul t_. their' doctorF
:i.72SS1Y0
III. Due to one or more �of the reasons 'checked below, this water sample is unfit for
human consumption:,-. A. High Bacteria B High Nitrates _
REMARKS:
Y X: t:10 $ et.;':tt i f G e
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CC: Barnstable Board of Health
Pie'ahan Well Drilling
7/17/84 Laboratory irector
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