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UPC 10239
No. H163BE0�57.CONSJ���
HASTINGS, MN
No.IL/ -- .-e H Ell....
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
.....1-OW 0..............oF........EAI tf ST, Lt.......................................
Appliration for Uiivoiial Works (foutitrurtion Prrutit
Application is hereby made for a Permit to Construct ( �r Repair ( ) an Individual Sewage Disposal
System at:
"0'
--- ..... ...._.......I.L-!�ti!-------------�.............................. --...---------..........................�T.....----....-----•--•--•-----------•-----------
tocation-Address or Lot No.�_r
Owner Address
D ice.. .tC c°n.�:.sa C�1��_.......... .Z S. W_ f l ls2 l._ 13ctk1�_ t��� ....
Installer * Address
Size Lot.... G t"-----S
d Type of Building �� -----------�---•
Dwelling—No. of Bedrooms___-•--------..._-�......................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers — Cafeteria
a Other fixtures -------------------------------- -
W Design Flow.......................56.............gallons per person per day. Total daily flow.___---_--.---_..__.--•-3.�3®_....gallons.
WSeptic Tank—Liquid capacity AQCC)..gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No. .................... Width ------- Total Length..................... Total leaching area....................sq. ft.
'..._. Depth below inlet....:.. _..... Total leaching area.....�M__sq. ft.
Seepage Pit No..........I---------- Diameter........
z Other Distribution box ( Vf Dosing tank ( )
----•- Date.----- �� q I..........
Percolation Test Results Performed by._...�,_�1�'�'�.�.�'__.__Y4_______________________ �'.___�
aTest Pit No. 1.....A------minutes per inch Depth of Test Pit.......... Depth to ground water----
Test Pit No. 2................minutes per inch Depth of Test Pit..........j�e.... Depth to ground water........................
------------------------------ -•- --- --- -.------
--•--•----•--------_.----------..---•- -•-------•-•--------------
O Description of Soil 'z -c?I�-Mn�.. -__?+�1'SS�t?-t`'---•-•z'--�---WL�- pr�L-r�--$ N� 5®ti1 -�ILrteA
W ---------------------- 1�[� � SA. a
UNature 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 En ental Code— further agrees not to place the
system in operation until a Certificate of t -is ,ihealth.
l
Signed
Date
Application Approved BY --- - ----------- --- ----- ----
.......--'---------'---'.. ----------------
Date-'......
..........
Application Disapproved for the following rear n - -- -- -------------- ------ ------- ----------------- ------------------------ -------. -- ........
IIDate
Permit No. -------71----------- ............... Issued ............... ----
� 9 A 0
No.JL A/ FEic
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
v... .Gt. �.j .. oF......... r�. to -- ---------------------•--...-----------
Appliratiun for Disposal Works Tonstrurtiun 1hrutit
Application is hereby made for a Permit to Construct ( r Repair ( ) an Individual Sewage Disposal
System at
L,.t)!1/1 �` U.! t,/T
...................................... ..... --...---•----•--------------...............•. --------••----•-•-----•--•-•-----------••----•----•--•-----•--------------------..................
Location-Address or Lot No./
�lt�ialT0 -D�'-�f1 (''t.l.V�%
•-•---•---•-•-•-------................••---•-•-..........-•--------.._..--•••-------........_--•• ----••--••-.............--------...............---....---------•--------------------•----.......--
owner Address
-------------------
Installer Address
dType of Building 2 Size Lot......-------�-i--- _._..Sqr-fecN
V Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
A4 Other—T e of Building No, of persons............................ Showers — Cafeteria
a Other fixtures . -----•--•-•-•------•----•-•-- .
W
Design Flow........................`�.�.........--__gallons per person per day. Total daily flow.......................... ....gallons.
WSeptic Tank—Liquid capacity.!q _gallons Length................ Width........ Diameter................ Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No----------I---------- Diameter:........ ' ___. Depth below inlet..... Total leaching area..... t.sq. ft.
Z Other Distribution box ( Dosing tank ( ) _
~' Percolation Test Results Performed by...- I, g--re1 .._ _.. M .............................. Date...._��.`.�. �' �___._..__.
.. .-•-
Wa Test Pit No. 1...... ......minutes per inch Depth of Test Pit---------- ... Depth to ground water....-..............
Gi, Test Pit No. 2................minutes per inch Depth of Test Pit---------- ... Depth to ground water......_.................
P' ....................................-- ----................................................................................................................
O Description of Soil------•-•-•�'`--L 4or + +- �iNsot%....,_.. -,-G WC-LJ- u-1AOLZD S 04� /SC7AA� St�"fCt-Aq
x ...•----.....•-••-••---•-•....•.
(y- 10 ur�t..t.. [r l;s i i�� S a t-j j�ns� ��s (u - : ( 1.►'7 ?� tr
AA _.._. .P`lr«..._..
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 Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has, jeen issued by the,b�o, d f health.
Signed ..
r, ,�,�_ 1 '........................ Date
Application Approved B ? � �if i'1 �r• a v��--- �> - � ��l�,h,--- ----------------------PP PP Y ----- --------
.. v Dace
Application Disapproved for the following rear n - ----------------------------------------------------.......................---------------------------------------------------------
----------------------------- �--' .........-... .
/ J01
l Dace
Permit No. ! ...... Issued .----�= ---- 't
v
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
... { ::'.r . OF tad .fit.. .........................................................
CC.er#tfirate of (11omplianre
THIS-*770 ERT'F Th t he ciiv' ual Sewage Disposal System constructed ( �or Repaired ( )
Y - - - -:----r--- .-...- -- -- ---- -- - - ---------------------------'-----------........... - ........------------
Installer
has been installed in accordance with the provisions of ITLE s e 'b din
the application for Disposal Works Construction Permit No. .....n../heAtate-Environmental
Y `� dated --
THE ISSUANCE F THIS CERTIFICATE HALL NOT BE CON fR ED A A ARANTE HA, THE
O S C CA S O S U S GU
SYSTEM WILL FUNCTION SATISFACTORY.
DATE - `a.- ..1---------------------------------------- Inspector ............. i .............................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
0/ V ...................J.��(.t��......OF__.... .f'�.P��f.�: �'�"'-------•--.......................
No......... di FEE...•--•00- •-••....
..... ...
Disposal k (t t �trudiq _ rrnti#r7T `�/�( k`e
Permission is hereby granted.......... .. _....!!....._.a.�� � � �J�.. ��`-'-1!:<��..f.u-•----......
to Construct ( or Repair ( ) an Individual Sewage Disposal System
atNo................ -----------------•-•--•••----•..........-••....---......•--••••••--•...---••--•••••......-----••• .....-� •" ----------••-•;' r
_...
Street
as shown on the appli ion for Disposal Works Construction Permi ., _ _rn4 D' ateO/`
Board of Health
DATE............... y , ..........................
FORM 1255 HOBBS & WARRE INC., PUBLISHERS
t '
3 V
No--------------------- Fee---------------------
BOARD OF HEALTH'
TOWN OF BARNSTABLE
Application-for Vell Con5truct ion permit
Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at:
Location — Ad ress Assessors Map and Parcel
-- -� _--------- t � --- -- ----- -- � r -- - - - -- -
Owner A�ddreess / ✓�
__sal -L 2 �;l _/�_
Installer — Driller ( Address
Type of Building
Dwelling -- =t — --- ------ -
Other - Type of Building------------------------ No. of Persons-----5------
Type of Well-- -J���- ----- --- ------ 0
Y _ �,- I - ------- Capacity__—s�-- -v� �-�-------------------------
Purpose of Well Z��-_________
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 a Certificate of Compliance has been issued by the Board of Health.
Signed
date
Application Approved By—
ate
Application Disapproved for the following reasons:----------------__—_—____
date
Permit No.---—--- --- ---- -- -- — - - Issued -- ----- --- ----- — --
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate (of Compliance
THIS TO CERTIFY, hat the Indivi ual We Constr cted><,), Altered ( ), or Repaired ( )
by - -L I - -— --- -- -------------------------------- -------------
Insta er
at - - - -- --- --
has een 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. -� —7 Dated-------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL,
SYSTEM WILL FUNCTION SATISFACTORY.
DATE-- ----- ---_ _-- - --- - Inspector-- - —--------—---- -- -- -- --
I �r: _ _ i.��. r.w:'r.-tF•n..« .:��'r.!,�`il.t.✓i}��'N�'+C-�+-^.�F.+d."t"°..M+ii'`w�.l�i•'"*-..v''�t,t�w :.r.,Q4, t46.. -.. sM-^c.y �.. .�� .
!� .�.,
No.-----`�9
-----� r � '�. Fee---------------------
BOARD OF HEALTH`"
TOWN OF BARNSTABLE t:
01ppIitationi orVell Cootruct ion Permit
Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair (. )an'individual Well at:
� fit: �t�i.,yu4�Le--------- ---- �G' ------`:C.re�Zi' `7/� -- ---------------------------
------_--------------------
Location — Ad ress Assessors Map and Parcel
---—--------------------- ----:------- r`'�Fe_}=!l?2''-__ -`----------------
—
L� Owner Address
y
,
"""'�' ""`2`i"+t`.• Installer — Driller Address
Type of Building
Dwelling —
Other - Type of Building ------ No. of.Persons------ 3------=-------------------------------------4
YP g------------.--- -
� -- ---------- _3 -� -----
Type of Well- - - Ca aclt, �- = - -
Purpose of We11 ' h r�> .---------- -------
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 a Certificate of Compliance has.been issued by the Board of Health: -
Signed-- - -- --
Application Approved By----�.a � _-�� .��,:z --�: =- i ------�.}-'�Y�sae
\! k date
Application Disapproved'fors the following reasons
r {— tv date
,
' Permit No.=---- —— -==—= - ==- :- =- Issued ---- ----------
date
.._ .d..-_..- ........'w ... .«- • .,a_ ..,w�n�% ike,M�,�q, a7�� � ,�{ f�� t..... -.-. -. �, .•. ` .-. Str.,....
f BOARD`OF HE4LTHiYT'J..
TOWN Off" BARNSTAB E :
Certificate ®f CompUnce
THIS TO CERTIFY,hat the Individual W/elllr Constructed,( ), Altered ( ),,.or Repaired
--- ------ - ----- ---- -
-- - y
sta e11.
r
z�� �� ,
hasV beeninstalled-in accordance with the provisions of the Town,of Barnstable Board of Health'Private Well Protection
Re ulation as described in the application' for Well Construction P'e rnit No. -i1/--- --- -----
g PP .�-�-- �`-- �--t- Dated -
THE ISSUANCE OF THIS CERTIFICATE SHALL_NOT•BE CONS_TRUED•AS'A GUARANTEE THAT THE-WELL '
SYSTEM WILL FUNCTION',SATISFACTORY., « .
DATE - --------------------- -- - Inspector-= - -- --- ----- -----------------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Vert Con5tructionpermit
No.------- - — ---- Fee-- ---'-
ir4
Permission is hereby granted - - ------------ '� -----------------
A------------------------------------ - -
to Construct ), Alter ( ), or Repair an Individual Wel a� 4
No. -- -- - r-= -- _-_4- - z---------------------------------
i Street
as shown on the application for a Well Construction Permit
No.—--------------------------------- ------------------------------------- Dated--------------------------------------------------------------------------------------
------------------- -� =`---- -------------------------------------------
C$oard of Health
DATE-----------:-- -' „' r,-��---------------------------------------------
TOWN OF BARNSTABLE q �I
LOCATION ®"r ;?- —,-V , SEWAGE # /�-
VILLAGE W , 64t2+. tp,&E ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY L ®®o G-f ,
LEACHING FACILITY:(type) LT— (size) 6
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER W6Lo_
BUILDER OR O WNE Sub ik V 1 S r
4
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED: �--
VARIANCE GRANTED: Yes No
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ENVIROTECH LABORATORIES \Mass. Cert.%MA03 :
449 Route 13Sandwic,MA053 . (0) aaa-40
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E CLIENT: Judith Davis LOCATION: Lot 2 Plum Street
E .
E ADDRESS W. Barnstable, MA
COLLECTED BY: L. Wile SAMPLE DATE 5--1 TIME j
DATE RECEIVED:5-6-91 SAMPLE IDZ251 ]
k
E JOB f New Qom]] WELL DEPTH 80' 102all§n .
E �
RESULTS OF ANALYSIS
E . _
k
E Parameter Units Recommended limit Result
E 4
[ Cdi r b c! wa/10 m! (MF Method) O 0 q
E _
PH pH units R AR 5 6.28 \
4_
U Conductance umhos/m 500 I05
Sodium mg/E \2$
14.0
\ Rt k-N mg/E 1¢0 <O:J
Iron mg/E 03 j
k 3.73 \
Manganese mg/L 0.05
k
E 0.53
Hardness m//E as CaCO J 5O
1&.4
k_ Sulfate mg/L 250
+ 4.6 j
k � _
6 Potassium mg/E 2¢0 . !
K 1.2 %
% Alkalinity mg/L 20 �
21.4 )
Chloride mg/E 25'
19.3
¢ Turbidity NTU &O
k 9.1 \
C017 APC units 15.0
k 40.0
c �
Background bacteria
\ A
COMMENT EPA601/602 Chloroform = I ug/ (see attached report) k
Iron and manganese are not health hazards, but may cause taste, atdining, and odor )
k problems. A filtering System should be considered. q
F . G
. r .
YES No WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. .
xmx 0 k
� ! DATE
r J
�. . �
�!! �i��!! ���!��� . ku�
�
1
�.�Vlillf Iifllililiiillitllflf 11111111111111111111111111111111111i1R111111111111tINi111lilHiilhiltitilllilt11111ititi!!ii!it11111tt11Ril(iflflfi!tl!ltit!ttit!1llititif!iltgifitl!IfKit!f'tifll!!11iitit1111111!lttilfifititfilti!1111!!t!!!��
ENVIROTECH LABORATORIES =z
Mass. Cert.#:MA063
449 Route 130 Sandwich,MA 02563 508 888-6460
ac =
€ CLIENT: _,LUAith3-aK S LOCATION: . Lot 2 Plum St. _
ADDRESS: _ W. Barnstable, MA
COLLECTED BY: L. Wile SAMPLE DATE: —5Sz91 TIME:
DATE RECEIVED: 5-6-91 SAMPLE ID: 7251_
A
JOB ": New Well — WELL DEPTH: — 80' lOgal/min
RESULTS OF ANALYSIS:
Parameter Units Recommended limit Result ^�
:g
Coliform bacteria/100 ml (MF Method) 0 0
pH pH units 6.0-8.5 6.28
Conductance umhos/cm 500 105
JSodium mg/L 20.0 140
E 4
Nitrate-N mg/L 10.0 <0.03
Iron mg/L -- - 0.3 3.73 --
Manganese mg/L 0.05 0.53
_z
Hardness mg/L as CaCO 500 14.4
Sulfate mg/L 250 4.6
Potassium mg/L 20.0 1.2 =
Alkalinity --mg/L —— 200 -- 21.4
Chloride mg/L 250 g
19.3
Turbidity NTU 5.0 9.1
Color APC units 15.0 40.0
Background bacteria
COMMENT: EPA 601/601
Chloroform ug/L 1
(see attached report)
Iron & manganese are not health hazards, but may cause taste, staining & odor problems. ::
YES No WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED.
UX 0 _y
DATE
��II UII UIIII UII UlII11lIIIII11111 UIIIIII UIIIIIIIIIIIIIIIIIIIIIIIIIIII iIIII11111111 NIIIIIIII tlI U1►lIlllll iliuuu111UiiUlUtllifl UtUulUiitliillUiiui ifilUlliNiUliUllllliilitUtiiliiilfiiiilitiililliiUUillUUtiUtiuuiti��`'
GROUNDWATER
ANALYTICAL
EPA METHODS 601 and 602
Volatile Organics (GC/PID/ELCD)
Field ID: Z-251 Lab ID: 1288-01
Project: Davis Lot 2 QC Batch: VGA-765
Client: Envirotech Sampled: 05-06-91
Cont/Prsv: 40ml VOA Vial/NaHSO4 Cool Received: 05-07-91
Matrix: Aqueous Analyzed: 05-08-91
PARAMETER CONCENTRATION REPORTING LIMIT
'(ug/L) (ug/L)
III
Dichlorodifluoromethane BRL 5
Chloromethane BRL I
Vinyl Chloride BRL I
Bromomethane BRL 5
Chloroethane BRL
1
T richlorofluoromethane BRL I
1 , 1-Dichloroethene BRL 1
Methylene Chloride BRL I
trans-1 ,2-Dichloroethene BRL 1
1, 1-Dichloroethane BRL 1
cis-1 ,2-Dichloroethene * BRL 1
Chloroform 1 1
1 , 1 , 1-Trichloroetllane BRL 1
Carbon Tetrachloride BRL 1
Benzene BRL I
1 ,2-Dichloroethane BRL I
Trichloroethene BRL 1
1,2-Dichloropropane BRL I
Bromodichloromethane BRL 1
2-Chloroethylvinyl Ether BRL 1
trans-1,3-Dichloropropene BRL 1
Toluene BRL 1
cis-1,3-Dichloropropene BRL 1
1,1 ,2-Trichloroethane BRL 1 .
Tetrachloroethene BRL 1
Dibromochloromethane BRL 1
Chlorobenzene BRL 1
Ethylbenzene BRL 1
m+p-Xylene * BRL 1
o-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
Bromochloromethane 30 28 93 % 83 - 117 %
Fluorobenzene 30 30 100 % 87 - 113 %
BRL = Below Reporting Limit. * Non-target compound. "Trace" indicates probable presence below listed
Reporting Limit. Method References: Method 601 - Purgeable Halocarbons and Method 602 - Purgeable
Aromatics, 40 C.F.R. 136, Appendix A (1986).
ENVIROTECH LABORATORIES INVOICE,
A0051
449 Rte. 130
DATE
Sandwich, MA 02563 5-15-91
(508) 888-6460 ACCOUNT NO.
YOUR P. O. NUMBER
INVOICE
Judith Davis
__j
DATE CITY. DESCRIPTION UNIT AMOUNT
PRICE
5-6-91 1 Water Analysis $ 50 0 $ 50 00
1 EPA 601/602 165 0 165 00
Lot 2 Plum Street, W. Barnstable, MA
i
VII
PLEASE PAY FROM THIS INVOICE
SUB TOTAL
TOTAL $ 21 00
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TOTAL
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