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0010 VILLAGE LANE - Health
V�1 4axS'�bl� Pr ::;! 155- 00 -opt( 0 No. 4210 1/3 BLU C� ESSELTE 10% 0 a a No. ;?o V ~Lf3 77- Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS es 01ppfitation for Misposar *pstem Construttion permit Application for a Permit to Construct( ) Repair(I'Upgrade( ) Abandon( ) ❑Complete System Ellindividual Components Location Address or Lot No. IC) v,\6 ��, Owner's Name,Address,and Tel.No.�v �r t J 6 Q Assessor's Map/Parcel !a � Installer's Name,Address,and Tel.'No. . esigner's Name,Address,and Tel.No bo t< CSC GzDK Type of Building: �/ Dwelling No.of Bedrooms Lot Size � T o��(� sq.ft. Garbage Grinder( ) Other Type of Buildings, No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 30 gpd Design flow provided �, gpd Plan Date 01 j S q Number of sheets Revision Date Title Size of Septic Tank ©Z::) , Type of S.A.S. S �,e�1c�,.r CC�.,a�,,,��►z-a, c.��S� Description of Soil Nature of Repairs or Alterations(Answer when applicable) off'3" �'dy.� CV, 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 Certificate of Compliance has been issued by this Board of He Signed Date 1c 10 Application Approved by c Date Application Disapproved by Date for the following reasons Permit No. 9LO tO— 43 IL Date Issued 0 No. ;?0 _ j5 t Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: s PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2pplitation for ]Disposal *pstrm Construttion 3permit Application for a Permit to Construct( ) Repair(VY Upgrade( ) Abandon( ) ❑Complete System C]'Individual Components Location Address or Lot No. (b v ,\(,•4 �„a, Owner's Name,Address,and Tel.No.`¢:) u Assessor's Map/Parcel S,S- Installer's Name,Address,and Tel.`No. -Designer's Name,Address,and Tel.No Z Vbo\{l< 4N6SC 3©x 3-7 l r:',c" Sow- <:Z - G- (:L> ` Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building 9-nS, No.of Persons Showers( ) Cafeteria( ) Other Fixtures c Design Flow(min.required) 3 3d gpd Design flow provided `7 (©_ gpd Plan Date_�a ((q ` Number of sheets Revision Date Title Size of Septic Tank O"J ,� �" Type of S.A.S. SQpcz, Description of Soil C �� Nature of Repairs or Alterations(Answer when applicable) s. C \ - �o <<c ti L 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 Certificate of Compliance has been issued by this Board of Health. Signed G� Date /Q6 e'/C) ."� Application Approved by j Date Ar - r y Application Disapproved by Date for the following reasons Permit No. ao t o 43 --�L Date Issued- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Cornpfiante THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(V/ ' Upgraded( ) Abandoned( )by �•.a� vt 4 r , at ( (n ; \\ _ L,..,n a has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. o 016.t(3�'dated /0 Designer #bedrooms V Approved desi ow 11 - 3 3 K) - gpd The issuance of this permit shall. of be construed as a guarantee that the system will funchh p Jn as�designed. /� Date 11 Inspector �w `U' , /� el . � No. Bolo— ((3- Fee &t) - - - THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Bisposal *pstetn Construction ertnit Permission is hereby granted to Construct( ) Repair("�' Upgrade( ) Abandon( ) System located at C) U a. I and as described in the above Application for Disposal System Construction Permit. The applicant recognized 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 permit.__-// Date /O- " r y Approved by V Town of Barnstable Regulatory Services Thomas F. Geiler,Director MWsfABM s Public Health Division . 39. Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date:;Osi,`(, DoCO Sewage Permit# Q0�0-(37 Assessor's Map/Parcel Installer& Designer Certification Form Designer: s0 i�A-*e,e�. Installer: Address: �.U. `3©tc �03 c7 Address: Vn, ix)x 37( On CZ OT �6 was issued a permit to install a (date) (installer septic system at (,,,v,,,e_ based on a design drawn by (address) dated (designer) _IZI 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. Stripout (if required) was inspected and the soils were found satisfactory. 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. equired) was inspected and the soils were found satisfactory. (Installer's Signature) - 9 v a s �SSinTaAl � (Designer' Signature) (Affix De ere) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice formsWesignercertification form.doc No. _"_06 00/ 1 ((��((�� Entered in computer: THE COMMONWEALTH 0 ASSACHUSETTS Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 2ppricatfon for Migoml *pgtem Construction permit Application�ca Permit to Construct( )Repair( )Upgrade( )Abandon( ) Complete System El Individual Components to Location Address or Lot No % / Owner's Name,Address and Tel No. Assessor's Map/Parcel �/i � L Gc� 6 Installer's Name,Address,and Tel.No. 0677 Designer's Name,Address and Tel.No. am" lA_j Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building ; —No.of Persons Showers( Z) Cafeteria( ) Other Fixtures Design Flow //0 X 3=31 a gallons per day. Calculated daily flow 3 .7[S gallons. Plan Date ,l!2. ! 7 /9 C Number of sheets / Revision Date Title G47c, --l' ' Size of Septic Tank / ' -a 6 Type of S.A.S. 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 issued by this Bo of Hea Signed Date Application Approved by Date d' Application Disapproved for the following reasons Permit No. �' Date Issued ''� " TOWN /OF BARNSTABLE 1� LOCATION ./,Or c SEWAGE # VELLAGE L_,_oA ASSESSOR'S MAP & LOT/ INSTALLER'S NAME&PHONE NO. Z i/ AV/ SEPTIC TANK CAPACITY S'cj- LEACHING FACILITY: (type) 0) V0`i T!r./ 0 e (size) ASW NO.OF BEDROOMS_ BUILDER OR OWNER i PERMrrDATE: COMPLIANCE DATE:—' 2 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility ` r t Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) l�Q Feet Edge of Wetland and Leaching Facility(If any wetlands exist l 7 Q Feet within 300 feet of leaching acility) Furnished by a Q ei' No. .s Fee - THE COMMONWEALTH OF(IGIASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pprication for Xh6pooal bpgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) Complete System ❑Individual Components 0 fo Location Address or Lot No. y �' / -*4�' Owner's Name,Address and Tel./No. Assessor's Map/Parcel / ` �/� / / G� / L� �i G- Installer's Name,Address,and Tel./No. pB 7 Designer's Name,Address and Tel.No. 19eG ice/'/ /� C�i_a. / -,f / 46/ — ate lee Type of Building:" Dwelling No.of Bedrooms Lot Size �� q.ft.- Garbage Grinder( ) Other Type of Building � Showers;( 2) Cafeteria( ) Other Fixtures / 1r Design Flow //D Y 3=3'1 V gallons per day. Calculated daily flow 3 gallons. " .Plan Date ./I Z / 7 /9 G Number of sheets i Revision Date Title Size of Septic Tank 4 b Type of S.A.S. Description of Soil / cr..� o gn --,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 nd not to place the system in operation until a Certifi- cate of Compliance has been issued by this Bo of Healt i Signed Date ! Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (tompliance THIS IS TO CERTIFY, that the On-site Sewage Disposal Sy em Constructed( ;�`)Repaired ( )Upgraded( ) Abandoned( )by ems- at G f l/ ar g4,,7 l has been constructed in accordance with the provisions o Title 5 and the for Disposal Sy tem onstruction Permit No '* dated��'' Installer c�� /lX C 0,/ Designer The issuance of this permit shall not beconstrued as a guarantee that the system will function as designed. Date t9 - 2 / 7 Inspector � \ No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS . =tsspaar Apgtem Construction Permit Permission is hereby gran ed to Cst ct( '�)Repair( )Upgrade( )Abandon( ) System located at 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 it. Date:.��j'_-7 Approved b A v 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 CLIENT: Nickolas Building Co. LOCATION: Lot #4 ADDRESS: c/o Desmond Well Village Lane W.Barn.stable MA SAMPLE DATE: 12-9-96 COLLECTED BY: T. Desmond DATE RECEIVED: 12-10-96 TIME: 4:30 LAB I.D. #: E12119 JOB TYPE: New Well SAMPLE I.D. #: E12119 WELL SPECS. : 60/14 RESULTS OF .ANALYSIS: Parameters Units Recommended Limit Result Coliform bacteria/100m1 (MF Method) 0 0 pH pH units 6.0-8.5 6.64 Conductance umhos/cm 500 150 Sodium mg/L 28.0 9.1 Nitrate-N/Nitrite-N mg/L 10.0 LT 0.04 Iron mg/L 0.3 IT 0.02. Manganese mg/L 0.05 0.015 Volatile Organic Compauncis See Attached Report ND EPA Meth-ad 524.2 COMNF'NTS: YES WATER IS SUITABLE FOR DRINKIN RPOSES R PARAMETERS TESTES. XXX Date ZRo -ld J ari Laborato Director LT = Less Than ND = None Detected --------=-------- -------- -- -- -------- "Decr-3-1. —96 12 : 24A P . 03 1 LAPUCK LABORATORIES,INC. ENVIRONMENTAL TESTING WASTE WATER DISCHARGE 50 Hunt Street TESTING Watertown, MA 02172 FOOD ANALYSIS (617)923-0300 CHEMICAL ANALYSIS k1- FAX (617)923-0301 FORENSIC TESTING REPORT LAB NO. 57021-2 December 27, 1996 Mr. Ron Saari ENVIROTECH LABORATORIES, INC. Sample Received: 12/12/96 449 Route 130 Client I.U.: Nickolas Bldg. Co. Sandwich, MA,02563 Sample I.D.: Drinking Water Test Results: Volatile Organics-ppb(ug/L) Method#524.2 Benzene ND 1,2-Dichloropropane ND Bromobenzene ND 1,3-Dichloropropane ND Bromoohloromethane ND 2,2-Dichloropropane ND Bromodichloromethane ND 1.1-Dichloropropene ND Bromofonn ND Cis-I.3-Dichloropropene ND f3romonwthaue ND "brans-1,3-Dichloropropene T"D N-Butyl Benzene ND Ethylbenzene ND Sec-Butvl Benzene ND Hexachlorobutadiene ND Tert-Butyl Benzene ND Isopropylbeazene ND Carbon Tetrachloride ND P-Isopropyitoluene ND Chlorobcnzene ND Methyl Chloride ND Chloroethane ND Naphthalene ND Chloroform ND N-Propylbenzene ND Chloromethane ND Styrene ND 2-Chlorotoluene ND 1,1,1,2-Tetrachloroethane ND 4-Chlorotoluene ND 1.12.2-Tetrachloroethane ND 1,2-Dibromo-3-Chloropropane ND Tetrachloroethene ND Dibromomethane ND Toluene ND 1.2-Dichlorobenzene ND 1,2,3-Trichlorobenzene ND 1,3-Dichlorobenzene ND 1.2,4-Trichlorobenzene ND I A-Dichlorobenzene ND 1,1,1-Trichloroethane ND Dibromochloromethane ND 1,1,2-Trichloroethane ND 1,2-Dibromoethane (EDB) NU Trichlorofluoromethane ND Dichlorodifluoromethane ND Trichloroethane ND 1,1-Dichloroethane ND 1,2,3-Trichloropropane ND 1.2-Dichloroethane(EDC) ND 1,2,4-Trimethylbenzene ND 1,1-Dichloroethelene ND 1,3,5-Trimethylbenzene ND Cis-1,2-Dichloroethylene ND Vinyl Chloride ND Zara s- 2-. ic�lor e�th-ylene ND Total Cylene �ll N.D. =Not Detected Analysis Date : 12/18/96 Method Detection Limit =0.5 ug/L Recoveries o Sttrro at��e- 1,2.Dichlorobenzene-d4 100 P-Bromofluorobenzene 100 ---�� Testing 'ng Services ames Fontenarosa, Lab Manager for over 30 Years . . . r—:.!,-r i:in¢or other numoscs orcr our - a N ��= '-- Fee------- -- o.-�/-- BOARD OF HEALTH TOWN OF BARNSTABLE Application-for Veil Cootruct ion Permit Applicatio is hereby ma e f permit to Construct ( ), Alter ( ), or Repa' )an individual Well at: ' Location — Add s Assessors Map and Parcel ------ ------------------------------ ----------------------------------------------------------------------------------------------- �,C /vOwney�J Address ----Q --------- f C — ..� —��sf3jfO�l — -----------—----------------------------------- Installer — Driller Address Type of Building Dwelling------ _--------- r' Other - Type of Building --- No. of Persons----------------- Typeof Well-- --- -- _/-- - Capacity---------------------------------------------------------------------- Purpose of Well------------ ---fA------�e'-77-------- 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 p Application Approved By - ---------------- ---- —�_����1_-Z_� date Application Disapproved for the following reasons:----------------------------------------------------------------------------------------- --------------------------------------- -------------------------------------------------------------------------------------- // date Permit No. - tf-" --—— —- Issued----------------------------------------------------------------------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) by----------—----——-------------------------- --------------------------------------------------------------- - - ----------------------- ller at-- G,�— —� * —__ Insta _----------- 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. Dated----------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE- ---- ---—— — - — -- -- Inspector----------------------------------------——- ----- No. Fee------ 5_--- �si BOARD OF HEALTH r.. ;! r TOWN OF BA�RNSTABLE Applicat ion Ar Vell Congtruct ion Permit Applicatio i ereby made!,.fc)rA permit to Construct ( ), Alter ( . ), or Repa' )an individual Well at: a Location — Add re - Assessors Map and Parcel �Own ey Address , ---------------------------------------- ------ - ��. ------ Installer — Driller Address Type of Building Dwelling 1 --I_ __--------/___ �" Other - Type of Building----------------------------------- No. of Persons-----------=-------------------- ----------- Type of Well----- ---C ----------- - -- Capacity ---------------------- - ----— Purpose of Well----------- � '�--- 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 - ------ -- - -- --------- - --------------------------- date Application Approved By---_'� _ ) _- ----- date ----— --1 '7 Application Disapproved for the following reasons:------------------------------------------------------------------>------------------ �-_.. date i Permit No. -- A-1 �----—---------------- Issued------------ -�--- date W i BOARD OF HEALTH TOWN OF BARNSTABLE v r Certificate Of Compliance _ THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) by-----------------——-------------------------- - ---------- Installer at has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Dated-------------------------- g PP VJ-74t4-- Regulation as described.in the application for Well Construction Permit No. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. —=- -- Inspector---------------------------------- - DATE---------------------------- -- ---------------------------- ` r i �'ym amr rats imoc am e�ce a.�ceasrss eta f�: a ;rabs,. cb a ..st 'a:.r?. .. r—MO' .cam am Owv= BOARD OF HEALTH TOWN OF BARNSTABLE Vell Congtruct ion Permit No. -Y 4JA ------ Fee---- ----- --- �I Permission is hereby granted-------- ---------------------------------------------------------------------------------------------------- j to Construct ), Alter ( ), or Repai an Individual Well at: C' 'eS41ce---------- - - - —- - - street as shown on the application for a Well Construction Permit ; No.- - ---- ---- ---- --- - -- -- - Dated --------1 r� a -� --- f C} Board of Health DATE ------------ I r r{. Department of Environmental Management/Divisicin of Water Resources Alk WELL COMPLETION REPORT WELL LOCATION GEOGRAPHIC DESCRIPTION Address to-A U I)a Ifn.trs ( .a��, U.. N S E W, of fleet! (circle► City/Town U.I")o-Kk5 %4 n(( "1 p Well owner.A l k-y"I cl ei !road! Address mil- 4)`� N S E W of , 1m1,in tenihsl (cliclel . Board of Health permit obtained: yes , no❑ rnrersecr. w/ (roadl WELL USE WELL DATA Domestic ® Public[] Industrial ❑ Total well depth ft. Monitoring❑ Other Deptli to bedrock ft. Water-bearing rock/unconsolidated material' Method drilled 4• A>+tart� Date drilled -g'S G' Description Water=bearing zones: CASING type :�'44= (40 ?VC.` 0 From To D 2) From To Length's ft. Dia(.I.D.) in. 3) From - To Length into bedrock ft. Gravel pack well: dia. } Protective well seal: Screen: dia. Grout-El Other Slot Jf-ILLL length 'C/_from 7- for-b STATIC WATER LEVEL(all wells), " Static water level below lands u face N ft. Date WELL TEST(production wells) j � 3 Dlawdown ft. after pumping3hr. min.at Z gpm !x e r O . S � a How measu a �° ec very it. after u n r d R —I min.. Y o LOG of FORMATION1-1ro COMMENTS Materials From ^,� rxDriller t Vt<vt,64 Qn.n,s F- 01 50 Firm Addressr. City/Town 0-le.._ 01 A 076 Supervising Driller,Reg.# 22 17 \• ` Si nature o/su`eFws� Fe lsferod well drl/!er P/aase print hrm/y BOARD OF HEALTH COPY -I---- i I I - I __L___j__t__1_______��----------------------L------L__L_ I - � I : 1,, I A ,III " Y, I'll , Y,,�, " . -, - ":. - �-,V_ I- "�.,, 11 I ., �� �, -____:_1 0 V , ��,�",�,�_, -�: ;� -,,, 1 , I - �,,,,- I .,1� :1�. . - In"�� , '"' * ',�� 1- I " �!: .11' ' , .,�_ ,,��, I -- " "I,I ,'.; I I � I , ,_� " , — -I ., . , ,;��-`� " �-,77,,_,�, i V '��- I , , .11 I- - , , , � I �:,,�'�" - �: � . , �-1 �M -- 1, " ,, -, 1, 1 . -- , �, . 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OF BEDROOMS OWNER `��s� �-Q PERMIT DATE: (O��� [ Q COMPLIANCE DATE: L Q) Separation Distance Between the: i 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) i Q _ Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) l Feet FURNISHED BY �� �--- G3 C. 6G( � 63