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HomeMy WebLinkAbout0077 BURSLEY PATH - Health 77 BURSLEY PATH, W. BARNSTABLE A=110-25-2 P 4 No. `' u °' FEE - ( COMMONWEALTH ®F MASSACHUSETTS Board of Health, MA. APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION IRMIT Application for a Permit to Construct Repair( Upgrade( Abandon( - ❑Complete System ❑Individual Components Location 77 /9vPLz'/J� /i1 -' . lzfl Owner's Name Map/Parcel# V, 25 Address 99( Lot# NO. Telephone# Installer's Na`7 i � A 1s) Designer's Name ��j����i rd� Addres� C a-s`C.f� e I �-' l�W 7c� Address ��v ,S Vj)Q1—AfO7111 :�)2570- Telephone# ,d C- P P f 3 Telephone# g 4771;'' Type of Building Lot Size ® � sq.ft. Dwelling-No.of Bedrooms ®s Garbage grinder ( ) Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow (min.required) gpd Calculated design flow 330 6/�� Design flow provided gpd Plan: Date Number of sheets /r Revision Date Title Description of Soil(s) ��I Soil Evaluator Form No. AWC Name of Soil Evaluator ✓f���'� Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to pot to place Olystem in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date 7_4� -t7 4 �/ Inspections No. � � °' 6s� FEE Z4;:� �lr�) � COMMO� LT14 OF MASSACHUS ETTS Board of Health, E Zy ' 42 ,MA. CERTIFICATE OF COMPLIANCE Description of Work: 0 Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed (Repaired ( ),Upgraded ( ),Abandoned ( ) by: �A - t? J at L - has been installe in accordance with e provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. dated �'� Approved Design d PP � �p� PP n Flow g U gP � Installer Designer: Inspector: ate: The issuance of this permit shall not be construed as a guarantee that the system will fun ''on as designed. FEE /4" rc.'4J T COMMONWEALTH Of MASSACHUSETTS f Board of Health, �/}"57, 4 MA. Application for a Permit to Construct)(Repair( ) Upgrade( Abandon( ❑Complete System ❑Individual Components Location 94IA�'LL� ,�yfy Owner's Name Map/Parcel# 0 �, Z$ Z Address 9X /5�4 I'V-r�:SZ-0 7 41 Lot# NO, Ltj 4 Telephone# 1p7-?4 Installer's Name _Z;:A Co 4'S) Designer's Name �d GY lj)�%SeG "y Address Pc�-s4c , R� S A w�C� A_Jan Address 46X �S" A//�A 0Wr,1/02571/ Telephone# S"p 1 P f 3 Telephone# 833-,¢.77s- ,T Type of Building Lot Size OB.2 sq.ft. Dwelling-No.of Bedrooms 19 ' Garbage grinder ( ) Other-Type of Building No.of persons w Showers ( ),Cafeteria(`) Other Fixtures Design Flow (min.required) D gpd Calculated design flow 3 (J G/J.� Design flow provided gpd _Plan: Date /7 Number of sheets Revision Date Title .,f. Description of Soil(s)'� Soil Evaluator Form No. /�l�N/G Name of Soil Evaluator ✓bWLE Date of Evaluation. DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees_to not to place fhe tem in operation until a Certificate of Compliance has been issued bywthe Board of"Health. ;. r Signed Da e '6� 95 4't' Inspections i No. FEE COMMONWEALT14 OF MASSAC14USETTS ; Board of Health, 4=, MA. ` f CERTIFICATE OF COMPLIANCE Description of Work: ❑Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( Repaired ( ),Upgraded ( ),Abandoned ( ) by: X / "I at has been insta(le in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. dated �'�°'/ .� ''/�. Approved Design Flow (gpd) ` Installer A Vie`: l Designer: Inspector: i The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. 9/ -- FEE Board of Health, MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( �/Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system at C � � � /F A - . . �/�as described in the application for Disposal System Construction Permit No.7 4. �/dated ., Provided: Construction shall be completed wit in 'hree years of the date of;this�permit. All local e6 ditions must be The(. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date 1J / Board of Health Bo`Ltle Number: 512�:01. Fate: 117/18/97 S ®� 15A . BARNSTABLE COUNTY HEALTH AND ENVER®Nf�IEN3"AL DEPARTMENT 0 >' grx r SUPERIOR COURT HOUSE ® s BARNSTABLE, MASSACHUSETTS 0263E A S el PHONE: 362-2511 LAB 337 Client: ALL CAPE WELL DRILLING, Collector: Mai 1inq P.O. BOX 126 Affili.at ion- Address : BREWSTER , MA 02631 Tvpe of Supply: Private Well Telephone : Well Depth: Not Reported Sample Location: 77 BURSLEY PATH Date of Collection: 07/17/97. Town: W. BARNSTABLE gate of Analvsis : 07/17/97 PARAMETER SAMPLE RESULT RECOMMENDED LIMITS Total Coliform Bacteria/100 ra1L. A 0 off Conductivity (rnicromilos/cm) 500 Iron (ppm) 0 . 3 Nitrate-Nitrogen (ppm) 10 . 0 S Sodium (ppm) Copper (ppm) � ' t�t'a . 3 :u. BASED ON THE ANALYSES PERFORMED , THE FOLLOWING ADGISORTES ARE (1TVE''N: This is a Retest. Water sample meets the recommended limits for drini:inl-' ;dater of all above tested parameters . = f�"`CJ-wcl"-._ �� .�/_C.d,ti,�-.a. .�- �•��It[3-1--L 7 Thomas F . Bourne , Laboratory D er: 7Cor Barnstab=le County Health and Environmental Laboratory w Superior Court House, Route 6A P.O. Box 427 Barnstable, MA 02630 (508) 362-2511 ext. 337 V.olatile' Organic Analysis Analytical Method: 502_. 2 Collection Date: 07/16/97 Date Received: 07/16/97 Analysis Date: 07/16/97 Client: ALL CAPE WELL DRILLING Mailing P.O. BOX 126 Sample Location: 77 Address: BREWSTER, MA 02631 BURSLEY W. BARNSTABL E Sample ID: 77 BURSLEY Laboratory ID: 5.09702 Sample Description: PRIVATE WELL Compound Amount MCL Reporting Detected (ug/L) (ug/L) Limit (ug/L) Benzene BRL 5 . 0 0 . 5 Bromobenzene BRL 0 . 5 Bromochloromethane BRL 0. 5 Bromodichloromethane BRL 0 . 5 Bromoform BRL 0 . 5 Bromomethane BRL 0. 5 n-Butylbenzene BRL 0 . 5 sec-Butylbenzene BRL 0 . 5 tert-Butylbenzene BRL 0 . 5 Carbon tetrachloride BRL 5 . 0 0 . 5 Chlorobenzene BRL 100 0. 5 Chloroethane BRL 0. 5 Chloroform 1. 2 0 . 5 Chloromethane BRL 0 . 5 2-Chlorotoluene BRL 0 . 5 4-Chlorotoluene BRL 0 . 5 Dibromochloromethane BRL 0 . 5 1, 2-Dibromo-3-chloropropane BRL 0 . 5 1, 2-Dibromoethane BRL 0 . 5 Dibromomethane BRL 0. 5 1, 2-Dichlorobenzene BRL 600 0 . 5 1_, 3-Dichlorobenzene BRL 0 . 5 1, 4-Dichlorobenzene BRL 5 . 0 0 . 5 Dichlorodifluoromethane BRL 0 . 5 1, 1-Dichloroethane BRL 0 . 5 1, 2-Dichloroethane BRL 5 . 0 0 . 5 1, 1-Dichloroethene BRL 7 . 0 0 . 5 cis-1, 2-Dichloroethene BRL 70 0 . 5 trans-1, 2-Dichloroethene BRL 100 0 . 5 1, 2-Dichloropropane BRL 5 . 0 0 . 5 1, 3-Dichloropropane BRL 0 .5 2 , 2-Dichloropropane BRL 0 . 5 1, 1-Dichloropropene BRL 0 . 5 cis-1, 3-•Dichloropropene BRL 0. 5 trans-1, 3-Dichloropropene BRL 0 . 5 Ethylbenzene BRL 700 0 . 5 Hexachlorobutadiene BRL 0. 5 BRL: Below Reporting Limit MCL: Maximum Contaminant Level .. page 2 Sample ID: 77 BURSLEY Laboratory ID: 509702 Compound' Amount MCL Reporting Detected (ug/L) (ug/L) Limit (ug/L) Isopropylbenzene BRL 0 . 5 4-Isopropyltoluene BRL 0 . 5 Methylene chloride BRL 5 . 0 0 . 5 Naphthalene BRL 0 . 5 Propylbenzene BRL 0 . 5 Styrene BRL 100 0 . 5 1 , 1, 1, 2-Tetrachloroethane BRL 0 . 5 1, 1, 2 , 2-Tetrachloroethane BRL 0 . 5 Tetrachloroethene BRL 5 . 0 0 . 5 Toluene BRL 1000 0 . 5 1, 2 , 3-Trichlorobenzene BRL 0 . 5 1, 2 , 4-Trichlorobenzene BRL 70 0 . 5 1, 1, 1-Trichloroethane BRL 200 0 . 5 1, 1, 2-Trichloroethane BRL 5 . 0 0 . 5 Trichloroethene BRL 5 . 0 0 . 5 Trichlorofluoromethane BRL 0 . 5 1, 2 , 3-Trichloropropane BRL 0. 5 1, 2 , 4-Trimethylbenzene BRL 0. 5 1, 3 , 5-Trimethylbenzene BRL 0 . 5 Vinyl chloride BRL 2 . 0 0. 5 Total Xylenes BRL 10000 0 . 5 BRL: Below Reporting Limit MCL: Maximum Contaminant Level Thomas. F. Bourne, Laboratory Director TOWN OF SAWNPOOH- LOCATION: . VILLAGE:!! ' /� � / / —• PERMIT # INSTALLER'S N1.ME: INSTALLER.' S...,X0ONE # : LEACIIINGZ,ILITY: (type)vaze) NO. OF BEOROCMS: _ __33UDDER OR OWNLR:_. — PERMIT EL& —COMPLIANCE DATE: DATE: DRAW DIAGRAM ON BACK -_ -� PA i s•' M. A i 00 101 No.— -----/-------- Fee----1-/S —'- BOARD OF HEALTH TOWN OF BARNSTABLE A pp[ication-*r Vell Construction Permit Application is hereby made for a permit to Construct ( Alter ( ), or Repair ( )an individual Well at: ----------------------' — — — — -!�G,/11t�—— tt 3Z -- ,c — ------------ — — Location — Address y�� 1 �— Assessors�p and Parcel Fi'�Z a�' �Y r I.,�Yri�. ®ICY..' �ry (` ------------------ �=-----�--cam-------�""------------------------_------- --------------'l�Jt��-------- ------------------------------------------------ Owner Li,- Address p�� p�G- �� err �►a+e�e turn+0 n - a,C ti Z� �atws-1 ev 1AA 926 3 I -------------------------------------------------------------------------- Installer — Driller Address Type of Building Dwelling k s Other - Type of Building--------------------------------- No. of Persons-------------------------------------------------- �� C. ------------------------Type of Well------------------------------------------------------------------ Capacity---------------------------------------------- Purpose of Well ------------------- Agreement: The undersigned agrees toAnIored scribed individual well in accordance with the provisions of The Town of Barnstable Board ofe We Protection Regulation — The undersigned further agrees not to place the well in operation uno .of ompliance has been issued by the Board of Health. Siged �VN, date Application Approved By-- ------------ ------—---------- Application Disapproved for the following reasons:----------------------------------------------------------------------------------------------- -------------------------------------------------------------- ----------------------------------------------------------- ------------ q date PermitNo. --- `_ A— --- -- - Issued — =------------------------------------=_----------- ------------------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate (Of (Compliance THIS IS TO CERTIFY, That the Individual Well Constructed (k' Altered ( ), or Repaired ( ) bY---------- Installer at- ---7 - — '- ----1 has been installed in accordance ' h the provisions of the Town of Barnstable B a o H alt rivate 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------------------------------------------------------------------------- - --�-= ='- Fee---- �1 - BOARD OF HEALTH TOWN OF BARNBTABLE Rppliration_*rVell Con!5trurt ion Permit Application hereby may for a permit to Construct ( Alter ( ), or Repair ( )an individual Well at: ------------------ -------------—------ — -- —— -- P -------------------------------- Location — Address �— Assessors and Parcel ...Y�_y...r -. -1om � - - - ` 'Nar2�N! — ------------------------ ----------- ------ ----------------------- Owner Address P ------A-II... ------- mow+ �z��u +o n ----- cw_ s-R e" ®� 3- -- ------------ --------- ------------ Installer — Driller Address Type of Building Dwelling -��=�' ------------------------------------------ Other - Type of Building -- -- No. of Persons----------------------------------------------------- Typeof Well, —- —>V --------------------------------------- Capacity --------------------------------- Purpose of Well ------------------ .� Agreement: /The undersigned agrees to in I h ` fored scribed individual well in accordance with the provisions of The Town of Barnstable.Board of e t °P ' a e We Protection Regulation — The undersigned further agrees not to place the well in operation un rti to .of 1 ompliance has been issued by the Board of Health. �.� Sig e - - - -- -----=---------------------------= ---------------------------- ---- c"� date 1 APPlication Approved By- -. ate wry ' -..Ap.plication Disapproved,for the following reasons:-----—----------------------—-------------—---------—-—---------—---—----- t: - -----------------------------------—---------------------------------------------------------------------- �y date PermitNo. ---- L_ / _Z_--_;;�6_____- ----------- Issued-----------------------------------------------------— -------------------- date BOARD OF HEALTH TOWN OF 'BARNS,TABLE S f , THIS IS TO CERTIFY, That the Individual Well Constructed Altered ( ), or Repaired ( ) bY------------ ----- — -------------------------------------------------------------------------------------------------------------------- Installer at----------7 -- -- -- - - _ - - - has been installed in accordance h the provisions of the Town of Barnstable B Wa ,). H 1 h rivate Well Protection mitRegulation as described in the application for Well Construction Per No. ------------- ated-------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE- --- —- —-- — - ------- —- Inspector-------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Veil Con$truct ion Permit No. _ Fee- -- -----;- Permission is hereby granted---- { _0, " ,------------------------------------------------------------------------ to Construct (>r, �Alter ( ), or Repair ( ) an Individual Well at No. ----—-----------------¢ — --P-A -- -----------W------ --O/C---------------------------------- Street as shown on the application for a Well Construction Permit No.---------------------------- - ------------------------------------------ Dated-----— - --------------------------------- — --='-- ------------------------------------------- Board of Health DATE---- - - -- - —----------------— TOWN OF SARWROWi _ LOCATION: o!� LOT # : /�� _PERMIT # : _ , ._ _ - _ INSTALLER S NAME: �. ,� /�� � � t>����-- o- INSTALLER° &�GONE # : LEACHING , iA� ILITY: (type)����� _ �(s.ize) NO. 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