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Home My WebLink About0080 PETER BLOSSOM LANE - Health 80 PETER BLOSSOM Ll :j�/ .__:_: � A=088-006.003 : UJ a o TOWN OF BARNSTABLE G LOCATION /-o /3o rso�W SEW GE 0 VILLAGE G� �R�-)� �� _ASSESSOR'S MAP & LOT C- off'`4S3 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ZM1 641- (hype) Z- 30- etX w/ 'Si,E{�n� (size) LEACHING FACII.ITY: ) NO.OF BEDROOMS S BUILDER OR OWNER /P/ O lli fg- PERMUDATE: 7 - Z�4 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 o � � SO TOWN OF BARNSTABLE LOCATION ��Sg 13Zf a / oo�wf W SEW GE# �� / VH,LAGE GJ .�iPA�,S'�4�11.� ASSESSOR'S MAP & LOT LfLL 0C`VJ INSTALLER'S NAME&PHONE NO. J1_4,'q ES /Ally SEPTIC TANK CAPACITY 1320 G41- LEACHING FACILITY: (type) 0 3 M 4X ` / Y,S (size) NO.OF BEDROOMS BUILDER OR OWNER O✓ O Li a,5_ PERMITDATE: '� —Z6-4r COMPLIANCE DATE: 9 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 J 1 P °5 P s� A• gy -D 3 o A3•g7-� A,r V_6 No. ^ � s C) U ®�lS�` FEE Board of Health, ' VAS °0 MA. APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) - 64omplete System ❑Individual Components Location � �p�Qµ� N Owner's Name Map/Parcel# 1 e Address =I— Lot#,$ Telephone# Installer's Name ®N Designer's Name Address Address Telephone# I Telephone# Type of Building Nt a� r4 v t t L se {LtN $ Lot Size-6.5377 sq.ft. Dwelling-No.of Bedrooms Garbage grinder ( )4V Other-Type of Building No.of persons Showers ( ),Cafeteria( ) Other Fixtures Design Flow (min.required) 01C gpd Calculated design flow .7 r 0 Design flow provided CO 4 gpd Plan: Date 3 j Z' /9 Number of sheets Revision Date Title -52.W QA 6 t 5'4-L d .,V Description Soil Evaluator Form No. 0 Name of Soil Evaluator /t'dV !2 Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS "f/ The undersigned agrees to install above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agr to not to place th tem in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date Inspections �.r. s `�.i. �t .Y.. r+V 'r-- .Y'r' Yh! Jj � w...�..�-f�'f _.�ti s«�r w r �wtw� i!^I.. .• .f! �, w X J <- COMMON VV ')Of MASSAC1USET L /� Board of Heal th.' �{Jtir S MA APPL ATION FOP 61SPOSA , W' STE [ CONSTRUCTION PERMIT Application for a Permit to Construct Repair( Upgrade Abandon &Com lete System ❑Individual Components PP ( ) P ( ) Pg ( ( ) P Y . Location o 71 f(L Z)OSOle_,� LANE Owner's Name Map/Parcel# \IV &Lk Address Lot#-, '� f Telephone# !Installer's Name 1� . Designer's Name ON Address Address•,.we O 9 r,'.F wDtv1 bZ� Telephone# Telephone#. �` (� S S -�402 Type of Building l A/G 1 rA o4 t L y �t y 9 Lot Size 3 3 7 7 sq.ft. Dwelling-No.of Bedrooms Garbage grinder Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures �/ �-^ Design Flow(min.required) 0 i0 `J gpd Calculated design flow SS i Design flow provided CO 4 _gpd Plan: Date 3/ZI /9 F Number of sheets Z ,\\ Revision Date / /14 Title Sg w ?A i s -5, I f r•-"► Dr im W Description of Soil(s) -2 , /G �S" So 7 2,_5 / `" ,,,w/J "nb 1 Soil Evaluator Form No. U 2n� Name of Soil Evaluator ARA/f AA/1U Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS 64 The undersi ed agrees to install a above described Individual Sewage Disposal System in accordance with,the provisions of TITLE 5 and further agr to not to place th stem in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date /- ZS Inspections p (y , No. '��7 (� �T��T EAL114 OF TSETTS FEE t3 Board of Health,�Gt,rvt f �J�-l0 MA. CERTIFICATE Of COMPLIANCE Description of Work: ❑Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed'O,Repaired ( ),Upgraded ( ),Abandoned ( ) by: A As n" S,,,,r at 8!0 has been installed iin• accordance with the provisions of 10 CMR 15.00 (Title 5) and the a p>;oved design plans/as-built platis.relating to application No.9O"q 3 dated o -45 Approved Design Flow 6 y Z- (gpd) Installer �p Designer: Inspector q Date: 9 "zs�- The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No.-� � 7,EE l COMMON V'V'EA1111`0 MASSA' 14USETTS Board of Health, �T MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system at go .-b 4- t,44&4 11J4 3J h as described in the application for- Disposal System Construction Permit No. dated Provided: Construction shall be completed within three years of the date of th• ermit. All local conditions ust be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date Board of Hea1,G1� ��7� 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: Grace Olive LOCATION: Lot 17 ADDRESS: Peter Blossom Rd. W. Barnstable, MA SAMPLE DATE: 2-7-95 COLLECTED BY: L.Wile & Son Well DATE RECEIVED: 2-7-95 TIME: N/A SAMPLE I.D. : . 17 B JOB TYPE: New Well WELL DEPTH: 2" test well RESULTS OF ANALYSIS: Parameters Units Recommended Limit Result Coliform bacteria/100ml (MF Method) 0 0 pH pH units 6.0-8.5 5.64 Conductance umhos/cm 500 64 Sodium mg/L 28.0 5.9 Nitrate-N mg/L 10.0 0.14 Iron mg/L 0.3 0.10 Manganese mg/L 0.05 0.015 COMMENTS: . Low pH indicates high corrosive characteristics. Yes No WATER IS SUITABLE FOR DRINKING PURPOSES OR PARAMETERS TESTED. XXX 1z)54L&44' Date on ld J. ari Laboratory Director LT = Less Than 07-10-199'a 227P,,-J, C-APE COID TOBAC.00 1-7CINTROL 150306212'603 F.02 Barnstable County Health and Environmental Laboratory Superior Court House, Route 6A P.O. Box 427 Barnstable, MA 02630 (508) 362-2511 ext. 337 Volatile Organic Analysis Analytical Method: 524.2 Collection Date: 07/07/98 Date Received: 07/07/98 Analysis Date: 07/07/98 Client: A.N. OLIVE ITT Mailing A.N. OLIVE III Sample Location: 80 Address: 11 GRACE AVENUE Y.C.G.A. PETER BLOSSOM LANE HUNNIS MA 02601 WEST BARNSTABLE Sample ID: 844402 Laboratory ID: 844402 Sample Description: PRIVATE WELL Compound Amount CL Reporting Detected (ug/L) (ug/L) Limit (ug/L) Benzene BRL 5. 0 0.5 Bromobenzene BRL 0.5 Bro,mochlororqethane BRL 0.5 Bromodichlo�omethane BRL 0.5 Bromoform. BRL 0.5 Bromome"thane BRL 0.5 n-Butylbenzgne BRL 0.5 see-Butylbenzene BRL 0. 5 tert-Butylb4nzene BRL 0. 5 Carbon tetrachloride BRL 5. 0 0.5 Chlorobenzone BRL 100 0.5 Chloroethane BRL 0.5 Chloroform 0.7 0.5 Chloromethane BRL 0. 5 2-ChlorotolUene BRL 0.5 4-Chlorotol2#ene 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-Dichlorpbenzene BRL 600 0.5 1,3-Dichlorobenzene BRL 0.5 114-Dichlor6benzene BRL 5.0 0. 5 Dichlorodifliuorovethane. BRL 0. 5 1,1-Dichlor6ethane BRL 0.5 102-Dichloro6thane BRL 5.0 0.5 1, 1-Dichlorolethene BRL 7. 0 0.5 cis-112-Dichlloroethene BRL 70 0.5 trans-1,2-Di�chloroethene BRL 100 0.5 112-Diohloro4ropane BRL 5.0 0.5 1, 3-Dichloro r opane BRL 0. 5 212-Dichloro;ropane BRL 0.5 1,1-Dichloropropene SPIL 0.5 cis-lt3-Dioh�orqpropene BRL 0.5 trans-1.3-Di�hloropropene BRL 0.5 Ethylbenzene! BRL 700 o.5 Hexachlorobut, adiene BRL 0. 5 BKL-.; SellQw: Reportin4 Limit MCE: Makl5a ConEaminant Level 07-10-1998 CK-:2,31AIII CAP- COD TCIBP.,--,CCI C0t--.JTRCIL 1536:3622603 P.073 page 2 Sample ID: 844402 Laboratory ID: 844402 Comnd- AMov-nt YICL Report ng Deteic"Ced (ug/L) (ug/L) Limit (ug/L) 6RL 0. 5 4-Tsopropyltolucile BRT, 0.5 Methylen- chloride BRL 5. 0 0.5 Naphthalanc BRL 0.5 Propylbenzupe BRL 0.5 Styrene BIZL 100 0.5 1, 1, 1,2-TeAC-rachluruethane BRL 0.5 1, 1,2, 2-Tetrachloroethane BRL 0.5 Tetrachloroothene BRL 5.0 0.5 Toluene BRL 1000 0.5 BRL 0.5 1, 2, 4-Tri=h'.'orohvn2a!Aie BTRII 70 0.5 11 1,. 1-Trl ch I oroc-Chklile BRL 200 0. 5 1, 1, 2-Tri,r-;i 1 cj-r L3et 1,a.,i e BRL 5.0 0.5 Trichlorootherr-, BRL 5.0 0.5 Trichlorofluoromet'cane BRL 0.5 1.2,, -'-Tr j.chIorcpro,7aanc BRL 0.5 1,2,4--Trimfvi:hy1'ber--inc. BRL 0.5 113 1 BRL 0. 5 Vinyl BRL 2 . 0 0.5 Total Xyl--nes BRL 10000 0. 5 Methy-tertiary-�jvt, I --?-ther BRL 0.5 Limit MCL: Maximum ContaminanE Level Thomas F. Bourne, Laboratory Director TOTAL P.03 r N --------------- --- ti ' Fee- �------------- BOARD OF HEALTH TOWN OF BARNSTABLE Application-*rVei[ CootructionA3ermit A plication is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: - 1 ------- — - - --- — - -- — — -----------------------------Assessors Map-and-Parcel------------- ------------- Location — Address — — — —� - — f —��"---- --d-5��-�---� -�-- - ------- -- - ----------------------- Owner Address _ Installer �n ler Address Type of Building Dwelling-------—------------------------------------------------------ Other - Type of Building ----------- No. of Persons--------------------------------------------____-_ Type of Well— - = Capacity----------------------- - — - — --— - ---------- -------------------- Purpose of Well--------- d4 - ---- - ---------- 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 Certificate .of Compliance has been issued by the Board of Health. Signed -L — ------------- /5—.e Application Approved By1�!_ ate Application Disapproved for the following reasons:--- -—------------- --------------------------------- --- ----------------------------------------------------------------------------------- _ irate Permit No. -- ~ � Issued ---'= ------ ----------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certif sate ®f Compliance THIS I T CERTIFY, That the In 'vidual ell C nstructed ( , Altered ( ), or Repaired ( ) bY - - ,� -- - - --- -- - - -- ----------- ----------------------- //�� —r— --------------- Installer l has been installed in accordance with the provisions of the Town of Barnstlabbllee Board of Health Private Well Protectior , Regulation as described in the application for Well Construction Pe In "No Dated - � - THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE------------------— — —---—-----------------— — - Inspector---------------------------------------------------------------------------- "' .i'.a tGYi�.. r�.L. .aL:�t.F+a„'.,,,`rt +•ryyr p�,y`1' MXF� i,;/ 'r^?ss..N+il`t�t"`-a y ...-C`��v�r '�+'�'�..C4 F4ev ri r _7 IjNe -------- -------' - �„ s ! Fee _- ----- ---- BOARD_ 0F'iHEAN"H d TO W N O F� �t'`A NS T A,B L E r aw}� 'Op21 , [itat iotao. e1C Cott ;trust ion hermit Application is hereby made for:,a permit to Construct (. ), Alter ( ), .or Repair ( )an,individual Well at: Address Assessors Ma and Parcel ----- Location..— -- ---------—------------- Owner -- — i { �_I®r&_A Address 15 Installer :� Address !' Type of Building f Dwelling 'it Other Type of Building--------------------------------- No. of Persons---- M� = t --- Type of Well r :Q�N `—=----- Capacity. ------ —------ Purpose of Well _'_ — - - — Agreement P - 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 Certificate .of Compliance has been issued by. the Board of Health. i Signed I date (' Application Approved,By \ -? '� ate Application Disapproved.Eor the following reasons:------------------------------_-------------------_--___—___—� r ---------------- ------- — -----— _ — - --- ------------ j ate C Permit No. -- -- ------date — — — - - --- - ----- -- ---- Issued----- -- - s BOARD OF HEALTH TOWN OF BARNSTABLE t C ertif irate ®f Compliance THIS I TQ CERTIFY, That the.Ind'vidual ell Constructed ( , Altered ( ), or Repaired,( ) by - -°� —�� `: - ' ----- --- - - --- Installer L4 U _/_ W A� at ;0. ------- ---- -------- 6 - ----------- ---55 has been installed in accordance with the.provisions of the Town of Barnstable Board of Health Private Well P otection „_ Dated------a 9 g PP �1�0�-----`�"--�„-�---Re ulation as described in the application for Well Construction Per THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL j SYSTEM WILL.FUNCTION SATISFACTORY. DATE- --- ------------------— - --=—- =-F` Inspector-- -------- -------- ------------ ----- --------— - r � j BOARD OF HEALTH TOWN OF BARNSTABLE Veil CongtructionPermit No. -- ----/ ------ Fee 1 Permission is hereby granted? ! - -r --j£�- ------ ----------------- ------ to Construct ( Alter ( ), or Repair ( ) an Individual Well at: f -------- Street. as shown onithe application for a Well Construction Permit 6'/ N - Y - - — -—---- ------ Dated- - - - " _ ! - - -- - f . Board of Health DATE-- --- -------- - — e '--- - 1 4 _ ! - j E i S 1TT- E ,STii\\ � \ �4� �n oM � Cf�4z.�-I F� �c`�� Tye FO0"DA i 0JJ �a !ef CTtIHL_ Ly LvC1�?-€P 14 4t ; clV PLAr�I � {, AIMENSIoNsVEp, / ! � -'� KINGSBURib Y OF ,4SSq �� 0 � HARRY Cy EARL Gam. LANTERY, 1R. Nr 124 \3' ` 26575 p 00 \ ` L \ A €A -P iK 0 PC) S� [ S i C PLIN "A T P M. `L i\ . R'KT ®L\'J 'F A-\/T- . Y_ C . G. A. / \ LEI, 17 � 56 LA G3 78 / �4 28'-- -___—Tom___. s- a 55°-t 3' z a" .N --- ---------S----3 --.�z, ----3 5 -��, -----— L o T ! 5 6 FIE T ER 13L C)S 0 M L N . I N .9 co00 0F C-`� d N o O F- R ST, .f N ry I rn M ry N rti F -t_ L= A 'SSQC. TECH . SERVICES j F(w_ J"`L0DR EL. l )_7 \ 1 To1�o .b✓ALL F11,/.GR EL I ' S.o EXVs;1NG GR.EL. 113.0 k x x X 1�I o E : P� 1�10 VE ALL I M PE Imo/ W S ! Ili)crL= p ► hL s 5 P.,i.c, rN� 112.� IM4 Irl.s lnV,cL a o sob I / 1 11= 7L A N .�Iy I r2.3 GAL_ I CELLAR FL- 0A, 10 )J I N, f c C (�co ► 'T S I-" C 1^N• � i.Z � ., -i -• ., �. T I►f Y. ) )1.0 3i. SCAL 1= �— 20 MIN, R vim- � of D1S1 0SAL SYST9-M O E '�-DISFOSAL SYSTEM'. -V0 B� COMST-KUCTF—D 1N STRICT t ,4 ccorzp Art c.E of C oM Nc. of -1"1As S. EN v [Rom. C of-T � q fZ4 C sU-RN Ey _,C) AT/\ P,A)j " PETSR a L 0 3 S M ESTATES IWEST aI-\P\kJS R,Lf i 1 Ta AN. - T 1 99 s `�4 P�ZH OF M�S I 3 4 ' S N 1 of 3 Q LAND CoUPIT, B /—V�h,J TP 3I �� HARRY/ ugcya i R E- G. ! 1 !- �� C 1;nTl= fit 13A L D F-I 1 1 �. 3 PESO T ;i� ® , o EARL �, 1 _ TtST P - BY i � — .r ITS �L1RC ��S T � LANTERY JR. v,2�aw >J CIa � .JJ C, R 1 C-� y A 1`'�O1) Ij I /i. p No.26575 �— LYI �TING — 0RAbL 2 I i I DC SIGN jGt 119.s PL,r�,�.' J t ` J 1 ( I Sc A L E: - i SI NGLE >`AM1,_`/ DWELL IN G W/5 R tDR OG 1-1 S i r C,r,fE Ra V. g/2eJ�e 10 GA -8 A G E M SPOS _ - N C t t .-� n l t wri'1� � `� s _ 5 55 S i SF—P-7 iC TANK NCL R� QD;� ` snJ�O �,�� I 0 ►� J\• - KA A R-T L L 1 V t I _ EA v 7tir E R h F r_� r , I >, , , J S > 2 S-E T,�_ L) J i T/ , ,T C., _ :, 4' S—o, ;E o�1 , �S T O r 1r P E i. L 1 ��''L 0 S D M 'E 5 i AT E`.) �T `{ a x+_ t i : IA i e 1 2 A SS CC T S S C r -- - - __ _