HomeMy WebLinkAbout0030 SHAWS LANE - Health } y
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BOARD OF HEALTH
TOWN OF BARNSTABLE
Zpprication-*rVell Congtruction3permit
OApplicatio i hereby made for a permit to Construct ( Alter ( ), or Repair ( )an individual Well at:
L cation - Address a Assessors Map and Parcel
- I� 6�..1��Lhls — ---=-- - - -
a Owner Address
Installer - Driller Address
Type of Building
Dwelling -- --___ —-------
Other - Type of Building--------------- No. of Persons-.---------- -- -------------
Type of Well----------___—__—______—__—w___ Capacity-------------_�_—___�_�-- --
Purpose of Well ------ -----------
Agreement:
The undersigned agrees to install the aforede cribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Priv to We Protection Regulation — The undersigned further agrees not to
place the well in operation until C tifi at of ompliance has been issued by the Board of Health.
a
Signed ---- -----__—`� � ��/ _
/ dat
Application Approved By— — `// ! —------ _�-1—r -
ate
Application Disapproved for the following reasons:
- - --�-- - -- - date
Permit No. ' ------ -- Issued -
date
BOARD OF-HEALTH -
TOWN OF BARNSTABLE
Certificate Of �Gompliance
THIS IS TO C TIFY, That the Individual Well Constructed ( Altered ( . ), or Repaired ( )
by- f, f l. ------ -----— ---- ----- - - —
-�-►-3+[-- c'� y stall r
at
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— _ -------
—,' r BOARD OF HEALTH
TOWN OF BARNSTABLE
_. Appficat ion iforVell Con5truction3dermit
/ Applicatiori is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at:
i--Y---5—e � � �—! � N� - ------------------------------------—---------
Location — Address a Assessors Map and Parcel
LIE�j��p Owner Address——---------
-- :A�— �v —---- -- — — — ' ------------ --—----—
Installer — Driller Address
Type of Building
Dwelling -------- - - - --- -- -
Other - Type of Building------------------------------------ No. of Persons--------------------------------------
Typeof Well-------------------------------------- Capacity--------------------------__-----__________
Purpose of Well---------------------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private We Protection Regulation — The undersigned further agrees not to
place the well in operation untiill�a Ce tifi fat t of t ompliance has been issued by the Board of Health.
Signed
g date
Application Approved By—��—"---
Ate'
Application Disapproved for the following reasons:-------------------------------------------------------------------------------------------------
_-_______ __1__--________--______-_______-_-_
r date
Permit No. -- -----
---------- - -'- Issued-----------------/
d ate Z
w
.. .� .-� ..:,...,.,: ,„•M,,,,., - -.: ._.,.. BOARD"OF-HEALTH.. •
TfOWN, OF BARNSTABLE
ctC ertif irate.0f Compliance
THIS IS TO CER1TIFY, That the Individual Well Constructed �Altered ( ), or Repaired ( )
by-- - �, /_r� - -----------------------------------------------------------
Installer
at--� � - ----m - - ------/ -- _ - - - -- —--- — —
has been installed in accordance with the provisions of the Town of Barnstable Board
of H ealtb Private Well Protection
Regulation as described in the application for Well Construction Permit No. V -�-5r--r-Dated
---------------
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
Yell Con5tructionPermit
No. - Fee v
r
Permission is hereby granted-------
to Construct ( Alter ( or Repair( ) and Individual Well at: )
No. -- - — _(1l _ �_ 1 m'!k e--� � / � ------------------------------
�.. —
Street /
as shown on the applicati-n for a Well Construction Permit
No. v % r , Dated
--------------------------------------- --------------- - - B-o a./rd a
of Health
DATE q�—----
--r-=� .-:,.�--- ------------------
V, ASSESSOR'S MAP NO. /?4 PARCEL OOP- DO /
LOCATION h � SEWAGE PERMIT NO.
i74,
V3fLLAGE a
I N S T A LLER'S NAME a ADDRESS
B U I L D E R OR OWNER
DATE PERMIT ISSUED
DAT E COMPLIANCE ISSUED
l
'H Gv � �
3O TOWN OF BARNSTABLE OP // /��
- �oo
LOCATIOdot SEWAGE #
VILLAGE__,WS� �l V ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO. , C
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) 2 `Le (size)
NO. O'F BEDROOMS PRIVATE WELL OR PUBLIC WATER/ f
BUILDER OR OWNER
DATE PERMIT ISSUED:' ' 7/
DATE COMPLIANCE ISSUED: �
VARIANCE,GRANTED: Yes No L/
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THE COMMONWEALTH OF MASSACHUSETT MAP t �
P '� T3 BOARD PF HEALTH PARCEL �a2oo,
7�V;�.'4...............OF...............- tSs ,e, ... LOT..... t
Appliratiun for Dispaaal Works Tomitrudfun rrrnti#
Application is hereby made for a Permit to Construct (Jo) or Repair ( ) an Individual Sewage Disposal
System at: V
....................... [,-I `- 4 5 - .. .......................�:..........
. .,.............
Location-Address or Lot No
.............•---------.T......_-5 !.r-. CS.-----......... . ......... �-�..3`fie.....------..L'S_ . 4 :---- ---- ----
Owner Address
W
a ..�. �•-• ------------ ...............................
Installer Address
Type of Building Size Lot.....` `t.,5. ..Sq. feet
,-, Dwelling—No. of Bedrooms............—.............................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers —
W YP g -•-------------------------- P (----)--.....Cafeteria
dOther fixtures .----•--•---•------------------•-•----..........----•-.--..........•---••-•-•----•-•-•----------•-•--•......... -•--....•--
W Design Flow...................)_--------------------gallons per person per day. Total daily flow...............��.'.- c:>...............gallons.
t� Septic Tank—Liquid capacity.� 1.gallons Length._v'_So".. Width:_4.Jk.. Diameter:............... Depth...S a.`.`
Disposal Trench—No..__� ......... Width•--.. ..,?` Total Length........�-�.. Total leaching area..Z-`j 3.:.1.sq. ft.
3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box O Dosing tank ( )
aPercolation Test Results Performed by.._- .'- ..... `� �►-�............. . ........ Date. .....d-n.Z, .........
Test Pit No. 1.... .........minutes per inch Depth of Test Pit_.... Zo Depth to ground water.......... ./ ._.
fZ, Test Pit No. 2................minutes per inch Depth of Test Pit........1�✓�... Depth to ground water..........t41! ..--.
O Description of Soil...l-:A: 1..........
-----Q--3.�: .s S.�a----,-_._.- `�_'....(
v���►'r�d! - .....----••••'rt `....-xaP •s-fig_J, ............�' -t.".... .. 5•�ri<o
U .------`------------------------------
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V 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 TL IT UZ 5 of the State Sanitary C- e—' he undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b ssue y 4boarof health.
Signed.................... ... -- .... o-� ':.....
Date
Application Approved By...........
) c�-••�..lain ........................... .....•--- , _.-Y� ---7 ..... -
c'� Date
Application Disapproved for the following reasons:............................................•-•-------..............------•----•------......---•----........ ..
....................................•--...ey...........-...............••-•-_...•-------......•--•..............••••------_........................---•----•---•-•-••--.......---... ............
Date
Permit No........ 15-99------------------- Issued......................
...................................
Date
�„ 0�7���- J T 'y _�s 9 �y '_�• `d ,r s ' //J � 7eS
ATo.i _ ...............r J.'�8 9M i THE COMMONWEALTH OF MASSACFiUSETTS 7 yP
t.' B L
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rlgr $t ,r r fg�: �i � 1:. irk iCn�a� r�trtiun pa#
Application Is hereby rriade for`a Permrt�to Construct (' )` or 'Repair ( ) an Individual Sewage Disposal
System at
�.. .....(5 .............................,..,................................................
Location Address or Lot No
IL
.... .....• .............. .•-•-- --- -- .... _- -•-- ------ ......
Owner t Address
a .....YP ...l.rr,�. _.,� .'- - . . -• __ , ••. _-- . . .................
.
p Installer Address ;
of.Butld>iI g ypeg Size Lot_._.. `� `�71 Sq..`feet
Dwelling-No. of Bedrooms 3 Expansion Atfic (9, Garbage.Grinder (- )
aOther .Type of, Building ........................ No. of-persons_- ------- - Showers'(: ) — Cafeteria ( )
w
Other fixtures •.-- --••• ................................
Design'Flow_____ _________� _.___ .___.,.__._gallons per person per day. Totaldally flow _.__ 3 3c� gal
WIons.
W ..Septic•Tank Liquid capacity .gallons Length' ��':_. Width_. ._Diameter Depth . 8..
Disposal Trench:- No. .;...
-3:____.._ Width____ ._"�.'. Total Len'th._.._.._2 �_,_:Total leach n area:_ `� :.:�__sq. ft.
P g g
3 Seepage'Pit No. Diameter ....::... .......: Depth'below inlet____.... _____:Total leaching area..................Aq. ft.
z Other Distribution box (K') Dosing tank ( ' )
Percolation Test`Results Performed by.. ��..`'_'...........................................................1 �- y ' Date. 6:___-Z4 : I_Z
a Test •Pit.No 1 .` minutes per inch: Depth of..Te'st Pit Depth to ground water_......:_
Gz. -Test Pit No 2 _.__.........minutes per inch De th of. Test Pit 1. � ,p Depth to'ground water.....__:. +��!�,.__.
x r`... ...._.__ ,
}
O Description of Soil. i t 1 rs .1 "ate 1.......................................��.... . . .__..
�' "I `Cp <1 " � ..................................(`4J✓7 F=
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l ----- - ` -- 1rt(�
W - --- ----
••'. ' U Nature of Repairs or Alterations Answer when applicable t
---y �
Agreement. q
The' undersigned agrees, to install ',the aforedescribed Individual Sewage:Disposal System in accordance with �^
'the proVisions of .I:LL 5 of the State S1mtlry'Code` The-undersigned further agrees not to place the system_ in ti
operation until a CertitlCate,of Complidnce has bee�issuedfby the bbard'of health
N L Grp g Date
Application Approved By -.-; .wt :_ 'f}''`"'`"'�" �� ......2�-•-�--
V d l>•-
PP_u� .PP � f , r � Date ;•.
A lication Disa roved or the'.folloiving reasons:.
.
�
� Date
n
Permit a .. r R ...:.: ued. --- .......................
..Date'
THE COMMONWEALTH OF MASSACHUSETTS i
"BOARb "OF' HEALTH -
/9lA....t...........OF...._1P
Tr if tratr of Tyr pliana
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired'
by ----
at �-
/�
Installer -has:been installed m accordance with the �rovisions of TIT�L. ' :�of The State Sanitary Code*as -
- P ` Y
- d'escribed in the
application for Di posal Works Constrdctitrn Permit N6._.....21k= Y_9 rl ___ dated ._.
THE ISSUANCE'OF THIS CERTIFICATE SHALL:NOTIBE CONSTRUED AS A GUARANTEE THAT-THE'
SYSTEMWILL FUNCTION SATISFACTORY-. -
p
DATE_::.. ..........................; .'Inspector
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF"HEALTH
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F � ....:...No._ EE.__G-
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wa
Permisslon is hereby granted....... /_._. .--. .__ ---- -- --------
to Construct �k)'or Repair (', ), an .Individual Sewage Di posal System
at No.:_--:_.. •-/ � G ..........:. . ..�..fir_. ..-t�-.._..ra.-..lr:__._._
as shown,on the application for Disposal Works Construction Permit No..��O/�__.Dated► .
l 1. -''%� �f 2L1
:vBoard of 11ealth s
DATE ol
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ENVIROTECH LABORATORIES
Mass. Cert. #:MA063
449 Route 130 Sandwich, MA 02563 . (508) 888-6460
CLIENT: Tom Jenkins LOCATION: Same
ADDRESS: Lot 1 Sheas Lane
W. Barnstable, MA
COLLECTED BY: L Wi le SAMPLE DATE:ll-1,)-qq TIME:
DATE RECEIVED: 1 i-i g-g2 SAMPLE ID: 7.77q
JOB #: WELL DEPTH: 120'
RESULTS OF ANALYSIS:
Parameter Units Recommended limit Result
Coliform bacteria/100 mi (MF Method) 0 0
pH pH units 6.0-8.5 6.54
Conductance umhos/cm 500 104
Sodium mg/L 20.0 12 2
Nitrate-N mg/L 10.0
0.08
Iron mg/L 0.3
3.58
Manganese mg/L 0.05
0.25
Hardness mg/L as CaCO3 500
31.6
Sulfate mg/L 250
16.4
Potassium mg/L 20.0
1.2
Alkalinity mg/L 200
18.8
Chloride mg/L 250
9.3
Turbidity NTU 5.0
6.2
Color APC units 15.0
<1.0
Background bacteria
601/602 # None detected
COMMENT: Iron and maganese are not a health hazard, but can cause taste, staining and
odor problems.
Filtering system should be considered.
F See attached.
M "0 WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARAgETERS TESTED.
(9X ❑
w DATE S'Z
i -t
GROUNDWATER
ANALYTICAL
EPA METHODS 601 and 602
Volatile Organics (GC/PID/ELCD)
Field ID: Z779 Lab ID: 4079-01
Project: Jenkins Lot 1 Shaw Lane Batch ID: VHA-1094-W
Client: Envirotech Sampled: 11-13-92
Cont/Prsv: 40ml VOA Vial/NaHSO4 Cool Received: 11-13-92
Matrix: Aqueous Analyzed: 11-16-92
PARAMETER CONCENTRATION REPORTING LIMIT
(ug/L) (ug/L)
Dichlorodifluoromethane BRL 5
Chloromethane BRL 1 ,
Vinyl Chloride BRL 1
Bromomethane BRL 5
Chloroethane BRL 1
Trichlorofluoromethane BRL l
1, 1-Dichloroethene BRL 1
Methylene Chloride BRL 1
trans-1,2-Dichloroethene BRL 1
1, 1-Dichloroethane BRL 1
cis-1,2-Dichloroethene * BRL 1 n
Chloroform BRL 1
1, 1, 1-Trichloroethane BRL 1
Carbon Tetrachloride BRL 1
Benzene BRL 1
1,2-Dichloroethane BRL 1
Trichloroethene BRL 1
1,2-Dichloropropane BRL 1 ,
Bromodichloromethane BRL 1
2-Chloroethylvinyl Ether BRL 1 A
trans-1,3-Dichloropropene BRL 1 ` '
Toluene BRL 1
cis-1,3-Dichloropropene BRL 1
1, 1,2-Trichloroethane BRL 1 3
Tetrachloroethene BRL 1
Dibromochloromethane BRL 1
Chlorobenzene BRL 1
Ethylbenzene BRL 1
m+pp-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 a
1,2-Dichlorobenzene- BRL 1 F
QC 'SURROGATE COMPOUND SPIKED MEASURED RECOVERY QC LIMITS
Bromochloromethane 30 32 108 % 83 - 117 %
Fluorobenzene 30 30 102 % 87 - 113 %
E.
3
BRL = Below Reporting Limit. Non-target compound. Method References: Method 601 - Purgeable
Halocarbons and Method 602 - Purgeable Aromatics, 40 C.F.R. 136, Appendix A (1986).
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