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HomeMy WebLinkAbout0100 SHEEP MEADOW ROAD - Health OEM- �0:SI-IEEPMEADOW'PjMA D WBARNSTABLE A9 025 / ` J No. k)dW 6 Fee BOARD OF HEALTH TOWN OF BARNSTABLE ZfppYicactiou _for Yell Cou5tructiou Permit Application is hereby made for a permit �to�1 Construct(�, Alter( ), or Repair( ) an individual well at: l�Q 0 S V—ems Mom,o \V.&(f4alD L , ®(�1 C)Z5 Location-Address Assessors Map and Parcel vk-cc- ®4 S o N ow R1,V. A* Owner Address 20234 o-rk&\-\S oL653 Installer-Driller Address Type of Building / Dwelling i/ Other-Type of Building No. of Persons Type of Well 4 SC �O f y�C✓ Capacity D I1 VV\ Purpose of Well UM-Y,41'c Agreement: The undersigned agrees to install the afore described 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 Certi c e f ompliance has been issued by the Board of Health. Signed 2-01 c Date l Application Approved By 4�N Date/ Application Disapproved for the following reasons: _� 1 2 Date Permit 1V��6 l I�p� Issued 7 ate ---------------------------------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed( ), Altered( ), or Repaired( ) by Installer at has been in3talled 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 VVILL FUNCTION SATISFACTORILY. Date Inspector / No. kd O)-1q 169 Fee BOARD OF HEALTH t TOWN OF BARNSTABLE 01pplication ifor Yell Construction Permit Application is hereby made for a permit to Construct , Alter( ), or Repair( ) an individual well at: Location-Address Assessors Map and Parcel �O O S�4���.�t�`W �� �l.B•. Owner Address \00 2-1$�, 1c1^�S a2�053 Installer-Driller Address f Type of Building x Dwelling Other-Type of Building No. of Persons Type of Well 4� SQN(�$ ?qc- Capacity ���-q p m Purpose of Well DM-vJq,L r Agreement: The undersigned agrees to install the afore described 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 we11 in operation until a Certificate of Compliance has been issued by the Board of Health. 7 q Signed kLU'l- t 712-0 1 c// Date Application Approved By ! y l { I( /�i, ! , "� �'(�it i ;! UDate/ Application Disapproved for the following reasons: ) 2 t Date Permit OA Issued J Date i T---_—._ -------- ----®--------------a-- ---------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE 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 Regulation as described in the application for Well Construction Permit No. Dated y , THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector --_-_ __—__ _____.____ .__----------_. -- BOARD OF HEALTH TOWN OF BARNSTABLE Yell Con!5tructtou Permit No. L�a U 1 Fee �J Permission is hereby granted to I J p_{'m, r,4 V PW D C-M i r q J n c Installer "J to Construct N, Alter( ), `or Repair O an individual well at: No. `0 0 S , �-�/Y 1 '�9 &llW Q4. , ,�j- Street / as shown on the application for a Well Construction Permit No. �V(� y� Dated Date 3 �J .,/�! n /��l�Gf Approved By �'Kt I �A K— LOCAT ION MAP ( 4TS) 0 ool , ; ; JK : . � r 00 - -- � CERTIFICATE OF ANALYSIS �o ' �Yt Page: 1 Barnstable County Health Laboratory ��snC �w Report Prepared For: Report Dated: 2/11/2008 David Slater Order No.: G0845010 100 Sheepmeadow Rd. West Barnstable, MA 02668 Laboratory ID#: 0845010-01 Description: Water-Drinking Water Sample tl: Sampling Location 100 Sheepmeadow Rd.W.Barnstable,MA Collected: 2/6/2008 Collected by: D.Slater Received: 2/6/2008 Routine ITEM RESULT UNITS RL MCL Method# Tested Nitrate as Nitrogen 3.1 mg/L 0.10 10 EPA 300.0 2/6/2008 Copper ND mgfL 0.10 1.3 SM 3111B 2/7/200S Iron 0.15 mg/L 0.10 0.3 SM 3111B 2/7/2008 Sodium 21 mg/L 1.0 20 SM 311113 2/7/2008 Total Coliform Absent P/A 0 0 SM9223 2/6/2008 Conductance 240 umohs/cm 2.0 EPA 120.1 2/6/2008 pH 6.9 pH-units 0 SM 4500 H-B 2/6/2008 Sodium level is above the maximum contaminant level. Those on a low sodium diet may wish to consult aphysic' n. Approved By- (Lab irector) 1 t7C7 .� 7r r �'+ ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 -4 3grel,. a -,; -�2Fr L.�a,z5u :s,�- y u-••,.. "s" ty x<'+G' r:; -i' �zzt. ,'u1. jr+lMr„'k+`m h. 4 LYys.4o-' �SS+v-; V �F r.y,�.y' -� "�`f, - z 3-.'r ZF 1�Y-: '� ���� t�b ,,sa '�''. tr xr ;y'iS. .s s w.. v.._ 't s a. � TOWN OF^BARNSTABLE %� LOCATION z .a SEWAGE #124VLl J 1 VILLAGE , _> ll�� ASSESSOR'S MAP & LOT I INSTALLER'S NAME&PHONE N0. eL� ,��77 Wg� 6 SEPTIC TANK CAPACITY d L • da. size G FACILITY: ( ) LEACHING ) tYPe ,t;, , NO.OF BEDROOMS ;- 'BUILDER"OR OWNE°R --PERMITDATE: (,m ." '�� COMPLIANCE:DATE; n Separation Distance Between the: 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) Feet ,.. Edge of Wetland and Leaching Facility(If any,wetlands exist within300 feet of leaching facility) f Feet /p Furnished by. �:l�i , zip;K; t� n Town of Barnstable P# Department of Health,Safety,and Environmental Services �Tw Public Health Division "Date (?l 367 Main Street,Hyannis MA 02601 Y S RARNMABLE, • - ' ArEo gar Date Scheduled d ) Pfyf D, Time Fee Pd. e Soil Suitability Assessment for Sewage'Disposal Performed By: f �• �'�v� "7 Witnessed By: LOCATION & ENERAT,INFORIYIA.' Location Address/00 6A/Mp J�ry� nmcc Owner's Name �V• ,/^'' Address Assessor's Map/Parcel: `D17 Z� Engineer's Name 1, NEW CONSTRUCTION REPAIR Telephone# Land Use Slopes(%) Surface Stones A114 Distances from: Open Water Body -74 w ft Possible Wet Area 71V 60 ft Drinking Water Well 4550 R Drainage Way A+ 4 ft Property Line 770-/ R Other ft SKETCH: (Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 60 � . Parent material(geologic) Depth to Bedrock /na Depth to Groundwater: Standing Water in Hole: ' "' Weeping from Pit Face Estimated Seasonal High Groundwater �� IAO0ASdf�L A1IL� s Method Used: ...... Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# __. .Reading Date:.__,._._ Index Well level....-.--- Adj.factor Adj.Groundwater Level . . PERCQLATION TEST Ante'' t T�, e Observation I zz Holey Time at 9" �a� J De th of Perc Y / YL p � '" Time at 6" v Start"re-soak Time / •� @ Time(9"-6") :End Pre-soak /�•�� :Rate Min./Inch S: , a Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back j Copy: Applicant a DEEP OBSERVATION MOLE LOGIoIe # Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,° Gravel _ „t3Z1 �t Lo DEEP ORSERVATION HOLE LOG Hole#: ,.. Depth from SoffHorizon Soil Texture Soil Color Soil_ Other Surface(in'.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. M Consistency,% ravel .............. ............................ ..............................bBSERVATION Hb ....................... ....................... LE L O;..................... ...... ... G Hole# .......... ...... Depth from Soil HoriT�°n Soil Texture Soil Color Soil Other Surface(in.) f! (USDA) °' (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,%Gravel i l DEEP ORSER'V;A,TION HOLE LOG Hole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (ionsistency, tructure,Stones,Boulderes. ° Gravel) Flood Insurance Rate Map: Above 500 year flood boundary No Yes _ Within 500 year boundary No Yes Within 100 year floddboundary No_ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? W2,12 If not,what is the depth of naturally occurring pervious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of EnvirQnthental Protection and that the above analysis was peif0 rmed by me consistent with the required training,e rtise and exp rience described in 310 CMR 15.01 .Signature ' Date J10 I TOWN OF BARNSTABLEN LOCATION SEWAGE # '-Ss VILLAGE I i�• 1 c� ��� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /00 LEACHING FACILITY: (type) (size) ®?X,.3; x —� NO.OF BEDROOMS BUILDER OR OWNER ®d - G PERMITDATE: (a —(2 -0/ COMPLIANCE DATE: Separation Distance Between the: 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) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching/facility) .?� Feet Furnished by �. j�,�►v�,ww� � • � r -�d �.__. .� �5 �. , . No. I- 3J-7 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2pprication for Zigont *pztem Construction Permit Application for a Permit to Construct( )Repair()()Upgrade( )Abandon( ) El Complete System X Individual Components Location Address or Lot No.'00 Sh eeplxeadow Pd Owner's Name,Address and Tel.No. LU l o� Mea«� �'es? RArtV Assessor's Map/Parcel /Q 9�7_3 36 2 5-9/ 3 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. S'4vdt�� `thous F,�(d S/a-✓)� Tay Dec Qnrtrt Ro,xevT,a4 I ( C 7AA S-e(aAS r i A-^w4117 eAS? SAM0w icW S6X LE^A2. ¢'01re370A(2 MC'. 21 7 -7 Type of Building: t/ Dwelling No.of Bedrooms Lot Size N/A sq.ft. Garbage Grinder(No) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 44 1-o 4 gallons per day. Calculated daily flow 4 U gallons. Plan Date -Z.00( Number of sheets l Revision Date AJ0Ad-e- Title Size of Septic Tank `ekt 5 t0c)O Type of S.A.S. Lekc k C'GuA-,enlaRr3 (3 ) Soy Description of Soil See p 1A N Nature of Repairs or Alterations(Answer when applicable) P&(p A-�2 F-,i (-9—0( k Zc c-6 l^« f 5 - Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system i 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 is by this ar f ealth. Signed Date Application Approved by Date 1 , Application Disapproved for the following reasons Permit No. Date Issued No. 3.Tsr., t `. . ,. ` .. . '.�. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: V ;,,;,,��•.� Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for Xkgomf 6pgtem Congtruction Permit Application for a Permit to Construct( )Repair�()UpgraVe( )Abandon( ) ..El Complete System A Individual Components Location Address or Lot No (b Sti?Qp�ead ow Q d j; Own�s Name,Address and.Tel.No. w e „� S��e�' „2 c was RAN Assessor's Map/Parcel S � 1 d0 S [PM -C.(�ow /0 9 —p Z�-" S,6 Z. 6 9i 3 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �ovs F,e (,4 5A1j4 rA-R-� Se��►�e p s c e"tt 14foo•CN74 1 (.{ C .JAA S-e 0AS r i A,"w )411.1 r A$i SA-nOw 1cH Box L45 2- F 0,1 e.MDA(P MCI, 02C-14 Y 9- 2 1 7 -7 Type of Building: Dwelling No.of Bedrooms Lot Size N�4 c sq.ft. t eGa{bage,,Grinder(No) Other Type of Building No.of Persons ` Showers( ) Cafeteria( ) Other Fixtures Design Flow 441, 04 gallons per day. Calculated daily flow U gallons. Plan Date Number of sheets Revision Date N UN-e- Title Size of Septic Tank ,e Xi 5 V OJC1 1000 Type of S.A.S. L Pc'e C N 4VI bIf S CR 5 0 Description of Soil e Q 1 A fV Nature of Repairs or Alterations(Answer when applicable) P_Q 1P 4 2. r-C., (R Ot k Q C c 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 is. by this ar f ealrth. Signed ' Date G Z�p Application Approved by Date G / Application Disapproved for the following reasons Permit No. Date Issued ----- --------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-s'te Sewage Disposal System Constructed( )Repaired,(k)Upgraded( ) Abandoned( )by Z bL61`,e (c 4A,7QQc, S�i v 1 c e `;�'/v c at 160 S'h_.Q e DM PG d O"v JZ C1 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ?.cld "3 J'7 dated fo /2 V / Installer a j s r,e (cA Designer J)t3 4- The issuance of this pe 't hall t be construed as a guarantee that the syste 11 furigo s desig d Date 2 Z Inspector No.—��" J)� ---------�o 9-0 Z.� ---- ------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTSr . 1i6pogai *pgtem Congtruction Permit Permission is hereby granted to Construct( )Repair Upgrade( )Abandon( ) System located at 100 3h-e-e .o M PCicJo<.j le-e LUes-r N . 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:Constru tion rpust be completed within three years of the date of this pqrmit. Date: G /Z G� Approved by ' /� r BOUSFIELD SANITARY SERVICE . 17 Burbank Street Sandwich,Massachusetts 02563 Name Sewer Permit No.� Location: ) �t�� ►�' �fl[? t�, Builder's Name and Address S )Uf'! G1 'V C Date Permit Issued: -LJ Date Compliance Issued: 11 �� 1 t � r� j Y `,' C? ,� C v� o. •- 'lS' No......................... - > u$............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. ...........OF...... / V' Appliratiun -for Dhipoml Workii Tonstrurtion Prrntit Application is hereby made for a Permit to Construct (r-1�`or Repair ( ) an Individual Sewage Disposal Sys tejn at: Y/e(1) L cation-Address or Lot No. - --------------------------------------- ---------------- - -- - --"--------=-- --------......---- /Owner Address Installer Address Z' UType of Building Size Lot..._ _O .......Sq. feet Dwell_ng-L­N�o. of Bedrooms__-__-___-.-----------------------------Expansion Attic (M Garbage Grinder,," Other—Type of Buildin pig ---- P (� ( ) dOther fixtures - ------------------------- ----------------------------------------- W Design Flow./.............. �._..._. gallons per person per day. Total daily flow.. ._ ...... ................gallons. G4 Septic Ta k l Li capac' ?.V -gallons Length________________ Width................ Diameter................ Devil;.-_:_--_--._.... Disposal Trench Width._ _ to n � hing area.... .sq. ft. Seepage Pit No,,;, _________ er- _____-__t _ Dept e .w i t_._ VTotal leaching -----------------sq. ft. z Other Distribution box ( ) Dosing tank �,+ ) U�� C ��- _-/ — 7 f , Percolation Test Results Performed by 1 - ............- - ....... -------------------- Date........... ,-� Test Pit No. 1__,/_ ---minutes per inch Depth of Test Vit.................... Depth to ground water..-._--_.-----.--_.-:_-- 1:14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground s water__..-.__-------._.---_-.-_-- . . - 3_ ••---- Ix ----------•----------- --.--•. •--- O Aescrpton of Soil--------- 4 %J � c -------------------------U ------•----------------------------------------------------------------------------------------------•--------------•----------------•------------.....-- --------------------------------------- Z ------------------------- ---------------- ------------------------------------------------------------------------- ---------------------------...--------------------------------- U Nature of repairs or Alterations—Answer when applicable._.............................................................................................. -- - ----- ------- -- ------- - -------- Agreement: 2_ J Cl 7�- d�` The undersigned agrees to install the aforedestribed Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary Code—The undersigned further agrees not to place the system in operation tmtil a Certificate of Compliance has b issued by"bo of heal Sig d--�- - 7 -Date Application Approved BY Fes' ' .-_7 .--- Date Application Disapproved for the following reasons:....................................................................................................... ........ ••-----•-----------------------•-------------------------------------------------------------------------•-------------•----------••----•--------••----------..... ---------------................... Date Permit No................................................-........ -Issued:__?._Y'.7- -- Dat No `S .... It's$... � ..`."...► THE COMMONWEALTH OF MASSACHUSETTS BOARD OF .,.HEALTH Avv ire flolt -fear, 'Mipiml �xk�:Cn�tt��rtzrti�tt �rru�it Application is herebyr;made for a Permit to Construct (4-<or Repair ( ) an Individual Sewage Disposal Syst .at: Location' Address or Lot No. t ----------------------------------------- •-- /1 f -1v�........ Owner s _ Address W �y / %R ___________________________________ ___Ldf7•�''w. _ ----_._.__.__._ .____________._ :/,V Installer Address p i,6 UType of Building Size Lot----- U __Sq. feet.. Dwelling 5o. of Bedrooms-----------�___________________________Expansion Attic VVO Gartage Grinder.," a4 Other—Type of/Building __ �_ A'-YI�...._. No. of persons............................ Showers ( — Cafeteria ( ) rOti e rtures .00 ----- -------------------------------- -------------------•---- ---------------- - d------ " ---------------------- Design Flow_,_ gallons W � _-4..�_ per person per day. Total daily flow-------7 ____-- ..._._.------ :--_-_--gallons. W Septic "1'.Ink�� capac�v gallon ength________ '. Q Width Diameter = Depth x Disposal Trench o Width--- to th ----------- 4oViaachinghiug'Irea----' 1/�_sq. ft. Seepage Pit N er_ _ ,_ ____ ep I et__. ____�_ area__ __-_____.__sq. fI. Z Other Distribution box ( ) Dosing tank Percolation Test Results Performed by h� r .................. Date-------------- Test • ,-� { f ,A Pit No. 1__Z�'___minutes per inch ,Depth-of "Pest. it__ _________________ Depth to ground water:-___-_____-___._-..-. Test Pit No. 2................minutes per inch Depth of Test`Pit-------------------- Depth to ground:water-:.__-_______-______-- f __________ . - Description of Boll r " ' + ------ rW U. Nature of Repairs or Alterations Answe'T when applicable -- _______________'`:___-_----______-_______--------------------------------------------------------- Ag- ---------- ------ - ..................... Agreement: The undersigned agrees"to install"the aforedesEribed Individual Sewage Disposal.'System in accordance with the provisions of Article XJ.of the State Sanitary Code—The undersigned further agrees not to place the system in operation until A Certificate of Compliance has b issued,by the boa4Z of healt -t Sig'- d.....: _ . .................. ----- :------- Application Approved BY --- -------------- ---- Date a Application Disapproved for the following reasons:........................................................................................................................ ----------------_- ••-•--------------- Date Permit No. --•---•----•. ._. ,'_. Issued Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . .. ..................OF.....,e .¢^✓gym Trrfifira#r of Complitturr THIS TQ�CER,;I'IFY, TWtthe.. ndividual wage isposal System constructed (�or Repairedby -----••---•----•----•---------•-••-------------------------------•- �� In/st!aller� has been installed in accordarlc with the prvtsl,�sns of ArXof'The State Sanitary CQ�e as-describ'd in 4the application for Disposal Works Construction Permit. No------------------- _'"_L + '�"` 4 dated---------------------••---•-------:--,•---_----- THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE TFIAT'TIiE SYSTEM WILL FUNCTION' SATISFACTORY. DATE--- ------ ----------------------- ------••------------•-•------ Inspector- --............................................................. 7 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH s - ..:....... .. . OF..... ..�....... . ...................._..-.--._... I t No ---- - FEE------ ----•-. k� �>anfitrur iOtt r i _ .-- t Permtsston.Is hereby granted___..__ _._�_ ___________ ,.� to Construct ( epair -' ) an I dividual wage Is osal-Syst�In at No `' b r� - �' ----- - ----- - f -----••--•- Street 'as shown on the ap lic tion for Disposal Works Construction Per D o._._..__.. ©' -•-----_-- �* w1 f - 1 . ............ Al Board o Boa f Healtfi • ' DATE.------- ---- --••--- --- ---r-------------- --.. FORM 1255 HOBBppS & WARR�iEN.)�INC.. 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