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HomeMy WebLinkAbout0066 WILLOW STREET - Health 66 WILLOW STREET,' A=150-034 lAJ• C3CUC n S-�-o�.bl�. k CERTIFICATE OF ANALYSIS Page: 1 ' Barnstable County Health Laboratory AD � sqy Report Prepared For: Report Dated: 4/29/2009 Jun Robichaud Order No.: G0951248 66 Willz)w Street West Barnstable, MA 02668 Laboratory ID#: 0951248-01 Description: Water-Drinking Water Sample#: Sampling Location�66 Wi�W.Barnstable,_MA Collected: 4/14/2009 Collected by: J.Robichaud Received: 4/14/2009 Test Parameters ITEM RESULT UNITS RL MCL Method# Tested Hardness 67 mg/L as CaCO 0.10 SM 2340B 4/21/2009 Routine ITEM RESULT UNITS RL MCL Method# Tested Nitrate as Nitrogen 1.5 mg/L 0.10 10 EPA 300.0 4/15/2009 Copper ND mg/L 0.10 1.3 SM 311113 4/15/2009 Iron ND mg/L 0.10 0.3 SM 311113 4/15/2009 Sodium 18 mg/L 1.0 20 SM 3111E 4/15/2009 Total Coliform Absent P/A 0 0 SM9223 4/14/2009 Conductance 250 umohs/cm 2.0 EPA 120.1 4/14/2009 pH 6.9 pH-units 0 SM 4500 H-B 4/14/2009 Water sample mee:.s the recommended limits for drinking water of all the above tested parameters. Attached please find the laboratory certified parameter list. Approved By: (Lab rector) m __ 22- --c Cb �' C.7 tr. ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 CERTIFICATE OF ANALYSIS Page: 1 � Barnstable County Health Laboratory Report Prepared For: Report Dated: 5/14/2008 Jim Robichaud Order No.: G0846102 66 Willow Street West Barnstable, MA C-2668 Laboratory ID#: 0846102-01 Description: Water-Drinking Water Sample#: Sampling Location 66 Willow St.W-Bar_nstable,MA Collected: 5/7/2008 Collected by: J.Robichaud Received: 5/7/2008 Routine ITEM RESULT UNITS RL MCL Method# Tested Nitrate as Nitrogen 1.4 mg/L 0.10 10 EPA 300.0 5/7/2008 Copper 0.25 mg/L 0.10 1.3 SM 3111 B 5/14/2008 Iron ND mg/L 0.10 0.3 SM 3111B 5/14/2008 Sodium 16 mg/L 1.0 20 SM 3111B 5/14/2008 Total Coliform Absent P/A 0 0 SM9223 5/7/2008 Conductance 350 umohs/cm 2.0 EPA 120.1 5/7/2008 pH 7.6 pH-units 0 SM 4500 H-B 5/7/2008 ._. . (`Water.sample meets the recommended limits for drinking water,of,all the above tested parameters.y Approved By• (Lab rector) ND 'gone Detected RL — Reporting Limit MCL—Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates COST $30.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in the Town (WHICH YOU MUST DO BY M.G.L. - it'does not give you permission to operate). You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 151 FI., 367 Main St., Hyannis, MA 02601(Town Hall) and get the Business Certificate that is required by law. 1 DATE: Ia' Fill in please: f ._.. APPLICANT'S YOUR NAME: ' BUSINESS YOUR HOME ADDRESS: (J J�I l o A -Isy� TELEPHONE # Home Telephone Number: -CP Y, - 1.5L NAME OF NEW BUSINESS`7`- l ( 5 > TYPE OF BUSINESS r IS THIS A HOME OCCUPATION? YES NO Have you been given approval from the building division? YES NO ADDRESS OF BUSINESS S —lam_ MAP/PARCEL NUMBER When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corn.ey Yarmouth Rd. & Main Street)to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. -BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 2. BOARD OF HEALTH This individual has be 'nformed f th it requirements that pertain to this type of business. Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual ha n info 'of the li in re u e ents that pertain to this type of business. Authorized Signature** COMMENTS: CERTIFICATE OF ANALYSIS Page. , ��ss��Lsv�i Barnstable County Health Laboratory Report Prepared For: Report Dated: 01/05/2004 Order Number: G0323906 James Robichaud . 66 Willow Street West Barnstable, MA 02668 Laborator✓ ID#: 0323906-01 Description: Water-Drinking Water Sample#: 23906 Sampling Location: 66 Willow Street West Barnstable MA Collected: 12/30/2003 Collected by: J Robichaud Received: 12/30/2003 Test Parameters ITEM RESULT UNITS MDL MCL Method# Tested LAB:Microbiology Total Coliform Absent CFU/100mL 0 0 P/A 12/30/2003 Note: Water sample meets the recommended limits for drinking water of all above tested parameters. Approved By: n %l L a (Lab Director) Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 �pFB� CERTIFICATE OF ANALYSIS Page: 1 Barnstable County Health Laboratory Report Prepared For: Report Dated: 12/17/2003 Order Number: G0323679 James Robichaud 66 Willow Street West Barnstable, MA 02668 Laboratory ID#: 0323679-01 Description: Water-Drinking Water Sam lin Location: 66 Willow Street West Barnstable Sample#: 23679 p s � Collected: 12/3/2003 Collected by: JFR 156-034 Received: 12/3/2003 Routine ITEM RESULT UNITS MCL Method# Tested LAB: IC Lab Nitrates 0.4 mg/L 10 SM 4500 12/6/2003 LAB: Metals Copper 0.3 mg/L 1.3 SM 3111B 12/16/2003 Iron <0.1 mg/L 0.3 SM 3111E 12/16/2003 Sodium 14 mg/L 20 SM 3111E 12/16/2003 LAB:Microbiology Total Coliform 1 Present" P/A Absent 309 12/3/2003 LAB: Physical Chemistry Conductance 151 umohs/cm EPA 120.1 12/3/2003 pH 7.3 pH-units EPA 150.1 12/3/2003 Note: <Recommended maximum contamination level exceeded due to Coliform Bacteria.Retesting is recommended Approved By: h ff ,-- (Lab Director) L2 GZ �3 � .,- s. `• _ '-� .. .'� 'i - !..''�`,- is Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 Town of Barnstable P# Department of Regulatory Services Public Health Division Date G frTt�� Prop 200 Main Street,Hyannis MA 02601 ► BABNSr'ABIA MARS; peg 0 f Time U Do Fee Pd. • Date Scheduled Soil Suitability Assessment for Sewage Disposal Performed By: Jv�n» - Witnessed By: s �d,1d.L,�:r� 3 ..:....,_ , :....�: ..::.:..a:.... :n: ,i ixi!, i•i i'YI>•':i"I!rM!i faI - .. ., �.; ":':,.!! r.l�n:,.I. L!u,.!I!t:dda::9.,m*,:au,!�„!n'ma 15t.,.,.:..... :�!.:. �i'i' :;!r.,!:I, ;:!;:m I,:!I:;I!�Ip!;':':•!'11!10!!,.1.5.!r':''•I'' I•�, L n;!? ':! .:�I,.at^":�!:. i e,: u I• .�!,y5: nt :,,. iimeii•ii ki'h,,:;�1.;�ri I' !.h� III�:.:II,li�;;!,f!i�,!. ,h..: II .:!{ aa `Ai' - -.,!.E!:I!,w'1 hair�':�;.,!.�i: .+,. a'�.!"!L,7!•!x.nll?,�t.N:.r !!:�i,:. �! ;I!!nt!I•]��•!y��}�@p j�, ',,�{!��[7; !PGA. T. .;t. ..�!'. ^i�,j.ii::c.: .I!' '��ii '. ! 'lli, .•ni''!lil i'�IA.!::!II'Ih iliMi hl'tt3'f.'i!4 ! 'iNf'f.'i� itv,:e�'i.:k.'i. '�.,:I np';. ..t_nN,.,71.n Owner's Location Address 66 W il(bu✓S / p1 weft �fnrn/�,6� Address 1S/- O Engineer's Name-�'� /�/!/ Assessor's Map/Parcel: 4, NEW CONSTRUCTION `'r' REPAIRTelephonel! ��•��" �� Slopes(%) surface Stones Land Use �g ft Drinking Water Well n�"� ft Distances from: Open Water Vpdy 5Dft Possible Wet Area ft Drainage WaolkA�1,7 ©� ft Property Line ? _—ft Other SKETCH:(Street name,dimensions of lot,exact locations of test holes&Pere tests,locate wetlands in proximity to holes) vo � f I& N � ' f 100 .� i Nj � Parent material(geologic) Depth to Bedrock r� '1 11 Weeping from Pit Face i 1 Depth to Groundwater: Standing Water in Hole: {..�auf��, — Estimated Seasonal High Groundwater ... .: n:�.P,:i'.c•n .! n,:'a^!:.. •.: .n?-! +{: mn�"!+ rw;r�,"�i,nrg'�;? n w•m:r mnc:mnc'n:,rm:?m7,�:o�,;rr n:'i'�!n, ht�ii F.!!!' �i✓':.: j r,•':{.:;�, u! !jii! �.! ��� :�f_`_.°`j iti.n x , ! ? .�'!•a !!:,:i i�l� !:;i!.•`. �,i('�A ,:I�� :I:��rii„ n!,Pr•`� : m._.�w_.a�.:o: ..•a�'1;7:����'�>I��a is•'.I�", °I: :!.'' iy !-61 !„�,'�',m _m.._,.n_.r_+_._..._ .... ._um ._ nu.•rmn.:•'n_m,:em mn 4 amn::u Inman. ,4 rn u If�::c,�hun:� b:_,aenna �:_ ��,• •• Method Used: Depth to soil mottles: in, Depth Observed standing in obs.hole: n� in. Groundwater Adjustment ft Depth to weeping from side of ohs.hole: • P t r Level P Adj.factor Adj.Groundwa e _ Index Well# Reading Date: Index Well level�._ n.n-. 'L'e!.......^rmi". "!':' _ ^2.,!..!�,;I,�'.•m.^P2S?,:.!: . .... ..:..:.. _.....,„ :nn,.......::::.....!-:,!:n a:„r.;nP•.:.'..:�r� .. _ { ,•,5n.,_•m f'-A ;.u,�A,4.!q,:;.Nii l{�i:+i!. _'�F .:aF,?�•�: .,I w°54 n,".nn!i'''�'. !;.,..i....;1:!:.;...n:r;P•._, I,...ri.;,:: �' !: -.: ''• �'!.!, ..�d a*.%!' �'?"1d{'44� " :'r!�!f ii!1,@!:' ,:;'Ip"I i I:i.i i:':kf"AI '�!�°'!!. �Ru l'I!�'�!�,�!II'!! �r` ii' 'I I .1,4!! Fk..:ux, i�;!nf�hn�n4 rll !I•; r{fl li �li'9'r44,�,i�i:u"t!.,hp;i,.,a.!(!I;. .hp�..,,! .� !':,!'I: :j!:. !:! ;f' iii i �!�n t, h .aa 1, . r!G} ' �..� �;� uN i'� ' . . �:��.�a�i �!� h:H6��! fI!..!. `�:�..: . j Observation ` Time at 9" Hole# •i�° Time at 6" Depth of Pere I�--- Time(9"-61 Start Pre-soak Time End Pre-soak Rate MinAnch r" ` Additional Testing Needed(Y/t) Site Suitability Assessment: Site Passed ✓. Site Failed: : ....:..:... .... ' ��• Soil Other Depih from r Soil Horizon Soil Texturt $oil Color Moulin Structure,Stones,Boulderes. Surface(in.) (USDA) (Mansell) B ( e �. 6 M I t.� O lJ lz. 1 S It'act lY� a !o Z I 0 11 a 1 '''`1 7 I�o 1�10 .::........:.:.:.......:.... O z::»::>a::>s:<>.<.:<;;•:.;>:�:>::.:.:•::::......:..:::..:.; Depth from Soil Horizon Soil Texture_ ther Soll Color Moulin (Structure $tones,Boulderes. Surface(in.) (USDA) (Mansell) g f Soil Other Depth from Soil Horizon Soil Texture Soil Color Mottling (Structure,Stones,Boulderes. Surface(in.) (USDA) (Munsell) c ...............:......:..................:. :...: .�I�'CAA.T��I'�:::H:a:L��;�.::.::.:�.;:>..�:.::::::...:....::.:.:....... : .. ...•..... ... :.:.:...:.:::.:..:... ..:::.<•DOH+ ?<::Q .............:...•.,::«.;:.>::<;<.:::..:.:......,.. .:.:,•:::::..::.�.::. Soil Other Depth from Soilllorlioo Soil Texture Soil Color Mottling (Structure,Stones,Boulderes. Surface(in.) (USDA) (Munsell) o Flood Insurance Rate lyian: a Above Soo year flood boundary No_ Yes Within S00 year boundary No_ Yes Within I o0 year flood boundary No_ Yes Depth of Natltrally 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? 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 - _L...... ivas nerformed by me consistent with a c, 'No. `�� �� FEE Board of Health, IMP�J!J�, MA. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) UpgradekAbandon( ) -,Complete System ❑Individual Components Location LW W Owner's Name Map/Parcel# 1 5-G 0 Address &G W I L Lot# Telephone# ® Installer's Name _� Designer's Name ,� �� Address / Af` OMS Address 10 Telephone# `j O _ 4J2- d L Telephone# S g 1 ZQ Type of Building l ( 1 Il]G Lot Size 2 ��± sq.ft. Dwelling-No.of Bedrooms Garbage grinder ( ) Other-Type of Building No.of persons Showers ( ),Cafeteria( ) Other Fixtures Design Flow(min.required) 3S® gpd Calculated design flow �;lso Design flow provided 4L= gpd Plan: Date ikW 177F ?no?— Number of sheets Revision Date �--' Title 5 fTE V AQ 1!k-A?nC_ C2P6aA0 E R-A-0 Le� 1 �� �� '5T- Description of Soil(s) t �C O 0yr Soil Evaluator Form No. (] 12 Name of Soil Evaluator J-6•LAt-'QC-C9- of Evaluation ®A 2 DESCRIPTION OF REPAIRS OR ALTERATIONS RAMP n2j-- 4 R-etiU oas/m1.-, The undersi W1c the ove ribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and fur agrees to t eration until a Certificate of Com fiance as been issued by the Board of Health. sled' Date s� '. f ,ram �No/t ,wrY �►j! + FEE F COMMONWEALTH Of MASSAC14USETTS v� Board of Health, 15A 2 J!J"t&J , MA. r APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade Abandon( ) -( Complete System ❑Individual Components Location 66 VJ i ucw t>-rLOAK& Owner's Name JAMES • ► tHA•v Map/Parcel# , 163 4 Address Edo L ? S kU " 6AZt3 Lot# i "�' Telephone# � - Ye ZQ Installer's Name �dd r tU S v t 6A _L Designer's Name Address .�f Ar510 v5 ( Address IQ HAZJ0, V I L1, (�;) l Telephone# 0�. _ ���-�bs't� Telephone# S Type of Building Lot Size 2 ,J4±AG sq.ft. Dwelling-No.of Bedrooms 3 Garbage grinder ( ) Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow(min.required) gpd Calculated design flow �;'SQ Design flow provided 446 3► gpd Plan: Date M p--/ 1 1 2CO7— Number of sheets Revision Date -— '!" Titles f—,F- RAU / r 1C_ UPn A0 C— W ( 11- (-6 \411L4_6LA-) d ( . ISA-, A.)`7174Q� Description ofSoil(s) AA 'Cll t:7-C-U I 1(,•)V,Y, �A1� Soil Evaluator Form No. I! 12- Name of Soil Evaluators t CA z-9tFL<• 6Aybat of Evaluation S O O 2 DESCRIPTION OF REPAIRS OR ALTERATIONS SY57` X4 The undersi ed.agee�yton- All the ove de�crtbed Individual Sewage Disposal System in accordance with the provisions of TITLE 5_and further agrees to not to ipl cV e I' eration until a Certificate of Co fiance as been issued by the Board of Health. Si• ed / JE Dated( Tnspf}o n"s z- s c� J No. /FEE `� COMMO LALT14 OF MASSAI.HUSETTS � �J V'V' Board of Health, , MA. CERTIFICATE OF COMPLIANCE Description of Work: ❑Individual Component(s) ❑Complete System " The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired'J. radeda �,Abaridoned O by: at has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application NoAAWA,��Z,�,/�"' dated *16r,o�d< 4$4 Approved Design Flow (gpd) Installer A:/-- r Designer: _ Inspector: �✓� t"r Date: / 51YY/V The issuance of this permit shall not be construed as a guarantee that the system will function as designed. i No � �yC� FEE Board of Health, N� � MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT, Permission is hereby granted to; Construct( ) ,Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system at �� � '+�-Ll ail/ T✓'Q`/fi^ as described in the application for Disposal System Construction Permit N4-50 'VKO ,dated J14'''ZI "6.25 Provided: Construction shall be completed within three years of the date of thispermit. All local conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date O ;r.//"-Oaoard of Health TOWN OF BARNSTABLE E L LOCATION X SEWAGE # 2 0D 2 — �`b VILLAGE S ,,Jl ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. ��l7`• d j SEPTIC TANK CAPACITY /L Ind 4A/ LEACHING FACILITY: (type) •�. . c�i& Ksize) AD,i JVXor �l•�S� NO, OF BEDROOMS BUILDER OR OWNER PERMTTDATE: OMPLIANCE DATE: 3 D-z i 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 • Ix 3 �o d S� (f ,J o EIMROTECHLABORATORIES,INC. MA CERT.NO.:M-MA 063 449 Rte.I30 Sandwich, MA 02963 908(888-6460) 1-800-339-6460 FAX(908)8884446 CLIENT. James Robichaud LOCATION: 66 Willow St. ADDRESS: 66 Willow St. W. Bam stable, MA W.Barnstable, MA 02668 COLLECTED BY: Meehan Wells SAMPLE DATE: 9/14/2000 SAMPLE TIME: 11:30 AM WATER SAMPLE TYPE: New Well DATE RECEIVED: 9/14/2000 LAB I.D. #: 0009236 WELL SPECS.: 60' RESULTS OF ANALYSIS: Parameters Units Recommended Results Method Date Analyzed Limits Colifonn bacteria /100ml 0 0 9222 B 9/14/2000 pH pH units 6.5-8.5 6.22 4500 H+ 9/14/2000 Conductance umhos/cm 500 105 120.1 9/14/2000 Nitrate-N mg/L 10.0 0.312 300.0 9/14/2000 Nitrite-N mg/L 1.00 < 0.003 300.0 9/14/2000 Sodium mg/L 28.0 13.2 200.7 9/14/2000 Iron mg/L 0.3 < 0.005 200.7 9/14/2000 Manganese mg/L 0.05 0.026 200.7 9/14/2000 COMMENTS: pH is below recommended limit and may have corrosive characteristics. WATER MEETS EPA STANDARDS AND IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. S <=less than Date >=greater than RonaldJ. S d TNTC=too numerous to count Laboratory irector ASSESSORS MR (y, No4v--- PARCEL <7 Fee------ BOARD OF HEALTH TOWN OF BARNSTABLE 0(pplicationArVell Con!6truct ion Permit Ao&-Allwem"l leln-ilv Al- Application is hereby made for a perm*t to (;onWuc t Alter or Repair V)an individual Well at: _ Location — Add Ms Assessors Map and Parcel Owner Address ------------- ---------------- ------------------- Installer Driller Address Type ) B�':�Dwelling- -—----——--------------------------—--------------- Other - Type of Building —----------------- No. of Persons------------------------------ Type of Well Capacity——----------------- Purpose of Well Agreement: The undersigned agrees to install the aforeclescribed 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 - I ff, 0 igned 404114 date Application Approved By--W�d�� date Application Disapproved for the following reasons:-------- date Permit No. Issued ——-------- date ----------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed Altered or Repaired by---- Installer 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 Pegt'�PoV—--y 11 Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE Inspector c , " 3 --� No. - L Fee------1- --------- BOARD OF HEALTH } . TOWN OF BARNSTABLE 0(pp[icat ion,forWell Congtructionpermit Application is hereby made for a permit ;tVoon§jjuct ( ), Alter ( ), or Repair (/)an individual Well at: Location `Add Assessors Map and Parcel /��✓JO�w/ner / Address Installer — Driller ! Address Type of Building-` wed--- ------------------------------------- Other Type of Building----------- ------------=- No. of Persons------------------------=--------- Type of Well- ��� !1L�-------- - - 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 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. I Signed -__ ------ -- � 6- dateAl Application Approved� By - - - - =- _- -- date y — Application Disapproved for the following reasons:- -----------------=----------- --__ --- ------- --- - ---- --------- -- -- ----------- ------------------ date boy ,x Permit`No date w - -= Issued 1 ., .u=�nl�iE�i4a4sOiiri@G9>e a estr wi4isi.si9 �ee .le@.lir�axasieil::ei4aei�e+i�saai�zaiii9a. ir.4asa��nasasali��eai.l.:roili.e;.lisil.:r:.+aieiei�i@il�reei3.Kwasisi��sa4�saYi�r.+m BOARD,OF HEALTH ` TOWN OF BARNSTABLE Y Certificate Of Compliance M� . 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 110, Regulation as described in the application for Well Construction Per tV0V_!7' --ja-----Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL-' SYSTEM WILL FUNCTION SATISFACTORY. DATE __ __Inspector' =---=- -- - ------- -' Es4�Ei4i0i4i4iliSi�i93l�Oi4YTi!!�r46li4i@iti46pi4ili9iS69i4i4i�i4i@i4rlD9i4ili4i4i�4i'Pi4u9i?i@i4ilpW4.Ski@i449iiili4fWi!i�i'!i@s�aaw�34�!i�A�i/i9iTi@i4i��li!i?i W!i�i!i!n;i BOARD OF HEALTH TOWN OF BARNSTABLE Well Construct ion permit yy� Fee Permission is hereby granted ///� ''���'�/to Construct ( Alter ( , or Repair (-) an Individual Well at: XA Street as shown on the application fora Well Construction Permit No.-- "`�--� -- -------- Dated- -------------------- Board of Health DATE-- ��— -- r 1 i C t MAC 16657- 03 No..... �....._ Fim.... .. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliratiun for Disposal Works Tonstrnrtiun 1hrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .. ! .. �c1.�. . ��1........ ............................... ..............................._.......... at o r" or Lot No. jj 1. m Owner s / Ad ess Installer /Address fl*v VType of Building Size Lot............................Sq. feet �-, Dwelling—No. of Bedrooms.......... .............................Expansion Attic ( ) Garbage Grinder ( ) a Other—T e of Building No. of persons............................ Showers — Cafeteria 04 d Other fixtures --------------------------------------------------•--------•----•----------------------'----------------------------............-----................ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length...._............... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ ►-,1 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water--_._._______-__--..___. rX, Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................ 9 ------------•-----•-•--•-••-----------------------••-••...---------.......----------•--•••-••-------......................................................... 0 Description of Soil...............................................................................----------------------•-------------•---------------------------------------......••---- x U ------------------------------------------- -------------------------------------------------------------- .--------------------------- •------------- ------•-----...._........-------------- --------------- W •-----------------------------------------------•----'------------------------------------------......................................................... r-----------------•----- V Nature of Repairs or Alterations—Answer when applicable_ _ ___ L.. j a._..... .__ i-i'._ -------------/------.�sT, ...... ;j ,fie � - .................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental .ode—The undersigned further agrees not to place the system in operation until a Certificate of Complianc been issued by—the board of health. Signed ...... . e ------------ .... '--.-- ---I.......... " ......... .....fl Application Approved By . / ...... ---------- - -... ... -------- - --- Application Disapproved for the following rear . ................................-------------........------- .--........--------'-...--------"------------------ . . ... ............................. . ... .... .. ............... PermitNo. ...... .. ....... .... ... . ----.............. Issued --------"------"--- '-- --- -------------"-' -- Date .... Date I k / ✓� 01, No.� -.�........... FEB THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE , ppliratiun for Disposal Works Cnlnstrnrtiun VarAft Application is hereby made for a Permit to�Coonsstruct ( ) or Repair ( ) an Individual`Sewage Disposal Svstem at: }� L al - r,'s or Lot No. .. 1 :...Y.( ......................... .......•---•.......................•...... ...........-----•--............................... owner - Installer -*Ad dress UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms....... ................................Expansion Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building ............................ No. of persons............................. Showers ( ) — Cafeteria ( ) a' Other fixtures ..................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter------------.... Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-_----------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ ,.� Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Q+' + 0 Description of Soil...............................................................................=....................................................................................... UW ............ _ ,......... ._......._............_..---•-•---•--...................__............-----....---......................_..--- -•---_•a___. _•--•••-••-•-••••••-•-----.-----.----- Nature of Repairs or Alterations—/Answer when applicable_ L ..__ _.._._!_.._...t'� y_. _L - ........ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental,Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance4 slbeen issued b he board of health. ''Signed ............ ` --.. . a............ Application Approved By .. .. ... ° r/ v-- ------------ ----- ............................... ----/0.. / f / Dace Application Disapproved for the following reasons`• -- ------------------------------------------ ------------------------ ------------------------- ------------------------- ............................................. .................. ---- -- ------------------. --- ---.......................-----------------------------------------....... .................--------......--..:.:. Permit No. qj.���------------------------- Issued ......................................--------------.Date f. Date THE COMMONWEALTH OF MASSACHUSETTS t BOARD OF HEALTH TOWN OF BARNSTABLE Cer#tftrate of (fomylianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by at .........( - 1. -"�------ ---....1--... �/1/-.3.1�5t r W. tT1�'�'-1'-- -! ------------------------------- has been installed in accordance with the provisions of TITLE 5 if The S t ronmental Code as described in the application for Disposal Works Construction Permit No. ..... �....... .. � dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED.AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. , , , DATE A Y �_1./-V- .-/ ----.. Inspector �! l L ! ...........................11 ` THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No. ..L................ / FEE...... Diu sat Works Tonu#ri ion ami# Permission is hereby grante _ ..,. G -- ---- --------•---------- to Construct ( ) or pair ( �n�Indivi.ual Sew ge Dis oosal S, s 4 at No........C� ✓ )/..�--Cam./�!� .._._:_ .. _a.... 0 (l-_ �~J Street (� as shown on the application for Disposal Works Construction Permit No.__I'l--�.___ aated.......................................... - --------------------------------•......--------•------------_ DATE.............. /----------------------------------- Board of Health /�--��---'�"---r-� .. FORM 3e5oa HOBBS&WARREN.INC.,PUBLISHERS - - tt � F W TREE 200.00' EXIST.37,0 /. WELL N LOTS 1 90 CV w ( .4 56/034 ) 2.54+/= AC. NO WETLANDS WITHIN 100' OF PROPOSED S.A.S OR ADDITION i 16.50' N 37.7 � 39.0 7g' � ` �\ 4 EXISTING 38 3 BEDROOM Gravel Drive DWELLING HOUSE#66 8T Deck � 78'. _ 40 901 39.2 1500 Gallon '11� P POSED Septic Tank DITION 11' i Shed / MBTA i Exist.Septic Tank, + Dist. Box&Leach. Pit w to be pumped-out& D-Box j filled-in or removed 31 as required 38.5 5'STRIP-OUT REQUIRED I C'I NO WELLS WITHIN - --e6� --�--� 150' OF PROP. S.A.S. N I I N 117' 10.83' 79' 40 et N i 38 . C\ 171.52' i SITE PLAN/ a SEPTIC UPGRADE PLAN No y, sCw B , �. LOT 1 ! #66 WILLOW ST. © f .. sSlpNAI ' BA RNSTABLE , MA. N F;. 1 s , APPLICANT: ENGINEER: M I : yr James F: Robichaud Norman Grossman, PE, RLS No. ,zri5 66 Willow Street 10 Marsh View Road LOCUS MAP West Barnstable' MA 02668 East Falmouth, MA. 02536 �►,�� LAB? !SCALE : 1"=2000' 508-367-7820 508-548.-1920 MAP SEC PAR LOT FLOOD ZONE ELEV ' MAP ' " "SCALE DATE SHEET NO PLAN NO., r 156 . 034 1 C F 250001 0011 D 1"=30 MAY 17, 2002 1 OF 2 H-71.3-1 SEPTIC SYSTEM PROFILE ter. FIRST FLOOR NOT TO SCALE ELEVATION.- -40-.7-_ FIN._GRADE AT_ _ _ _FIN. GRADEOVER _ - - FIN. GRADE-OVER - -- - - - - - - FOUNDATION SEPTIC TANK FIN. GRADE OVER SOIL ABSORPTION SYSTEM TOP FOUNDATION 39.2 39.0 y DISTRIBUTION BOX 38.1 ELEVATION 39.9 + + 38.5 + INVERT AT ++ + RISER SET TO W/1 + + 6"OF FIN. GRADE FOUNDATION + ++ ELEVATION 37.60 + (VERIFY IN FIELD + + 3" � 2"MIN. DOUBLE WASHED 1/8"-1/2"STONE 36.75 PRIOR TO START + - OF INSTALLATION ) +++ o - - - - - - - - - +++ 37.00 36.75 suMP +++ 1500 GALLON o 36.40 `- +++ SEPTIC TANK 36.57 36.25* + H-10 LOADING BASEMENT FLOOR__ ++ GAS..BAFFLE ON OUTLET TEE (_ 3 HOLE DIST. BOX + _ . _ _ _ 4.00' 5-INFILTRATORS 6.25' = 31.25' 4.00' ELEVATION + @ - 34.25 + H-10 LOADING TO BE SET ON A LEVEL TOTAL EFFECTIVE LENGTH = 39.25' +++++ AND STABLE BASE TOTAL EFFECTIVE WIDTH = 10.83' + + SEPTIC TANK SET LEVEL AND TRUE TO GRADE TOTAL EFFECTIVE DEPTH = 2.00' ON 6"CRUSHED STONE BASE ON * SEE NOTE#9 REGARDING STRIP-OUT MECHANICALLY COMPACTED NATURAL MATERIAL co DESIGN DATA SOIL EVALUATION 34"DATE OF TEST: MAY 10, 2002 INFILTRATOR CHAMBER IN CAPA CITY HIGH PAY Y NUMBER OF BEDROOMS................... 3 LOGGED BY: J.E. LANDERS-CAULEY H IGH X PA X IN --- H-20 LOADING G.P.D./BEDROOM................................ 110 G.P.D. WITNESSED BY: D. STANTON TOTAL DAILY FLOW.................:. TOWN OF: BARNSTABLE (OR APPROVED EQUAL) ......... 330 G.P.D. GARBAGE DISPOSAL.......................... NO PERC RATE: 5 MIN/IN LEACHING REQUIRED........................ 330 G.P.D. SOIL CLASS: 1 ( 0.74 GALS./S.F.) SOIL ABSORPTION SYSTEM LEACHING PROVIDED........................ 463 G.P.D. GROUND WATER: NONE ENCOUNTERED SEPTIC TANK REQUIRED................... 1500 GAL. NOTES: SEPTIC TANK PROVIDED................... 1500 GAL. 0° 38.1 TEST PIT#1 Q" 1. ELEVATIONS BASED UPON TOWN OF BARNSTABLE DATUM. 2. TOPOGRAPHY BASED UPON AN ON-THE-GROUND SURVEY. SIDEWALL AREA................................. 200.3 S.F. 9" O/A SANDY LOAM 3. PROPERTY LINE INFORMATION FROM BOOK 209, PAGE 57. BOTTOM AREA.................................... 425.1 S.F. 4. NORTH ARROW NOT TO BE USED FOR SOLAR ORIENTATION. TOTAL AREA. . .......... 625.4 S.F. SILT LOAM 5. ALL PIPING TO BE CAST IRON OR SCHEDULE 40 PVC. ALL SYSTEM COMPONENTS TO BE INSTALLED IN ACCORDANCE TOTAL AREA X 0.74 G.P.D./S.F........... 462.8 G.P.D. 36" B 10YR 6/2 6. WITH SEC TITLE V AND LOCAL BOARD OF HEALTH REGULATIONS. 7. NO CHANGES TO LOCATION/ELEVATION OF SYSTEM COMPONENTS WITHOUT WRITTEN APPROVAL OF ENGINEER. SILT LOAM 8. NOTIFY ENGINEER 24 HRS. IN ADVANCE FOR AS-BUILT INSPECTION. *NOTE: EXCAVATE TO ELEVATION 23.0 , OR LOWER,AS SOIL 174" C-1 10YR 6/1 9. STRIP-OUT REQUIRED; 5'AROUND SYSTEM, 14.5' DEEP, OR UNTIL CONDITIONS REQUIRE, TO REMOVE ANY TOPSOIL, SUBSOIL, SUITABLE SOILS ENCOUNTERED. SILT, CLAY OR OTHER UNSUITABLE MATERIAL BENEATH THE ti 1 INLET INVERT OF THE SOIL ABSSORPTION SYSTEM FOR A MINIMUM DISTANCE OF 5'AND BACKFILL WITH CLEAN SAND, JAMES ROBICHAUD SHEET NO. 2 OF 2 PER 310CMR 15.255:3. MEDIUM SAND U 222" C-2 10YR 7/3 e; LOT 1, #66 WILLOW ST. W. BARNSTABLE H-713-2