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Home My WebLink About0264 WOODSIDE ROAD - Health 264 WOODSIDE RM9 West Barnstable A = 128 - 011 No. t �I Fee (r BOARD OF HEALTH �••a TOWN OF BARNSTABLE 01pplication _for Yell Construction Permit Application is hereby made for a permit to Construct K Alter( ), or Repair( an individual well at: -o p� /Location n�-Address Assessors Map and Parcel Address _��L�i-^'�C (.C✓��Q(CCft✓�o_ � c C �a��C �R��. �9�IL�'1_Tsl'l� 0�$�\ Installer-Driller Address Type of Building Dwelling Other-Type of Building No. of Persons Type of Well aJ Capacity a 46�A Purpose of Well Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of He _ Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a C&Tffilc of pliance has been issued by the Board of Health. Signed A c. Date Application Approved By f�� -7 , ate Application Disapproved for the following reasons: Date Permit No. W �"V ( 7 — V!!��M Issued ( 7 Date -------------------------------------------------------------------------------------------------------- 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 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.SATISFACTORILY. Date .Inspector ..- ''�t.W �^-'S•� f 'i' ��ii� J{l1Y` T ,� • .. '�„ � ' .. 't1Y.� ..�.. *�.^�� 1 �•7.�.�.,f.r' ,,_ ,_ w ...�w....,�,. ` ,��-No. �;' V' Fee OF TOWN OFARBAERTNSTABLEA. ^ 01ppricactiou ifor Veil Cow5truction Permit Application is hereby made for a permit to Construct O Alter( ), or Repair( an individual well at: Location-Address ,1 Assessors Map and Parcel ,f r� lslTllt.�lJ ( _ /ljAFt uvT f 'G�U IJ `F�r_ iC� . rC AW Owner Address /�% ►�1 Z'C C L. C/ �A 1[LC n/Co_ C t ��t Q%als -4.M, A). &MM .,ad e2 { Installer-Driller Address f Type of Building Dwelling�/� Other-Type of Building No. of Persons Type of Well 6 ZU7 Capacity lC, � il/J Purpose`of Well ,��,/ [` 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 Cei-ificat of Co; liance has been issued b the Board of Health. p Signed }. y 7 Date r Application Approved By �Vut„ _✓�..t......--C � �/l '?/r --7 Date Application Disapproved for the following reasons: Date Permit No. LJ d 17 - 0( � Issued /r Date BOARD OF HEALTH TOWN. OF BARNSTABLE w" _. Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed( ), Altered( ), or Repaired( by - _ins er 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 SATISFACTORILY. Date Inspector BOARD OF HEALTH TOWN OF BARNSTABLE Very Cow5truction Permit No. J,J d ! Fee Permission is hereby granted to 44/, w Instiller to Construct(••)!� Alter( ), or Repair( an individual well at: a Street- �' 6/- - as shown on the application for a Well Construction Permit No. L-I —).o 1 7"o o Dated Date m� �/ Approved By 1 �f. In Massachusetts Department of Environmental Protection Bureau of Resource Protection Well Completion Reports Well Driller Please specify work performed: Address at well location: Replacement Street Number: Street Name: 264 WOODSIDE RD. Please specify well type: Building Lot#: Assessor's Map#: 1pomestic 128 Assessor's Lot#: ZIP Code: Number Of Wells: 011 02668 City/Town: Well Location BARNSTABLE In public right-of-way: GPS t C°°Yes C'No North: West: 41.68707 70.38255 Subdivision/Property/Description: Mailing Address: JPF click here if same as well location addres Property Owner: Street Number: Street Name: DONNA CARINDA 264 WOODSIDE RD. City/Town: State: Engineering Firm: BARNSTABLE MASSACHUSETTS ZIP Code: 02668 Board of health permit obtained: 0 Yes r)Not Required Permit Number: Date Issued: W2017 019 07/17/2017 �� r Massachusetts Department of Environmental Protection i` Bureau of Resource Protection—Well Driller Program Well Completion Reports(General) Well Driller - General Well Form DRLLING METHOD Overburden Bedrock uger Choose Bedrock— WELL LOG OVERBURDEN LITHOLOGY From(ft) To(ft) Code Color Comment Drop in drill Extra fast or slow Loss or addition stem drill rate of fluid r7 ----� Fine Sand Brown w/STONES& YES NO � oss Addition ROCKS I^Fest f'Slow 15 Silty Sand Brown FS ` �"°Fast f Slow 1: T r YES NO L� Loss Addition �� ._e_ rS r r Loss c 15 20 Boulders '• Brown YES NO r'Fast�`,Slow Loss Addition 1 WIROCKS { r (` 20 26 Silt �': Brown � �Fast{",Slow YES NO �� Loss Addition WIROCKS&SILT 26 40 Boulders � Brown .—_ (Ir Fast r Slow YES NO t� Loss Addition WISTNS C (" LLr C Fine Sand Addition 55 75 Medium Sand Brown WIFS t" r r �. �: r�`Fast C>Slow YES NO �� Loss Addition � C 75 94 Medium Sand '+`:• Brown �. �Fast t"Slow YES NO Loss Addition WELL LOG BEDROCK LITHOLOGY Drop in Extra fast or Loss or Visible Rust Extra From(ft) To(ft) Code Comment addition of Large drill stem slow drill rate fluid Staining Chip s L __—J Choose Code 7Addition :Y r. rYe es YES NO Fast Slow Loss ADDITIONAL WELL INFORMATION Developed r`Yes 1 No Disinfected f Yes P'No Total Well Depth 94 Depth to Bedrock Surface Seal Type jNone Fracture Enhancement `Yes l:No CASING r Is Casing above ground? From To Type Thickness Diameter Driveshoe 91 Certa-Lok Schedule40 l' Yes SCREEN r,No Screen From To Type Slot Size Diameter Massachusetts Department of Environmental Protection x Bureau of Resource Protection—Well Driller Program .. Well Completion � 91 I(94 1 I`Stainless Steel Well Point 10.010 I�4 WATER-BEARING ZONES DRY`HELL 1 From To wield(gpm) 73.5 IK:� 40 PERMANENT PUMP(IF AVAILABLE) Pump Description Wrs Variable Speed Horsepower �ubmersible 1/2 Pump Intake Depth(ft) E5 Nominal Pump Capacity(gpm) 15 ANNULAR SEAL/FILTER PACK From To Material 1 Weight Material 2 Weight Water Batches Method Of (gal) (count) Placement �J 50 Native Material — Choose Material �_� Gravity — WELL TEST DATA Time Pumped Pumping Level(ft Time To Recover Recovery(ft Date Method Yield(gpm) (HH:MM) BGS) (HH:MM) BGS) 9/13/2017 Constant Rate Pump~ 11 0:30 76.5 0:02 73.5 WATER LEVEL Date Static Depth BGS(h) Flowing Rate(gpm) Measured 9/'3/2017 COMMENTS WELL DRILLERS STATEMENT This well was drilled or altered under my direct supervision,according to the applicable rules and regulations,and this report is complete and accurate to the best of my knowledge. Monitoring[M] Supervising Driller PETERSON, DrillerC.ILIFFE Registration# 786 Signature RONALD,C ATLANTIC WELL Firm DRILLING,INC. Rig Permit# 477 Date Job Complete 10/9/2017 NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion. Page: 1 of 1 CERTIFICATE OF ANALYSIS Barnstable County Health Laboratory (M-MA009) 4s��xc.>�i' Report Prepared For: Report Dated: 9/21/2017 Ron Peterson Atlantic Well Drilling Order No.: G1.7103325 P O Box 339 North Eastham, MA 02651 Laboratory ID#: 17103325-01 Description: Water-Drinking Water Sample#: Sample Location: 264 Woodside Rd. W. Barnstable, MA Collected: 09/13/2017 Collected by: RCP Received: 09/14/2017 Routine_M ITEM RESULT UNITS RL MCL METHOD# ANALYST TESTED NOTE Nitrate as Nitrogen 3.4 mg/L 0.10 10 EPA 300.0 LAP 9/1.5/2017 Iron ND mg/L 0.10 0.3 SM 3111B LAP 9/15/2017 Manganese 0.0089 mg/L 0.025 0.050 EPA 200.8 LAP 9/21/2017 pH 6.2 PH AT 25C NA 6.5-8.5 SM 4500-H-13 DCB 9/14/2017 Sodium 29 mg/L 2.5 20 SM 3111B LAP 9/15/2017 Total Coliform Present P/A 0 0 SM 9223 RG 9/14/2017 Conductance 310 umohs/cm 2.0 SM 2510B DCB 9/14/2017 The recommended maximum contamination level for drinking water exceeded due to Coliform Bacteria. Tested Negative forE.coli. Retesting is recommended. Sodium level is above the maxium contaminant level. Those on a low sodium diet may wish to consult a physician. Attached please find the laboratory certified parameter list. Approved By-- (Lab Director) ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level 3195 Main Street, PO. Box 427, Barnstable, MA 02630 Ph: 508-375.6605 f � CERTIFICATE OF ANALYSIS R M' Barnstable County Health Laboratory (M-MA009) •��ACI[t S�C. Recipient:: Ron Peterson Matrix: Water-Drinking Water i Atlantic Well Drilling Sampled: 09/13/2017 16:20 x 339 Received: 09/14/2017 11:10 P 0 Bo i North 339 m, MA 02651 Collection Address: 264 Woodside Rd.W. Barnstable,MA Sample Location: Order#: G17103325 Description: ReKit Lab ID: 17103325-01 Date Analyzed: 9/14/2017 @ 11:43 Sample#: Analyst: yn Method: EPA 524.2 Dilution Factor: 1 Comment: The recommended maximum contamination level for drinking water exceeded due to Coliform Bacteria.Tested Negative for - _ -E.coli.Retesting is recommended.Sodium level is above the maxium contaminant level. Those on a low sodium diet may wish EPA 524.2- Volatile Organics by GC/MS Result MCL MDL Result MCL MDL Parameter I ug/L ug/L ug/L Parameter ug/L ug/L ug/L o.5o Chloroform --N-D - - a.50 Dichlorodifluoromethane ND 71 0.5o ND 50 Chloromethane ND , - Vinyl chloride ND 2.0 o.so cis-1,3-Dichloropropene- ND 0.50 0.50 Dibromochloromethane ND 0.50 Bromomethane �____.N�__•_. - ND ND 0.50 1,1,1,2-Tetrachloroethane ND 0.50- Dibromomethane _ --_--_ 1,1,1-Trichloroethane _ND 200 0.50 Ethylbenzene _ i1 1 2 2 Tetrachloroethane ND - 0.50 0.50 Hexachlorobutadiene _ ND - 0.50� - ,.---------�- -.-_ _ __-__ 11,1,2-Tdchloroethane ND 51 0 0.50 Isopropylbenzene ND - 0.50 �..__._.___.--------...---�---•----__-_-� -.--ND_-_-__- o.so Methylene chloride ND 5.0 0.50 �1,1-Dichloroethane _ - _ -------- - --- - 1,1-DichlOroethene - _ ND 7.0 0.50 Methyl-tert-butyl ether _ND - 0.50- 1,1-Dichloropropene _ -_ - ND- 0.50 - Naphthalene -� - ND __ - 0.50 - I. - 0.5o n-Bu (benzene ND 0.50 1,2,3-Tdchlorob_enzene ND ty - .--- - -- 1,2,3-Tri�loropropane -- ND - - 0.50 n-Propylbenzene ND 0.50 j1,2,4-Tnchlorobenzene -ND-� 70 J 0.5o^ p-Isopropyltoluene ND 0.50 - 1,2,4-Tr'methylbenzene ND 0.50 sec-Butyibenzene ND o.50 ND 100 0.50 1,2-Dibromo-3-chloropropane ND_ 0.50 _ Styrene -._- __ _---_- - - _---------__-_-� - -_.� tert-Butylbenzene - ND 0.50 ND 0.5o � i1,2-Dibromoethane(EDB) i - I - (1,2-Dichlorobenzene ND 600 i 0.50 ITetrachloroethene i ND 5.0 4 0.50 L-_____ - _ _• ND 1000 i 0.50 i1,2-DichloroethaneD_ 5.0 j 0.5o Toluene i ND i o.so Total xylenes ND 10000 0.50 11,2-Dichloropropane 100 0.50 �1,3,5-Tdmethylbenzene ND i o.5o trans-1,2-Didiloroethene ND 1,3-Dichlorobenzene ND o.5o �tjra�ns-1,3-�Diloropropene ND 0.50 1,3-Dichloropropane _ --ND 0.50 _ loroethene ND 5.0 0.50 1,4-Dichlorobenzene ND 5.0 0.50 ITrichlorofluoromethane _ ND - 0.50 2,2-_Dichioropropan_e__ _ _- _ ND__ 0.50 Surrogates %Recovered QC Limits(%) 2-Chlorotoluene j ND 0.50 p Bromofluorobenzene__ 91%_ 70 130_ 4-Chlorotoluene - 0.50 1,2-Dichlorobenzene^d4 _ 99% 70 130 Benzene ND �•0 0.50 Bromobenzene ND ! Bromochloromethane ND 0.50 Bromodichloromethane _ Bromoform ----YND -_-_. I•_ 0.50 - Carbon tetrachloride ND 0.'_ Chiorobenzene _ _ Ch of 0.50 methane I Y ND �- ,----- Approved By. - Attacned please find the laboratory certified parameter list. (Lab Director) ��.�/ � ND=None Detected RL = Reporting_Limit MCL=Maximu on!t pant Lev I V 3195 Main Street, P0. Box 427, Barnstable, MA 02630 Ph: 608-376-6605 Page 1 of i i r ENVIROTECH LABORATORIES,INC. MA CERT.NO.:M-MA 063 8 Jan Sebastian Drive Unit 12 Sandwich,MA 02563 (508)888-6460 1.800-339-6460 FAX(508)888-6446 Client Name Atlantic Well Drilling Location 264 Woodside Rd. Address PO Box 339 W.Barnstable,MA No.Eastham MA 02651 Sample Date 09/28/17 Collected By Chuck Sample Time 12:00 Sample Tvpe Drinking water Date Received 09/28/17 Lab Order Number DW-173681 Well Specs New,73.5 Static,94'deep Xrncatlon;Source = Dd k Collec#ed 1 line Collected � Comnien(s , A. :09120117 �.,,,., 12 OC. ,., _ . „ K ..a,Topzof vgell Analysis Requested Units Recommended Limits Analyst Result I Method -Date Analyzed Analyzed By Total Coliform _^ —CFU/100mL _ 0 0 SM9222B 9/28/2017 IRS Comments: I Date 10/2/2017 Ronal .Saari Laboratory Director BRL=Below Reportable Limits *See Attached Page 1 of 1 cCertifi.ation is not available for this analyte for potable water samples.. CERTIFICATE OF ANALYSIS Page: 1 of 1 Barnstable County Health Laboratory (M-MA009) Report Prepared For: Report Dated: 9/21/2017 r Ron Peterson - Atlantic Well Drilling Order No.: G17.103325 - P O Box 339 North Eastham, MA 02651 � Laboratory ID#: 17103325-01 Description: Water-Drinking Water Sample#:. Sample Location: 264 Woodside Rd. W. Barnstable, MA Collected-N" 09/13l2017 i Collected by: RCP Received: 09/14/2017 Routine_M ITEM RESULT UNITS RL MCL METHOD# ANALYST TESTED NOTE Nitrate as Nitrogen 3.4 mg/L 0.10 10 EPA 300.0 LAP 9/1 512 0 1 7 Iron ND mg/L 0.10 0.3 SM 3111B LAP 9/15/2017 Manganese 0.0089 mg/L 0.025 0.050 EPA200.8 LAP 9/21/2017 pH 6.2 PH AT 25C NA 6.5-8.5 SM 4500-H-13 DCB 9/14/2017 Sodium 29 mg/L 2.5 20 SM 3111 B LAP 9/15/2017 Total Col�iform Present Pm 0 0 SM 9223 RG 9/14/2017' Conductance 310 umohs/cm 2.0 SM 2510B DCB 9/14/2017 The recommended maximum contamination level for drinking water exceeded due to Coliform Bacteria. Tested Negative for E.c:)li. Retesting is recommended. Sodium level is above.the maxium contaminant level. Those on a low sodium diet may wash to consult a physician. Attached please find the laboratory certified parameter list. Approved B - (Lab Director) ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level 3195 Main Street, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 CERTIFICATE OF ANALYSIS Barnstable County Health Laboratory (M-MA009) Recipient: Ron Peterson Matrix: Water-Drinking Water Atlantic Well Drilling Sampled: 09/13/2017 16:20 P 0 Box 339 Received: 09/14/2017 11:10 North Eastham, MA 02651 Collection Address: 264 Woodside Rd.W. Barnstable, MA Order#: G17103325 Sample Location: Lab ID: 17103325-01 Description: ReKit Date Analyzed: 9/14/2017 @ 11:43 Sample#: Analyst: yn Method: EPA 524.2 Dilution Factor: .1 Comment: The recommended maximum contamination level for drinking water exceeded due to Coliform Bacteria.Tested Negative for E.coli. Retesting is recommended.Sodium level is above the maxium contaminant level. Those on a low sodium diet may wish EPA 524.2- Volatile Organics by GC/MS Result MCL MDL I Result MCL MDL Parameter ug/L ug/L ug/L Parameter ug/L ug/L ug/L Dichlorodifluoromethane ND 0.50 Chloroform ND 80 0.50 Chloromethane ND 0.50 cis-1,2-Dichloroethene ND 70 0.50 Vinyl chloride ND 2.0 0.50 cis-1,3-Dichloropropene ND 0.50 Bromomethane ND 0.50 Dibromochloromethane ND 0.50 1,1,1,2-Tetrachloroethane ND 0.50 Dibromomethane ND 0.50 1,1,1-Trichloroethane ND 200 0.50 Ethylbenzene ND 700 0.50 1,1,2,2-Tetrachloroethane ND 0.50 Hexachlorobutadiene ND 0.50 1,1,2-Trichloroethane ND 5.0 0.50 Isopropyl benzene ND 0.50. 1,1-Dichloroethane ND 0.50 Methylene chloride ND 5.0 0.50 1,1-Dichloroethene ND 7.0 0.50 Methyl-tert-butyl ether ND 0.50 1,1-Dichloropropene ND 0.50 Naphthalene ND 0.50 1,2,3-Trichlorobenzene ND 0.50 n-Butylbenzene ND 0.50 1,2,3-Trichloropropane ND 0.50 n-Propylbenzene ND 0.50 1,2,4-Trichlorobenzene ND 70 0.50 p-Isopropyltoluene ND 0.50 1,2,4-Trimethylbenzene ND 0.50 sec-Butylbenzene ND 0.50 1,2-Dibromo-3-chloropropane ND 0.50 Styrene ND 100 0.50 1,2-Dibromoethane(EDB) ND 0.50 tert-Butyl benzene ND 0.50 1,2-Dichlorobenzene ND 600 0:5o Tetrachloroethene ND 5.0 0.50 1,2-Dichloroethane ND 5.0 0.50 Toluene ND 1000 0.50 1,2-Dichloropropane ND 0.50 Total xylenes ND 10000 0.50 1,3,5-Tri methyl benzene ND 0.50 trans-1,2-Dichloroethene ND 100 0.50 1,3-Dichlorobenzene ND 0.50 trans-1,3-Dichloropropene ND 0.50 1,3-Dichloropropane ND 0.50 Trichloroethene ND 5.0 0.50 1,4-Dichlorobenzene ND 5.0 0.50 Trichlorofluoromethane ND 0.50 2,2-Dichloropropane ND 0.50 . Surrogates %Recovered QC Limits(%) 2-Chlorotoluene ND 0.50 p-Bromofluorobenzene 91% 70 130 4-Chlorotoluene ND 0.50 1,2-Dichlorobenzene-d4 990/0 70 130 Benzene ND 5.0 0.50 Bromobenzene ND 0.50 Bromochloromethane ND 0.50 Bromodichloromethane ND 0.50 Bromoform ND 0.50 Carbon tetrachloride ND 5.0 0.50 Chlorobenzene ND 100 0.50 Chloroethane ND 0.50 Approved By. v�r.. Attached please find the laboratory certified parameter list. (Lab Director) � ND=None Detected RL Reporting Limit MCL=Maximu:Co`ntnt Vrn��antLEvdll 3195 Main Street, P0. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 Page 1 of 1� G TOWN OF BARNSTABLE r LOCATION SEWAGE VILLAGE,4�; �,g?,�,011 1-4l l (ASSESSOR'S MAP & LOTIR e-'Olf INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) size) NO. OF BEDROOMS ;PRIVATE WELL.OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: '"',. -� DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No \� � \. J� � i l ��t r �� (n� � �� '� . �` �' �� (`� � _ par 01 f o-----------"P -R VED Fps..... .......... B n COl189N n DePrMagXTHE COMMONWEALTH OF MASSACHUSETTS 24BOARD OF HEALTH i net Date TOWN OF BARNSTABLE - Appliration for Ali►ipw3 al Worlo Tomitrnrtiun rnmif Application is hereby made for a Permit to Construct ( ) or Repair (/<an Individual Sewage Disposal System at: .................... G.z.B.�� ..... ...----1 f� al.!�----------------------- -.... ,1 Location- ddress or Lot No. Owner Address .............................••... .............•...................._.._.. Installer Address C(! Type of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms------------_3-------------------_._.-_Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons-____--__-______---..----.-. Showers ( ) — Cafeteria ( ) Q' 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. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq..ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------- --------------•----------------••••......---••----------•---•---- Date........................................ Test Pit No. l................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2..._------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 •------------------- ------------------------------------- ....._........ •-------- •----------- •------- ------------- ---•..... ....... .-••-... ..•----.......... •-- 0 Description of Soil........................................................................................................................................................................ W U ....•••------------------------------•----•---•----•-•---------.....••••••-•••--•--••••••••...•------•--------••--•-•--•------•-----------•••••••...................................................... W ------•---••----......-•----•--•••••.................... ••-------------------------------•••--•------- --------•-•-•-----------••-•-••----------------•---...........••••••••......................-- UNature of Repairs or Alterations—Answer when applicable-2-mi.4.11-......../..'._.L /O.ZI: ......P4-4.....J/M.C. r• • )_ � 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 Compliance has bee 'ss d by the board of health. Signed -------- -------- -- - ----- ----- - ... ............................ -------. '.�3..'. .`✓. Dare_ Application Approved By .-: :..d -------- . ... ..... ........ ................................................. .....7� Dace Application Disapproved for the following reasons: ........................ ................... . ..... ......... ........ ........................... ............ ............ ....... ............................- ....................... ... ....................................................... . ................... ........................................ Permit No. .... ..� ......... Issued ........ �_ . .......... ... Dare ....... Dace..... - •-Y •..•..,.,••,r�;" `•,.,,,,� -..JAi�„� :��er�•:-.:a,,.y nr,,"ri..r�.,,,*'.v--..(.ti.: .. w ..=,:• -�.�.�-.f-,.i�'7.r ---'w �.:v��yn: �v �•_—� _.�. � .�.. V_.__. _____ O 1 1 No...: ... ---------_.. Fi$.....�� .......... �1 COMMONWEALTH OF MASSACHUSETTS f�"/THE y`BOARD OF HEALTH TOWN OF BARNSTABLE Apphration for Ui►ipv�al World, Tomitrnrtinn Permit Application is hereby made for a Permit to Construct ( ) or Repair (�an Individual Sewage Disposal System at: .... . ............ Address or Lot No. ..........®_r n.�:._.....l--.GC t• a !'- ..................................... •-----•----•----•---------•---.................-----...........---......._............_........... Owner Address Installer Address Type of Building Size Lot............................Sq. feet I-, Dwelling— No. of Bedrooms.__--__•_-_-�---------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) 04 Other fixtures ................................. . Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W WSeptic Tank—Liquid capacity............gallons Length---------------- Width_---_--_--_..--- Diameter---------------- Depth................ x Disposal Trench--No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 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 toDepth of Test Pit.................... Depth to ground water........................ 4.1 Test Pit No. 2...............minutes per jtrich Depth of Test Pit.................... Depth to ground water........................ r/J ODescription of Soil........................................................................................................................................................................ W V ..........-•••-•--•••-•--•------••••--•••--.......--••••---•-••-----------•--------•-••-•••-•----......•••-•-••---------------------•--•-••--••-••-------...._...................---••---•--...._•..•-•-- W Z. ---•-................................................................................................................................................................................................. U Nature of Repairs or Alterations—Answer when applicable-- t?.3. AI/__._.....�.. ._. ..6....._4..J. 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 Compliance has beenissuthed by the board of health. Signed .................. .... ....�.....`. .( .`.`,, bir '4r" 1 ;.................................. ........... Dace Application Approved By ......�,,�r�,;7.Q... ..... .... . ......... . ................................................. ... �./... ... ��. Date Application Disapproved for the following reasons: .............................................................................................. ................. . . ....... .............................. . . -------------------------- ------ ............ .............................................. ........................................ Date Permit No. .... `......�� .... -- ...�........ Issued ------` ��1 -... Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (fertifirak of Cfomptialarr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( �� by ------...._... ...._.. ,,._ ... ............----------_........._....------ -....._------...-Ins---- .._.._....... ...... ....................._.... ./...._.../,...................................................... ---------------- ..._..... -( -.�..j. S1 t4........- ......................................... . has been installed in accordance with the provisions of TITLE of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ..... -.Jam.... ...._ dated .j..�..^....�.__.G.-..—...�� THE ISSUANCE OF THIS CERTIFICATE SHALL NOT Bf CONSTRUE" S A GUARANTEE T AT THE SYSTEM WILL FUNCTION SATISFACTORY. lnspeccorl.�---�''-__........................... �� DATE.__...... .. ._•�yJ ..............._. ----------- -------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �;J TOWN OF BARNSTABLE FEE.....3_U.......... �i��n�tt1 nrk� �un�tr�trtuan �rrnttt Permission is hereby granted......... -------- }-----------•-•--------------------•-----•---•---------------•-••--••••---•-....................... to Construct ( ) or Repair ( ,man Individ] al Sewa e sposal System 41 Street + as shown on the application for Disposal Works Construction Permit o '_ kJated__/.__:.. _ ........... - ram? •-• —� !1- �. / Board of Health DATE..------.. .!_ -------------------- / FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS - \�o L ,28 O00 "Cp ----=— yAcP11lN�60 - SHED Nu C4t � i - i 1V 9r _ ov O LOT 29 ;1 ti ra l/d�. ll�� RES. ZONE.- "RF" This MORTGAGE INSPECTION PIa is For FLOOD ZONE.- "C" nk Use Only TOWN: A T4 5_ FFEEY F & DON.1V DEED REF �9 2 BUYER �E�1N�1 ' DATE: 1 t,�'1 ,2 PLAN REF: �39, 37w �_ SCALE:1"= 40___�FT. I HEREBY CERTIFY TO d��►��EDFO�� L7�TIp.�112$ ®yl�L -• ITS_SUCCESSCRS ANDIOX ASSIGNS_. ATIM.�THAT THE BUILDING A '- YANKEE SURVEY SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN AND 'THAT ITS POSITION DOES ____ CONFORM CONSULTANTS TO THE ZONING LAW SETBACK REQUIREMENTS OF THE ME THrb,1 4 143 ROUTE 149 TOWN OF —._ARAYS_TAI&�—-----------AND THAT o. 098 a; ARSTONS MILLS, MA. 02648 IT DOES_MT-- LIE WITHIN THE SPECIAL FLOOD HAZARD AREA AS SHOWN ON THE H.U.D. MAP DATED...F/-J9,/M _ �lOTC..`�.Qa`' TEL 428—0055 250001 0015 C L FAX 420-5553 � __ THIS PLAN NOT MAD+ FRO ►N UMENT tI A MERIT P _ —_ SURVEY, NOT TO BE USED FOR FENCES. ETC. 10056 BJS AsBuilt Page 1 of 1 G TOWN OF BARNSTABLE LOCATION 076 &e_ SEWAGE# VILLAGE`/(",`, 2�8! Af?_466 ASSESSOR'S MAP & LOT/A' e'0// f INSTALLER'S NAME& PHONE NO. A & B CANW 775-6264 SEPTIC TANK CAPACITY ��tc LEACHING FACILITYAtypeo �,/S(size) 4614 NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER /l DATE PERMIT ISSU)9D: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No <3 � ' S a!i Sys r.� �,JClr1 i http://'issgl2/intranet/propdata/prebuilt.aspx?mappar=128011&seq=1 7/17/2017 TOWN OF BARNSTABLE LOCATION 00 � SEWAGE # J VILLAGE_ j -V'�,- ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. `- Y, -'�,leTR SEPTIC TANK CAPACITY LEACHING FACILITY:(type) T (size) � J:"t NO. OF BEDROOMS PRIVATE WELL OR R C W s" R BUILDER OR OWNERS ✓� ca e�h �1-.� DATE PERMIT ISSUED: (� DATE COMPLIANCE ISSUED VARIANCE GRANTED: Yes No 7-1! 57 tv.J� {oCGGi'� Lp U O i i G t -Fss....... ..fl..._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -owcry-.......OFF. 0&.. . -P.---------`..................... . Appliration for Disposal Works Tonstrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair (L)--an Individual Sewage Disposal System at ___...- �J n Vim-�_ ,eft ems, ...... .. 1 ....-• .: —._A....- --_........... ...... ... � .........................._----- -••-------.._..---..._....._...-•-...---•- Location- ddress or Lot No. a - _ ? s °; .---=--------- ...---•----.........1 . .� .k Address - ----- ..............._-...... ...._ Insfaller Address Type of Building Size Lot............................Sq. feet . Dwelling—No. of Bedrooms...�?i...................................Expansion'Attic ( ) Garbage Grinder ( . ) a`4 Other—Type of Building ._..... No. 'of-persons............................ Showers — YP g --•-----•------------ ...- --�---..._ ------ ( ) Cafeteria ( ) dOther fixtures .......•-------- ---------------------------- ------------••-•--.....-----•--------•----............. ........................... W Design Flow........s?r ....................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. ___.___ Depth below inlet.../6........._. Total leaching area__________________sq:ft. Seepage Pit No....... /---------- Diameter../.r�._.: 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......................... Ix •--•-•••••••-•----............................................................................................:....---•-----••-•••-_._••----•----------__•... 0 Description of Soil........................................................................................................................................................................ W , V ..--•--••-•.................................••••-----•--••....-•--••_... .. ----......._..--------•-------••------......--------•--•--••-...--••---•-•............ UW ......••-•-•---............................................................................................................................ •-------....-=-•------...-------------•---•---•--•--_•--•-- Nature of Repairs or Alterations—Answer when applicable....... ---...X.f_e.......... = '-------------------------- --------------------------------------•-. Agreement: d , The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITU 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. ``�� •. to Application Approved BY..... .yY! .. ............ .... ----••• � Date' Application Disapproved for the following reasons:-----------•-----•--•-•--•---------------•--••••••••---•---•---••-•---------••-•-•-••...._......-•-••-----•---•- ............................................................ --------------------------- Date Permit No./ ..................... Issued_..... Date '-:::. -. �"t n S-•... - r......«" +.'... i=.-,� `. �•, },;w 'r- '+,._ jw.;-.,� . ,;r...f � -.aY ,. .......i�.<<'�. . _�.. .e� rn. .l .-r• ..�9�`��>..�L�:::.*...,��:� No......_.........l.� .. T� O FEB............ ......�......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliration for Disposal Works Tonotrnr#inn Errant Application is hereby made for a Permit to Construct ( ) or Repair (t,,,,),an Individual Sewage .Disposal System at: ...... .:?' _-•--/.cvb JCS sue. —..Dn rv-2:..... .. !2w ,-- -- ---•... ................. .ter Location-(Address or Lot No. a ---•---------•....... .................. -F, .......................................................... O"n ? Address : ' ... -....C._ L► oS----------------------------•-----•--------- V Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.--:3�---------------------------------Expansion Attic ( )y Garbage Grinder ( ) Other—Type T e of Building ._..... No. of persons.......:.......... .. Showers — a yP g -------------•-•----• P ------- Showers ( ) Cafeteria ( ) • Other fixtures . ^ ...... Design Flow........5��- ....................gallons per person per day. Total daily flow....... .._. b..................gallons. Septic Tank—Liquid capacity............gallons Length................ Width............. ... Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No......./.......... Diameter..,!i5.-.__..... Depth below inlet....6.�........ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 1.4 Percolation 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........................ R� ----------------------------------------------- -------------------- ................................................................. ODescription of Soil.......................................................=•-•---...---...------.........-------•-------...----------...------..............-----------.........•-•-••..... W ........................................................................................................................................................................... ..._.....-•-•------•-•--•----•------•-----...-•----••-----•------•--- -•-------...••-•-•.................•--•-•-----•---••-••--••-•-•••••••-----•-....--•--•-•-••••-----.........•-•--•._........._. U Nature of Repairs or Alterations—Answer when applicable /�-YJ__ ____. ___. _:�%:._._ !. '"._t, /.�.--. • -- Agreement: ,The undersigned agrees to install,the aforedescribed Individual Sewa&e Disposal System in accordance with the provisions of ITIZ .5 of the State Sanitary Code—'The undersigned further agrees not to place the system in `operation un"tili a Certificate of Coinpliance,has been issued by the board of health: Signed. k_........��f / y / Date r Application Approved By--....n• U _........ ... ti .................. ......................... �--, Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------..--.-- ...................................•......-----------...------------.....-----------------........-------•--•----••---••-•---•--•-••----•-------•--•--•------------•-......-------••---••--••--......•. Permit No....o c - 1�ft .................... Issued---.-...�t� ------•------------------------ ---•-•----•--••---•---•-..Date...... Date -------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......... O ........ - �?:. .�� --<. ............. 01rrtifiratr of Tomplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by. ��, ....__S' : _.........................:......................................................................... Installer at J--:::�-�- ------------ ------ ---_-_---- i� Tic ......................F---._.................................... has been installed in accordance with the provisions of TIT�r. r of//TI . St to Sanitary Code as de-cribed in the application for Disposal Works Construction Permit No..___.__.X-� ._L�_�> _. dated___.___/✓ �.._.....: THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE C'O' STRUED� AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION—SATISFACTORY. Z 5cFACTORY. �II��.� DATE ....... / Ins ector..--•---------- --------------•----._..........------• P ---------- ' .................................... THE COMMONWEALTH OF MASSACHUSETTS BOA-R-D- OF HEALTH No.........:.........z... FEE........................ Disposal Works Tonotrnrtion f rm it Permission is hereby granted_.._ .V`)r. .......... V. 0......5 �f�� `—--------------- ...................................... to Construct ( ) or Repair ( l)_an Individual Sewage Disposal System j at No.-----------_Z_� i�t_� „ __. _ F-'��f ' -= 3 C__KJ.-------- ----------------- Street shown on the application for Disposal Works Construction Permit No.#.46—_ Dated------�'�_-..f`/ � ' fl _ 11uaTd o'f Health DATE / i Y t No....... . ... FEE...'((... THE COMMONWEALTH OF MASSACHUSETTS BOARD O �6EA . ------OF............. ...... ..�'yg67si.d .... ..... ............ . --- . pphratinn -for ilopaiial Norkii Towitrnrttnn Vrrmft ,Application is hereby' made for a Permit to Construct J) or Repair ( } an Individual Sewage Disposal System at: ®sWE � �,e� ---------------------------------------------------------------------------------------•---•---••• ................................................................................------ -------- L tion-Address raj pt No. F- f� .�` s �` �"7_ /�__W�/ ....../........................ltd�-r---•----•------ Owner Address a --v--•-••-----A ." __."�/............................. ........._..................... Installer Address P ®� Q Type of Building Size Lot.. ........................Sq. feet V Dwelling-le'No. of Bedrooms...--- --.-Expansion Attic ( ) Garbage Grinder ( ) a`q Other—Type of Building ---------------------------- No. of persons..--___---._---___.-........ Showers ( ) Cafeteria ( ) a ✓Other fixt e --- --------------- -------------- ------------------------------------- ...-.....----------..........------------ W Design Flow. gallons per person per day. Total daily flow.:.... ....................................gallons. fixtures .._--_ I 9 Septic 1'ank�Ligtud capacrtyJ gallons Length................ Width-----------..... Diameter-----.---------- Depth..__--_------- xDisposal Trench— o- -------------------- Width...._-----._- ._.� tt Le h _--...._-.- Total leaching area-------._--_-.._..sq. ft. Seepage Pit No.... ____________ Diameter.. !°Depth'-be ow in�et........_.. Total leachingarea.. ..__--- _-..sq. ft. z Other Distribution box ( ) Dosin%tank ( ) (f � � IX�Asq Percolation Test Results Performed by--------------------------------------- .................................. Date---------------------------------------- a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.......-...__.--._-. epth to ground water-_._-.-- .--.--------- aa 0 - > -------- ... ... ...................... Description of Soil---------.-O.....i�... .- ✓ -- •-- ._!�............ -------------- ..A -6 W -----••-------._-------- �PT Q�f. ...y"'---z - - b•- j ---_- _ �_ -_ . a._.__--.. VNature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------- --------------I--------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article NI 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 boar of healt . Sig --•--•--- � - .. l`t� Date Application Approved By-----... - ------------•------- -------------- Date Application Disapproved for the following reasons---------------------- ----------------------------------------------------------------------------------------- -- ---------•---•-----------------------------------------------------------------•--------...------------...--_--------- --------------------------------------------....---------------------------------- Date PermitNo......................................................... Issued.. 76-7A----...---------------- Date No...... :-.. . r FEs... ...""...... -r. THE-COMMONWEALTH OF MASSACHUSETTS BOARD 05 HEA .........OF......... ... -�� I ��"" "1 Applira$inn "for Ui_q nitt1 Nforkii Tomitrnrfilln Prrnli# Application'is hereby made for a Permit to Construct ( ') or Repair ( ) an Individual Sewage Disposal System at -• .....................•. ----------- ......-• ••-•-••-• •-----...... •---•-•-•-•••---•-....• .... ... L ti Address I �t Gf1 i� t i�' w ----------- ----------------- --- _ �...........................................................................f vOwn r Address W s - ........................••• . .....• ••••....••--••-••--••••-•-............•••....._....._. ...................••....-•-••••••••-----------•--•-••--•-•...•---•--•••••-•-•-•.............•--- Installer Address ��i� Type of Building Size Lot...............(._.`.......Sq. feet -, Dwelling*"No. of Bedrooms___.__.......................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—Type T e of Building --..__-.____ No. of ersons__-________•_______________ Showers — Cafeteria 0.1 YP g ---------------- P ( ) ( ) a Oer fixtures . d P •-..........................-�- Mons per •-- • • -----------------------------------,...._._....._.__.. ---------------------------------------------- Design"1'Tank " uld ca sac. __.. lo gallons p Lengthperson per day. Total.daily flow__...�OO............................gallons. Flow. ---•--------... Width------------_-- Diameter---------- ----- Depth--................ W Disposal Trench— o. .................... Width.- . _ __ e Total leaching area--------------.__--sq. ft. x - 3ll+SeepagePit No____ _______________ Diameter_: __y__y__� Ir Dept be owt_..._._____ Total leachin area _________ ____sq. ft. z Other Distribution box ( ) Dosin tank ( ) .� � L Percolation Test Results Performed bY---=---------............................................................. Date....•----- :---------- -------- Test Pit No. I..............;.minutes per inch. Depth of "Pest Pit.................... Depth to ground water------------------------ rZ4 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- epth to ground water........................ � t ---------- --- " —----------------••--------------------------------- -- O �r..Q a'Descriptionoo _.... om } W --- '°"" ' -#: `P �• '.,d. 1----- I J.�,1.'`�E- --------------- VNature of Repairs or Alterations—Answer when applicable.-.-_................:....................................................I.-----__.__-____-_--- --------------------------------•_._.--.------------------------------------....................... ------------------------------------------------------------•-----------... Agreement: The undersigned agrees-to install the aforedescribed Individul'. Sewage Disposal System in accordance with the provisions of Article XI 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 th oar of healt . Sig -------- =�� Date Application Approved By-------- - .-- .___ Date Application Disapproved for the following reasons------- --------•••••• •-----------....--------•-----------------....------------------------------.............. ------------------ Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH ............OF......... -............ rdifirtttr of %UVftt' tittnrr THIS IS T TIFF, That the Individual Sewage Disposal System constructed ( Repaired ( ) by..-• ... -- ....................-. ---------- -. •----•' - nstalle +w t a'.- } e ----- -ha Pee i stalled in accordance with the provisions of Article I o The State Sanitary Code as described in' the application for Disposal Works Construction Permit No..._.__� _._..._...._._... dated._../.;2----` �(•----•...-..-. TkiE ISSUANCE OF,THIS CERTIFICATE SHALL NOT BE CONSTRUED AS ARANTEE THAT THE SYSTEM,WILL FU CTION AT SFACTORY. DATE - ✓ ......................•• Inspector -/ ---------------_- 1. .....-•---•---- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH . ... . OF.......... �� ........................................... No......I..m............ FEE...f --....,+�•"' -•----..... BisVagal Workfi Qlunitrnrflon rrrmif Perm' sion is ereby granted_:.......... ----------•-----•-----•------------------------•------------- . ......................... ----•--••••----•-------.....---- to Co tctor epa'r ( ) an Irui' idua S age sposal to at - -----Z-j------L�l-•Q^.'j a0�---- t.....A. .. . ----- --------- - '; Street Ss as shown on the application for Disposal Works Construction t Dated__�____..�___ .... ._..__._.. -- f ------------•----•-----•.... DATE------------ - ��-7-'� � ------- � ,B� w ---- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS } , a \ � i n Y , a r . , � 1 V r a t. �r a a ' Y t , 1001.1 Cl A t r r a z , i , I. , t. µ tt , v , . �* 4 _ 6 , i E w , Y • ) r i F ,