HomeMy WebLinkAbout0242 COMMERCE ROAD - Health 242 C&hii nerce Road
318 025 001
A ,n
c Barnstable
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"- - Date: C�
TO IC AND HAZARDOUS ATERIALS REGI TRATION FORM
NAMEOFBUSINESS: r %/� .�' 1y GxAz�'
BUSINESS LOCATION:
MAILINGADDRESS: Mail To:
..��c� � .����� a Board of Health
TELEPHONE NUMBER:
Town of Barnstable
CONTACT PERSON: P.O. Box 534
EMERGENCY CONTACT TELEPHONE MBER: Hyannis, MA 02601
TYPEOFBUSINESS:
Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own
use? YES NO
This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed
envelope for your convenience.
If you answered YES above, please indicate if the materials are stored at a site other than your mailing
address:
ADDRESS:
TELEPHONE:
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health has determined that the following products exhibit toxic or hazardous character-
istics and must be registered regardless of volume. Please estimate the quantity beside the product that
you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS.
Quantity Quantity
Antifreeze(for gasoline or coolant systems) Drain cleaners
NEW USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road Salt (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor oils Pesticides
NEW USED (insecticides, herbicides, rodenticides)
Gasoline, Jet Fuel Photochemicals (Fixers)
Diesel fuel, kerosene, #2 heating oil NEW USED
Other petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil . NEW USED
Degreasers for engines and metal Printing ink
Degreasers for driveways & garages Wood preservatives (creosote)
Battery acid (electrolyte) Swimming pool chlorine
Rustproofers Lye or caustic soda
Car wash detergents Jewelry cleaners
Car waxes and polishes Leather dyes
Asphalt & roofing tar Fertilizers
Paints, varnishes, stains, dyes PCB's
Lacquer thinners Other chlorinated hydrocarbons,
NEW USED (inc. carbon tetrachloride)
Paint & varnish removers, deglossers
Any other products with "poison" labels
Paint brush cleaners (including chloroform, formaldehyde,
Floor& furniture strippers hydrochloric acid, other acids)
Metal polishes
Laundry soil & stain removers - Other products not listed which you feel
(including bleach) may be toxic or hazardous (please list):
Spot removers & cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
WHITE COPY-HEALTH DEPARTMENT/C RY COPY- INESS
Massachusetts Department of Environmental Management q 1 4
Office of Water Resources 15
TYPE OR PRINT ONLY Well Completion Report
1. WELL LOCATION e GPS(OPTIONAL) ITUD .'LONGITUDE
Address at Well Location. W/ u. Property Owner. 7 1 M
Subdivision Name: Mailing Address: O l
City/Town: �rQ�2A(J7",q B City/Town: j6,CIe-A(ST.4&-,9—
Assessors Map Assessors Lot#: NOTE: Assessors Map and Lot# mandatory if no veet,address available
Board of Health permit obtained: Yes/'KP Not Required ❑ Permit Numbe Date>Iss ed�
D �� . �
2. WORK PERFORMED 3. PROPOSED;USE. - 4. DRILLING METHQI) w
ew Well ❑ .Abandon ❑ Domestic rigation ❑. Cable Auger
❑ Deepen ❑ Recondition ❑ Monitoring ❑ Municipal ❑ Air Ham erg ❑ Direct Push
❑ 'Replace ❑ Other ❑ Industrial ❑ Other ❑ -Mud'Rota� Other
5. WELL LOG - sa! 0= Unconsolidated Consolidated 6.SITE SKETCH use 4`
W Permeability
permanent"inarks with distances
Q > a
From (ft) To(ft) Hign t ow `3 m 9ther Rock Type
40
a�' Via ' -� :� i p� ����, •
-- .
7.WELL CONSTRUCTION,- 8. CASING'
7otal-Depth Drilled--. ( From (ft) To (ft)- Casing Type and Material Size O.D. (in) Well Seal.:Type_.
Date Dr* "ng.C plete ���. to jC� le
9, SCREEN
f_. . i
�� „
,.
From (ft) To (ft) Slot_Size Screen-Type
and Material Screen Diameter
e
7-77-7
10. FILTER PACK/GROUT/ABANDONMENT MATERIAL 11. ADDITIONAL WELL INFORMATION
Developed? kPYes ❑ No
From (ft) To(ft) Material Description Purpose Fracture
Enhancement? E Yes No
�. Method
-: Disinfected? ❑ Yes o
12.WELL TEST DATA={#PRODUCTION WELL S)w fr �� =. 13. STATIC WATER UEL(ALL-WELLS)
Yield '\Timee Pumped Drawdown to Time Recovery to Depth Below
Date Method (GPM) (hrs_&min) (Ft. BGS) (hrs& min) (Ft. BGS) Date Measured Ground Surface (FT)
14.PERMANENT PUMP JIF AVAILABLE] 15.NAMFJADDRESS OF PtJIA`tNSTALLATION COMPANY
Pump Description 1. Horsepower 5 IL/J (! %Z � - 2i,GLi /
Pump Intake Depth 4 ' '(ft) Nominal Pump Capacity (gpm) IRK /y/,p ayz j.
16. COMMENTS ;, a`<
17. WELL DRILLER'S STATEMENT IThis well was drilled and/or ab Boned under my supervision, according to applicable rules
and regulations, and this repo is complete a nd correct to the best of my knowledge.
Driller: C� f � eupervising Driller Signature: / f .dear.rl Registration
Firm: i*� ��2� / �°. Date: -�6 �' Rig Permit#:
NOTE Well Completion Reports must be fiYed by the registered well driller within 30 days of well completion
BOARD OVHEALT1i'-COPY'
t.Ss l•x+E dt r. c{.:{SQ we rod$rq ,AY' �klar y F s 4rL"X,Knt-`,Y M 'd ! f}#- .yrk a'jix5� 4`s♦ tkK t'4. 4;
_ > 1 ♦vt. "sn 1U5 ; 4 a i[ 4' Si S� i@ i4. � F i.i.t S�i:S t £.yl
ENVIROTECHLABORATORIES,INC
MA CERT.NO.:M-MA 063 '
449 Rte. 130
Sandwich, MA 02563 AUG 2 3 2002
508(888-6460) 1-800 339-6460 .
FAX(508)888-6446 TOwN OF ggRNSTgg
FAITH paPT. �E
CLIENT. Tim Friney LOCATION: 241 Commerce Rd.
ADDRESS: 241 Commerce Rd. Barnstable, MA 02630
Barnstable, MA 02630
COLLECTED BY. Desmond Wells_ SA
MPLE DATE: 8/13/2002
SAMPLE TIME: 3:30PM
WATER SAMPLE TYPE. New Well/Irrigation DATE RECEIVED: 8/14/2002
LAB I.D. #: 0208368
I
WELL SPECS.: 4"/50718'
RESULTS OF ANALYSIS:
Parameters Units Recommended Results Method Date Analyzed
Limits
H units _ l
H i s 6.5 8. +5 7.17 4500 H
P P 8/14/2002
Conductance umhos/cm 500 129 120.1 8/14/2002
Nitrate-N mg/L 10.0 < d.01 300.0 8/14/2002
Nitrite-N mg/L 1.00 < 0.004 300.0 8/14/2002
Sodium mg/L 1000.0 7.8 200.7 8/14/2002
Iron mg/L 0.3 0.2 200.7 8/14/2002
Manganese mg/L 0.05 0.119 200.7 8/14/2002
COMMENTS: Manganese is not a health hazard, but may cause staining on
walkways and buildings.
WATER IS SUITABLE FOR IRRIGATION PURPOSES FOR PARAMETERS TESTED.
<=less than � �C(. [�-�. ` Date
>=greater than R ald J.Saa d
TNTC=too numerous to count La oratory r ctor
No.----------------- Fee
BOARD OF HEALTH
TOWN OF BARNSTABLE
ApplicationfforlVell Cougtructionpermit
Application is hereby made for a it to Construct (✓j; Alter ( ), or Repair ( )an individual Well at:
eation — Address Assessors Map and Parcel
O Address _ —
PC
Installer — Driller Address
Type of Building
Dwelling ----_--___ _—__-_—
Other - Type of Building---__- --__-_ No. of Persons----A-
Type of Wel G��(°4Z Tu'P��T/� '"-4A-'Capacity— °=22� ✓��O
Purpose of e���
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 f C pliance has been issued by the Board of Health.
Signe .'/ 6 2 —
�— d to
Application Approved By —--t �daatt o
e
Application Disapproved for the following reasons: ------------- _____—__—__— —_
date --
Permit No. 1 — Issued =-- - --
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
(Certificate ®f Compliance
THIS S�TO CERTIFY, That the Individual Well Constructed (--I, Altered ( ), or Repaired ( )
by--- --- 4166--- ---- ---------5--------------- -----__-- ----- '
staler
at (/.�(/�Sri-FYI AiL2� Cc.y1t�� �----_ —_—_------
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Prlo,tpction
Regulation as described in the application for Well Construction Permit No Dated— t
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE--- Inspector----------_—_ _ —,__
6
lszcx�2-Ys 1 ��
No.—------------ Fee
BOARD OF HEALTH
TOWN OF BARNSTABLE
Applitat ion-for V ell Contrutt ion Permit
Application is hereby made for a permit to Construct (✓�Alter ( ), or Repair ( )an individual Well at:
LL tion — Address Assessors Map and Parcel
O of Address —
_��__ESrrlar,a y( E � �` a- a��-3__ DI� I�is
Installer — Driller Address
Type of Building
Dwelling ------------ h ,
Other - Type of Building.-.�; ----- No. of Persons----'- _------_-__
Type of W
YP re-11
eel ea C Tu; -.Z-le'e "� PY�Ca acit Pup o
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.
Signed / _�•;�rY7�
l d to
Application Approved By .` ----�--
- date
N,
Application Disapproved-for the following reasons: ---------- __— -_
date -----
Permit No. l� _- Issued ------ - �
-� i `S 'dare ---—
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate Of Compliance
THIS j TO CERTIFY, That the Individual Well Constructed ( Altered ( ), or Repaired ( )
by—_�EoS/7L4 r7�- �E'GC.. �/�iG C�N- ----���--------------�----------------------
1 -- —-- In taller /
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Pr tgction
�,LCo -- 51 ��i 1
Regulation as described in the application for Well Construction Permit No. Dated---- 0Z
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE---- - Inspector----------- - --
BOARD OF HEALTH
TOWN OF BARNSTABLE
VrIl Contruct ion Permit
No. -__ w___-_ Fee
Permission is hereby'granted 5-2� M z7 17.6 14 04 P 6 e
-�-�i�-----
to Construct (t-)Alter ( ), or Repair ( ) an Individual Well at:
No. ---,Z t.D/77 Gc .4_-7t�o. tiov! � - - -- --------
street
as shown on the application for a.Well Construction Permit
oo
No.- _ D,ted - ,-
c �--
-- --- -- ��� ---------.----_------
Board of Health
DATE
d•
No. ���
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
-/1 PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,, MASSACHUSETTS
ZIpprication for Migoml *pgtem Congtructcon Permit
Application for a Permit to Construct( Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Addres Lot No..ry f- ' Ow Ais Name,Address and Tel.No.J, -,// 7—,joovsl¢-
Assessor's Map/Parcel J?1g §S_�
Installer's Name,Address,and Tel.No. .3 bS-62-3-7 Designer's Namg,-Addre s and.T, 1.No#
Type of Building: /f c,iLu
Dwelling No.of Bedrooms Lot Size �° q.ft. Garbage Grinder(A/56'
Other Type of Building a No.of Persons Showers( ) Cafeteria( )
Other Fixtures 2 �y
Design Flow gallons per day.,Calculated daily flow 3 7 �� gallons.
Plan Date ��`
Title Number of sheets .l /���s'� Revision Date
.... »
Size of Septic Tank Type of S.A.S.
Description of Soil 15�� ?'� P
Nature of Repairs or Alterations(Answer when applicable) C!5
Date last inspected:
Agreement:
The undersigned agrees to ensure con ction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of ' le 5 the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been' is Board of H alth.
Signe - 01
Date -16
Application Approved by C/ Date
Application Disapproved for the following reas s
— W�
Permit No. Date IssuedZKY
...»--'+i,�tsi{,:,,;eq,',r,�3;se',,r..s^•-9."^.-.. !+�.; �!:,.- .r'�. '4-+ ".�:.:,�,.J-. �r�r...,,,. �+�-*�..�•.r -
150
N. do Fee
e THE COMMONWEALTH OF MASSACHUSETTS m� Entered in computer:
Yes
PUBLIC'HEALTH O DIVISION -TWN OF BARNSTABLE, MASSACHUSETTS
x ='
Zipprication for ]Di-qpogar *pztem 6on5truction Verntit
Application for a Permit to Construct(, Repair( )Upgrade( )Abandon( ) O Complete System O Individual Components
Location Address Lot ory, �o f-/�,re- Ow�eis Name,Address and Te.No.
r r I ( K(�� BA C'/I Tea--e,it.ei✓e � � G' t /L"S
Assessor's Map/Parcel `
6Z-62- 6 6�
Installer's Name,Address,and Tel.No. �3 7 Designer' N .Address and T 1.No. �
Otis - es�� ! 1/ � 3
�GGi S tJ tZv S . l
Type of Building: , g�2 , At(Lu
Dwelling No.of Bedrooms Lot,Size sq:ft. Garbage Grinder(MD .
Other Type of Building No.of Persons AR" "- ti. Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons perday. Calculated daily flow f ' gallons.
Plan Date _�-"" Number of sheets ���f¢- Revision Date '
Title
r� Size of Septic Tank �.5—�'`' S� � ;�Type �S.A.S. e /La :
3kV S-
Description of Soil ` --�- Ca 6
Nature of Repairs or Altgatio (Answer when applicable) - A
Date last inspected:
Agreement:
The undersigned agrees to ensure con ction and maintenance of the afore described on-site sewage disposal system
411
in accordance with the provisions of e 5 the Environmental Code and not to place the system in operation until a Cetifi-
cate of Compliance has been' u is Board of Health. '
-4
Signe -` ' Date
Applicatton Approved by 4 Date ,
Application Disapprovedor the following reas s
t
Permit No. Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of (Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired(Vupgraded( )
Abandoned( )by
.at elS Cot-nlerCq KC1 QA,ro t en constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
Installer 1;j S 6 r"o);ke y S sty o�0, Designer S r P r, 1 / i A
The issuance of this permit shall not be construed as a guarantee that the system 11 u ctio as de it
Date /2 iq Inspector - t, t,
.k.
——————
No.�f ----------------- -- Fee 0
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
XDisspogal 6potem Construction 3permit
Permission is hereby granted to Cons%t_( )Repair( )Upgrade( ,�)-�A-baandon( } �.�1"
System located at �. [ e—I--"�- f!�V 6 A,Af-/T �
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:Construction` ust be Completed within three years of the date of
Date: / Approved byT_
LI G'
t
t;i.
- - - _-----
�1
TOWN OF BARNSTABLE
LOCATION COMMERCE ROAD BARNSTABLE SEWAGE # 99-28
VILLAGE BARNSTABLE ASSESSOR'S MAP & LOT-3 1 'S/%5- 1
INSTALLER'S NAME&PHONE NO I ; ? r n n n T € 5 C 8 N S T 99 . 9 6 623
3
SEPTIC TANK CAPACITY 15 C C
LEACHING FACILITY: (type) (size)
NO.OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
g
rN -o
Vk
TOP OF FOUNDATION
CONCRE c. COVERS
CAST IRON 9'r .,/ :4 '-lr
OR SCHEDULE 40 4"SCHEDULE 40 P.V.C. (ONLY) LEACHING TRENCH (/)RED.
9"MIN.P.V.C- PIPE MIN. plpE-PAIN 1/8"- 1/2" WASHED STONE 36"MAX.
ii ?ITCH I/4 PER.FT PITCH 1/4-PER.
• 2,.
.'. INVERT GAS BAFFLE--*. 4,'O 'p �.,
EL/4,.0- / INVERT ONE INVErZT yca,;em _it,C1''C7, !��L7'C7; �_ 24"
i —J I SEPTIC TANK / ys- sC, -o,,�,o;d;; ,
`'�I /57/nl� .• INVERT /Soo GAL. INVERT - 47 /1,za
EL/T7.So DIST, INVERT ,.
-L. Precast 500 Gal.Leach 3/4"-I V2"-1
1(/Dy-� cFssPooG. BOX (L) REO. ChOMber WASHED STONE
r-x;<-�,,;� , • 6.'CRUSHEO STONE __...... oVE.0
C'ES3/PODL 7b BE i;• r 45 �- I H_ /7 J SB
zs
<.c_tEr z./. - PROFILE 0 F ��o.,_ �co •,-- eE�,
r GROUND WATER TABLE
BARMSTA�E �TI„L, SOIL LOG SEWAGE DISPOSAL SYSTEM TYPICAL CROSS SECTION
'A-_ y,/�/f-, ,o.00,q,y NO SCALE LEACHING TRENCH
TIME . . . . NO Sr_^,_E
7EST COL_ I TEST HOLE 2 A;PAI.�4-nu 4AIS
\ \ LE . . .. ?. DESIGN DATA '
Ev !ZZ
v\\\\\\\ .E!*' \� .�Or •I. ' °ECROCnts . . . . . . . . . . 1 9 ';A;N• WA-SHED 36"MAX.
- �\-� / TOTAL ESTIMATED FLOW .. ... ... . ... GALLON S/DAY 8"
_!.e•3a'»'� �a�3 _----•r fir,``__ \ O T //' _
B'/S,To BOTTOM LEACHING AREA .: C7SSO.rT./irt-cNCi�237 x =1 aN
o�D 1 - r /S _ _ 6:P,D. �a"
JONN ( � flr , • •--' ._. d,,L" L AZ.� i SIDE LEACHING AREA ..�3� �0.;I./TRENCH///. .
\\ \ ,,, \ �••t N„ �- , l;�j>�/A�/ y 98 ,_ice. D;-t�-:•.
\\
�C-*Ief 6.5 � d� ��'��/.� I EZ./do3 f I GARBAGE DISPOSAL AREA INCREASE)
41(
TOTAL LEACHING AREA - 7zr. .7. SORT. L'$
1 e oVA7�
t,, \ RCOLATION RATE /PER.INCH
°.` ` pE �e.4S� /Ari l MM/ J'..S�8
�! c (�6 ,A+v L _
RFnfRlc a .\ / -, c PER pc n—
waRo S ,,�� ``�f \ \ \ , \ . ��\�•yrr S.f / /n `/R 7 LEACHING AREA R �COL..�10.1 RAT ,L
nROSSM TN 'N4b - '\� \'N• \ \\ ' ',\\\\�\ \\ I / 111
\ (�'� j GROUvD WATER :3 APPROVED .. . . . . . . . . . . .. 30a=D Or HEAL-,;i L_
AS
wwsuR e
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