HomeMy WebLinkAbout3775 MAIN ST./RTE 6A(BARN.) - Health tt
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BOARD OF HEALTH
TOWN OF BARNSTABLE
0(pprication-*rVerr Congtructionpermit
Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair (>I�an individual Well at:
Location — Addre Assessors Map and Parcel — —
-- Owner Address _
------------------------------------------------ ----- --�-
Installer — Driller — Address
Type of.Building
Dwelling
Other - Type of Building No. of Persons---- - - ---
Type of Well- z-`�4����. - -- —- - Capacity------------------------ ----- —--
Purpose of Well ---?_`G-------------------------�_
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 nt 1 rtifi pliance has been issued by the Board'of Health.
Signed — =� ---- --— — --- --
date _
Application Approved By
date
Application Disapproved for the following reasons:
------------— --—----------------------__------ - ---—
date
Permit No. — -------- `---— Issued------ --- dais
BOARD OF HEALTH
- TOWN' -.:.OF BARNSTABLE
(Certificate ®f Compliance
THIS IS TO CERTIFY, ThatAhe Individual (Nell'Constructed (S.�Altered ( ), or Repaired ( ) .
- ------------------------------------
Installer -
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at-- -- �' Ay,—J'-A ---— ---- -------------
--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. Wf-LaL Dated- -L
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE Inspector
7�, '
No.-y --- ------n- Fee------ --------------
y" BOARD OF HEALTH
TOWN OF BARNSTABLE
zpptuation•- orlVefi Coft5truct ion Permit
Application is hereby made'for a permit to Construct ( ), Alter ( ), or Repair ( an individual Well at:
------- r �$ Y — ——— — — —
Location — Address Assessors Map and Parcel
--,f%ir�a�L!��' Gr�L`�L-/rg � ----------- ------------------------------------------------------ ----------------------
Owner Address
Installer `Dnller r Address
Type of Building ,
`- .. Other- Type of Building -------------------- - No. of Persons -y"' ----------------------------
Typeof Well--,� G" Q-- ;------------------------------ Capacity----------------------------------------------------------------------------
Purpose of Well----2, t T- !` -----------------------
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 oI/ pliance has been issued by the Board of Health. _
,� � ��
Signed �u - --- -
r , / —date
Application Approved B -- -/-- _
,J date
Application Disapproved for the following reasons:---------------------_---_------------_------
-------------------------------------------------------------------------------------------------------------------
date
Permit No. i____________________
r ------------------------ Issued----------------------=--------------
-�)--�-.�--�------=.�
----------------------------------------
date ,
.` BOARD OF HEALTH
TOWN OF BARNSTABLE
Certifitate Of Compliance
THIS IS TO CERTIFY, Tha�t,�h-e�Individual Well Constructed (,.,.)!"Altered ( ), or Repaired ( )
bY- i-, — --�� '_-- .= ----------------------------------------------------=----------------------------------------------------
�- ��.;T c. Installer
at -`' �/ � — -��s � � -------- ,� �__ �,J------------ -- :------------------------------------------------------
has been installed in taccordance 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. 1 r=-?- -----Dated--- �?�-� -!--
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE---------------------------------------------------------------------------------------- Inspector------------;-------------------------------------------------------------------
BOARD-OFF HEALTH
TOWN OF BARNSTABLE
Veli ton5tructionPermit
� aD
W-J�=Sj---
No. Fee --
Permission is hereby granted — -4--- -----ct dL
A -
to Construct ( ), Alter ( ), or Repair ( ) an Individual Well at:
No. ---------,� 7 �� -r ,1 -C�^ na�_t,_tJ
------------------------------------------------------------------
Street
as shown on the application for a Well Construction Permit
No.- - �-";- -=- T ---------------------------------------- Dated '- 2r 7 - -- -
- ,i
) Board of Health
"I!_ / ------------------------------------ --
DATE-----`---�------ -- ---
r
TOWN OF BARNSTABLE
LOCATION 37,;�5 S17 SEWAGE #
VILLAGE AS ESSOR'S MAP & LOT35-5 "Z_ _3
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type);,!�/ JX�/?Sr� (size) ! 1xIC-49 .
NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER A c,
BUILDER OR OWNER M g°' t s'f_0747e_
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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ENVIROTECH LABORATORIES ==
Mass. Cert.#:MA063
x 449 Route 130 Sandwich,MA 02563 • (508) 888-6460 =
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CLIENT: Kim Bassett LOCATION: . 3775 Rte 6A _
ADDRESS: BOX 75 _ Barnstable,MA
Cummanuid,MA 02637 =x
COLLECTED BY: F. L fford SAMPLE DATE: 5/29/91 TIME: 2 PM
DATE RECEIVED: 5/29/91 SAMPLE ID: ET 632
JOB #: WELL DEPTH:
30 ft
RESULTS OF ANALYSIS: -_
r
Parameter Units Recommended limit Result
Coliform bacteria/100 ml (MF Method) 0 0
fi. pH pH units 6.0 8.5 5.58 A
e Conductance umhos/cm 500 172
zr Sodium mg/L 20.0
12.2
Nitrate-N mg/L 10.0
4.40
z_ Iron mg/L ` 0.3 <0.05
z' Manganese mg/L 0.05
c
Hardness mg/L as CaCO 500
EE 3
A
x Sulfate mg/L 250
Potassium mg/L 20.0 =
«. Alkalinity mg/L 200
BE
BE Chloride mg/L. 250
Turbidity NTU 5.0
Color APC units 15.0 -
z
Background bacteria,
COMMENT: _
I �
Volatile organic compounds UG/L see attached report NONE DETECTED
Ir
_ (EPA Method 601/602)
° YES NO WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETE TESTED.
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c qX :x
c DATE
f iUililliilllltltilU11111U1i11U1111h1h;liitUlltiltUhilllttiillllUUU111itUl1111111 law i ►slui ii 1111i11111 iiliilliilli;iiiull i1 t iliiitiiiiiil;1111i11114iiiltlliIsala iti111i1ililtiiiiilUi11111t11111illiii1111111q,
r 6— 6-9' _ -.22 :CR0UD!DWA^2R A:iA' Y T'—A.L 508 ?59 4 -7.5 2/ _
GROUNDWATER
ANALYTICAL EPA METHODS 601 and 602
Volatile Organics (GC/PID/ELCD)
Field ID: ET-632 Lab ID: 1410-01
Project: Bassett/3775 Rt 6A QC Batch: VGA-783
Client: Envirotech Sampled: 05-29-91
Cont/Prsv: 40ml VOA Vial/NaHSO4 Cool Received: 05-30-91
Matrix: Aqueous Analyzed: 06-04-91
PARAMETER CONCENTRATION REPORTING LIMIT
(ug/L) (ug/L)
Dichlorodifluoromethane BRL 5
Chloromethane BRL i
Vinyl Chloride BRL
Bromomethane BRL 1
Chloroethane BRL
Trichlorofluoromethane BRL 1
1, 1-Dichloroethene BRL I
Methylene Chloride BRL 1
trans-1,2-Dichloroethene BRL 1
1,1-Dichloroethane BRL I
cis-1,2-Dichloroethene * BRL i
Chloroform BRL
1,1,1-Trichloroethane BRL 1
Carbon Tetrachloride BRL i
Benzene BRL
1,2-Dichloroethane BRL 1
Trichloroethene 1
1,2-Dichloropropane BRL 1
Bromodichloromethane BRL 1
2-Chloroethylvinyl Ether BRL 1 {`
trans-1,3-Dichloropropene BRL I
Toluene BRL I
cis-1,3-Dichloropropene BRL 1
1,1,2-Trichloroethane BRL I g
Tetrachloroethene BRL 1
Dibromochloromethane BRL 1
Chlorobenzene BRL
Ethylbenzene BRL 1
m+pp-Xylene * BRL_ 1
o-Xylene * BRL
Bromoform BRL i
1,1,2,2-Tetrachloroethane _ BRL 1
1,3-Dichlorobenzene BRL
1,4-Dichlorobenzene BRL 1
1,2-Dichlorobenzene BRL 1
QC SURROGATE COMPOUND, SPIKED MEASURED RECOVERY QC LIMiTS -�
Bromochloromethane 30 31 103 % 87 - 113 %
Fluorobenzene 30 30
BRL m Below Reporting Limit. * Non-target compound. "Trace" indicates probable presence below listed
Reporting Limit. Method References: Method 601 - Purgeable Halocarbons and Method 602 - Purge able
Aromatics, 40 C.F.R. 136, Appendix A (1986).
No.- - - FEs............._............._
' THE COMMONWEALTH OF MASSACHUSETTS -
BOARD OF HEALTH
TOWN OF BARNSTABLE
Applira#ion for Diipnaal Works Tnnitrnrtinn ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal .
System at:
.............. 27._-�......�t ------d.14-•-----------------•---•----•----- ............-•-- Lot c�
/ ) Location-�d/res p (_or Lot No.
...............••-••-•-•.Addres
Installer Address /�
Type of Building Size Lot__ _____/YJv._Sq. feet
U Dwelling—No. of Bedrooms.............. ---------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers (� ) — Cafeteria ( )
Q' Other fixture _
-
W Design Flow.................. ..... _ allons per person r day. Total daily flow_-__-__...__._______. _
WSeptic Tank—Liquid capacity..f� allons Length___....... Width................ Diameter---------------- Depth................
xDisposal Trench-.,)-No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
�. Seepage Pit No. -. ._ ._ D' _ __ pth below inlet.................... Total leaching area..................sq. ft.
z Other Distribution b� i n ( )
aPercolation Test Results Performed by--------------------*..................................................... Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water.....................__-
fi, Test Pit No. 2................minutes per inch Depth of Test Pit---:................ Depth to ground water........................
------------ ---•- .............
.---
----------------
•----------------------------------------
0 Description of Soil.............
x
W ------•----•-----------------•---••-•--------•----------------•-•••. ......--••--•-•---. -•••-----------•--------.......-•-----•-----••------•---••••----••••-----•--•--.......---------------•----
UNature of Repairs or Alterations—A wer when plicable-----------------------------------------------
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 as been issued by t board of health.
Signed .. �- -----------� ------ .-- --. �.t fe
ApplicationApproved By - ---- -------- - pp --- --- --------------------------------------------..-........------------------. ------------...........................
Date
Application Disapproved for the following reasons: ---------------------..........-.................------------------------------------------------------------------------------------
---------------
s
Permit No. 1-1-------- -------------- Issued 1-----------Date
-
e
_ - - '
"M4��r —5--4 THE COMMONWEALTH OF MASSACHUSETTS -
F
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Diinoiial Works Tomitrnrtion Prrmtit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: _
......... `? ... .............t ..._. .�.-••-•------•-•••--•-•-•-------•-- --........-•----•-•••-.....-•-----•-.....L-°..--# ------------•--..........------.
Location-A dyes or Lot No.
•-------------•� !1.7. o ....� . c 7 f" 31�-5-......! ... p....................................... I I :... �
------------------------ ---•..---
W 8�!1N V Address
Installer Address /�
d Type of Building -.. ..Size Lot _____,t �!..Sq. feet
U Dwelling—No. of Bedrooms...............j.•-•---------__..._-_--_-Expansion Attic ( ) Garbage Grinder ( )
aa Other—Type of Building ............... No. of ersons..........___.._..__._______ Showers
yP g ------------- P (/) — Cafeteria ( )
Otherfixture -------------------------------------------------------------------------------------- j T
W Design Flow...................3 ..._.._ _ allons per person r day. Total daily flow................. v�__�J..gallons.
W Septic Tank—Liquid capacity..�Q al
Length___....... Width................ Diameter--._-__..._____- Depth................
x Disposal Trench�' No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.US- ._ _. Dim� ��Jam.L _ pth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box1P '' "�osiftg�( )
aPercolation Test Results Performed by.......................................................................... Date.........................................
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water-._-_---_____-__.-.__--. ;
(i, Test Pit No. 2.................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 ............................................................. .------..._••••--••-•••••-•----.............................................................
0 Description of Soil------..... -- ............. -- --•-• --•------ -•.-•... ----- ---. --- -- ---------------•-......-=-------------------•-----•----------
U •-------------------•-- •- - -- •• . --• -•-•- •--
W
UNature of Repairs or Alterations—A wer when plicable._-----------------".---_..---___-.--__----.---_----_-__----_-____-___...........................
............................................................
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 as been issued by t board of health.
Signed ......... .. �---- -----------�
Application Approved By ...... .... .. ... . .. ......... . .L '---........--------------
.............................................. ........................................
Date
Application Disapproved for the following reasons: ...
......
............
................................_..........................
-----........1..-------....---------- .-------
--------------------------------------- ---------- ---.....- ------------------------------------------------ .-- - ------------------
� Dare
Permit No. ' Issued .............. -
te
l
t
1
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Ger#ifiratr of Compliana
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( }O or Repaired
by................. - - -- -------------------------------------------------------------- ----------- ----------------------------------------------- ............./` a
/�J✓/ ' /'�^/s 7�7'
tallat -L'..< ...... ! :7...... .- .... �eC y...�........! � � ..............has been installed in accordance wthe provisions of TITLE,5 o Th tatur E v'ronmental Code as described in
the application for Disposal Works Construction Permit No. - .Q - - dated -.......-.'......................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISF TORY.
DATE.. a! �G� / Inspector ...--:..-=--.-------------------------------
THE COMMONWEALTH OF MASSACHUSETTS t
BOARD OF HEALTH
-�` TOWN OF BARNSTABLE
No. ---•-•---•-----..... FEE... ------
Disposal Vorkg Tonstr Torn rrmtit
Permissio is hereby granted...............------------------------------------------•-----------------.........------••----------......----------..................••--
to Constr or aJ i ' Sewa e osal ys ) j�
at No...... ... ... ......... ''ff''�� / /,� •.
� L'' - m
Street .�+
as shown on the application for Disposal Works Construction Permit No.._. _._._._. ated.... __ _ .��.... ......
�9
. ..............................................._......._....-_............................................
Board of Health
DATE----------------•----------------------•--....-----._.........-•-•••-•••-••••--
FORM 36508 HOBBS 6 WARREN,INC..PUBLISHERS '
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