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Home My WebLink About0094 LAKEVIEW DRIVE - Health 94 LAKEVIEW DRIVE Centerville A = 214 - 046 No. C Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in cif PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pplitation for 33isposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade(✓*`Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. L,A440, .V l 6'u--) b 2 Owner's Name,Address,and Tel.No. 4- is 601(l.� IV c� 3 Assessor's Map/Parcel Z Q , .61W, 0a Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when a licable) Date last inspected: v Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boajd of Heal d Date/d Z g Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued ML 4) , r No. � � Fee puter: THE COMMONWEALTH OF MASSACHUSETTS Entered in com Yes 1 PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 4plication for 351spoBal *pstem Construction i3ermit „Application for a Permit to Construct( ), Repair( ) Upgrade(V%00'Abandon( ') []Complete System ❑Individual Components Location Address or Lot No. eq 4 1_�46 V1 `t/J b fZ- Owner's Name,Address,and Tel.No. / Assessor's Map/Parcel �P Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Buildings Dwelling No.of Bedrooms Ljf' Lot Size sq.ft. Garbage Grinder r Other Type of Building No.of Persons Showers( ) Cafeteria( Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when a plicable) /1 e AL Date last inspected: U�` Agreement: �. The undersigned agrees to ensure the construction and maintenance of the-afore.described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until..a Certificate of Compliance has been issued by this Bo d of Health. y/ Signedvw o Datei'�G�/ Application Approved by / / i'/ Date 9 Application Disapproved by "Date, for the following reasons Permit No. �� Date Issued I THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance > THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) F Abandoned(tom by //G��?G►�c'/J /t� _9 F ' - at �9L - _ been - cted in accordance >- with the provisions of Title 5 and the for Disposal System Co cti�i4aP�be " o d ted Installer Designer bedrooms Approved design flowgpd The issuance of this permit shall no)be construed as a guarantee that the system will funotion as designed. Date Inspector,,,.--- . _ . Y -----.------------------------------------------- No. e ' Fee - THE COMMONWEALTH OF MASSACHUSETTS ° PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon System located at e L._/0'le&- f'/�%�??2,c/il_.�•G� ' Y1z if and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/heir duty to comply with t Title 5 and the-following local provisions or special conditions. a Provided:Construction/must be completed within three years of the date of this permit. Date Approved by .� , ------ BOARD OF HEALTH TOWN OF BARNSTABLE zipplicat ion-for IVPU Be5truction permit Application is hereby made for a permit to destruct an Individual Well at: Location — Address Assessors Map and Parcel Owner Address Installer — Driller Address Type of Building Dwelling- - ---- - - --- — -- Other - Type of Building -- No. of Persons--------------------------__--- � � Type of Well-�- ----�� Capacity----------------------_------ ----- -- Agreement: The undersigned agrees to destruct the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation. Signed w-i h Z 14 --- ------- ---------------------- date Application Approved B - --- --- ------------------------------ — _---__ _____ ------ date Application Disapproved for the following reasons:---- --------------------- -- -date Permit No. t _�_ 3 _____—_�___-___ Issued-----�1� ° - / -_- ---: date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Coniphance THIS IS TO CERTIFY, That the Individual Well destructed by--`� �s[J�_ _ Installer at . . �1/� .��/� . .�? . . .� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has been destructed in accordance with the provisions of the Town of Barnstable Board of Health as described in the application for Well Destruction Permit No.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . ... . . . ..... ... . has been destructed in accordance with the the provisions of the Town of Barnstable Board of Health as described in the application for Well Destruction Permit No. . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . ... . ...... .. .... .. DATE-------------------- -------------------- ---- --— - - --- Inspector LIA q; cD - No. --- ------�--- --- Fee--------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Zippiication forlVell Br5truction Permit j Application is hereby made for a permit to destruct an Individual Well at: `�U�-- ----- --------- Location — Address Assessors Map and Parcel ---------------------------------------------------- Owner _ Address ---------- Installer — Driller Address Type of Building Dwelling-- --------------------------------------------------- Other - Type of Building -------------------- No. of Persons-------_---------------___________________ Type of Well _�n YYLf Agreement: The undersigned agrees to destruct the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation. ' Signed N�`- -�'�-`--�lr`-=' �� -------------------------- ��Zi ----- I date Application Approved B --- t — date— — Application Disapproved for the following reasons:- ----------------------------------------------------------------------- -------------------------------------------------------------------------------------------- �� date lJ Zojq - D`Z - Permit No.—_ - - T----- � --- -- --- -- Issued------ - date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well destructed by----��--- �� 1)1�� __-------_____---------------_--------------- Installer at . . ��' .� G.�,�� r,�1. . . �-. . . .0 T. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has been destructed in accordance with the provisions of the Town of Barnstable Board of Health as described in the application for Well Destruction Permit No.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has been destructed in accordance with the the provisions of the Town of Barnstable Board of Health as described in the application for Well Destruction Permit No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DATE--------------------------------------------------------------------------------------- Inspector---------------------------- - -- ---------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Vern Dr0truction Vermit No. - - = - - Fee- = i I Permission is hereby granted- - J�U -- !'> = .• �-k�)�_ �` C='----------- to destruct an Individual Well at No.-- __L _ _________ ___ __ _ __-------_-----------___________ Street as shown on the application for a Well Destruction Permit / No.�'L Z �� ---UT��-' - - - -- - - Dated --L//2-a_�/-Kljt j._- - � � Board of Health DATE------�_ YZ6f ------------------------------------ �� i ` Massachusetts Department of Environmental Protection <- Bureau of Resource Protection Well Completion Reports Well Driller Please specify work performed: Address at well location: Decommissioned Street Number: Street Name: 94 LAKEVIEW DRIVE Please specify well type: Building Lot#: Assessor's Map#: Domestic Assessor's Lot#: ZIP Code: Number Of Wells: 02632 a CityITown: Well Location BARNSTABLE In public right-of-way: GPS r'Yes G No North: West: 41.68159 70.34306 SubdivisiontProperty/Description: Mailing Address: r click here if same as well location addres Property Owner: Street Number: Street Name: BOND 94 LAKEVIEW DRIVE CitytTown: State: Engineering Firm: BARNSTABLE MASSACHUSETTS ZIP Code: 02632 Board of health permit obtained: r'Yes r Not Required Permit Number: Date Issued: W2014 038 11/26/2014 f + I Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program Well Completion Reports(Decommission) i Well Driller - Decommission Form WELL INFORMATION Date Decommissioned 12/1/2014 Depth of Decommissioned Well 28 ADDITIONAL INFORMATION(IF AVAILABLE) Original WCR#for Well ended in formation type Decommissioned Well (;.Overburden C+, Bedrock Was a new well drilled? r Ye WCR#for New Well CASING Casing Type j6alvanizad Pipe Casing Diameter 2 Was casing ripped or - -Was Casing left in place? r'Yes r A perforated? I r Yes t ; No From 0 To 28 Were obstructions left — - in the well? Oyes 0, No If yes,what type? Choose Description-- ........... Surface Seal Type1119 DECOMMISSIONING MATERIAL From To Material 1 Weight Material 2 Weight Water(gal) Batches Method Of Placement 0 28 Bentonite Chips/Pellets -Choose Material--- Gravity WATER LEVEL Date Measured Static Depth BGS (ft) Flowing Rate(gpm) 12/1/2014 14 1 COMMENTS THREE WELLS WERE ABANDONED IN BASEMENT.THE 2"WELL IS DESCRIBED IN THIS REPORT.TWO 1.25"GALVANIZED STEEL WELLS WITH DEPTHS OF 27'/14'AND 17712'WERE ABANDONED USING THE SAME METHOD-FILLING WITH BENTONITE. I Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program Well Completion Reports(Decommission) 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. DESMON THOMAS E Monitoring[M] Supervising Driller III, Driller DESMOND III Registration# 764 Signature THOMAS, DESMOND WELL Firm DRILLING INC. Rig Permit# Date Job Complete 12/1/2014 NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion.