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HomeMy WebLinkAbout0654 STRAWBERRY HILL ROAD - Health 654 Strawberry Dill Rd -< Centerville A=249 - 087 No. 4210 1/3 ORA Pendaflexo 1 00/0%V '4 No. `-�---�=-�� Fee------Jf-`=!!:�----- BOARD OF HEALTH TOWN OF BARNSTABLE 2pp[icat ion-for Well Co0truct ion Permit Application is hereby made for a permit to Construct (✓), Alter ( ), or Repair�y( )an individual Well at: p Locati — Address Assessor s Map and Parcel „ _l.?f_''�— — I Owner J Address ----- ----------- - Installer — Driller Address Type of Building f Dwelling _---------_--Other -- Type of Building-=---__--____ No. of Persons--- Type of Well L4a1 SG Purpose of We11.1 - —_--_----_ 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 CertificateQQ.of Compliance has been issued by the Board of Health. 10 - Si a y " _^__'`_------ 0 Z311Z — - date 1 Application Approved date Application Disapproved for the following reasons: -__—________—___—.__—__—__— c� date Permit No.- Issued-----------------_--�------------____-- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, ,n,That the Indi1vidual1 Well Constructed (�), Altered ( ), or Repaired ( ) by Y�n04\� tU.- 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 Permit No.tam)2�'0 3----=--------- ated J015940 � THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE --- - Inspector---- -- - -- -____�—_�---- - No. © 3 Fee—---- L_S=�------ BOARD OF HEALTH TOWN OF BARNSTABLE Zipplicat ion ArWell Congtrurtionjoermit, Application is hereby made for a permit to Construct (�✓), Alter ( ), or Repair ( )an individual Well at: y_ScQw1� �c� C Ic —__ Location — Address Assessors Map and Parcel �1S��_aw�����Al A n i,0 Owner -- Address �— Z�S�------ Installer — Driller J Address Type of Building Dwelling ------ - -- __ _-- - Other - Type of Building- ---_________ No. of Persons--- __----------_—__—_—______ Type of Welly�tv� 1O'..�� Capacity—" y-- _---------- Purpose of Well- --—---- ---- �TY�_'___—___--_. 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 r �� t„ _--__- (0 7-311Z -- — ' date _ L Application Approved — -__---_----_—__-- /U �_- date Application Disapproved for the following reasons: V e J 'U�5 ! L date Permit No. -- Issued--_/- / - date BOARD OF HEALTH t TOWN OF BARNSTABLE C ertif irate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed (✓), Altered ( ), or Repaired ( ) by(C�Q Sys'ew4 ---- J Installer at— Ct75(t has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protec ion Regulation as described in the application for Well Construction Permit No.l -Dated 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 Well Congtructioni9ermit No. Fee- --�-�-,- Permission is hereby granted a— -tiyy"�n A Ll Vj-���`��-�L-------------- - to Construct ( / Alter ( ), or Repair ( ) an Individual Well at: No. 5(( 4 �c .11^e `.� , C'_.u,�. c r v h--- -- ----------------------------------------- street as shown on the application.for a Well Construction Permit No.-____._ --Dated---_—_.-----..—__-----------------_--------------------- -— - --_ _ -- --- ------------------ DAT E �� G1 /� 2 Board of Health ---.�—!__-4'—�" ---_ 81-21'7 L0CAT,f-1N SEWAGE PERMIT NO. -- VILLAGE Centerville, MA 02632 INSTALLER'S NAME i ADDRESS A BG B CPSRj�oo] spryl c A —, 128 Bishops Terrace, Hyannis, MA 02601 0 U I L 0 E R OR OWNER Stephen Russell 654 Strawberry Hid�Rd•, i-nt pryi l l P,. MA 02652 DATE PERMIT ISSUED 5/ 1/81 _ DAT E COMPLI_ANCE ISSUED IN L+�SSPmI_ O 6 og FEE...$.... ..00......... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH p � 0� .........................T.e.Wn......OF.....Baimstahle...............-------•---....----------................. � l� Applira#iou for Di:'qpnial Workfi Tomuurtiou Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at: 654 Strawberr Hil1..Rd:., -Centerville._ A ..02632...................•-•-----......----•-•-- .............................. ........................ Location-Address or Lot No. Stephen G. Russell .. 6 •• ..,_..0entstille.,...f)2632 ....... Owner Address a ..._A__&__.. Cesspool Service........................................ 128-B----- _Terr.c__..... . _e, Yzlrxa,�.,. Q26.Ql Installer Address d Type of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms....................3.._..._..._...___.___Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons-------- ................. Showers ( ) — Cafeteria ( ) Otherfixtures ..................................•------...----------................................................................................................ 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........................................ ►4 Test Pit No. I................minutes per inch Depth of Test Pit-_______------_.-_-- Depth to ground water-.--_.--_____-__--___.-. f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water................... 9 •--••-•---••-----------------•••••-••-•••••---••-••----------•--•-•••--•----••-•._........----••--•-......................................................... ODescription of Soil........................5.alld...................................................................................................................................... x W UNature of Repairs or Alterations—Answer when applicable----------.inata.11a-ti_oii_.of...a'_].,..00---gall-0n-,_..Pre-cast, stone packed leach pit (overflow Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TT LEE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has Ven ' sued b_rthe bo health.- Signe ....................•••.•. .... ....... .....5----1 .81...---•-•-- / Date Application Approved BY /� ... =6 •-----•----------------------- ----- 5� 1�81 Date Application Disapproved for the following reasons-------------------------- -----------------------------------------------------------------------------------••. -••-•---•••-••-•-•--....-••••-••••-•-•-----••••••-••------•--•-••••------••--•---••--•.-•--•-•----•••--•... ------------------ Date Permit No.81................................................... Issued_ �"�..1 $ ----- Date NcOl ...21_�P... SmQQ......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Tom-------OF....Barnstable---------------------------------------------------------- Appliratilan for Bhipoii al Works Tomitrurtiun Vautit Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at: ...6r....'..Str�wT..errx_Hill..��a..Centerville..� -•Q26.32 -..... Location.Address r Lot No. 0 Stephen G..Russell 6y�.•Strewber.. I117...�Rd_ +--- entezvi7.].e,..A2fz�2 ll.----..••. o ner Address a ••-A--&--B........ l Service......---•------------------••......-•-••- 128_.Bishops•...g3M Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms....................).....................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ---------------------------- No. of persons.......?.................. Showers ( ) — Cafeteria ( ) dOther fixtures .............................................---------------------•-•------------------.....----------------------••-•--••-•-•------......._-•-----• W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Septic Tank—Liquid*capacity............gallons Length................ Width................ Diameter---------------- Depth................ W 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-.---..._--_-.-_-_-_.. (;!, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 -----------------------------------•----•-----------------••-------------------.........----•-...---......... D Description of Soil........................ V .....•-•---••-••----•--•••-•----•----•-----•----•--------------------------•-•--•-•------.....•------------------•-------------•---------•-•----•--•----•-•-------------------•-.....---•----•-••--•----- W U Nature of Repairs or Alterations—Answer when applicable----------1-nat-allation--of..a..l,.00.0-.gau-0n,...of. -Cast, stone packed leach pit (overflow),____....... -------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'Li z� p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has en ' gued by the bboo• - 'o health. .......... ........i I..... ....51..Val........... / Date Application Approved By----...�„--_._ ±•J s-......r' ............................... ............51.11%........... Date Application Disapproved for the following reasons--------------------;--------------------------------------------...------------------------------ •..................•---------•-•-----•--------------------------•------••------•.....------•-••-•--------••----••--•---••--------••-----•--•-•--------------••------•---••--------------•--------------- . /4.. Date Permit No l 51..V4.................................. Issued....51 .----------.......-•------------ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......................T own.........O F.......Barnstable................................................... Trrtifiratr of ToutpliFanrr J,%I�IOC TO CFIRgIFY That t Individual Sew, e Disposal System constructed ( ) or Repaired (X ) by. esspoo--_ ervice, 12B Bishops Tex ace, Hyannis' 02601 - ------------------------- Installer at.... Stmxbexry.Hi11..&la Center�ril�e, A __0263Z- Russel:1------------------------------------------------ has been installed in accordance with the provisions of TI" E: 5 of The State SanitaryCode a de•cribed in the application for Disposal Works Construction Permit�'o.__g1l�.a_1 ................ da.ted ..........S 1? 1 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FU C ION SATISFACTORY. DATE................... 5 '�tS�81 .................................................. Inspector...-------`-----. . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................Town...............OF..-------...Barnstable.......... $ 5.00 ��...... ................ FEE...--...--.--..-........ Billpos al Works %'Dunntrttrtiun panfit Permission is hereby granted---------A & B Cesspool-.SeTvir e............................................................................... to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at No......654 Strawberr,�r x 11-Rd.�...Centerville,-.--MA----02632----Stephen_&ug.q,0j............................ Street as shown on the application for Disposal Works Construction Permitt No 8.. ------------- ated.._..........5�.1�8.. -- •rx.° ----------------------------------------- DATE 1 81 Health ..............51-•1 1...------•--••--•-----------•---------•-----•---- FORM 1255 HOBBS & WARREN, INC., PUBLISHERS 't of, "A '� CERTIFICATE OF ANALYSIS Page: 1 of 1 Barnstable County Health Laboratory (M-MA009) 9rsio,,�Uc�^' Report Prepared For: Report Dated: 12/12/2012 Sally Desmond Desmond Well Drilling Order No.: G1271900 P O Box 2783 Orleans, MA 02653 Laboratory ID#: 1271900-01 Description: Water-Irrigation Well Sample#: Sample Location: 654 Strawberry Hill Rd. Centerville, MA Collected: 12/10/2012 Collected by: Customer Received: 12/10/2012 Routine ITEM RESULT UNITS RL MCL METHOD# TESTED Nitrate as Nitrogen 1.2 mg/L 0.10 10 EPA 300.0 12/11/2012 Copper ND'- =mg/L 0.10 1.3 SM 31116 12/12/2012 Iron 0.12 mg/L 0.10 0.3 SM 3111B 12/12/2012 pH 5.4 PH AT 25C NA 6.5-8.5 SM 4500-H-B 12/10/2012 Sodium 60 mg/L 2.5 20 SM 3111E 12/12/2012 Total Coliform Absent P/A 0 0 SM9223 12/10/2012 Conductance 420 umohs/cm 2.0 EPA 120.1 12/10/2012 Sodium level is above the maxium contaminant level. Those on a low sodium diet may wish to concult a physician. Attached please find the laboratory certified parameter list. Approved By: Q`"� (Lab Director) `_%2-/- ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 Massachusetts Department of Environmental Protection Bureau of Resource Protection s WELL DRILLER Please specify work performed: Address at well location: New Well Street Number: Street Name: 654 STRAWBERRY HILL ROA Please specify well type: Building Lot#: Assessor's Map#: Irrigation 1 — —7 249 Assessor's Lot#: ZIP Code: Number Of Wells: 1087 102632 City/Town: Well Location BARNSTABLE In public right-of-way: GPS r�r Yes r�ti No North: West: 42.05760 170.01862 Subdivision/Property/Description: Mailing Address: b click here if same as well location addres Property Owner:_ Street Number: Street Name: DAVIS 1654 —� STRAWBERRY HILL ROA City/Town: State: Engineering Firm: IBARNSTABLE MASSACHUSETTS ZIP Code: 02632 Board of health permit obtained: Per Yes rJr Not Required Permit Number: Date Issued: 012 035 10/24/2012 ra %0 .W Massachusetts Department of Environmental Protection — Bureau of Resource Protection—Well Driller Program Well Completion Reports(General) Well Driller - General Well Form DRIWNG METHOD Overburden _ Bedrock Auger Choose Bedrock-- WELL LOG OVERBURDEN LI THOLOGY From Drop In Extra fast or slow Loss or addition of To(ft) Code Color Comment (it) drill stem drill rate. fluid 20 Medium Sand Yellowish Brown Ye rjq Fast rji Slow rjo Loss Addition 20 40 Medium Sand ellowish Brown Ye jii Fast Tja Slow eJei Loss r�� 1 Addition 4 d �� 0 50 Medium San Yellowish Brown , Ye q Fast I,Slow �� Loss ij Addition WELL LOG BEDROCK LITHOLOGY Visible Extra From Drop In Extra fast or slow Loss or addition of To(ft) Code Comment Rust Large (it) drill stem .drill rate fluid Staining :.Chips Choose Code [------� Ye sja Fast rjai Slow jki Loss if,Addition Ye Ye ADDMONAL WELL INFORMATION Developed ji Yes tJi No Disinfected T ,Yes ,jy No Total Well Depth 150 Depth to Bedrock Fracture Surface Seal Type 1.14one Enhancement Yes ji No CASING c Is Casing above ground. From To Type Thickness Diameter Drlveshoe a� 47 Polyvinyl Chloride Schedule 40 0 EYe Sy MEEN No Scree From To j Type Slot Slze Diameter 47 50 Stainless Steel Well Point 0.012 L� WATER-BEARING ZONES DRY WEI From To Yleld(gpm) 10 PERMANENT PUMP(IF AVAILABLE) ---Choose Pump ---Choose Horse ower-- Pump Description Horsepower Description--- - Pump Intake Depth(ft) Nominal Pump Capacity(gpm) Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program Well Completion Reports(General) ANNULAR SEAL/FILTER PACK a From To Material 1 Weight Material 2 Wter Weight Batches Method Of Placement (gal) Choose Material lChooseMaterial �� Choose One-- WELL TEST DATA Time Pumping Time To Date Method Yield(gpm) Pumped Level (ft Recover Recovery (it (HH:MM) BGS) (HH:MM) BGS) 12/1 0/2012 Constant Rate Pump 110 1:00 133 001 132 WATER LEVEL Date Measured Static.Depth BGS (ft) flowing Rate (gpm) 12/10/2012 32 110 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 a knowledge. Driller WILLIAM URQHART Registration# 877 1 Monitoring[M] F Supervising Drill Firm IDESMONDWELLDRI Rig Permit# 1024 Date Job Compl NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion. TOWN OF BARNSTABLE LOCH H5` !e S-4AA-( y3- Rv j' 11 k-o SEWAGE # V1LLAGEC_rprJ p'UL i If ASSESSOR'S MAP & LOTV-5e r l INSTALLER'S NAME& PHONE NO.���yN�S ��' C,4Qjg4/!� vj� SEPTIC TANK CAPACITY' LEACHING FACILITY:(type) (size)` 0 NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATERAQC BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 4/7 P-9 Ag