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HomeMy WebLinkAbout0110 LAKEVIEW DRIVE - Health pia - C�� + ASSESSORS MAP NO ,� f PARCEL N0: "`•- No.�`-�-�--`---�d� , Fee-- BOARD OF HEALTH TOWN OF BARNSTABLE ZipplicationArVell Congtruct ion Permit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ('-Ian individual Well at: - ---------------------------- Location — Address Assessors Map and Parcel Q—M 'J lci 1S! —R1 Oi` —' — — ---- —— I/r ` rUc e v 4/� C e l'e/v P-------------------- Owner Address Ir -------------------- ---`----- - Installer — Driller Address Type of Building Dwelling `mac------------------------------------------------------ Other - Type of Building ------------------ No. of Persons---------------------------------------------------- Typeof Well_�t--------------------------------------------------------------- Capacity----------------------------------------------------------------— Purpose of Well--�e�,e e I!` A-1-, - J�------------------------- 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 - -- ----- Iol/Y�S )- - -- ---------------------------- �d�tee Application Approved B � 1' ----i------------- ----- --- date Application Disapproved for the following reasons:------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------- ------------------------------------------------------------------------------------------ date Permit No. _ I — ---- _✓-� �---------------- Issued - - L — ---------------- date — BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired (-I by--------- ------------------------------------------------------------------------------------- -- --- --- --- Installer lr � I`------------------------------------------------------- - 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.� j--wted THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE- ---- -------- - ------ -- Inspector-------------------------------------------—- - ----------- q/ No. ~ �- � Fee-- ` BOARD OF HEALTH TOWN OF BARNSTAB � E. 0uulication-*rVell Congtructionpertnit Application is(hereby.made for a permit to Construct ( ), Alter ( ), or Repair ('`Ian individual Well at: ------- --_--==-- - Location — Address5 t Assessors Map and Parcel it A - �, �4 Owner , Address --------------- = Installer Driller .— .,_Address Type of Building Dwelling /' -=----- -- ------------------------------------- Other - Type of Building--------------------- - C- No. of P Jersons--------------- ------ - V Type of Well-`� - -- -------------------------------------- CI pacity-—---------------------------- -- - - - ----- Purpose of Well -- I C G ` Agreement: ) / The undersigned agrees to install the aforederribe�5d�individual well in accordance with the provisions of The _ Town of Barnstable Board of Health Private Well;Protctiorir Regulation - The undersigned further agrees not to 1 lace the well in o -ration-until_a--Certificate-.of-Com Nance has been tssued-b the-Board-of-Health:----- - Signed /vf /�y >a - ---------- (� \ date .. Ap lrra�ion�►pproved B — - - —! ___------- date Application Disapproved for the following reasons:=-----------------------------=------------------------------------------------------------------- ------------- -- --- ------------ - ---— - - - - - --------- --- ------- ---------------------------------- date Permit No. - - - � i---------------- Issued --- �-- ---------------------- I date i BOARD OF HEALTH j TOWN OF . BARNSTABLE Certificate ®f Compliance THIS IS TO CERTIFY, That the:Individual Well Constructed ( ), Altered ( ), or Repaired bY- ------------ --------=---------------------------------------- / Installer ------------------------------------------------------- C 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. -f-1?1-jV4ted-- --� THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. i DATE--------- ---- — ---- -- Inspector------------------------------------------—- - --=--------- BOARD OF HEALTH TOWN. OF BARNSTABLE lVell Con5truct ion Permit i _�: No. ---- ` Fee- -, - Permission is hereby granted-Q ----- ------------------ --------------------------------------- - - - to Construct ( ), A/lter ( ), or Repair (✓S an Individual Well at; 't No. Street as shown on theap lication for a Well Construction Permit No.- ---------------------------- Dated - -y- ---� --------------- -- - Board of Health DATE—�—�' _ -------- I 1 ----._ J- ;� l i � _ _ p a � � � 1 � � I � 1 � � �i �� !rv/ . I i - �� �,� � � � I j i i ;� � - r ,, t - ENVIROTECH LABORATORIES, INC. Cert. No.: M-MA 063 449 Rte.130 -- Sandwich, MA 02563 (508) 888-6460 1800-339-6460 FAX(508) 888-6446 CLIENT Brad Bond LOCATION: 110 Lakeview Ave. ADDRESS: 110 Lakeview Ave. Centerville MA Centerville MA COLLECTED BY: D. Pennini/DA Scannell SAMPLE DATE: 10-14-97 SAMPLE TIME: 3:00 WATER SAMPLE TYPE: New Well/repair DATE RECEIVED: 10-14-97 LAB I.D.#: 9710254 WELL SPECS.: 43' RESULTS OF ANALYSIS: Parameters Units Recommended Results Method Limits Coliform bacteria /100ml 0 0 9222 B pH pH units 6.5-8.5 5.84 4500 H+ Conductance umhos/cm 500 109 .120.1 , Sodium. mg/L �_;; 28.0 13.1 200.J Nitrate-N/Nitrite-N mg/L 10.0 < 0:04' 4500 NO3'E Iron mg/L 0.3 0.05 200.7 Manganese mg/L 0.05 0.005 200.7 COMMENTS: Low pH indicates high corrosive characteristics. YES WATER IS SUITABLE FOR.DRINKING PURPOSES FOR PARAMETERS TESTED. Datel d so r�t—. Ro ald J. Saa Laboratory Director <=less than >=greater than TNTC=too numerous to count 3 Department of Environmental Management/Division of Water Resources. ) IF WELL COMPLETION REPORT. 1, WELL LOCATION GEOGRAPHIC DESCRIPTION Address N CS ';E W of tTE�• /.ttP .. (leer! (circtel w City/Town Grb+f�.�� �� �. tJe Well owner 6 r ' �..� t (road) Address t/r. /.. rv. j e N D W of ( `,y (ml.I' n tenths! (clrclel intersect, w/s1cw/`lFly;_' K..�l Board of Health permit o�to ed: yes no;� (roedl WELL USE WELL DATA Domestic a Public❑ Industrial ❑ Total well depth . ft. Monitoring❑ Other Depth do bedrock ft. Water-bearing rock/unconsolidated material: Method driller),/r ! / Date drilled 4111ig 6; Water;bearing zones: CASLNG� t)from To Typ „ 2) From To Length,t!a It. Dia(.I.D.). in. 3) From To Length into bedrock ft. Gravel pack well: dia. Protective-well seal: Screen: r Grout-� Other Slot�',lf lengiti. om, tom STATIC WATER LEVEL(all wells) Static water level below land surface 23 ft. i Date WELL TEST(production wells) Drawdowti _ft. after-,," Ping hr. �� min at How measured t-Recoveri(f di4it. af let —hr min ' s o LOG,of FORMATIONS COMMENTS -Materials' From To t Driller / k Addresses•wit 1rGo / e V,3 94/Townes rt. ©ac y 9 Supervising Driller Reg# r signature o superwsln re israted we/Fdrlller, i Please prinr.firmly .,- BOARD OF HEALTH COPY