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Home My WebLink About0180 GOSNOLD STREET - Health 180-GOSNOLD STREET. 'Hyannis" 3 � r A = 306- 121 s o t_ 0 0 Massachusetts Department of Environmental Protection Bureau of Resource Protection WELL DRILLER Please specify work performed: Address at well location: New Well Street Number: Street Name: 180 IGOSNOLDST - Please specify well type: Building Lot#: Assessor's Map#: Irrigation 306 Assessor's Lot#: ZIP Code: Number Of Wells: 1121 102601 City/Town: Well Location BARNSTABLE In public right-of-way: GPS f North: , West: + 41.63954 170.28588 Subdivision/Property/Description: Mailing Address: e click here if same as well location addres Property Owner: Street Number: Street Name: DAN MEECE 124 —� BAY RIDGE DR APT City/Town: State: Engineering Firm: INASHUA NEW HAMPSHIRE ZIP Code: 03062 Board of health permit obtained: r Yes Not Required Permit Number: Date Issued: IW2013 005 5/6/2013 ZE C— N cm NO — � c r Massachusetts Department of Environmental Protection LF�j 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 LITHOLOGY From To(it) Code Color Comment Drop in Extra fast or slow,Loss or addition of � (it) ;drill stem drill rate fluid 20 Fine To Coarse Sand Brown Ye i_Ia Fast JJa Slow �)a Loss i�a Addition 20 25.5 Fine To Coarse Sand Brown :Ye iJn Fast �ja Slow ��1 Loss rja Addition WELL LOG BEDROCK LI THOLOGY From Drop In Extra fast or slow Loss or addition of Visible Extra To(ft) Code 'Comment Rust Large (it) drill stem drill rate fluid Staining Chips Choose Code Ye ija Fast tja Slow ��a.Loss a Addition Ye Ye ADDITIONAL WELL INFORMATION Developed Yes No Disinfected 5,Yes ],No Total Well Depth 125.5 Depth to Bedrock Fracture Surface Seal Type INone I Enhancement Yes ,ji.No CASING Is Casing above ground? From To Type Thickness Diameter ..Drlveshoe 0� 21.5 Polyvinyl Chloride Schedule 40 114 Ye SCREEN G No Scree From To Type Slot Size Diameter 21.5 25.5 Stainless Steel Well Point 0.012 F WATER-BEARING ZONES DRY WEL From To `Yield (9Pm) 13.6 25.5 12 . i PERMANENT PUMP(IF AVAILABLE) 3 Wire Variable Speed Pump Description Horsepower r Submersible 1 1/2 w Pump Intake Depth(ft) 21 Nominal Pump Capacity(gpm) 125 ANNULAR SEAL/FILTER PACK J Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program Well Completion Reports(General) .. - Water ;From To ;Material 1 WelghtMaterla12 Weight Batches Method Of Placement` (gal) Choose Material Choose Material --Choose One WELL TEST DATA Time Pumping Time To Recovery (it, ,Date :Method Yield (gpm) Pumped Level (ft Recover (HH:MM) _ -BGS) ,(HH:MM) BGS) 5/22/2013 lConstant Rate Pump 12 130 15.5 0:01 13.5 WATER LEVEL ^Date Measured Static Depth BGS (1t) ,Flowing Rate (gpm) 5/22/2013 113.5 - 12 COMMENTS i 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 IWILLIAM URQHART I Registration# 1299 1 Monitoring[M[ Supervising Drill Firm DESMOND WELL DRI Rig Permit# 1024 1 Date Job Compl NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion. mo=None Detected nL = Reporting Limit MoL~Maximum Contaminant Level ' LR No. �J Fee BOARD OF HEALTH TOWN OF B-A'RNSTABLE 01pp[tcatiou _for Yell Con5truction hermit . Application is hereby made for a permit to Construct(A Alter( ), or Repair( ) an individual well at: J J() GrOSnola �+ , M�arris 3c)(.1 IZI AA`` Location-Address Assessors Map and Parcel T.h�C\ IM2 2C C Z4 Q a�ti lk N N 030(0-L Owner Address \�U\< j�"j— ?o •Quy. 2_—m ,Oclears IMA 0!(63 Installer-Driller Address Type of Building -Dwelling Other-Type of Building No. of Persons Type of Well H It S C�ALio NC_ Capacity I Purpose of Well C C 1 ati'llrsrn Agreement: The undersigned agrees to install the afore described 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 Certi cate of Compliance has been issued by the Board of Health. Signed �6�I3 Date ` Application Approved Date • F Application Disapproved for the following reasons: { C l Date Permit No. Issued Date -----------------------7-------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance r THIS IS TO CERTIFY,that the individual well Constructed( ), Altered( ), or Repaired( ) } by b9_SV o W!)A Df AV"A Ayy_ Installer at Qlu �coS Y,o�c� S N4arr�C has been installed in accordance wA the provisions of the Town of Barnstable Board of Health Private Well rot ction Regulation as described in the application for Well Construction Permit No.��1 � ti� 5 Dated 51b THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector + No. G 5 Fee �J t BOARD OF HEALTH TOWN OF A-=RNSTAB. LE ZIPPricattou jFor Vern Cougtructtou Permit Application is hereby made for a permit to Construct(�), Alter( ), or Repair( ) an individual well at: A Location-Address Assessors Map and Parcel tU\-u.4L 24 eia-11� K\.�Ao �i -(�p�(n WAc�nuc_ � 0106Z Owner J Address Installer-Driller Address Type of Building Dwelling Other-Type of Building No. of Persons Type of Well y + S(_ L40 N(_ Capacity Purpose of Well �f f 1 jq�- i 7m Agreement: - The undersigned agrees to install the afore described 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 . 51101-1 Date Application ApprovedCIL Date Application Disapproved for the following reasons: Date Permit No. 1 i� �C?� I 3 Issued / Date BOARD OF HEALTH TOWN OF BARNSTABL ,E, Certificate of Compliance THIS IS TO CERTIFYI,that the,in`dividual well Constructed( ), Altered( ), or Repaired( ) by �Y�-ora ,YVo� �i�t y"'t I J Installer at 190 CtoSv,ol� Sk +11��ar��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,\A\_-. 1 cG `j Dated 516 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Inspector BOARD OF HEALTH TOWN OF. BARNSTABLE Ivell Cou6truchou permit No. ��/J Fee �I Permission is hereby granted tobcSYh6hN Insta ler t' to Construct(✓), Alter or Repair O an individual well at: No. I f? G-0so l Sy, J Street as shown on the application for a Well Construction Permit No. &,J�,C,/3 005- Dated Date Approved By �� s