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Home My WebLink About0258 GOSNOLD STREET - Health LfJ��,V�O'S..N RAJ S J7. � 3 IA a is A= 306 — 113 F�fi •`� Massachusetts Department of Environmental Protection 3010 U3 Bureau of Resource Protection Well Completion Reports Well Driller n Please specify work performed: Address at well location: New Well Street Number: Street Name: 258 GOSNOLD STREET A" Please specify well type: Building Lot#: Assessor's Map#: aR Irrigation all OD Assessor's Lot#: ZIP Code: _ 00 Number Of Wells: 02601 City/Town: Well Location BARNSTABLE In public right-of-way: GPS v t' Yes C No North: West: 41.63918 70.28904 Subdivision/Property/Description: Mailing Address: click here if same as well location address Property Owner: Street Number: Street Name: BOB MOLLOY 171 HELEN DR CityrTown: State: Engineering Firm: ABINGTON MASSACHUSETTS ZIP Code: 02351 Board of health permit obtained: rv.Yes (---.Not Required Permit Number: Date Issued: W2016 024 O9/27/2016 i I Massachusetts Department of Environmental Protection f«^ Bureau of Resource Protection-Well Driller Program j Well Completion Reports(General) k , l.w Well Driller - General Well Form DRILLING METHOD r► i Overburden Bedrock /4uger;: Choose Bedrock- WELL LOG OVERBURDEN LITHOLOGY i From(ft) To(ft) Code Color Comment Drop in drill Extra fast or slow Loss or addition stem drill rate of fluid r r r C 20 Fine To Coarse S Brown �"Fast r'Slow YES NO Loss Addition 20 28 Fine To Coarse S !T Brown ; (" tZ Fast r Slow Loss Addition WELL LOG BEDROCK LITHOLOGY Drop in Extra fast or Loss or Visible Rust Extra [From(ft) To(ft) Code Comment addition of Large drill stem slow drill rate Staining fluid Chips ------------��--�'`�''�--- — — --- ------- ----- I Choose Code C"' N L f" Yes r Yes YES NO I 1;�_� [ Loss Addition ADDITIONAL WELL INFORMATION Developed (::Yes t'No Disinfected Total Well Depth 28 Depth to Bedrock Surface Seal Type INone ��racture Enhancement CASING r.Is Casing above ground.. From To Type Thickness Diameter Driveshoe ..._.._.... - ----- -- — -------.. -- ---- - - - - _— - --- - - — - -- �0 25 Polyvinyl Chloride Schedule 40 �4 ri Yes SCREEN r.No Screen From To Type Slot Size Diameter — — 4 ---- 25 128 - Stainless Steel Well Point _� 0.012 �� WATER-BEARING ZONES r DRY WELL From To Yield(gpm) PERMANENT PUMP(IF AVAILABLE) 2 Wire Constant Speed Pump Description Horsepower Submersible C� Pump Intake Depth(ft) 24 Nominal Pump Capacity(gpm) 10 ANNULAR SEAL/FILTER PACK From ITO Material 1 Weight Material 2 Weight From-- Batches Method Of (gal) (count) Placement i I r Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program Well Completion Reports(General) L_� Choose Material Choose Material I —Choose One ! WELL TEST DATA Method Yield(gpm) Time Pumped Pumping Level(ft Time To Recover Recovery(ft Date (HH:MM) BGS) (HH:MM) BGS) 09/22/2016 Constant Rate Pump 12 1:30 19 0:01 17 WATER LEVEL Date Static Depth BGS(ft) Flowing Rate(gpm) Measured 09/22/2016 17 1 112 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 and accurate to the best of my knowledge. JOSHUA Monitoring[Ml Supervising Driller DESMOND, DrillerBROOKS Registration# 299 Signature THOMAS,E DESMOND WELL Firm DRILLING,INC. Rig Permit# 024 Date Job Complete r 10/O_2016 NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion. CERTIFICATE OF ANALYSIS Page: 1 of 1 Is M, Barnstable County Health Laboratory (M-MA009) ��Hsr�crtus`�� Report Prepared For: Report Dated: 09/29/2016O . Sally Desmond t7 Desmond Well Drilling Order No.: G1696886 . P 0 Box 2783 M/1 3 U 6P- 113 Orleans, MA 02553 CM . s Laboratory ID#: 1696886-01 Description: Water-Irrigation Well w sample#: Sample Location: 258 Gosnold St. Hyannis Collected: 09/27/2g Collected by: DWD Received: 09/27/2016 Routine_M ITEM RESULT UNITS RL MCL METHOD# ANALYST TESTED NOTE Nitrate as Nitrogen ND mg/L 0.10 10 EPA 300.0 LAP 09/28/2016 Iron 0.14 mg/L 0.10 0.3 SM 3111E LAP 09/29/2016 Manganese 0.28 mg/L 0.025 0.050 SM 3111E LAP 09/29/2016 pH 4.7 PH AT 25C NA 6.5-8.5 SM 4500-1-1-13 DCB 09/27/2016 Sodium 45 mgtL 2.5 20 SM 3111B LAP 09/29/2016 Total Coliform Absent P/A 0 0 SM 9223 RG 09/27/2016 Conductance 390 umohs/cm 2.0 SM 2510E DCB 09/2712016 pH is low and its retesting is recommended. Sodium level is at the maximum contaminant level. Those on a low sodium diet may wish to consult a physician. find the laboratory certifled parameter list. Approved By: i Attached please fi ry (Lab Manager) ' i ND=None Detected . RL =.Reporting Limit MCL=Maximum Contaminant Level 3195 Main Street, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 No. Fee BOARD OF HEALTH TOWN OF BARNSTABLE Application ,for Vern Con!5truction Permit Application is hereby made for a permit to Construct Alter( ), or Repair( an individual well'at: Location-Address Assessors Map and Parcel Owner G Ad ress S cc WQA\ 2— %3, 0Ak 1j W GZV3 Installer-Driller Address Type of Building Dwelling Other-Type off pB�uilding No. of Persons Type of Well �' S(J\a4b VVC- Capacity �C)spy" Purpose of Well (l1gcU��r 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 Certifi ate of Compliance has been issued by the Board of Health. Signed Zb 6 0 WDate Application Approved By rIZ7- I 'rl /t,!;,l v . Application Disapproved for the following reasons: Date Permit No. r Issued Date --------------------------------------------------=----------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO" CE-R-TIIFY ( ), or Repaired( IS ) by x�1�i \ AR A f i 1.\"M `-AL- Installer at has been installed in accordance with th provisions of the Town of Barnsta le a He rivate Well Protection Regulation as described in the application for Well Construction Permit No. ated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector i No, Fee BOARD OF HEALTH TOWN OF BARNSTABLE ZIppricatiou --for Yell Conotructiou Permit Application is hereby made fora permit to Construct(f), Alter( ), or Repair( an�individual well at: 257) Q,csy,�1A Sk , \AkAonr;s `30�� t13 Location-Address Assessors Map and Parcel e_ - 1JNON,\ l �le1�Y, ��, O�b;Nt ,1��A�oZ35I Owner A ress �51rn��1 �c�t��Y�9,,1�,� ��y•13uY. Z��3 , Ut�,rS � 6Z6S 3 Installer-Driller Address Type of Building Dwelling Other-Type of Building No. of Persons Pe of Well y SUM 'VVC. Capacity �C) Purpose of Well 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 Certifi ate of Compliance has been issued by the Board of Health. Signed �Zb 16 0 D to Application Approved By ® /� / Date ;F 1 Application Disapproved for the following reasons: r I Date Permit No. Issued( .� t I Date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed(4 Altered( ), or Repaired( by 12LO �Nkk rk� lrt- Installer at --- ..has-been.installed.in accordanceiwith the pro 'visions of the Town of Barnstable. a I He rivate Well Protection "-"--Regulation a§'d'escribed'iti ttie application-foi We11'Constiuction Permit No. ated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date i 4 Inspector BOARD OF HEALTH TOWN OF BARNSTABLE Very Cougtructiou Permit No. Fee Permission is hereby granted to beS Yrc Installer J 1 to Construct(/), Alter( ), or Repair( an individual well at: No. Street WIIZYA�-4- as shown on th applica on for a Well Construction Permit No. ted Date Approved By