HomeMy WebLinkAbout0074 TRACEY ROAD - Health 74 Tracoy_ Road
Cotuit
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CERTIFICATE OF ANALYSIS
Page: 1
Barnstable County Health Laboratory
,ysrirHLtiS��. Report Prepared For: Report Dated: 2/2/2009
King F. Lowe
Lowe,King F. Order No.: G0950618
P 0 Box 1790
Cotuit, MA 02635
Laboratory ID#: 0950618-01 Description: Water-Drinking Water j
Sample#: Sampling Location:r74 Tracey Road Cotuit,MA Collected: 1/29/2009
Collected by: King Lowe Tap Received: 1/29/2009
Test Parameters
ITEM RESULT UNITS RL MCL Method# Tested
Total Coliform Absent P/A 0 0 SM9223 1/29/2009
Laboratory ID#: 0950618-02 Description: Water-Drinking Water
Sample#: Sampling Location: 74 Tracey Road Cotuit,MA Collected: 1/29/2009
Collected by: King Lowe Fridge Received: 1/29/2009
Test Parameters
ITEM RESULT UNITS RL MCL Method# `" Tested
i
Total Coliform Absent P/A 0 0 SM9223 1/29/2009
i
Approved By
7(Lrector)
{
ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level
Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605
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ASSESSORS W 0 O D5
No PARCEL N� Fes$....... ..._...............
THE COMMONWEALTH OF MASSACHUSETTS
/o -B AR . ®�F ALTH
.................`- -.- -.....oF..... A..........................
Applirta#ivaa for Diupuuaal Wurkii Tonstrurtivaa Vrrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System a • X
..�. "..� _ .. .. ..................lw��_o...................................................
or No.
K/A/(3-.. _... Lo�catio ss. .......................................Lot ...
W Address
•.........S� ._H ....t.-0�--�.Mo.................................. .......................................
04 Installer Address
dType of Building Size Lot____________________________Sq. feet
U Dwelling—No. of Bedrooms........ ..................................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building ....... No. of persons............................ Showers — Cafeteria
a' Other fixtur ..
W Design Flow.............................. .......gallons per person per day. Total daily flow__.............................____._......_gallons.
WSeptic Tank—Liquid capacityi5allons Length................ Width................ Diameter................ Depth................
x Disposal Trench—N . .................... 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----------------------------------------
04 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
G14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-___-__-.._____.._____-
P4 -------------------------------------------Ll
-------- ------------------------------------------------------ ------------------------------------------
0 Description of Soil............................... --------------------------........._..----
124
U -•-------------------- ------------------
W ------------------------------------------------------------------------------------------ --- ------------------ -----------------------------------------------------------------------------
VNature of Repairs or Alterations—Answer when acable...............................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of'T' �.%
p of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be nss d by the board oAhne h.
Signed--- ------. �%�Z . o--_ --..... f` I
Date
Application Approved By.. _... ....... .... .. .
Date
Application Disapproved for the f ollowing r ons:
...........................................................
--------------------------------------------------------- ------------------
...-----------------
-----------------------------------------------------------------------------
Date
Permit No..U_Q.......�1.. ..................
Issued------------------ -----------
l�ate
Nog?..—L37
THE COMMONWEALTH OF MASSACHUSETTS
BQAR F L_jC7ALTH
/Ill/ L 'A'
... ......... orf-.7- -
.................. OF. ......... ..... . ....... 6..........................
Appliration fur Dhipaaal Works Tomilrurtion rumit
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
System qt.,;, X
. ................/0..... ax�.,.LOZ ..17 Jwn..(0..................................................
or Lot No.
IS
..........\:jVBt4....4A..�.ro.................................. .............................................Address.....................................................
Installer Pq Address
d Type of Building Size Lot............................Sq. feet
U
Dwelling—No. of Bedrooms.... -----------------------Expansion Attic Garbage Grinder
PL4 Other—Type of Building ............................ No. of persons..............._............ Showers Cafeteria
al Other fixtur
Design Flow.......... .......gallons---P-,e--r---person-----------per-day.--------Total-----------daily-- -----fl-,o---w------------------------------------- g--a--1-1-o--n--;--.
9 Septic Tank—Liquid capacity/.50L'kallons Length................ Width.........._..__. Diameter.___._.......... Depth................
Disposal Trench—N ... Width.........._._..._... Total Length_......_.._......... Total leaching area....................sq. ft.
Seepages Pit No......a�zl)iameter.................... Depth below inlet........._.__._._... Total leaching area..................sq. f t.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date----------.............................
a
04 Test Pit No. I................minutes per inch Depth of Test Pit._..............__._ Depth to ground water_-___---__--_-----------
fi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........___.____......_.
P4 --------------------0 ..........................................
-- - -------- -
---------- ------------
---- ------------------ r-----------------------------
............................................ ...... ...... ,
0 Description of Soil................................ .......... .. ... .............. .. .. . ........ ...........................................
.............................................................. .. ......................... ............................................................................
U --------
W
ZI ---------------- ---------------------------------------------------------------- .......... ---------------------- .............................................................................
U Nature of Repairs or Alterations—Answer when ap icable.------------------------------................................................................
.......................................................................................................................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of'T'I�Z 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
,L-, 11
operation until a Certificate of Compliance has be .Vssyd by the board of h9lith.
Signed.,��_. .................. ................
Date
Application Approved By.&. �.... .......
. ....... ........................................
Date
Application Disapproved for the following Zons:..............................................................................................................
.................................................................. ... .......*-------------------------------------------------------------------------------------------*............*-----------
Permit 3. .................. Issued ...........................................Date--------
DSt_
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEAL-TH
_1...... A7
........ . ..... 6.4..C
Trdifiratr of Tompliancr
THL TO ER� A.F.T� Tha;. the Individual Sewage Disposal System constructed or Repaired
by ......................0............................................................................................................
,_Jnstaller
at------ ...1.0.......4/9CY....QD.!)...... ----------------------------------------------------------------------------
has been installed in accordance with the provisions of g'I, 1p- late Sanitary Code aA e in the
...7
application for Disposal Works Construction Permit No. ........ dated....
...........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO STRIDE® AS A GUA ANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
OARJ F EA,�7.... ......
NO2�F..... ..OF... .................................. FEE.....7
Disposal lv�f kg tnll -wit Virrmit
Permission i hereby granted...J-01 ---- - --------------------------------------------------------------------------------------------
ssion
to Constr .ct or Repairidu -Bewage I& stt
------------ - -- ----
at No.. .. .. ... ..... ... -----------
Street
as shown on the ft Disposal Works Construction Permit No..... .... a applicatio: for ted.. . ......
.......................................
----------------------------- S
oard of Health
DATE............................. .../.. . ........................
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
_ c
Ij Department of Environmental Management/Division of Water Resources
\u r; WATER WELL COMPLETION REPORT
WELL LOCATION
Address Zy� /0 Tf(,k( ..e Pr r,A
City/Town
c
G.S.Quadrangle Map
Grid Location \
Owner ,,c.r 1w-cl�,ye f`
Address P('r) k— x. k A,., ;n r
WELL USE CONSOLIDATED WELL
r Domestic❑rt Public ❑ Industrial ❑
Type of Water-bearing Rock i
Other
Water-bearing Zones
Method Drilled i'�4ktaf�,_X_ t) From To
2) From To
Date Drilled �l I ? ?1 3)From To
4) From To
CASING p Depth to Bedrock
Lengtht� Diameter
Type PlG :r UNCONSOLIDATED WELL
STATIC WATER LEVE L Water-bearing Materials
Feet below land surface k oC�A Sand: fine 0,—medium❑�coarse❑
Date measured jilt I C,i Gravel: fine❑ medium❑ coarse❑
Screen:
GRAVEL PACK WELL 1 V/
Slot¢ length from to
Yes ❑ No ❑!f
Split Screen (or 2nd screen)
WATER QUALITY TESTS MADE Slot# ' length from to
Chemical ❑"� Biological ❑ DeptW To Bedrock
PUMP TEST j
Drawdown � feet after pumping days "7 hours at r U GPM.
How measured CX41' DQfrA f.`!Recovery feet after hours.
LOG of FORMATIONS COMMENTS: (On well or water)
Materials From To
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A P� 1A.d/�'�
DRILLER r Cb
Firm { 1 1" ti,n ram. IAJr,
Address Ir� 'C)<7 \
city .fir; ��(•<'�ltil-
Registration No. 1 l)
k V ,lcc
ignatu'r�eAerators
ease pnnr firmly E
BOARD OF HEALTH COPY ism o as sonol
7 �
. k . ENVIROTECH LABORATORIES
449 Route 13 Sandwich, MA 0 5 a • (50) 8%6 6 k
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F CLIENT Tyler Foster LOCATION: tot IO Tracy Rd. q
k ADDRESS: Rox 564 Cot=it 2
¢ Ran isispart, MA 02647 '
F COLLECTED BY: Meehan SAMPLE DATE: IO/l8/88 TIME: 55555 AM
-
EE DATE RECEIVED: lO I8 B8SAMPLE p: ` D 340 7
F 2
K JOB f New W£11 WELL DEORIft
F
RESULTS OF ANALYSIS
_K q
UParameter Units Recommended limit Result . k
1
_F Co br b de a/10 m (MF Method) O 0
PH pH units &Qa 3 5.78
Conductance umh scm 500
I08
k �
Sodium mg/L . 20.0
16.6 d
F _
Nitrate- mg/L 10.0
.04
% Iron mg/E ¢a <,0
k k
E Manganese mg/L 0.0 =
K �
CE Hardness mg L as CaCO 500. ® . .
_% Sulfate mg/L 250
k k
F Potassium mg/L 20.0
_
K_ �
Alkalinity mgE 20
k_ Chloride mg L 250
_ T2B±% NTU &O k
% Color APC units l&O
_U Background bacteria
.
F 2
COMMENT .
F � i
YES NO WATER ISSU TABLE FOR DRINKING PURPOSES FOR PARAMETERS SEED. k
. DATE �� 2
,
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BOARD OF HEALTH
TOWN OF BARNSTABLE
ZIppYication-for Vefr Con!5tructionpermit
.T� Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair (,Ilan individual Well at:
Location`— Address — Assessors Map and Parcel ,
Kl Lower -
- - --- -------------- ------------------- - - ----- -- -- - —---
_______—___ Owner _ Address
OA' Snz,, !� 2nl C.
------- ------------__----------- --------------_—_-- T -
Installer — Driller Address
Type of Building
Dwelling iAt_----------------------------
Other - Type of Building------------------------------_-_ No. of Persons-------------------------- ---
�! --------------
Type of Well - �UC ----------------------------------- Capacity---------------------------------------------- -------- —---- —
Purpose of Well ---
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 C rtificat of Compliance has been issued by the Board of Health.
Signed --- -- —-A yj
{ date
Application Approved By------<J U: - ----------------_— -73
date
Application Disapproved for the following reasons:-------------------__--------___-__-----_-------------___—________._._:______�_
—-----------—_-
date
Permit No. Issued--------------------------- _— -
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
(Certificate Of Compliance
THIS IS TO CERTIFY, That the Individual V
1 Constructed ( ), Altered ( ), or Repaired (✓)
O
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. Dated-----------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE------------ ---- - —-- ---------------------- Inspector------------------------- ---- -- - -_ —
r F�'
�.
_ -
Fee[BOARD OF.HE LTH
TOWN OF B,ARNSTABLE
ZippYitat ion' -for Vell ton5truttion3permit
;ri S
Application is hereby made for a permit to Construct ( ), Alter (, ) or Repair ( ")an individual•Well at:
~Location — Address � Assessors Map and Parcel
- zo C-)--4P -- -------- — --__-- -- --------------
Owner , A; Address
Installer — Driller Address
Type of Building
Dwelling----- r, r
---------------------------------
t
Other -`Type of No. of Persons----------- - _ -------------------
Type of Well�—���__ ____—__----_--_-- Capacity--------- -----------------------------
Purpose of Well ----------
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 C rtificate of Compliance has been issued by.the Board of Health.
/JLu,��Signed--�—_�_-----------
--- ----___—__— __!/ /"�-�--------------
date
Application Approved By ----_---__—_______ —date
CT _
Application Disapproved for the following reasons:------------------------------- ----------------
---------------------------------------
date
Permit No.-- - -- - —_�_ --___ - --------- Issued-------------—----- ------
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate Of Compliance
THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired (✓)
-------------------------------------------------------------------------------
y / Installer
at—- `� ! ``;l - -- - °- ` T-''`—`` - -- ------------------------------------------------
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. IX!,P-:?-=- -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 BA.RNSTABLE
Ivell �tCoi�m rtionverittit
I � S-----------------------------/----------- -- — -- ---—e --- 7 ==-No.
Permission is hereby granted—=�-- r /// --
--
to Construct ( ), Alter ( ), or Repair (✓) an Individual Well at:
No. -------------------------------=---------------------------------------------------------------------------------------------------------------------------------------------------------------
Street
as shown on the application for a Well Construction Permit
No.---------------------------------------------------------------------------------- Dated----------Y ------
------------— -_ � - -_------------------------
- 0 Board of Health
— 1
DATE-------------�---------�--------�---------------------------------------
aDepartment}of,`Environmental Managetnent/Division of Water Resources r�
WELL COMPLETION REPORT !/v
WELL LOCATION GEOGRAPHIC DESCRIPTION
Address P
�/D N S, ® W of
pe, peer/I /�(circle)City/Town - A -� V I[ j
Well owne oad)
r f�t��_�p�� r
Address/9 Q�,4 ev/off /1J N S W of
(mL.ir)tenthsl Ic clel /
/ intersect. w/G141M Tie!/ea&4e
Board of Health permit obtained: yes 9" no ❑ ;(fOed)
WELL USE WELL DATA '.. .t.,
Domestic [R-*1Pu6Iic❑ Industrial ❑, Total well depth Jr� It.
Monitoring❑ Other Depth to bedrock ft.
Water-bearing rock/unconsolidated material:
Method drilled LJ l
Date drilled x4A T sL ` Description/ awn ae SGn -1
Water-bearing zones: ,
CASING
/ n 11 From To `
Type �C / VQ /'iJt
n 2) From To,
Length J' ft. Dia(I.D.) ! in.
3)'From To
Length inio.bedrock it. .,
Gravel pack well: dia.
Protective well seal:
Screen: dia.
G'rout_El. Other Slot OIS length Vic_'—from to.Er2_
i STATIC WATER LEVEL(all wells)
Static water level below land surface ft. Date
- � - —
WELL TEST(production wells)
Drawdown _It. afterpumping _hr. min at. /�_gPm
How measured Te./�r� 'Recovery i'3Tft. after hr. min.
0
LOG of FORMATIONS COMMENTS g
Materials From. To -
DrillerrT
,,.., Firm �04 -Qc �-����1��
Address,fin•�nj,l ECG
City7Town' � as
Supervising Driller Reg#'
i natureblatipervising registered well dr.'lller a'
eleesepr,nrt„m" BOARD OF HEALTH COPY
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