The URL can be used to link to this page

Home My WebLink About0039 MAPLE WAY - Health 39 Maple Way Hyannis r A=246 — 127 �I fill llI ® UPC 17734 ' 0.2-153C ' . � o ..!`� Q "�+. I I No. Fee HE COMMONWEALTH OF MASSACHUSETTS Entered in compu er: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS YesO 2pplication for Disposal *pstem (Constru>rtion permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ❑Complete System ❑Individual Components Location Address or Lot No. j Owner's ar4 Address,and Tel.No. Assessor's Map/Parcel 0 r �" "V � �t�,�� ( I14 C ;t °7—/9p Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd- Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the const tion and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Env` ental Code and riot t lace the system in operation until a Certificate of Compliance has been issued by this Board of Healt . S ne Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued_0Y1ji7: Imo,' {"'"',.:�r^Msaa,,:.,�t'.e;/:,.1,•;:E...,r.i,nrb:.:sw"'woi^t`F1�.1K!b'�'�".�eY`�""l..a`ilk,E7�: #Odin.:.11S$O'�3�'"iN'njvr-ir.*v.i.'^�',._:,`''"'„u""".'"y:.ye''c.--n.-.-..:.-4,>+:.-._,....,-.:.r..:.-_.^+r,+n"tr ""-:.-i.i-r�Sr�•-.t,,,f s.. '� - i No. �E51 a/ Fee THE COMMONWEALTH'OFMASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF.BARNSTABLE; MASSACHUSETTS , Yes i, 2pplication for Disposal b p stem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon Y ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No.Assessor's Map/Parcel Q� _T0Sf f h J 1114 C, y 13 - a V7`/Qp Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of-Building: y Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. /Description of Soil Nature of Repairs r Alterations(Answer when applicable) K3A�D 6 Date last inspected: Agreement: The undersigned agrees to ensure the constgu tion and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Envtrotental C de d riot t lace the system in operation until a Certificate of Y Compliance has been issued by this Board of Heal Signed 1 a, Date Application Approved by Date Application Disapproved by, Date for the following reasons Permit No. Date Issued l THE COMMONWEALTH OF MASSACHUSETTS ,gyp BARNSTABLE,MASSACHUSETTS _ ~ 1 (Certificate of Compliance THIS IS CERTIFY,that the O .site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned by l � , atA11 �VlB has been con°s�n"inaccance with the provisions of Title 5 and the f r Disposal System Construction Permit NoA0ated Installer Designer #bedrooms Approved desii�flow /1 gpd The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date a`� �� Inspector - -_------No.-Q= _ - f Fee- --_ /^ -� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION r.BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction 3oermit Permission is hereby gr; d Co� ct(® Re''rLe' �( t�Up /rade�P�e b don( ) System located at 4 �/1/ Wog 1 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constuctio ,muustbe completed within three years of the date of this permit.rove Date / C/ A d b I , PP eY assachusetts Department of Conservation and Recreation t Office of Water Resources 157507 TYPE OR PRINT ONLY --� Well Completion Report 1.WELL LOCATION GPS (Required) North _° See !�rT� ,�c West Address at Well Location: 3 n%n 191 GvN-y1 Property Owner/Client: D, Subdivision Name: Mailing Address: 3 /��1'�G-" G✓/,rc City/Town: Mtn S fi- 6 le-City/Town: Bqz S><A 6 ?1 , `/ Assessors Ma Assessors Lot#: NOTE: Assessors Map and Lot#mandatory if no street}address available Board of Health permit obtained: , Yes ❑ Not Required lam' Permit Number Datej e 2.WORK PERFORMED 3.WELL TYPE 4.DRILLING METHOD 6.CASING---?; Ov burden I Bedrock From(ft) To(ft) -- ype Thickness Diameter Ik 5.WELL`L(3G' OVERBURDEN Extra raQ❑❑ Water Loss or Drop in . Fast or 0❑❑: LITHOLOGY Bearing Addition Drill Zone of Fluid Stem From (ft) To (ft) Code Color Comment D Slow 7. SCREEN Rate Al Y / N Y / N F / S From(ft), To ,�,`"r Type Slot Size. .Diameter El El /y0" .a2o2D, .SC, Aj Y / N Y / N FVS ' ❑❑❑ - - - p' c,29 0 (f, n/ Y /. N Y / N F / S *^�� ❑❑❑ Y / N Y / N F / S g„ANNULAR_SEAL/FILTER PACKIABANDONMENT MTL. . Y / N Y / N F /A FroF�-(ft) To(ft) Material Description Purpose Y / N Y / N F / S ❑ ❑.� Y / N Y / NF %S y ❑El Y / N Y /1N� Ff S ❑❑ EIS❑ WELL--LOG BEDROCK Extia 9 SITE SKETCH s_ = . Water Drop in Extra Vlsible Loss or .#.of. , LITHOLOGY BearingDrill La a Fast°C`/Rust Addition Fractures ,' �. From (ft) TO (ft) Code Comment Zone Stem Ghis slow Staining of Fluid perfoot 19n` O rZf~ _J Y S Y,. / N Y / N ' Y / N ,Y�NF / SY / N -Y / N � Y,/ NYC/-N F / S Y / N Y / N 10o� Y N,Y / N F / S Y / N Y / N Y,IN / NF / SY / NYIN �. Y,NY /,NF / SY / NY / N o .. Y�lNY / NF / SY / N.Y / N NY / N F / S Y / NY / N Y / N Y / N F / S :Y / N. Y / N � �zF►A�e c.J aN Y / N Y / N F / S Y ( N Y / N b 10.WELLIEST:DATA(ALC=SECTIONS-MANDATORY FOR,PRODUCTION"WELLS) 11"STATIC WATER LEVEL(ALL.WELLS) Yield Time`Fumped Pumping Level 'Time to Recover Recovery Depth Below Date -- Method (GPM) (his&min) (Ft. BGS) (hrs& min) (Ft.BGS) Date Measured Ground Surface (ft) 12. PERMANENT PUMP(IF AVAILABLE) =_ >- _ 13.ADDITIONAL,WELL INFORMATION ' Pump Description ❑ ❑ Horsepower Developed Y /(N Fracture Enhancement Y /Q C. l PumpIntake Depth _ ft Nominal Pump Capacity m ❑❑ P � O P P tY (9p ) Disinfected Y L�Surface Seal Type 14. COMMENTS /'/,S �evy� ,tea ` � � � /-1d�e Total Well Depth — a� Depth to Bedrock---'' 15.WELLDRILLER'S STATEMENT - This well was drilled, altered, and/or abandoned under my supervision, according to applicable rules and regulations,and this eport is c�td orrect to the best of my knowledge. Driller: »�ccnn� Supervising Driller Signature: Em if Registration #:1 1 71 V1-t I �tlfdMfCTICtJT VALLEY ARTESIM4 WELL CO, ;i�t, RigPermit#: Firm: - Date Complete: J /v9 'f' r NO.TE.,�Wedt CgMjdetior4 Reporo must,`be•filed'by the registered-weld-driiler within'30 da F r ys of wedd•corrapletron - . .'_F't'. .`BOARD=bE'HEALYIi COPY=�,_ '. '. *'°.,•, . - '. . .. . . .....'.'> .' 'p='� Well Completion ,Report Codes Section-2 '-` 'Section 3 Section-4 Work Well Drilling Work Performed Type Method Performed Code- Well Type Code Drilling Method Code Decommission DC Cathodic Protection CTPR Air Hammer AH , Deepen - DP Domestic DMST Air Rotary, Ak, Hydrofracture HF Geoconstruction, GCON Auger- AG New Well NW Geothermal Closed'Loop GTCL .Cable Tool,, CT Repair RP' Geothermal Open'Loop GTOL Casing Advancement CA Replacement RE Industrial INDS Core CR Injection INJC Direct Push DP Irrigation IRRG Drive and Wash DW Monitoring MONT Dug DG , Public.Water Supply PBWS _ _ `Mud Rotary MR Recovery '� RCVR Reverse Rotary RR Test Wells TSTW Sonic SN Section.5 r Section`6 Overburden Casing Lithology Overburden Overburden Overburden Bedrock Type Thickness Name:. (OB)Code Color Color Code Bedrock Name (BR Code) Casing Type Code Thickness (NO CODE) ArlificialfFill AF Black BL Amphibolite AM Cerla-Lok CTL Schedule 5,- Boulders - B Bluish-Gray BG Basait- BS Fiberglass FBG Schedule 10 Clay CL Brown, BR ConglomeratelBreccia CG/BR Galvanized Pipe GLP Schedule 40 Coarse Sand` CS Dark Gray DG Diorite DI HDPE HDP Schedule 80 Cobbles C Greenish Gray GG Gabbro GB NSF Coated Steel NCS Schedule 160 Fine Sand FS Light Gray LG Gneiss GN PVC PVC SDR 13.5 Fine to Coarse Sande FCS Reddish Brown RB Granite. GR Stainless.Steel SST SDR 17 Gravel. G Yellowish Brown Y6 Limestone LS Steel STL SDR 21 Medium Sand MS Marble MA SDR 26 Organics _ 0 Quartzite QZ SDR 32.5 Sand&Gravel SG Rhyoli#e, RH SDR 40,. Silt SI Sandstone SS `_ 17# Silty Clay SICL Schist SC 19# Silty Sand SIS - w Shale SH Silty Sand&Gravel SISG Slate/Phyllite SUPH Till T # 'ii Pegmatite PM Section 7 ` Section 8 Section 10 ' ' - Annular Seal/Filter t Screen i Annular Seal/Filter ;Pack/Abandonment Purpose f:Method. Screen Type Code 1 Pack/Abandonment,. Material Code Purpose Code Method Code Carbon-Steel CST Bentonite Chips/Pellets BC Fill -FL Air Blow with Drill Stem AB Continuous Wire PVC CWP Bentonite Grout, BG Filter 'FT Air Lift AL Galvanized.Wire Wrapped, GWW Cement/Bentonite Grout CB Seal AS Bailing BL Perforated Pipe - PFP Concrete CT Constant Rate Pump CR Pre-pack PVC PPP Sand SD Variable Rate Pump VR Pre-pack Stainless PPS Native Material NM Slug SG Slotted PVC SLP ` Stainless Steel-Vee Wire SSV' Stainless Steel Well Point SSP " Section 12' Section-13 Pump Description Well Seal Pump=Description" Code Horsepower Surface Seal Type Type Code . 3 Wire-Variable Speed Submersible -3WVS. 112 20 Cement CM _ 2 Wire Vanable,Speed Submersible ' 2WVS 3/4 25 Cement/Bentonite CB 2 Wire Constant Speed Submersible- 2WSS 1 30 Concrete CT., 3 Wire Constant.Speed Submersible 3WSS 1 1/2 40 None NO Constant Speed Submersible Turbine CSST - 2 ;50 .,Variable Speed Submersible Turbine.'VSST. N 3 ' 60 4 Jet JET . '5 a.. -,75 Line Shaft Turbine LST 7 112 100 Centrifical *CENT 10• 125 } 15, 150 '200. any. i Y/ ° 38 . a5-3 N � J (0( t � • o e � s t� GorMERM�L 39 l00 r A PL WAY DONALD J,. ::...: SMITH NO.31380 ate` D s j ?. ,; "LAN 0. SMITH A;SSOC I ATES ' SUAVIEYONS•. INC.