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HomeMy WebLinkAbout0142 BOG ROAD - Health �142 Bog Read Marstons Mills A = 045 017004 + Z TOWN OF BARNSTABLE _ LOCATION y I. 6O�Z tf SEW # �Z 00-7. — ;°42 iVILLAG ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. T_ if, 44 �o SEPTIC TANK CAPACITY LEACHING FACILITY: (size) ���� 30 X ,3- NO.OF BEDROOMS_ BUILDER OR OWNER PERMIT DATE: COMPLIANCE D ATE. Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by Lu✓^rr5 GCS � 330" .20, 3 ay;' -ar i ENVIROTECHLABORATORIES,INC. MA CERT.NO.:M-MA 063 449 Rte. 130 Sandwich, MA 02563 508(888-6460) 1-800-339-6460 FAX(908)888-6446 CLIENT. Joe Vaughn LOCAT"r,ON: 142 Bog Road ADDRESS: c/o DA Scannell Barnstable MA COLLECTED BY: DA Scannell SAMPLE DATE: 11/6/2002/ 11/8/2002* SAMPLE TIME. 9:OOAM WATER SAMPLE TYPE., New Well DATE RECEIVED: 11/6/2002/ 11/8/2002* LAB I.D. #. 0211082/0211118* WELL SPECS.: 4"/33' RESULTS OF ANALYSIS: Parameters Units Recommended Results Method Date Analyzed Limits Coliform bacteria /100ml 0 0 9222 B 11/6/2002 pH pH units 6.5-8.5 6.60 4500 H+ 11/6/2002 Conductance umhos/cm 500 82 120.1 11/6/2002 Nitrate-N mg/L 10.0 < 0.01 300.0 11/6/2002 Nitrite-N mg/L 1.00 < 0.004 300.0 11/6/2002 Sodium mg/L 20.0 7.2 200.7 11/6/2002 Iron mg/L 0.3 0.2 200.7 11/6/2002 Manganese mg/L 0.05 0.339 200.7 11/6/2002 Volatile Organics* ug/L See report. None Detected. EPA 524.2 11/18/2002 *Sample Taken COMMENTS: Manganese is not a health hazard, but may cause staining and/or give water an odor or taste. WATER MEETS EPA STANDARDS AND IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. <=less than Date_ZL2L,d >=greater than tborato nald J. S TNTC=too numerous to count Di ctor i F R.I. Analytical Specialists in Environmental Services CERTIFICATE OF ANALYSIS Envirotech Laboratories, Inc. Date Received: 11/12/02 Attn: Mr. Ron Saari Date Reported: 11/19/02 449 Route 130 P.O. #: Sandwich, MA 02563 Work Order #: 0211-14976 DESCRIPTION: SCANNELL (ONE DRINKING WATER SAMPLE) Subject sample(s) has/have been analyzed by our laboratory with the attached results. Reference: All parameters were analyzed by U.S. EPA approved methodologies. The specific methodologies are listed in the methods column of the Certificate Of Analysis. Data qualifiers (if present) are explained in full at the end of a given sample's analytical results. Certification #: RI-033, MA-RI015, CT-PH-0508, ME-RIO15 NH-253700 A & B, USDA S-41844, NY-11726 If you have any st' s re rding this work, or if we may be of further assistance, please contact us. Approved b Paul err tti Da t Re orting M ager e C ain of stody 41 Illinois Avenue,Warwick, RI 02888 131 Coolid;.::Street, Bldg 2, Hudson, MA 01749 Tel:(401) 737-8500 Fax: (401) 738-1970 Tel: 56870041 Fax: (978) 568-0078 Page 2 of 3 R.I. Analytical Laboratories, Inc. CERTIFICATE OF ANALYSIS Envirotech Laboratories, Inc. Date Received: 11/12/02 Approved by- Work Order# 02 1 1-14976 I. Anal Sample#: 001 SAMPLE DESCRIPTION: 0211118 142 BOG ROAD BARNSTABL ZAB1 08/ SAMPLE DET. ANALYZED PARAMETER RESULTS LIMIT UNITS METHOD DATE/TIME ANALYST Volatile Organic Compounds Bromodichloromethane <0.5 0.5 ug/I EPA 524.2 11/18/02 19:19 NPV Bromoform <0.5 0.5 ug/l EPA 524.2 11/18/02 19:19 NPV Dibromochloromethane <0.5 0.5 ug/l EPA 524.2 11/18/02 19:19 NPV Chloroform <0.5 0.5 ug/1 EPA 524.2 11/18/02 19:19 NPV 1,2-Dibromoethane(EDB) <0.5 0.5 ug/1 EPA 524.2 11/18/02 19:19 NPV Benzene <0.5 0.5 ug/I EPA 524.2 11/18/02 19:19 NPV Carbon Tetrachloride <0.5 0.5 ug/1 EPA 524.2 11/18/02 19:19 NPV 1,2-Dichloroethane <0.5 0.5 ug/1 EPA 524.2 11/18/02 19:19 NPV Trichloroethene <0.5 0.5 ug/I EPA 524.2 11/18/02 19:19 NPV 1,4-Dichlorobenzene <0.5 0.5 ug/I EPA 524.2 11/18/02 19:19 NPV 1,1-Dichloroethane <0.5 0.5 ug/l EPA 524.2 11/18/02 19:19 NPV 1,1,1-Trichloroethane <0.5 0.5 ug/I EPA 524.2 11/18/02 19:19 NPV Vinyl Chloride <0.5 0.5 ug/I EPA 524.2 11/18/02 19:19 NPV Bromobenzene <0.5 0.5 ug/1 EPA 524.2 11/18/02 19:19 NPV Bromomethane <0.5 0.5 ug/1 EPA 524.2 11/18/02 19:19 NPV Chlorobenzene <0.5 0.5 ug/I EPA 524.2 11/18/02 19:19 NPV Chloroethane <0.5 0.5 ug/l EPA 524.2 11/18/02 19:19 NPV Chloromethane <0.5 0.5 ug/l EPA 524.2 11/18/02 19:19 NPV 2-Chlorotoluene <0.5 0.5 ug/I EPA 524.2 11/18/02 19:19 NPV 4-Chlorotoluene <0.5 0.5 ug/1 EPA 524.2 11/18/02 19:19 NPV Dibromomethane <0.5 0.5 ug/I EPA 524.2 11/18/02 19:19 NPV 1,3-Dichlorobenzene <0.5 0.5 ug/I EPA 524.2 1V1.8/02 !Q•19 'NPV 1,2-Dichlorobenzene <0.5 0.5 ug/l EPA 524.2 11/18/02 19:19 NPV trans-1,2-Dichloroethene <0.5 0.5 ug/I EPA 524.2 11/18/02 19:19 NPV cis-1,2-Dichloroethene <0.5 0.5 ug/I EPA 524.2 11/18/02 19:19 NPV Methylene Chloride <0.5 0.5 ug/I EPA 524.2 11/18/02 19:19 NPV 1,1-Dichloroethene <0.5 0.5 ug/I EPA 524.2 11/18/02 19:19 NPV 1,1-Dichloropropene <0.5 0.5 ug/I EPA 524.2 11/18!02 19:19 NPV 1,2-Dichloropropane <0.5 0.5 ug/l EPA 524.2 11/18/02 19:19 NPV 1,3-Dichloropropane <0.5 0.5 ug/I EPA 524.2 11/18/02 19:19 NPV cis-1,3-Dichloropropene <0.5 0.5 ug/I EPA 524.2 11/18/02 19:19 NPV 2,2-Dichloropropane <0.5 0.5 ug/1 EPA 524.2 11/18/02 19:19 NPV Ethylbenzene <0.5 0.5 ug/I EPA 524.2 11/18/02 19:19 NPV Styrene <0.5 0.5 ug/I EPA 524.2 11/18/02 19:19 NPV 1,1,2-Trichloroethane <0.5 0.5 ug/l EPA 524.2 11/18/02 19:19 NPV 1,1.1.2-Tetrachloroethane <0.5 0.5 ug/1 EPA 524.2 11/18/02 19:19 NPV 1,1,2,2=fetrachloroethane <0.5 0.5 ugil EPA 524.2 11/18/02 19:19 NPV Tetrachloroethene <0.5 0.5 ug/l EPA 524.2 11/18/02 19:19 NPV 4 Page 3 of 3 R.I. Analytical Laboratories, Inc. CERTIFICATE OF ANALYSIS Envirotech Laboratories, Inc. Date Received: 11/12/02 Approved by: Work Order# 0211-14976 Anal tical Sample#: 001 0211118 142 BOG ROAD BARNSTABL GRAB 0 SAMPLE DET. ANALYZED PARAMETER RESULTS LIMIT UNITS METHOD DATE/TIME ANALYST 1,^•,3 T i h!ar p:oi�. <0.5 0.5 u,/I. EPA 524.2 11/18/02 19:19 NPV Toluene <0.5 0.5 ug/l EPA 524.2 11/18/02 19:19 NPV Xylenes <0.5 0.5 ug/I EPA 524.2 11/18/02 19:19 NPV 1,2-Dibromo-3-Chloropropane <0.5 0.5 ug/I EPA 524.2 11/18/02 19:19 NPV Bromochloromethane <0.5 0.5 ug/I EPA 524.2 11/18/02 19:19 NPV n-Burylbenzene <0.5 0.5 ug/l EPA 524.2 11/18/02 19:19 NPV Dichlorodifluoromethane <0.5 0.5 ug/I EPA 524.2 11/18/02 19:19 NPV Trichlorofluoromethane <0.5 0.5 ug/I EPA 524.2 11/18/02 19:19 NPV Hexachlorobutadiene <0.5 0.5 ug/I EPA 524.2 11/18/02 19:19 NPV Isopropylbenzene <0.5 0.5 ug/I EPA 524.2 11/18/02 19:19 NPV p-Isopropyltoluene <0.5 0.5 ug/I EPA 524.2 11/18/02 19:19 NPV Naphthalene <0.5 0.5 ug/I EPA 524.2 11/18/02 19:19 NPV n-Propylbenzene <0.5 0.5 ug/I EPA 524.2 11/18/02 19:19 NPV sec-Burylbenzene <0.5 0.5 ug/l EPA 524.2 11/18/02 19:19 NPV tert-Burylbenzene <0.5 0.5 ug/I EPA 524.2 11/18/02 19:19 NPV 1,2,3-Trichlorobenzene <0.5 0.5 ug/I EPA 524.2 11/18/02 19:19 NPV 1,2,4-Trichlorobenzene <0.5 0.5 ug/l EPA 524.2 11/18/02 19:19 NPV 1,2,4-Trimethylbenzene <0.5 0.5 ug/l EPA 524.2 11/18/02 19:19 NPV 1,3,5-Trimethylbenzene <0.5 0.5 ug/I EPA 524.2 11/18/02 19:19 NPV Methyl Tertiary Butyl Ether <1 1 ug/I EPA 524.2 11/18/02 19:19 NPV n-Hexane <to 10 ug/l EPA 524.2 11/18/02 19:19 NPV SURROGATES RANGE EPA 524.2 11/18/02 19:19 NPV 4-Bromofluorobenzene 119 80-120% EPA 524.2 11/18/02 19:19 NPV 1,2-Dichlorobenzene-d4 113 80-120% EPA 524.2 1V!8/!32 19:19 NP%, Department of Environmental Management��_,,V/4Massachusetts Office of Water Resources 114381 TYPE OR PRINT ONLY Well Completion Report o:�V V 1.WELL LOCATION GPS (OPTIONAL) LATITUDE W LONGITUDE 1yQ %6 G Rd oP UCA(,Aq �Address at Well Location: Property.. _ Subdivision Name: Mailing Address: 3 G.,L 'I Cityfrown:/`''" t� S rlr�; rum CitylTown: 5 u. 4.;<< ^1 .Assessors Map Assessors Lot#: NOTE: Assessors Map and Lot # mandatory if no,street address available Board of Health permit'obtained: Yes 12r Not Required ❑ Permit Number Date,Issued 2.WORK PERFORMED 3. PROPOSED USE 4.DRILLING METHOD v New Well ❑ Abandon E975omestic ❑ Irrigation o ❑ Cable R. 4 , `[E,Auger ❑ Deepen ❑ Recondition ❑ Monitoring El Municipal. ❑ Air Hammer— ❑ Direct Push ❑ 'Replace ❑ Other ❑ Industrial ❑ Other ❑ MudiRota ❑ Other 5. WELL LOG Unconsolidated _ Consolidated 6.SITE SKETCH (use permanent landmarks with distances) W Permeability T From (ft) To(ft) High Low W ( m Other Rock Type `'' p rr j,. D N ie - D s E APR 1 7 2003 h ' TOWN OF BARNSTABLE HEALTH DEPT. 7. WELL CONSTRUCTION 8. CASING , Total Depth Drilled �� From (ft) To (ft) Casing Type and Material Size.O.D. (in) Well Seal Type Date Drillin Complete //AS °� 9. SCREEN From (h) To (ft) Slot Size Screen Type and Material Screen Diameter 10."FILTER PACK/GROUT 1 ABANDONMENT MATERIAL 11. ADDITIONAL WELL INFORMATION � ti ' Developed? El Yes ❑ No From (ft) To (ft) Material Descriptio6<� Purpose Fracture ` Y Enhancement? ❑ Yes ❑ No Method Disinfected? ❑ Yes ❑ No 12.WELL TEST DATA(PRODUCTION WELLS) 13.STATIC WATER LEVEL(ALL WELLS) Yield `,,Time Pumped Drawdown to Time Recovery to Depth Below Date Method (GPM (his-&'min) (Ft. BGS) (hrs & min) (Ft. BGS) Date Measured Ground Surface (FT) f �. !\ � 14.PERMANENT PUMP(IF AVAILABLE) .NAMEIADDRESS OF PUMP INSTALLATION COMPANY Pump Description Horsepower �� S'a Pump Intake Depth 01� (ft) Nominal Pump Capacity (gpm) 16. COMMENTS 17.WELL DRILLER'S STATEMENT IThis well was drilled and/or abandoned under my supervision, according to applicable rules and regulations, and this report is complete and correct to the best of my.knowledge. Driller: ✓% +`' r Supervising Driller Signature: ' e Vie" A s � ��t l , p g g / Registration #: 'Firm: �/r` ` '.s �� w /l /ii, l�-1 Date: /f1�3�°� Rig-Permit#: NOTE: Well Completion Reports must be filed by the registered well duller within 30 days of well completion :-4♦. b y .. ♦.f t.. t t ♦ 4 •..; • t t , y 4 . i♦1 i s -. i t i t k t� _ f t tT S 4 L i 1 S.: u� Q�`� ' _' Fee-- ---------- No. -- BOARD OF HEALTH TOWN OF BARNSTABLE Zipplication-*rVell Con5truct ion Permit Application is hereby made for a permit to Construct A), Alter ( ), or Repair ( )an individual Well at: lam(306 ✓?J r1 AA — — -- C Location — Address Assessors Map and Parcel Owner Address lticl l �� _p°_1�2 _ �/6p 1k_ a< ©d a q — - - - Installer — Drill r— Address Type of Building Dwelling Other - Type of Building-- ----- No. of Persons------------ ---- Type of Well y tr -- Capacity -------------- Purpose of Well--- p01'`S n`L_—wu 7t E/ -- 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 oj Compliance has been issued by the Board of Health. Signed - — -�— — — dat Application Approved By O at Application Disapproved for the following 4s/ons: --- ---------- - ------------ -- — �— / —_ date -- .. Permit No. ---- Issued--- - -- — ---- A9 date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed (L-J, Altered ( ), or Repaired ( ) ® Installer at oG i2J t _�� has been installed in accordance with the provisions of the Town of Barnstable Board of Healt rivate Well Protection Regulation as described in the application for Well Construction Permit NoU& Dated---- --- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE---- - — Inspector----- ---------_�__--_--_____-- 1�ao� No.------------------ BOARD OF HEALTH � ....; � Fee--J-------------- TOWN OF BARNSTABLE " Application forlVell Con0ructionPermit .Application is hereby made for a permit to Construct OV Alter( ), or Repair ( )an individual Well at: •-_(306 R J M NI _ — — Location — Address Assessors Map and Parcel �, 11 f t, ro,x, — — -- —---AA C, _-- Owner Address — P. EWf)�t P°-" °x -9�0 /.t-s - Installer — Driller -- Address — `' Type of Building e Dwelling �""S --- -- ------- Other - Type of Building-- -- No. of Persons-- -- -- -- '` _ -_ Type of Well L+ --- - Capacity---------------------__ Purpose of Well-0"'S wu E� 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 o Compliance has been issued by the Board of Health. / -L.µ-A �u Signed - ---- ---- — - — d. Application Approved Byat Application Disapproved for the following r sons: --------- ---------- — date — Permit No. Issued — - - -- - ------ date BOARD OF HEALTH TOWN OF BARNSTABLE ; C ertif irate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ✓J, Altered ( ), or Repaired ( ) by--- ���^�!���-- ------------- ----------- _ __ _ Installer — a t--/Y d /3 u G i2<t L"&-S ------- ----- has been installed in accordance with the provisions of the Town of Barnstable Board of Healt rivate Well Protection Regulation as.described in the application for Well Construction Permit No.V�!-I-�O� - IDated---- -------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE ==__-- - Inspector--_------ __-----------—-- -00 BOARD OF HEALTH ` vv TOWN OF BARNSTABLE j Veil Con5tructiouPermit .��� D No. --t-T-,- — Fee- ---------- Permission is hereby granted —___--_— to Construct ( I ), Alter ( ), or Repair ( ) an Individual Well at: No. /tl,) . Q ofo /(') ---- -- ' Street as shown n e p li)ation fo/r' ell Construction Permit /? ��� . No.- Dated -� ------------------------ - --- -- - V Boa of Health DATE114110�, —_ i 4 Z TOWN OF BARNSTABLE LOCATION O�9 ��/I SEWAGE # 0�00*7' _ lO VILLAGE Ve-1-1>o-5 / t'llf ASSESSOR'S MAP & LOT 4 2 INSTALLER'S NAME&PHONE NO. T. C. 44, 1740 SEPTIC TANK CAPACITY Iraa� LEACHING FACILITY: (type) U (size) fG'',V 30 X o r .NO.OF BEDROOMS — BUILDER OR OWNER` e t ,g, a —Cr yo!-N. i PERMIT DATE: S — 7' 03 COMPLIANCE DATE:_�II D 3 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If zany wells exist on site or within 200 feet of leaching facility) 179 Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by Gam✓ � �� �(v s h 3.•0' .2 0 3 .v a ya�' 31a 2�f - _ a. No. `-1 a;�— 01- " FEE too l o d COMMONWEALTH OF MASSACHUSETTS Board of Health, &U(ULStzJVr-f` , MA. APPLICATION FOP DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct((4,'Kepair( ) Upgrade( ) Abandon( ) - S01fo—mplete System ❑Individual Components Location ILIA 806- RO A MjLt� Owner's Name SC-0-Tt fV1 tq" Map/Parcel# !S >7- / Address Lot# Telephone# Installer's Name ' Designer's Name A wlGr-e- �uvt,� (* , -go q ,q Address C ' Address y0 v ld/ZSlY1s Telephone# �j Telephone# 505r-- q q Type of Building a` C�" SI k4' {' � _'� Lyry Lot Size �3 j / 1 sq.ft. Dwelling-No.of Bedrooms Garbage grinder Other-Type of Building No.of persons ,;)— Showers( j,Cafeteria ( ) Other Fixtures ^�^� �7 Design Flow (min.required) J J® gpd Calculated design flow J 3 0 Design flow provided gpd Plan: Date 10'7— 0 Number of sheets Revision Date Title S t-fe Description of Soil(s) S e-e Soil Evaluator Form No. O Z/� Name of Soil Evaluato PtJG •m�Tilate of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned es to' tall the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees t to la th ation until a Certificate of��Co�Egliaance has been issued by the Board of Health. Signed Date /f ®d�- Inspectio FEE 1 0 �:' 06 Board of Health, /�►S�f-�b!� MA 'APPL 'CATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT - , ' Application for a'Permit to Construct(4o)0Repair( ) Upgrade( ) Abandon( ) - &Complete System ❑Individual Components ^. t ,. A Location/ 06- RO A tIAKSTM MI U.S Owner's Name SCv l I-fir Mq Alley ' Map/Parcel#, /7" 'y Address ,j Lot# Telephone# r Installer's Name Designer's Name �,tc35 g ,4 n(Ct e. �wi Cups c?`�n Address S -1 p Address//p 0% Ap.tTaw� mu,r Telephone# //^^ Telephone# S'©8r.- ZA8 OS Type of Building ' ' V�'' S'�Nc7)'F' tG (.tiQ i/ Lot Size �3 7 / / q.ft. j Dwelling-No.of Bedrooms 3 l Garbage grinder t No.of persons Showers Cafeteria Otlier-Type of_Building (_) Other Fixtures � Design Flow(min.required) 33 0 gpd Calculated design flow -3^J 0 Design flow provided gpd Plan: Date 10 -7— Q Number of sheets Revision Date �`- Title $ 1,9e 'j` S to/Fri Ir.. fO LI4 JV ',,Description of Soil(s) 4-14 A+ Soil Evaluator Form No:' ' t Q Name of Soil Evaluato N«3` I't��A �/» gate of Evaluation I�' DESCRIPTION OF REPAIRS OR ALTERATIONS ,The uridersigried a es toistall the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to/ t to la a th to •oper`ation,until a Certificate of Co pli/ance has been issued by the Board of Health. Signed Date - •4 0a.L, O No., f�!5(co- FEE Board of Health, MA. CERTIFICATE OF COMPLIANCE Description of Work: ❑Individual Component(s). r omplete System The undersigned hereby certify that the Sewage Disposal System; Constructed ,-,Repaired ( ),Upgraded ( ),Abandoned ( ) ,has been installed in accordance with the rovisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No.�QCQ-S('c-) , dated I�a 5 ^ya-- Approved Design Flow 33S (gpd) i Installer // t ( t Designer.\M,.KLrJyfuQl dy\,%SG4.44 Inspetor, �.1, ) Date: W3 I The issua/ce of'this permit shall not bej,e{{�c or bme'ddas a guarantee that the system will function as designed. No0 S6a FEE I 00 , 00 COMMONWEALTH OF MASSACHUSETTS � Board of Health, /4 a-f Vot ,. .. ., DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct((„f)/Repair( ) Upgrade( ) Abandon( ) an indi�ddual sewage disposal system at lif CY AO&- as described in the application for Disposal System Constru-;xion Permit No.�20QA7W dated Provided: Construction shall be completed within three years of the date of this permit. All local conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Bostor,MA Date I a Oa- Board of Health 0 r THE ANTIDOTE FOR CMUZATION Massachusetts Department of Environmental Management � - Office of Water Resources 114374 TYPE OR PRINT ONLY Well Completion Report ,1.WELL LOCATION GPS(OPTIONAL) LATITUDE _ LONGITUDE Address at Well Location: Property Owner- /)Out 4r- tu'71 Subdivision Name: Y Mailing Address: s4 r1` ��- /1,'S t CitylTown: nauis�o-�.S n,: City/Town: Ce.,7r•+���1- M.� oft 3 �� r r Assessors Map. Assessors Lot#: NOTE:-Assessors Map and Lot# mandatory if no t eet•address available permit obtained: � Yes �� `Board of Health sued' p �t Not Required ❑ Permit Number Date�ls �� 2.WORK PERFORMED 3. PROPOSED USE 4. DRILLING METHOD - Y New Well 4; El Abandon Domestic El Irrigation El Cable a,>Auger l ❑ Deepen El Recondition ❑ Monitoring ❑ Municipal ❑ Air Hammer'°,;Q Direct Push ❑ Re'lace ❑ Other, ❑ Industrial ❑ Other ❑ Muds Rota V� ❑ Other 5.WELL LOG Unconsolidated Consolidated 6."SITE SKETCH(use permanent landmarks with distances)A W Permeability y i Q CIS_ N N F- From (ft) To (ft) Hi h Low � U) o m Other Rock Type D S3 ✓ v ✓ 14, ' ` 4 APp 1 7 2003 TOWN OF BARi�ST HEALTH pEPTABLE 7 WELL CONSTRUCTION 8.CASING Size O.D. (in) Well Seal'T e `6tal Depth Drilled S}. ` From ML .To (ft) Casing Type and Material (' ) yp Date D1illin Complete o S? ,' ,�;�'�C Y �� , �i 9 SCREENFrom (ft) To (ft) Slot Size Screen-Type and Material Screen Diameter o 93 10.FILTER PACK/GROUT/ABANDONMENT-,MATERIAL, 11.. ADDITIONAL WELL INFORMATION N Developed? ❑_ Yes ❑ No From (ft) To (ft) Material Description"-,:7 Purpose Fracture Enhancement?. ❑ Yes ❑ No Method Disinfected? ❑ Yes ❑-No 12.WELL TEST DATA(PRODUCTION'.WELLS) 13. STATIC WATER VEL.(ALL WELLS) Yield_:Time Pumped Drawdown to . Time Recovery to DepthiBelow Date Method (GPM) (hrs`&min) (Ft. BGS) __(hrs & min) (R. BGS) Date Measured Ground Surface (FT) �+'"'••,, ,� is r �,70 7 /4. O �� 14. PERMANENT PUMP(IF AVAILABLE) 15.NAMEIADDRESS-OF PUMP INSTALLATION COMPANY Pump Descriptions Horsepower Purri,p Intake Depth ' - '(ft) Nominal Pump Capacity (gpm) 16. COMMENTS ti.\ 17.:WELL DRILLER'S STATEMENT This well was drilled and/or abandoned-under my supervision, according to applicable rules _4 and regulations, and thi. report is c mp to and correct'to the best of my knowledge. 4, s J Driller: o � t� Supervising Driller Signature Registration #:� Firm: � "� ` �( Date: Rig Ri Permit#: L I`� NOTE: Well Completion Reports must be filed by the registered well driller within 30 days of well completion. x; r s*� >•-., },�x r=f e r- � ;-. BOARD OF•:HEALTH CDPX,�, ,; �',.<� k�� < � -;-� r-''< f >.., c Q- a f...i i k .. �♦ £�c .},4 h C i •[ 3 4 . .'} - s. 2 S t T}c q [ t' i t £T 1 . l 4 i{ - Hoc `\ L OF 44.2 2 Bill' SITE & SEPTIC PLAN - LOCATED A7` BOG- -- LOCATED1442 BOG ROAD l MARSTONS MILLS, MA. � �IrAce Lad Q ' r PREPARED FOR \` s7.r ?COTT MAN LE'Y �' s OCTOBER 7 2002 + ,+� od V4CANp, L0T 9c��"'R�fs 'S+a�; ray l¢ ZLOG U pAuL .��^L�A. � � vER � 6B.3 i 01p p1 17 \\ \ LOCUS MAP DRIVE A'AY tp /2 + pLAN REF. PLANBOOK 453 PC 50 CAR RES- ZONE. RF- { SLAB Pro -_ �----- �� A.M. 45/17—4 C \ s.,: I � '���' AREA=43, 799f S.F. _ - a. �_,y � s 55-4�� , Ste` _ _ Q + y463 i 5 L :- 11TON e 0 R0D \,. �ilyllo YANKEE SURVEY GONSULTAN75 BENC.YAIARC c \ + S3 —_ h UNIT !, 40B INDUSTRY ROAD 3 +x �\ \ I �L! ------- P.O. BOX 265 STAKE EL= 54.3 22"�C' - \ V AIARSMNS MILLS. MASS. 02648 s \ iTEL. 5 FAX 420-5653 - - 7-0ABlU7TING.WELL SCALE ! _ 30 FEET NOTE NO SEPTIC WITHIN 150 FEET OF WELL �\+ SHEET I OF 2 JOB NUMBER-_ 53227_____- M1 1, C - `\ TOP OF BOG ` EL. = 44.2 SITE & SEPTIC PLAN LOCATED AT. z P 42 BOG ROAD - - '-- 44 - MARSTONS MILLS, MA. PREPARED FOR.- \ o ' RACE LNE SCO TT MANLEY \1�___ 46 OCTOBER 7 2002 \\ REV OCTOBER 16 2002 REV NO VEMBER 5, 2002 •loo. 56.2�\ U1gC�gNT LO �9`�,",�, LtN /c sT h 31 o 8 / e3 BRU G , S LOC 0CE 1B 10 0� / " US cy MURPHY = IVER No. 749 STER / 70 4 4 \ s�Z � \ DTP #1 �17 \\ ��• ,,,• � AR��� tv \ 21 LOCUS MAP 55 g \ \ 4\\ 8.0 o =\ w4 \® 1`.b 3RBEDSED NC~ \� -- - i�// ��/ `` S PLAN REF PLANBOOK 453 PG.50 T.O.F. �P #2 \` i sT EL= 58%/ _ 5 QQ PC,' '. j RES. ZONE : ..RF,.. �o'\ A. 45 17—4 o M.% 6,0 AREA=43, 799f S. F \4PA 63�el'AA \ IVE wA, 24.0 54. 7 �' R D BENCHMARK \ _——- _m 1DROPOSED o i YANKEE SURVEY CONSULTANTS STAKE EL= 54.3 \\ `� \� r� S`31 WELL -- ---J UNIT 1, 40B INDUSTRY ROAD �`'\ \ V `� P.0. BOX 265 MARSTONS MILLS, MASS. 02648 TEL• 428-0055 FAX 420-5553 . 40, <\ �� _ 150' \\ - TO ABUTTING WELL / SCALE 1 = 30 FEET \ NOTETHE KNOLL (EL 5B) /N FRONT OF THE HOUSE\\ \\\ NOTE• NO SEPTIC WITHIN 150 FEET OF WELL 70 BE RE—GRADED 770 ELEV.= 56' \ �.' SHEET I OF 2 JOB NUMBER _ 53227M i EL. _ TOP OF FYJUNDATION 20' MIN. 10' MIN. CONCRETE COVERS 4" SCHEDULE 40 P. VC 2 LA YER OF MIN. PITCH 1/8 PER FT. 1/8"-1/2" CONCRETE COVER WASHED STONE 6" MAX . ,6" MAXI / / / " � 4" CAST IRON PIPE r PITCH EQ/4 j MINIMUM I U » CLEAN SAND 9 FT MIN. PIPE PITCH 1/16" PER FT.= 0.005 MIN. FLOW LINE Q EL=53.0' INVERT 1 10" 14" _ MIN. EL.= 55 0�-- INVERT `2.0'— 0 0 0 00 0 0 0 ° o ° LEVEL o� ° o ° o ° » o0 0 00 ° °O o0 BAFFLE� _ 54 25' IN 6 SUM o 0 0 °0 0 0 0 0 0 0 0 ()' 0 0 0 0 0 0 0: °0 0 0 INVERT EL.—___ INVERT o 0 o0 0 9 0 t 0 +0 0 � 0 8 ° o o 0 L.=52.0' EL.= 54.5' EL.= 53.0 _ EL.= 52. 75' (M BE PLACED ON FIRM BASE) DISTRIBUTION INVERT MECHANICALLY COMPACTED OR 6" OF STONE BOX EL.= 52 1500_GALLONS TO BE WATER TESTED . FIELD FORMATION SEPTIC TANK IF MORE THAN ONE OUTLET O PLACE ON 6" STONE 3/4" TO I—I/2" SOIL ABSORPTION PROFILE OF DOUBLE WASHED STO E SYSTE'M (SAS SEWAGE DISPOSAL SYSTEM LOW POINT IN BOG ROAD BETWEEN CRANBERRY BOGS EL =45.7 _ NOT TO SCALE TOP OF BOG EL = 44.2 OBSERVATION HOLE 1 ELEV.__ 4_9.5 OBSERVED WATER TABLE (9111102) ELEV.= 42.0 PERCOLATION RATE _ MIN./ INCH AT _24-_ INCHES OBSERVATION HOLE 2 ELEV.=_ 5_0.1 DEPTH HORIZ TEXTURE COLOR MOTT OTHER DEPTH HORIZ TEXTURE COLOR MO TT. OTHER 0-12" B LOAMY SAND IOYR 4-3 0-36" B LOAMY SAND IOYR 4- 12"-60" Cl MEDD, SAND IOYR 6-6 36"-120 ' Cl MED. SAND IOYR 6- 60"-126 ' C2 MEDIUM IOYR 8-2 GENERAL NOTES WHITE SAND 1) ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO R E.P. TOP SOIL HAD BEEN STRIPPED FROM AREA TOP SOIL HAD BEEN STRIPPED FROM AREA TITLE 5 AND THE TOWN OF _&4RN_'TABLE____ RULES AND WATER ENCOUNTERED AT 7 5 FEET EL. = 42.0' WATER ENCO UNTERED AT 8.4 .FEET EL = 41. 7' REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 2) ONE COVER ON SEPTIC TANK SHALL BE BROUGHT TO SOIL TEST WITHIN 6" OF FINISHED GRADE, OTHERS WITHIN 12" DATE OF SOIL TEST 9111102 SOIL TEST DONE BY BRUCE G. MURPHY, R.S. 3) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN WITNESSED BY: DA VE STANTON 5 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE P#IOO42 DESIGN CALCULATIONS.• USED UNDER OR WITHIN 5 FT. OF DRIVES OR PARKING AREAS. 3 4) ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL NUMBER OF BEDROOMS . BE MORTERED IN PLACE. GARBAGE DISPOSAL NO 5) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH LEACH FIELD 30' X 16' X 6" TOTAL ESTIMATED FLOW F DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO INSTALL LEACH." 11 IELD IN MEDIUM ( 0--CAL/BR./DAY x 3--- BR.) 330 GAL/DA Y OBTAIN SUCH .DETERMINATION FROM APPROPRIATE AUTHORITY. HORIZON-- 5 STRIP OUT REQUIRED SEPTIC TANK CAPACITY 1500 GAL ) 6 UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCA VA TION CONTRACTOR MAY BE REQUIRED SOIL CLASSIFICATION . 1 IS TO CALL "DIG- SAFE" AT 1-800-322-4844 AT LEAST 72 HOURS DESIGN PERCOLATION RATE . . . . . < 2 MIN./IN. PRIOR TO COMMENCING WORK ON SITE. . 74 7) CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS EFFLUENT LOADING RATE . GAL/DA Y/S.F. SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. LEACHING CAPACITY (AREA X RATE) 355 GAL/DAY 8) PARCEL IS IN FLOOD ZONE___"C"_____. RESERVE LEACHING CAPACITY . 355 GAL/DAY 9) LOT IS SHOWN ON ASSESSORS MAP _45_ AS PARCEL _l 4 (30x16x. 74) = SHEET 2 OF 2 JOB NUMBER _ 53227M _____ �:4_GOLVlrLT1ES 3+r 16 Q{tySE__._: •\, - Y 12i4 a¢AelNc,--_ Y -1 it�CiCr- 1 I '2-as-taSLIC • __ _ 1%i SREaTZOIN ' n • it a9 A727fP.➢/A,tOI_.'-- i i� . • S/B'F.C-tn0 tirtrETPaGG I ' ' I _T'r 4.3'n]OS w/!L-IS rr.SSVL. SVB-FLOO=r"c-- A=A , -R�J9.IJSS�S-• - i .. ! _._ —___ _ ,DMA➢E¢S�EJLIG}_ .. I . I r - ' _ rt__ — -' — ----- ` 01 els,E.' I � 4 1 I - I -- IA 2:+ . t Ij{• OO '., 1 w�P0]P. 4B•.3re' j Ot i — L I ' ' le � SOFFIT_LiNF� V � �4� ve S_[RSPPJVS' -- 1 2.•.,o.'s..(CRSGD�- I •9l � _ 4 N� �I y2'SNEETO�GI✓_'__-- . 4428-619i I j rjl rl .e.o------ _ a'• ,n{ - 'o11.f11.1G 24 ryla'• m� 1 - 6-.6 ros'r- •_s A S-rL{DS' oAV - 0lS03/4^SVB_.FLOOZ'OrS.I.r4_FJ22:;ftT3O`.5T5e6/DF.C.6DSHEErROCK2:2V WALLS a CEUJNG o esigns ' 1 _ copyngi,t rI 2001 } 1' OI _,DiwSPPr<OOF.11.45._ All Rights I D QN \=t, �: - - I I Reserve0 . _1 a+� I s a»P�oPn ' - Yi j Fi�2Gli 1 i I ' _L- s•7HK.COIF SLAG -- i j' I•I ( j IV!6•'f r••X tC GA.W a1 I 1 i II 1 I'— - SEG1lOhi C-C-: 1 i i O 1 1 - }" `I Jj Qf P,7GLLH d 1 I I �y/ r� � I j I � _ • I g� Q 72 1 _�I[_eVT Preliminary Plans and layouts by DCD are for the use o1 their customers only Any ocher use R strictly Prohl Drte 1' - V - _ _ Ill