HomeMy WebLinkAbout0000 ANGELA WAY - Health 0 Angela Way
West Barnstable
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Massachusetts Water Resources Commission/Division of Water Resources
WATER WELL COMPLETION REPORT
WELL LOCATION
0
Address
City/Town tyeat Aflcjd��
G.S.Quadrangle Map
Grid Location
Owner
Address
,WELL USE CONSOLIDATED WELL
Domestic fv/P7/ Public❑ Industrial❑
Type of Water-bearing Rock
Other
Water-bearing Zones
METHOD DRILLED 1) From To
Rotary.(type) Cable❑ 2) From To
Other 3)From To
4) From To
CASING �r Depth to Bedrock
Length Z r� Diamete
Type 104/C UNCONSOLIDATED WELL
STATIC WATER LEVEL Water-bearing Materials
Feet below land surtace _ Sand: fine❑ medium❑ coarse❑
Date measured Gravel: fine❑ medium❑ coarse❑
Screen:
GRAVEL PACKW.ELL
Yes ❑ No ❑ Slot#t/�_length�-- -q—to
Split Screen(or 2nd screen)
WATER QyALITY TESTS MADE/ Slot* length from to
Chemical Biological r; Depth To Bedrock
PUMP TEST
Drawdown feet after pumping days hours at 4J2 GPM.
How measured Recovery feet after hours.
LOG of FORMATIONS COMMENTS:(On well or water)
Materials From To
DRILLER
Fir c
a
Address
City
Registration o.
A4
per.tor s ignature
ease print rirmly
1OM8/81.164843
i
No................_.....� ( / FEE..... '--
THE COMMONWEALTH OF MASSACHUSETTS'
BOARD OF HEALTH
_ .......................................... F..�7!.r4i!s7� 4-&.........................................
ApplirFa#ivaa for Dhipoii al Workii Towitrurtion Famit
Application is hereby made for a Permit to Construct ()(') or Repair (. ) an Individual Sewage Disposal
System at:
........SOT..:: ....._----- ... • ..._.... r!s -------- ----•..............•-----
Location-Address or Lot No.
ps_ M.. ��N -------------------- ----- z.r. �..... � ._.._.....-
owner Address
W
Installer Address
U Type of Building Size Lot___.4�Qt_P2Z..Sq. feet
�., Dwelling—No. of Bedrooms----AUI/Z.........................Expansion Attic ( ) Garbage Grinder ( )
'PL4_l Other—T e of Building No. of persons__-..__•____________________ Showers ( ) — Cafeteria ( )
Otherfixtures ------------------------------------------------------...-----------------------------------------------------------------------..........._......-•--
W Design Flow............./40.......................gallons per person per day. Total daily flow.......44.0......_..._._.......-....gallons.
WSeptic Tank—Liquid capacity/z _5o.gallons Length_ 0.r..__._.. Width...5........... Diameter................ Depth_.S--.
x Disposal Trench—No..................... Width.................... Total Length......._.___.-._.._. Total leaching area....................sq. ft.
Seepage Pit No.....2----------- Diameter---------8........ Depth below inlet...... Total leaching area...50.Z. ...sq. ft.
Z Other Distribution box (X) Dosing tank
aPercolation Test Results Performed by---------Xb.Y1_Z."ge FE 40.09._..__.... Date.....4_.1Z__& .........
Test Pit No. 1..<---2-._minutes per inch Depth of Test Pit-----4........ Depth to ground watery AXC..&V<VVN7ERC-0
fs, Test Pit No. 2................minutes per inch Depth of Test Pit.....)4._..._... Depth to ground water"_N6_.&450t/A)-rEPC'D
R+' •------•-•--•-----------•------------••---------------•----------------.........._-----------_------.........................................................
0 ;D�scription of Soil 1_.. ®7/ LO ¢ A-� Q ��....... Wf`vdwe!4-.....................
U -------------------------------•-------•------------ /
Z ---------------------------------------------------8-=.Z_4-...M.C.01---5s. #V49--..----•-•--------------------------------------•-------•-------------------------------------•-•-•----
UNature of Repairs or Alterations—Answer when applicable.........................:......................................................................
--------------•---------------------------------------•-------•-----------•------•-----.............••----•-----------------------------•---------------•-......--------••--------------------------.--•
Agreement:
The undersigned agrees to install the aforedescribed Individual S isposal Syst n accordance with
the provisions of'I E 5 of the State Sanitary Code— The undersi f zer agre of lace the s min
operation until a Certificate of Compliance s en is ed by t e boa i
Sign --- --- -- ---------------• --------------------------------
Date
Application Approved By----------- .------ -•.. .... ------ --- -------------- --_--
Date
Application Disapproved for th f flowing reasons----------------------------------------------------------------------------------=------------------------------
-----------------•------•------------
-------------------------------------•-------------------------•--•---•-.....-----------...•-------------••---•----•--•----------------•---•-•-------------•------
� r
PermitNo---------- -------------------------- --------------- Issued........................................................
Date,
No................-....... l FEB...........................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...................OF..... 7.!fB4 c.....-----......--••--•-----------------•
Appliration f0- ispaoul Works Tomuurtion amit
Application is hereby made. for a Permit to Construct ( x) or Repair ( ) an Individual Sewage Disposal
System at:
Location-Address _ or Lot No.
.......
Owner Address
W
Installer Address
Q Type of Building Size Lot_._.a�_4_/_6..Z__Sq. feet
U g— _..__Expansion Attic ( ) Garbage Grinder ( )Dwelling No. of Bedrooms.____fA._[�>�____________________
aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
Pa Other fixtures -----------------•----••------- -
W Design Flow............../!0.....................gallons per person per day. Total daily flow--____-_4.4`:4.........................gallons.
WSeptic Tank—Liquid capacity_/?._,�_Pgallons Length___/_P Width....5......... Diameter________________ Depth___. _f. r�
x Disposal Trench—No.____________________ Width....................
Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No-------2------------ Diameter.........8---_... Depth below inlet________________ Total leaching area____$Q_ __sq. ft.
Z' Other Distribution box ( .- ) Dosing tank ( ) //o S C-1cF'�eTi yr
'-' Percolation Test Results Performed by........... ......... Date......4'1Z_.,S.____._..
a
Test Pit No. 1---<... -__minutes per inch Depth of Test Pit------/I..._-____ Depth to ground water_r5to,vE_- ivC�unrigED
V4 Test Pit No. 2................minutes per inch Depth of Test Pit------ --------- Depth to ground water.�voNC-__6.�<CtIA)-r -'C-D
a ---------------------------------------------------------------
__-__-----------------•-•------•-__..---...:_----------•----••----------------•----•••-•-...
O Description of Soil ---< .......................[ . ir/-••...-•------•-•---------------- � .0 - % LcA�srf= �4
---------------------------------------------------- Cj?�t�i >A�16.7------------•--------------------------------••-------•-•------•-•---..._..-•---------•--•-----•-•----
U Nature of Repairs or Alterations—Answer when applicable.......................................:........:...............................................
----••--•-----------••------•--•--------------------------------- ----------------------------•••••---•--•---•-•--•-----------------•-•--•-------------•-•----------•---•-•--------._._........._...•---
Agreement:
The undersigned agrees to install the aforedescribed Individual S •sposal Systn accordance with
the provisions of TITLI 5 of the State Sanitary Code— The undersigl. f er agre of.to place the s�st_em in
operation until a Certificate of Compliance has been issued by the boar
$idnex � G"""°"'�—
g ...
Date
Application Approved By____________
--•--- ----............. ........................................
Date
Application Disapproved for th f o lowing reasons----------------•----------------------------------------------•----------------------------------------•-••-••--
..........................................-----...------------------•-----------------.....---------------•-•-` '==-•-------=----------------------------•-------••••---•--•-------------•-••-------
Permit No.........
_?.�:__---�-`�--/4 ... Issued Date
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD ..OF", HEALTH
..........................................OF.......................... - ....................................................
(Erdifitatr of Toutpliatta
THISIS Tq..CERTIFY Th the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by-•-------•--••••-•••_.__ r------......``` - e_�•K.. ------1................................................................................................
Installer
has been installed in accordance with the provisions of TIT" 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No......................................... dated---- ...........................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST UE® AS A GUARANTEE THAT THE
SYSTEM WILL FU CTION SATISFACTORY.
DATE................ 3 ------=------- Inspector:: 6 _ ....... ---•-•• •---
r
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
....................:.....................OF...--.....--.--...._.....__••--•----•-•--------....._....._...._................_..
No....... ..........•... FEE........................
irk n Uan rr�t�
Permission is hereby granted........... .... -•-_ •• --• ------ ---.
to Construct ( ) or Re it ( ) an Indiv•dual Sewage is oral S
1.
at No................. --- 111 ........ .t....--yst t�--zrc- � L... 7F�1---�`"�.
-•'• Street
as shown on the application for Disposal ��'orks Construction Perm>t No__ ______________ D ted___. _:.-._______----••4 ...
•----------------••--•••---•--• ............... -• ......•••-•--•.....----
DATE................ -•••-•-•••-------• --1
Board.of a It
FORM. 1255 HOB & WARREN. INC.. PUBLISHERS
T. s; t ,n tom- �3�,+. solo
FY
No. 1 NO. ZSITE PLAN
La.eM
/ 3
4
OF FOUNDATION El.; _-- / �„ �_�,4 5
•° /
°s ME F/-Es1
s.
• s -`1
°' — -- - -
°s !N Et ?�_-- +�:j • ' '� IAJ / � .✓2 ,t? CG[A,
-- A ELEl14
12 �
" E�ee_D/B W/ 6SUMP 9 . ToN r
13
6 LIQUID LEVEL _ - � ..
• C
y 1 ;, • . Q'�'F`- lit- a ' M tF F_' 15
- �NCGU/JYFLE/.7
�_ _, - . . . . ��2 ) ��o' x '_o•,�.�� , s�,, PE R C TEST RESULTS
PRECAST SEPTIC TANK WITH PERC RATF : .- <
CAST IN PLACE INLET AND EL 6o.g� °G !__�. __._.i.� _°� WHI'NESSL"n BY:
OUTLET T 'S PER TITLE Y , �5�-� •�T��c / ___._-___ } ; BOARD If HEALTH
' SIZE : G' Dn4 - i� Lo7 /T- 1/AcAj-r DATE
DUTCFT' BEA/EA �'fl +z.'SO
�sFMErVT Fro ,n; - ... - . ,• x � 4 �' T-_ram �- �_ ' _._ __} _
NCTE )trp,C /O'
s 1-5 TLC M �rpo EC FV4Tio-4 CO 9 �^,u� o x ---
RE►LifCE'
PROFILE 0F PROPOSED SEWAGE SYSTEM
SYSTEM DES16NED EY THE TBWN OF REGULATIONS AND
STATE TITLE Y E #Ui SUBSURFACE DISPOSAL OF SEWAGE . SCALE 1/4"= 1 0 " soo215,
N . B .
1. ALL PIPES SHALL BE SCHEDULE 40 P.Y.C. SEWER PIPE
2. ALL PIPES SHALL BE SLIPEB 1/4~ PER FOOT EXCEPT FOR �s8 6ofi
THE FIRST 2 FEET OUT OF THE 0/9 WHICH SMALL BE LEVEL K • a
3. DES16N FLOW --- '.-- BEOROOWS AT 111 GALDAY PER BR. may=- 6AL/DAY ; ,
SEPTIC TANK SIZE _ �. �.� X •� �:� GAL.
USE B At, W GARBAGE DISPOSAL ,
LEACHING SYSTEM . USE T f' !2' , - r, L$4. x at OV
p!T 4.. / a O"p! j trr��& ACC_ i•r s:.. k
7
h 7-1/ 6g.J ,gg 1
EFFECTIVE AREA: SIDE %� 77- d �. , � = ,c�15 �.� L � �� 3 �,
BOTTOM zI"� k x /. o > ,�� cAt �a� 7-7 .
LFAcN n
74
a TOTAL FLOW
_ y
TOTAL RE4 0 FLOW X W/ 6ARQA6E DISPOSAL
I RESERVE FLOW GAL/DAY
- 77/ B'
i REFERENCE PLANS : _ 00
k TN
29
11
APPROVED BY
_._ ______. _________ _________ _______ __ �F • - BOARD OF HEALTH f `��Y • =40"
DATE
PROPERTY OWNER I T E A I� S"' E '�/ ' � l F PLAN
- --`--: _�-E 'd •— -____--------- �- µ i�-, L ....__� � lei� . J >�A�k F .` .f�- Tj'
S 4 BiONOOI� SINGLE FAMILY DWELLING
— o `"G
RJM �T ` .
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f , 9LOT
#k 245 i_ COAT E 4- z.5 gf`
s � °"A` " - - 11 YLE AAASSOCIATES FALMOUTH , MASS.
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