HomeMy WebLinkAbout0211 CAPES TRAIL - Health 211 CAPE TRAIL, W. BARNSTABLE
A =088 008.008
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No. Fee------� ---------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Application-*rVer[ Congtruct ion Permit
2ll�'�4f� O>tL
Applicatio is hereb ma a for a permit to Construct (,Io� Alter ( ), or Repair ( )an individual Well at:
Location — Address Assessors Map and Parcel
Owner — Address
------------Z)= ---��---E%/D � it ------------- -- ' - .Pr�.�, ----------------------
Installer — Driller Address
Type of Building
Dwellin �fel�i�Y�------------
Other - Type
of Building---------------------------- No. of Persons----------------------------
Type of Well--1"��!-7_ir- ------- 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 Certificate.of Compliance has been issued by the Board of Health.
Signed - -- � �- - -ee ---
Q' _ - date
Application Approved L ! -'w� -- — ` e-�- -
date
Application Disapproved for the following reasons: ------------------ -------------- ----
A
date
Permit No. - �- —--- Issued—'✓-� i v ---- -
date — —
BOARD OF HEALTH 0
TOWN OF BARNSTABLE
Certificate Of Compliance
THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( )
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.��&: Dated-THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE----- - — Inspector--- ----------- -----------
No:1�"---'� Fee-------��-�'--d-'--------
ti' BOARD OF HEALTH
\`t TOWN. 'OF , BARNSTABLE
1
application Ar wetl Cootruct ion permit
.li / .''�
Application Is hereeb mgadee for a permitr to-
Construct Alter ( ), or Repair ( )an individual Well:at:
° Location : Address Assessors Map and Parcel
Owner Address
- --- --�--1 ,v �rd „��.v, _r�. s , - ---------------
Installer — Driller' " f"4ddress
Type of Building
Dwelling---� �1�iN 4
Other - Type of Building---- --- -- - - No. of Persons-'___-- ------------
�� �r��
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 Protectibn Regulation - The undersigned further agrees not to
place the well in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed ---
' / s date
Application Approved tBtit
- ' - - � -
IIdate
Application Disapproved for the following reasons: -------------------=-------=------------
�,. -- ----- - i ------- -- -----
date
Permit No. - ---- Iss ed—' "- — -
j J ---__•_•_ ______'
date
a
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BOARD OF HEALTH
TOWN] OF BARNSTABLE
F Certificate Of Compliance
THIS IS TO CERTIFY, That the Individual:Well Constructed Altered ( ), or Repaired( )
by---- ----- - --
Installer
at
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 Permi0.'r-�-�'� Dated— 66_ r
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE-------- * �.. ^k f. ;Inspector r. — --- ---- -
!N±aTiai4i+ii�r4i9eld4ipul/ili9i4iiisti�3Qa}p�iYiD21!i}i1N_i'JfiOAtTiK4iYiAlS/8.46031i1it�liBGfiYYYa fi ltil4YiY6¢b1i!f blaYiaLT:�9i�a?b!!d4i4iAiRiRa4nS�ti?i!i!i!iYi!iYiti!iSUti!i ri.°•eti
BOARD OF HEALTH
TOWN OF BARNSTABLE
Mil C0115tructionvermit
No. Fee-
Permission is hereby granted -- ------------
to Construct ( -') Alter ( ), or�Repair ( J an Individual Well at:
Street
as shown on the application for a Well Construction-Permit
Q
No.-__- , ,_4 00 u j �_-- Dated _-- --------- -
Board.of.Health
DATE
ro CERTIFICATE OF ANALYSIS Page. 1
Barnstable County Health Laboratory
Report Prepared For: Report Dated: 03/07/2000
Demayo,Tom Order Number: G0005202
Tom Demayo
95 North Winds Lane
West Barnstable, MA 02668
Laboratory ED#: 0005202-01 Description: Water-Drinking Water
Sample#: 05202 X709 715 Sampling Location: 95 North Winds Ln W Barnstable Collected: 03/06/2000
ollected by: Charlotte Stie Received: 03/06/2000
Routine
ITEM RESULT UNITS MDL MCL Method# Tested
LAB: IC Lab
Nitrates <0.1 mg/L 0.1 10 EPA 300.0 03/07/2000
LAB: Metals
Copper <0.1 mg/L 0.1 1.3 SM 3111B 03/07/2000
Iron 0.2 mg/L 0.1 0.3 SM 3111 B 03/07/2000
Sodium 31 mg/L 1.0 20 SM 3111B 03/07/2000
LAB: Microbiology
Total Coliform. Absent P/A 0 Absent P/A 03/06/2000
LAB: Physical Chemistry
Conductance 200 umohs/cm 1 EPA 120.1 03/06/2000
pH 6.2 pH-units 0 EPA 150.1 03/06/2000
EPA 502.2- Volatile Organics by PIDIECLD
ITEM RESULT UNITS MDL MCL Method# Tested
LAB: GC LAB
1,1,1,2-Tetrachloroethane BRL ug/L 0.5 EPA 502.2 03/06/2000
1,1,1-Trichloroethane BRL ug/L 0.5 200 EPA 502.2 03/06/2000
1,1,2,2-Tetrachloroethane BRL ug/L 0.5 EPA 502.2 03/06/2000
1,1,2-Trichloro ethane BRL ug/L 0.5 5.0 EPA 502.2 03/06/2000
1,1-Dichloroethane BRL ug/L 0.5 EPA 502.2 03/06/2000
1,1-Dichloroethene BRL ug/L 0.5 7.0 EPA 502.2 03/06/2000
1,1-Dichloropropene BRL ug/L 0.5 EPA 502.2 03/06/2000
1,2,3-Trichlorobenzene BRL ug/L 0.5 EPA 502.2 03/06/2000
1,2,3-Trichloropropane BRL ug/L 0.5 EPA 502.2 03/06/2000
1,2,4-Trichlorobenzene BRL ug/L 0.5 70 EPA 502.2 03/06/2000
Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605
., .
f CERTIFICATE OF ANALYSIS Page: 2
Barnstable County Health Laboratory
Report Dated:
Report Prepared For:
Demayo,Tom Order Number: G0005202
Tom Demayo
95 North Winds Lane
West Barnstable, MA 02668
Laboratory ID#: 0005202-01 Description: Water-Drinldng Water
Sample#: 05202 X709 715 Sampling Location: 1 Collected: 03/06/2000
Collected by: Stiefel T (-I, 2 /I�t^QltA4 ' Received: 03/06/2000
1,2,4-Trimethylbenzene BRL ug/L 0.5 EPA 502.2 03/06/2000
1,2-Dibromo-3-chloropropan BRL ug/L 0.5 0 EPA 502.2 03/06/2000
1,2-Dibromoethane(EDB) BRL ug/L 0.5 EPA 502.2 03/06/2000
1,2-Dichlorobenzene BRL ug/L 0.5 600 EPA 502.2 03/06/2000
1,2-Dichloroethane BRL ug/L 0.5 5.0 EPA 502.2 03/06/2000
1,2-Dichloropropane BRL ug/L 0.5 EPA 502.2 03/06/2000
1,3,5-Trimethylbenzene BRL ug/L 0.5 EPA 502.2 03/06/2000
1,3-Dichlorobenzene BRL ug/L 0.5 EPA 502.2 03/06/2000
1,3-Dichloropropane BRL ug/L 0.5 EPA 502.2 03/06/2000
1,4-Dichlorobenzene BRL ug/L 0.5 5.0 EPA 502.2 % 03/06/2000
2,2-Dichloropropane BRL ug/L, 0.5 EPA 502.2 03/06/2000
2-Chlorotoluene BRL ug/L 0.5 EPA 502.2 03/06/2000
4-Chlorotoluene BRL ug/L 0.5 EPA 502.2 03/06/2000
Benzene BRL ug/L 0.5 5.0 EPA 502.2 03/06/2000
Bromobenzene BRL ug/L 0.5 EPA 502.2 03/06/2000
Bromochloromethane BRL ug/L 0.5 EPA 502.2 03/06/2000
Bromodichloromethane BRL ug/L 0.5 EPA 502.2 03/06/2000
Bromoform BRL ug/L 0.5 EPA 502.2 03/06/2000
Bromomethane BRL ug/L 0.5 EPA 502.2 03/06/2000
Carbon tetrachloride BRL ug/L 0.5 5.0 EPA 502.2 03/06/2000
Chlorobenzene BRL ug/L 0.5 100 EPA 502.2 03/06/2000
Chloroethane BRL ug/L 0.5 EPA 502.2 03/06/2000
Chloroform 16 ug/L 0.5 EPA 502.2 03/06/2000
Chloromethane BRL ug/L 0.5 EPA 502.2 03/06/2000
cis-1,2-Dichloroethene BRL ug/L 0.5 70 EPA 502.2 03/06/2000
cis-1,3-Dichloropropee BRL ug/L 0.5 EPA 502.2 03/06/2000
Dibromochloromethane BRL ug/L o.5 EPA 502.2 03/06/2000
Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605
CERTIFICATE OF ANALYSIS
,•� 7�; Page: 3
1 Barnstable County Health Laboratory
Report Prepared For:
Report Dated: 03/07/2000
�
Demayo,Tom Order Number: G0005202
Tom Demayo
95 North Winds Lane
West Barnstable, MA 02668
Laboratory ID#: 0005202-01 Description: Water-Drinking Water
Sample#: 05202 X709 715 Sampling Location: 05 l�erN 'tmisrr-+.B �c �-,1�^s� Collected: 03/06/2000
ollected by: Charlotte Stie + /vv Received: 03/06/2000
Dibromomethane BRL ug/L 0.5 EPA 502.2 03/06/2000
Dichlorodifluoromethane BRL ug/L 0.5 EPA 502.2 03/06/2000
Ethylbenzene BRL ug/L 0.5 700 EPA 502.2 03/06/2000
Hexachlorobutadiene BRL ug/L 0.5 EPA 502.2 03/06/2000
Isopropylbenzene BRL ug/L 0.5 EPA 502.2 03/06/2000
Methyl-tert-butyl ether BRL ug/L 2.0 EPA 502.2 03/06/2000
Methylene chloride BRL ug/L 0.5 5.0 EPA 502.2 03/06/2000
n-Butylbenzene BRL ug/L 0.5 EPA 502.2 03/06/2000
n-Propylbenzene BRL ug/L 0.5 EPA 502.2 03/06/2000
Naphthalene BRL ug/L 0.5 EPA 502.2 03/06/2000
p-Isopropyltoluene BRL ug/L 0.5 EPA 502.2 03/06/2000
sec-Butylbenzene BRL ug/L 0.5 EPA 502.2 03/06/2000
Styrene BR.L ug/L 0.5 100 EPA 502.2 03/06/2000
tert-Butylbenzene BRL ug/L 0.5 EPA 502.2 03/06/2000
Tetrachloroethene BRL ug/L 0.5 5.0 EPA 502.2 03/06/2000
Toluene BRL ug/L 0.5 200 EPA 502.2 03/06/2000
Total xylenes BRL ug/L 0.5 10000 EPA 502.2 03/06/2000
trans-1,2-Dichloroethene BRL ug/L 0.5 100 EPA 502.2 03/06/2000
trans-1,3-Dichloropropene BRL ug/L 0.5 EPA 502.2 03/06/2000
Trichloroethene BRL ug/L 0.5 5.0 EPA 502.2 03/06/2000
Trichlorofluoromethane BRL ug/L 0.5 EPA 502.2 03/06/2000
Vinyl chloride BR.L ug/L 0.5 2.0 EPA 502.2 03/06/2000
Note: Based on the results of the parameters tested,the water has high levels of sodium.Persons on low sodium diet should consult
their doctor.
Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605
CERTIFICATE OF ANALYSIS Page: 4
Barnstable County Health Laboratory
Report Prepared For: Report Dated: 03/07/2000
Demayo,Tom Order Number: G0005202
Tom Demayo
95 North Winds Lane
West Barnstable, MA 02668
Laboratory I<D#: 0005202-01 Description: Water-Drinking Water
Sample#: 05202 X709 715 Sampling Location: 95 North Winds Ln W Barnstable Collected: 03/06/2000
ollected by: Charlotte Stie Received: 03/06/2000
Approved By:j' %�
(Lab Director)
3%712
Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605
V
Town of Barnstable- ' P#
Department of Health,Safety,and Environmental Services
oFV* Public Health Division Date
367 Main Street,Hyannis MA 02601
i
BARNBTABIE,
Date Scheduled /. �, Time Fee Pd. ICP 0
(Soil Suitability Assessment for Sewage Disposal
Performed By: VAtio D#wyAtJ_ 6yC- Gruel° Witnessed By: J tr y Dur�uleJC�
OCITION &CiERAT INFOAT�ON
Location Address `; ` Owner's Name
6AWF_ -n:4au.5 -Address—
We i3ft�t-�S'C/�gL� T'Aj , �3�4RNsrpti��,
Assessor's Map/Parcel: Engineer's Name 1 be 4VW , 1h6-
P
NEW CONSTRUCTION � REPAIR Telephone# +.r
Land Use VA(-AKI'1' %Slopes fE1�1/p ( ) � � Surface Stones
Distances from: Open Water Body "" it Possible Wet Areat It
It Drinking Water Well 7 5O
Drainage Way R Property Line e29"3S tt Other n
SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes)
/>
y�
�0
LOT (o
Ole
co
e�4p
u
Parent material(geologic) LNCi�V &i WAsvi Depth to Bedrock �- 144
Depth to Groundwater: Standing Water in hole: *006 0.850 ED Weeping from Pit Face /VGA)f O�S�LUE�
Estimated Seasonal High Groundwater 7 144�t
.............. .:.:....
:::::: »:. TNA"TY�1N 't�R SEASONALTtG '�VATETt TAT3L) .:>>::::::;...:<::::;:.,..
...............::.:..:::
;::..... ..... .
Method Used:
Depth Observed standing in obs.hole: in. Depth to soil mottles: in.
Depth to weeping from side of obs.hole: in. Groundwater Adjustment R.
.-index Well# 'Reading Date:_ Index Well level...--- Adl.factor Adj.Groundwater Level_
.....................................................
..:,.::::::,::.;.;:. .....
::.::::::.:.,; PERCOL�i,TION TEST .... .;.:;;note Jl.��,A': itne:.:
..... .... ............................._:.... ............: ...::..........:............_......_.: .... _.. ._. .
Observation - 1 1 �?�I <.�.
Hole# IP Time at 9"
Depth of Perc 5 5 " (,b Time at 6"
Start Pre-soak Time @ 1 t% 1t 11143 ;� 4AU b05 Time(9"-6")
0 pp
End Pre-soak 1'3 ��'�D �� �r? �lIMU•�S ;�•a- `'
RateMin./inch ? LZ
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YM)
Original: Public Health Division Observation Hole Data To Be Completed•on Back
(-. .,. A.,..n,.a.,F - -
1DEr C�BEl2�ATYON lOE T,oG Lute:# -►j
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
%
69MOLF MAN RouN Gv
- �& ��t gas gar.Fsg
"-I3Z" Few . % C2A0Ft,.
F aay �'� c�
5IM4IX 4RAiMe1) L 0&S E
DEEP OBSERVA,TIQN�IOI,E LOG Hole#: 7` 'w ,
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) _ (USDA) (Munseli)_ Mottling, (Structure,Stones,Boulderes.
%
�f- �d r, + W SL ,A /t.b�llFARM_ 9roNF5 jeoW4AOf RoV p�rles
� 2. FIND s tic, Z5Yo <QkuC-
QnosE
DE OBS R ATIQN t0 .0 LO:G Mole#
.
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
1
r
DEEP OBSEI[ VATION HOLE LOB Hale#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Gravel)
Flood Insurance Rate a • CA&i4mvtj171 PAQ'Et. SQDU/ 000 S C -
Above 500 year flood boundary No_ Yes )-
2UNf, G
�.- Within 500 year boundary No Yes
Within 100 year flood boundary No Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption system?
If not,what is the depth of naturally occurring pervious material?
Certification
I certify that on tIL (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with
the required tr fining,expert and experience described in 310 CMR 15.017.
f/
Signature Date w
9 L _ 3
2
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