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Home My WebLink About0455 CEDAR STREET - Health 455Ceder STt` srbu A=108-014 l I�I I TOWN OF /BAR/NSTABLE LG�r ic�iv /55 ° b&Q— St• -Ct# SEWAGE # VII.LAGE JJ �� ULQ ASSESSOR'S MAP & LOT 1Cs I C)l INSTALLER'S NAME&PHONE NO. i SEPTIC TANK CAPACITY ScT 2 LEACHING FACILITY: (type) sy P,A- (size) I b X NO. OF BEDROOMS BUILDER O� PERMITDATE: sI2r?/Lr/ COMPLIANCE DATE: 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'facihty) Feet .Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) _ Feet Furnished by ,•z Cb ' �. ) Si ST piSPo 9x!` S �t o:S�. � �2 t 51, f 17 ""c/ Loy ` Sz tqj i I '1 � / G2 i \ C E I I ). I- 00 - ,i C Co�f1(Z Ste, N ,f�>APLN Qlt �l'f Lol S� a J \` ' crrhT�ray / 6 2 / y CC ZN OF A4 5�\ E S iARRY R . .p No.265175`p f or �Ui` SIh53 %'U�FGIST�Ei�\`�`" FSSIONALF�G t AiLS E Lt'SS R aP T�Q G�lRv�4 f' 111�` S Auk L A u �y A SSA C_ CERTIFICATE OF ANALYSIS Page: 1 of 1 Barnstable County Health Laboratory (M-MA009) Report Prepared For: Report Dated: 11/2/2015 jam- Nancy Ashworth Order No.: G1590872 455 Cedar Street W.Barnstable, MA 02668 r � �e ry Laboratory ID#: 1590872-01 Description: Water-Drinking Water ry 7 -1 Sample#: Sample Location: 455 Cedar Street West Barnstable,MA Collected: 10/23/2015 Collected by: customer Received: 10/23/2015 Test Parameters ITEM RESULT UNITS RL MCL METHOD# ANALYST TESTED NOTE Total Coliform 0(14) CFU/100mL 0 0 MF-SM9222B RG 10/23/2015 Water sample meets the recommended limits for drinking water of all the above tested parameters. Attached please find the laboratory certified parameter list. Approved By: (Lab Director) ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level 3195 Main Street, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 I Page: 1 of 1 'CERTIFICATE OF ANALYSIS L �, Barnstable County Health Laboratory (M-MA009) "crAc,i„s�?� Report Prepared For: Report Dated: 9/18/2015 Nancy Ashworth Order No.: G1590397 455 Cedar Street. W Barnstable, MA 02668 Laboratory ID#: 1590397-01 Description: Water-Drinking Water Sample#: Sample Location: 455 Cedar Street, West Barnstable Collected: 09/17/2015 Collected by: customer Received: 09/17/2015 Test Parameters ITEM RESULT UNITS RL MCL. METHOD# ANALYST TESTED NOTE Total Coliform Present PIA 0 0 SM9223 RG 9/17/2015 The recommended maximum contamination level for drinking water exceeded due to Colifonn Bacteria. Tested negative for E.coli. Approved Attached please find the laboratory certified parameter list. A Pp By: (Lab Director) ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 Massachusetts Department of Environmental Management Office of Water Resources 104216 TYPE OR PRINT ONLY Well Completion Report 1. WELL LOCATION GPS (OPTIONAL) LATITUDE LONGITUDE Address at Well Location: S �� G Property Owner: Subdivision Name: Mailing Address: `t S' c r S"� City/Town: i c S l b r< a City/Town: G-cc Assessors Map 10 Assessors Lot#: 01� NOTE: Assessors Map and Lot# mandatory if no street address available Board of Health permit obtained: Yes 02"' Not Required ❑ Permit Number �ma J7 Date Issued' 2.WORK PERFORMED 3. PROPOSEWUSE 4..DRILLING METHOD ❑ New Well ❑ Abandon Q"Domestic ❑ Irrigation ❑ Cable s E�'Auger ❑ Deepen ❑ Recondition ❑ Monitoring ❑ Municipal ❑ Air Hammer ❑ Direct Push [T Replace ❑ Other ❑ Industrial ❑ Other ❑ Mud,1Rota '1-.';L❑ Other 5. WELL LOG aC Unconsolidated Consolidated 6 SITE SKETCHt(use permanent lartdmaks with distances) , W Permeability From (ft) To (ft) 3t High Low � C7 0 Other Rock Type `mow, ✓"'dam; 1r 4 7. WELL CONSTRUCTION 8.CASING Total Depth Drilled From (ft) To (ft) Casing Type and Material Size O.D. (in) Well Seal Type Date Drilling Complete b t; ' 1AJ 1-SCREEN From (ft)- To (ft) Slot Size . Screen-Type and Material Screen Diameter SS Y ' 10. FILTER PACK/GROUT/ABANDONMENT°MATERIAL 11. ADDITIONAL,WELL INFORMATION From (ft) To (ft) Material Description Purpose Developed? ET Yes ❑ No Fracture Enhancement? ❑ Yes - ❑ No Method Disinfected? ❑ Yes ❑ No 1.2. WELL TEST DATA(PRODUCTION WELLS)° _ 13. STATIC WATER LEVEL FALL WELLS) Yield -Time Pumped Drawdown to Time Recovery to Depth Below Date Method (GPM),: (hrs &'min) (Ft. BGS) (hrs & min) (Ft. BGS) Date Measured Ground Surface (FT) 01,3 /3 0!� 60 ,,.. �,�f S . �o /b� SG 14. PERMANENT PUMP(IF AVAILABLE) 15.NAME/ADDRESS OF PUMP INSTALLATfOkCOMPANY' Pump Description Horsepower �-� S E Pump Intake Depth 3 (ft) Nominal Pump Capacity. (gpm) 16. COMMENTS 17. WELL DRILLER'S STATEMENT This well was drilled and/or abandoned_under my supervision, according to applicable rules and regulations, and this report is c mppte and correct to the best of my knowledge. / r Driller: �1-/az4'^ cf� Supervising Driller Signature: Registration #:1 1 ')1 1a Firm: �` iu�rY,� %�� Date: s;k Rig Permit#: 5 NOTE. Well Completion Reports must be filed by the registered well driller within 30 days of well completion: BOARD OF HEALTH COPY i i, `&A �� 1 U CA No.— --; -- Fee--- BOARD OF HEALTH ►j ( TOWN OF BARNSTABLE 2pplicat ion-for Vell Cootruct ion Permit SLPL+ic Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair (fin individual Well at: ^— Location — Address Assessors Map and Parcel V b 4 wo --_-- /► (� /Owner Address — �/T JL[n Nw� !�e itJ�c e ___ _ �•/�tx /�6a �kGa$(� Installer — Driller —— Address Type of Building Dwelling ----- ---- ----- Other - Type of Building-- ---- No. of Persons— --------_—__ Type of Well 9 — Capacity ------------- Purpose of Well '0c"-5 t c, -42-6- 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 Certifi ate'.of Compliance has been issued by the Board of Health.. Signed date Application Approved By —c--�!-= - ----- date Application Disapproved for the following reasons;/ --------- - ----------_--_ N /I,9 ��`�'� �"_-- ---------------- date------ Permit No. — Issued ---- - -- -- ----- date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( y by-- -- - °� ----- _-_----- --- - - -- ----- Installer at CC-OOCnl S 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---------------____-- --------____-_ ,t> r y } 0� 4Z'M No. Fee---K____ BOARD OF HEALTH TOWN OF BARNSTABLE `l 0(ppiicationArVeit CongtructionPermit Ir _+� Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair (fin individual Well at: �2 / 1 t- ---- Location —/ Address Assessors Map and Parcel _— —� Owner Address - -- _—L— — ------- -- — - -- - - - - Installer.— Driller 1 Address Type of Building '1 Dwelling --- - ---- Other - Type of Building--- ------ No. of Persons- --------__—_-______ Type of Well y - - -- 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 t l - __ _ . 8 A a_- t r date Application Approved B i - o\ ----- pp pp y date Application Disapproved for the following reaso —----- --- -- a date Permit No. _ - Issued---------------- ' date--\. ----------^-- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate & Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( yr -------QA_ ��ti ---- 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------------- t THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE---- - Inspector-----------___ -- —---- i BOARD OF HEALTH TOWN OF BARNSTABLE Ivell Con5truct ion Permit (__ No. " '-{�- Fee- Permission is hereby granted OA to Construct ( ), Alter ( ), or Repair (-ran Individu Well No. ySS. C c ,Oa/ S 7- . 0 -------- --- ----------------------------- Street as shovin on�application for We Construction Permit / D L ) _ No.- v v — Dated --- - -- -- -- _ --- ---------------------- DATE - - Ooard o Health — — a' D�Tii 0i� A �� 1 ��1 C � Q�� S � J--tV vinvLLGLY LAtf"AYAI"KIP"J,LSVG. MA CERT.NO.:M-MA 063 . 449 Rre.130 Sandwich, MA 02563 508(888-6460) 1-800 339-6460 FAX(508)888-6446 CLIENT. Rob Ashworth LOCATION. 455 Cedar St ADDRESS. 455 Cedar St W Barnstable mA 02668 W Barnstable mA 02668 COLLECTED BY. D Pennini/DA Scannell SAMPLE DATE. 4/10/2002 SAMPLE TIME: 4:00 WATER SAMPLE TYPE. Existing Well Repair DATE RECEIVED: 4/11/2002 LAB LD. #. 0204199 WELL SPECS.: 68' RESULTS OF ANALYSIS: Parameters Units Recommended Results Method Date Analyzed Limits Coliform bacteria /100ml 0 0 9222 B 4/11/2002 pH pH units 6.5-8.5 6.04 4500 H+ 4/11/2002 Conductance umhos/cm 500 133 120.1 4/11/2002 Nitrate-N mg/L 10.0 0.08 300.0 4/11/2002 Nitrite-N mg/L 1.00 < 0.004 300.0 4/11/2002 Sodium mg/L 28.0 12.3 200.7 4/12/2002 Iron mg/L 0.3 < 0.t 200.7 4/12/2002 Manganese mg/L 0.05 0.093 200.7 4/12/2002 COMMENTS: pH is below recommended limit and may have corrosive characteristics. Manganese is not a health hazard. WATER MEETS EPA STANDARDS AND IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. <=less than Date ( /i/d2- >=greater than R nald J.S ri TNTC=too numerous to count Laboratory Virector RECEIVED APR 2 2 ZOOZ TOWN OF BARNSTABLE HEALTH DEPT. 1 i Fizz THE COMMONWEALTH OF MASSACHUSETTS .. BOARD OF HEALTH To�-,J../J"' .. ......OF.......... / �1-....... - -t--......--•........................... Application for Disposal Works Tunotrnr#inn ramit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: , ................-- ..1 C d r......gr.............. ............................................. - ALocf n-Add s r t o. ................... --- . �Ow a % Addr s t Installer Address Type of Building Size Lot_.s �._ .Sq. feet Dwelling No. of Bedrooms............... .Expansion Attic Garbage Grinder 00 '4 Other—T e of Building No. of persons.............1� .......... Showers — Cafeteria 04 d Other• Mures -----------------------••------•-•-------------...------------------------------------------------- W Design Flow............ N.._•.....................gallons per person per day. Total daily flow.......-��.0.....................gallons. WSeptic Tank—Liquid capacity.Q_Zgallons Length................ Width................ Diameter................ Depth..:............. x Disposal Trench—No..................... Width.................... Total Length.............�...._.Total leaching area.....c.�...............sq. ft. Seepage Pit No.....I---------------- Diameter... Depth below inlet......&......... Total leaching area..[._)0...sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ~' Percolation Test Results Performed by... E .1..4-9� .`'. ............................... Date_.., W .. - ,.a Test Pit'No. 1.j-Z........minutes per inch Depth of Test Pit......l2�.... Depth to ground water........................ Test Pit No. 2__Sc L.....minutes per inch Depth of Test Pit..._.. > Depth to ground water........................ x•----------------•.............-•-•••...-----•--- . - -( ! . - 0<--Descnption of Soil......0 � � - Id _ - e (� ---------••--•---- .........{ .. Sr :'1........Va_K: l..J!!L ! ." W UNature of Repairs or Alterations—Answer when applicable.........................................:...................................................... ---------------•---•--•--•-................--------....... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with Y the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be 'ssued by the boar iealth. Signed----- :- ...-•---- -- ..... ?AD4 ate � Application Approved By---------------, � « =!?% .... 4&A/11. ate Application Disapproved for the following reasons-------------•------------------------------------------•---...-----------------...----•-----•---•-......------... ............................................................=........................................................................-................................................................... Date PermitNo.......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' G 0,v &,, ........ 1�. .li/...........OF.......i .f? �� ' '. ./, ............................. /o i Trrtifi.rFatr of ToanpliFanrr °` T IS 1 0 CERTI Y, That the Individual Sewage Disposal System constructed (�) or Repaired ( ) by- J -1sX.-----------------------------------•...------- . --.....--------------------------...---------------------------------------...........----- . Installer at_::-----------*`--*.... ..._eb�1 ..-ST-------------- a�... .21� i� 4 .............................................................. has been installed in accordance with the provisions of TITIZ 5 of The State Sanitary Code as describibedJ in the application for Disposal Works Construction Permit �o:.___�o.- �................... dated_.-._. ..._.__ ._... THE . ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. _ DATE................................................................................ Inspector.................................................................................... " _ 4 Lqc; 9 No 6 Fmc ............... THE COMMONWEALTH OF MASSACHUSETTS 70f-,�ARD CT47ME-XtjT2H OF',' .....................I.................. Appliration for Bispo�a' l 19orkiiZongtrurtion ramit., Application is hereby made for a Permit to Construct or Repair. an Individual Sewage Disposal System at: Lication- =6 i q Ay 1),td r ------------------ ibtlii. ------------ .... ----------- .......... reX+c_Je.9*o4 1A 14(IS ............ ........... .................................................................................................. a ,:..... .................... Installer Address cc, �rw Type of,Building Size Lot......3!��._apaq-jeet, Dwelling—No. of Bedrooms...............3..................-----Expansionec Garbage Grinder ( 04 Other—Type of Building ............................ No. of persons........................... Showers PL ) — Cafeteria ( Other .5nwres .........................................................;........................................... -------------- Design,Flow.............. .......................gallons per person per day. Total daily flow..._._._.._:...__..__.._._'..__._._.__._.._.gallons. 9 Septic Tank—Liquid capacity..J.-LZ- allons ' Length................ Width..............._ Diameter____-__---_---_- Depth.....__......... Disposal Trench No..................... Width.................... Total Length.............._.....Total leaching area....................sq. ft. Seepage Pit No...... ............. Diameter....r.#........ Depth below inlet........&.1..... Total leaching area.... .. sq. ft.Dosing Z Other Distribution box, osng tank Percolation Test Results Performed by.___]EFOXX...Lo.��!y.............................. Dato��r, ;Os (Ro ............................ Test Pit No. minutes per inch Depth of Test Pit....... Depth to ground water........................ Test Pit No. 2..�.2......minutes'per inch, Depth of Test Pit.........o.,2.e!!.... Depth to ground water........................ ................................................................................................................................................................ 0 Description of Soil....... ........ ................ ....................................... e............I................. . ........ ...4I.Ail. IFTS.- ..................................................................................................................................................................................................... U Nature of Repairs`or Alterations—Answer when applicable...........................I................I................I-------I.............................. .................;...................m........... .................................................................................................................................................. Agreement: The undersigned.agrees to install the aforedekribed Individual Sewage Disposal System in accordance'with the provisions of TITS,;-. 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until..,a Certificate of Compliance has beMissued by the boar eflhealth. -Signe d....... :4,-------------- Application-Approved By.......... �Ii:r�le-e ................... .... ........ Application Disapproved for thefollowing reasons------------------------------------------------------------•--------------------------------------...--•--•... . ............................................................................................................................................................................................... Date PermitNo......................................................... Issued........................I............................... Date, 4-- THE COMMONWEALTH OF MASSACHUSETTS 341- BOARD a�M 14"12;wzg� ............................................OF..................................................................................... Trdifiratr of Tompliana T� VO-MERTOI hatthe age Disposal System constructed or Repaired A Sjudividual Sew, e7 . ........................................................................... .............................................. ------- Installer at... ..........................................................................................................................I..................................................................... has been installed in accordance with'the provisions,of TITLE 5 of The State Sanitary Code as described *n the i application for Disposal Works Construction Permit ..................... dated--... .. .... ........ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED ASA.GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. k DATE................................................................................... Inspector...................................................................... ........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 4\/ /V ..........0 F..... ............. ................................ ..................... FEE..... .�..........3 Permission s hereby granted.... ----------------------- ---------- ...... .............................. to Construct r �Ti',idu=iag�Disposal System .( ) an Ino�or Reie a_ e--!>A IL A/Z/v -;;,4 at No...........................................................:!:0/.................................................. .................................................................... Street as shown on the application for Disposal Works Constructi9 ermit No..................... Dated.._.-40;��2-43_ ........ . 1 dr, ............................................ B of DATE....4� ........ ..... -------- Health FORM 1255 HOBBS & WARREN. INC., PUBLISHERS • i bo Ali •, i i 5 2/ C C o.':>F�n, S�T. jA6LN�AY3Lt � �� >J✓ i n Uyooc A. ► o; Sz � \ i / G2 f ESN OF M etc , J ARRY L .T { J .o ,p No.26575`p � S O W e i V, V ILL . 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