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HomeMy WebLinkAbout0122 CHURCH STREET - Health 1.22 Church Street Barnstable tVeS t i y No. � 1 �—C� Fee �f r BOARD OF HEALTH TOWN OF BARNSTABLE Z(pplicatiou _for Yell Cougtructtou permit Application is hereby made for a permit to Construct( ), Alter( ), or Repair( ) an individual well at: I a h�trGh 547-,eef /5,3 / o ,'? Location-Address Assessors Map and Parcel U 0 ri tfc C&ZI-n Zega! why Yr- 199 ahavch ram' Owner Address Installer-Driller Address ©q/ C3 Type of Building Dwelling Other-Type of Building No. of Persons Type of Well Capacity Purpose of Well `IR(N KW Agreement: The undersigned agrees to install the afore described 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 Certi Cate of Compliance l ai een issued by the oard of Health. Signed Application Approved By � Date Application Disapproved for the following reasons: 11 Date Permit No. L") `a`) Issued -7 t Date -------------------------------------------------------------------------------------------------------- BOARD OF HEALTH - TOWN OF 'BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed k4 Altered( ), or Repaired( ) by !�P Sryu)rt cj Wa Dt l l�l hi C', Installer at �a`o� ��I✓1�,�Y1 SY� has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private We Protection Regulation as described in the application for Well Construction Permit No.W�i k��r� Dated �-y 1 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector i ! [ o17 ''0 1 S" a`c)—C� Fee s •` BOARD OF HEALTH TOWN OF BARNSTABLE 01pphratton jfor Veft Con.5tructton Permit Application is hereby made for a permit to Construct( ), Alter( ), or Repair( ) an individual well at: 19a C harch _ Vree-f , /513 / DIP Location-Address Assessors Map and Parcel y O[1.vc co rD Fi VC- � f���+�c/ whl Ee C.harcG1 .S�reO Owner Address 7)(S mo nct 1A)-e f I D ri ll i n rl Inc . 7)4 go)( 9 79,25 nt l a rls MA Installer-Driller Address Type of Building ✓ Dwelling Other-Type of Building No. of Persons Type of Well Capacity Purpose of Well Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of HH�eal"th Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Certiffcate of Compliance hag-Wen hissue:d�by the /Board of Health. —Signed Date Application Approved By Date . Application Disapproved for the following reasons: Date Permit No. W V,;ko (<3s" d c�Q Issued -7 / c�a, Date ary �-------aemvo------=_omeaeee_em> o_meovoovevmvmmevoammo>m =.ave_deee-oo__o_ . BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed'(, Altered( ), or Repaired4( ) by I)P <�f'Y oar( WI (( Drl )11i �i _ lhr /"� f� / Installer at lag -hUK-rV1 sl re-e /_ �v has l 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.W--)0 1'�k-Ca C) Dated '�J�)-y I j 4', THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL ' SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector r BOARD OF HEALTH TOWN OF BARNSTABLE Yell Con.5tructton Permit No. (� -t)D-C) Fee Permission is hereby granted to 1 of1/4 W[ t brI/l/r q Installer J to Construct( ), Alter( ), oar.,/ Repair( an individual well at: Street as shown on the application for a Well Construction Permit No. \,'QD 6S: G;�C,.,,Dated A Date ( � ) roved B Pr y r I 1. NO SEPTIC SYSTEMS WITHIN 200' OF PROP. LOCUS MAP c WELL NO SCALE d 2. DATUM: APPROX. NGVD ASSESSORS MAP 153 PARCEL 18 es �Ab/+44.85 44 +45 &v ts, 43.83 � ^� /B } o I si ,.66 t +�.IS p6 4 63 z66 .rez.,e }d9.15 � 1gL1 ].d }44,65 fi+,IDS$Ff 1� +°.3fi \ +39.18 b~- � N +a2. 4 J.1 � / + f .23 J 4041 +,2.47/ t<),28 }aJ Ph A5 +46.8 d3.81 }a6. / 3a,3 PROP.SEPRO IS AREA I +45.1 . (>200'TO Obi.t.AND / r PRO^OS6D�_'9) d' j p^ A$ ` P &d 1) P�pN +a6.55 O J+51,53 4 .66 pD+ �RFPRO%. 66 \+a8.33 6 / o /+ 50 SAS AREA(PER OWNER) v 0 J ,6 + .04 +° f + 1.22 +d 1 }Y✓51 J9 a 5.8 ) +a).J9 a E705f.OMEN. +.,6.99 + .22 t5t,)6 51 49. �._� 160.00, 3 Em.WELL P "+5. CHURCH S7RF� 50.2< _ +50.32 d'S0.26 PLOT PLAN SHOWING PROPOSED WELL AT 122 CHURCH STREET WEST BARNSTABLE PREPARED FOR fr 508-362-4541 OF 41,qa�e MICHAEL HAYFIELD ia,508 362-9880 ��ARNE ��yG Nm MAY 8, 2007 down cape engfneering, inc. H. J C/V/L ENGINEERS D Scale:I"=4D' LAND SURVEYORS d��7 ? 939 Moin Street - YARMOUTHPORT, MASS. 11 4.. ,IO 0 20 40 60 80 100 FEET 07-055 WELL PLAN DATE ARNE H. 0 P,Ln6E Massachusetts Department of Environmental Protection Bureau of Resource Protection Well Completion Reports -rw ' Well Driller " �r Please specify work performed: Address at well location: �ti? New Well Street Number: Street Name: 00 122 CHURCH ST -t r Please specify well type: Building Lot#: Assessor's Map#: rO Domestic 153 Assessor's Lot#: ZIP Code: Number Of Wells: 18 02668 City/Town: Well Location BARNSTABLE In public right-of-way: GPS C Yes I North: West: 41.69708 70.37880 Subdivision/Property/Description: CAPE COD FIVE Mailing Address: click here if same as well location address Property Owner: Street Number: Street Name: PAUL WHITE 717 PO BOX City/Town: Stater Engineering Firm: BARNSTABLE MASSACHUSETTS ZIP Code: 02668 Board of health permit obtained: I:,Yes ("Not Required Permit Number: Date Issued: W2018 020 07/24/2018 s Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program r, P dt..: Well Completion Reports(General) Well Driller - General Well Form DRILLING METHOD Overburden Bedrock uger Choose Bedrock— WELL LOG OVERBURDEN LITHOLOGY From(ft) To(ft) Code Color Comment Drop in drill Extra fast or slow Loss or addition stem drill rate of fluid 20 Medium Sand Brown f''Fast r Slow YES NC Loss Addition . L W 20 40 Fine To Coarse S Brown j' F I Fast r Slow _._._._...... YES NO l Loss Addition 40 52 Fine To Coarse S r��`w: Brown ► II Fast r Slow WELL LOG BEDROCK LITHOLOGY Drop in Extra fast or Loss or Visible Rust Extra From(ft) To(ft) Code Comment addition of Large drill stem slow drill rate fluid Staining Chips p Choose Code ADDITIONAL WELL INFORMATION Developed t:Yes('No Disinfected f�Yes t"Nvo Total Well.Depth 52 Depth to Bedrock Surface Seal Type lNone racture Enhancement 'Yes f�No CASING Is Casing above ground? From: 1 To: 0 From To Type Thickness Diameter Driveshoe C110 _ 49 Polyvinyl Chloride Schedule 40 C - Schedule 0 SCREEN r.7W.Screen From To Type Slot Size Diameter 49 52 Stainless Steel Well Point 0.012 14� WATER-BEARING ZONES 11._1 DRY WELL Fri om To Yield(gpm) 11 52 12 PERMANENT PUMP(IF AVAILABLE) Choose Pump Choose Pump Description Horsepower Description— Horsepower-- Pump Intake Depth(ft) Nominal Pump Capacity(gpm) Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program Well Completion Reports(General) ANNULAR SEAL/FILTER PACK From To Material 1 Weight Material 2 Weight Water Batches Method Of (gal) (count) Placement Choose Material 0 Choose Material + I —Choose One WELL TEST DATA Time Pumped Pumping Level(ft Time To Recover Recovery(ft Date Method Yield(gpm) (HH:MM) BGS) (HH:MM) BGS) F 7/27/2018 Constant Rate Pump Mom; 12 1.30 13 0:01 11 WATER LEVEL Date Static Depth BGS(ft) Flowing Rate(gpm) Measured 7/27/2018 11 � � 12 COMMENTS WELL DRILLERS STATEMENT This well was drilled or altered under my direct supervision,according to the applicable rules and regulations,and this report is complete and accurate to the best of my knowledge. PATRICK Monitoring[M] Supervising Driller DESMOND, DrillerDESMOND Registration# 877 Signature PATRICK, DESMOND WELL Firm DRILLING INC. Rig Permit# 024 Date Job Complete 7/27/2018 NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion. i CERTIFICATE OF ANALYSIS f Barnstable County Health Laboratory (M-MA009) �y'�t'n�iius'sS Recipient: Sally Desmond Qrder No. G181.08718 Desmond Well Drilling Report Dated: 07/3112018; P 0 Box 2783 Submitter: Well.Driller Orleans, MA 02553. Description: 3 DAY RUSH-122 Church St. �. ... ..... ...... . .... ......_. ........................_ _......_) Laboratory IN: 18108718.01 Matrix; Water-Drinking Water Sample M Sampled: 07/27/2018 15:15 By: Customer Collection Address; 122 Church St,W.Barnstable,MA Received: 07/27/2618 15:44. By: PalmerP Sample,Location: Turn Around: 72 Hr Rush Routine_M ITEM RESULT UNITS RL MCL METHOD# ANALYST TESTED TIME Nitrate.as Nitrogen 0.39 mg/L 0.01 10 EPA 300.0 LAP 07/27/2018 10:27 Iron.. 0.13 mg!L 0.10 0.3 EPA 200.8 LAP 07/31/2018 11:35 Manganese ND mg/L 0.025 0.050 EPA 200.8 LAP 07/31/2018 11:35 pH 6.7 PH AT 25C NA 6.5,8.5 SM 4500-W13 DCB 07/27/2018 16:10 Sodium 30: mg/L 2.5 20 EPA 200.8. LAP 07/31/2018 11:35 Total Coliform 0 /100ML 0 0 SM 9222B RG 07/27/2018 10:26 Conductance 250 umohs/cm 2.0 SM 2510E DCB 07/27/2018 16:10 55%11'. Sodium level is above the maxium contaminant level. Those on a low.sodium diet may wish to'consult a physician, ...... _. . ......... -._�_ - ._.........�...__.__ ... ............. ..:_.. Attached please find the laboratory certified parameter list. Approved By: (Lab Manager) /a 2� j v ND.=None Detected RL = Reporting Limit MCL=Maximum Contaminant'Level ea..__& 0A 0-- A77 Rarnatnhln MA n9t;'qn Ph- R11R_175_6605 Page:. 1 of 1 f,4ti`OFIlgpyry` GEC\ IFICAT OF ANALYSIS SIS Barnstable County Health Laboratory (M-MA009) Recipient: Sally Desmond Order No.: G18108718 Desmond Well Drilling Report bated: 07/31/201.8 P 0 Bw 2783 Submitter: Well Driller Orleans, MA 02553 Description: 3 DAY RUSH 122 Church St. ..... ...-.... Laboratory ID#: 18108718-01 Matrix: Water-Drinking Water Sample#: Sample& 07/27/2018 15:15 By: Customer Collection Addr: 122 Church'St.W.Barnstable,MA Received: 07/27/2018 15:44 By: PMmerP Sample Location: Turn Around: 72 Hr Rush Analyst: yn Method:.EPA 524.2 Dilution: 1 Date Analyzed: 07/30/2018. @ 15:29 - EPA 524.2- Volatile organics by GC/MS Regult M L MQL Result MCC MAD Parameter ug/L ug/L ug/L Parameter ug/L ug/L ug/L Dichlorodifluoromethane ND Mo. Chloroethane ND 0.50 Chloromethane 6-A 0.50 Chloroform: 12 60 0150 Vinyl chloride ND 2;0 0150: cis-1,2-Dichloroethene ND 70 0.50 Bromomethane ND 0.50 cis-1,3-Dichloropropene ND o:50 1,1,1,2-Tetrachioroethane ND- o.so Dibromochloromethane 0.54 0.50 1,1,1-Trichloroethane ND 200 0.50: Dibromomethane ND 0:50 1,1,2,2-Tetrachloroethane NDI 0.50. Ethylbenzene ND 700 0.50 1 j,2-Trichloroethane ND 5.0 0.50. Hexachiorobutadiene ND 0,50 1,1-Dichloroethane ND- 0.50 Isopropyl benzene ND 0.50 1,1-Dichloroethene ND M: 0.50 Methylene.chloride 1.1 5.0 0.50 1,1-Dichloropropene ND 0.50 Methyl tent-butyl ether ND 0.50 1,2,3-Trichlorobenzene ND 0.50 Naphthalene' ND 0.50 1,2,3-Trichloropropane ND 0.50 n-Butylbenzene ND 0.50 1,2,4-Trichlorobenzene ND. 70 0.50 n-Propylbenzene ND 0.50 1,2,4 Trimethylbenzene NO 0150 p-Isopropyitoluene ND 0:50 1,2-Dlbromo°3-chloropropane ND 0.50 sec-Butylbenzene ND 0.50 1,2-Dibromoethane(EDB) ND 0:5a Styrene: ND 100 0.50 1,2-Dichlorobenzene ND 600 0.50 tert-6utyibenzene ND 0.50 1,2-Dichloroethane. ND 5.0 MO Tetrachlome.thene ND 5.0 0,50 1,2-Dichloro.propane ND e;50 Toluene ND 1000 0.50 1,3,5-Trimethylbenzene ND 0.50 Total xylenes ND 10000 0.50, 1,3.-Dichlorobenzene ND 0.50 trans-1,2-Dichloroethene ND 100. 0150 1,3-Dichloropropane ND 0.50 trans-1,3-Dichloropropene ND 0.50 1,4-Dichlorobenzene ND 5.0 050 Trichloroethene ND 5.0 0.50 2,2-Dichloropropane ND 0.50 ITrichlorofluoromethane ND ,50 2-Chlorotoluene ND 0.50 Compound %Recovered QC;Limits(%) 4-Chlorokoluene ND o.50 1,2-Dichlorobenzene-d4 123% 70 130 Benzene ND' 5.0 0.50 p-Bromofluorobenzene 108%0 70_ 130 Bromobenzene ND 0.50 Bromochloromethane ND 0.50, Bromodichloromethane Bromoform ND 0.50 Carbon tetrachloride 3.6 5:0.. 0.50 Chlorobenzene ND 110. 0.50 Approved By: Attached please find the laboratorycertifled parameter list; j (Lab Director) '9 7 ND'= None Detected RL = Reporting Limit MCL= Maximum Contaminant Level 3195 Main Street, Poe,Box 427, Barnstable, MA 02630 Ph::508-375-6605 Page 1 of I 02 18 08:53a Greg Hamm 5083750948 p.1 0.> I�>•lastable r� 0? _US '�'owv of I3 alalorj ServicL fi r, nepntl.Rtta t°lnc n,►Ic : * - Public ucntl ji Division iAUXt ri■MA 01.601 �.w .+� 200 plane Swcct,ffynn r � Yee ra llinet:�L -- 110 vsal t, Soil Su �tliility�lssessnienifor Selvage Dj.S X. r°raRxeu ny: / �;a --All ON 3r Gl'sN RI TN�IOit LomlionlWdrw''/ 1a C Native 1I,,--4- tx�7i Addnesc G ..).^•-� : AssessorsMaPM41=t DN � RI'rA1R TInW CONSTRUQ?1 Suslece 5[oncs !=Lad Uu nkhcgSV ��,Q rossilde\Vdl Area. =� '.�'.; ,---�3 0 It U11x1 �___II 1'mp,7ty tiny_. p!ainagc Way j .. ws d tot easel{oCttion<of ickt Inttts&pae tests IOato Wertaeds is pm,"Urdrry to lades) b-ICETCH:(street xame, SIN A� p s C4+ ��` a e+ L ■ �'+ +..-: fie,•• o`4 2 ra,et� aoa s� cdl0 IcN�i.Cr It 1ltlbce Ppre■t etsater{al(g g Wegdnl from e■dwaler StandingyJata to Ilola' f J. . ' Uclnu co t3so. �� , malal5raa�'ala�1deGcoo�dwater tt-- -WkTM�'AD" 7. Bsli _ DICT.�LMINA'['�ON�-Oft S,rA,SONA.L I�IGIi ,r,,�•- `• In. -� P. - In• 10Sollntolilee: fr. Mcatod used: A aamlcnt Dcpth djWmar tlaedinp•JneLs.Isolc I �, �•QtvuodKnttrLevd�-•S hnln: N M.folot D t1 k jweering fmm stele Ixdwc W 1 kad It1s 1171 p0 i- Inch WC11 M ��. Rcadiag ItCOLiM N TO L1o1e � S7r �letert9s . Oltscrvation 1 rr 7, llotc 9 It �'r 7Utte a +. l�� Dcrlb of rere sorlrye:k7akllene,fd ' i• 0 S 4t GedLe--k G2; 4� RatL eh '�� Y Addil:o■el-rc sng Needed(Y)N►_—r-- AsSNciinpd Sitel'Issal�-P �r`l'ileAt_�— I (C(Cd OTtBack Silc 5uilayilliy ' Observdi°I Flolc DaUt T°�C C°rnp prlginal:robrrc'140 n1a11°p °u must first nutlfy llle 1 wr.+Jc prior to Ueginnleag- ***IC percol°grou test is to lie cutulueLcd�yefte4 SOU' dip rioro r e 13nrntlnUSc C411scrvauO it Division s►l tens( one{..) Aug 0218 08:53a Greg Hamm 5083750948 p.2 �►LLL'UltJLic t.....i1V 1tULA._,.Ai OtherDcpU�tiew $allllodsm SuilTenlure 7 .Sol IWar Sail i (USDA) (Miunocll) Atouliag (Suudara.SlOaa,Bauldas. Sal(iu)0- -7.7W4� c 2 LS •` r ;IlLla'O]tSI�,1iVA'1'I0N TfOL13 LQG. Iloll # Sal Soil9'=b1m Soilcalor Sail odxr Dgdhhnw (USDA) (Mnasclo MatGas (Stmclb►gStancs,DoWdca. Su&=((a.) r pT.LP OBSiTRVATION IIULE LOG Ilolc P - SoU 1lottrm .Soil..'resrare Soil Color soil CST peptll6ont ( (USDA) 6laastjl) lAatNng (SwdUre.Stoaet,Bouldoa SnrGrc(ui) C II e 0 15 6f 11W.FI'O11SERVATIONIIOLE LOG Hole# "Tertare 'Sailcilar Son t7r>tcr 0cp1b tiara Soil Itoritn to net.BauldeK. Since(w•) (USDA) (Muusctl) .. ,.Mal@ng (Strut I��$1a � e - o (flood Luttruo2e RnteMun: Ma )10 ra 5yru Mad baundary Now Y. �x Willial00ymrbouoduy No JC Ya. VAd&100 year flood bauatary No x Yn.?-- 1)e tth of Na(t aU (Ic rttsr plervlau alerlul o�scr l throughout thn Lktes at lets!fa r feat of nueurolly oa:++rrin8 Pervious rtwlerlul en�is all areas ved thrrnlg • arcs propc►sni U>e so[f oby°r}uion ay3leor? . it df naltsally otxurring loos materlul9 " If pol,wlwt Is the depl . arl3Acation fic I rrrtlly tlmt on. f I2 (data)I hove passed the mil cvyuamr axSIS was e inution byffv cOnhty.1cnt with Deparbncnt o411VI on ntal protretion stole 1 t ° �j9O 10 CUR 15.017rornied 4 rrlti the raquirt:d Irat expertise An • Sigtt>itur++ , i • Q:LSLTt'1L�!'ERCtiORM.DOC . Aug 0218 08:53a Greg Hamm 5083750948 p.3 f LOCUS MAP 1. NO SEFnC SYSTEMS WrrMN 200' OF PROP. NO SCALE WELL ASSESSORS MAP 153 PARCEL 18 2. OATUM:APPROX. NCVD F ,+e4.F5 4 +n YR r��1 e�ss �; eL 1ti +SPA y- IN + � I pfw.SEP'1C$15M A»A J �-- Am >. J�' �r2,\ `SL AWA:PER 0-0 �)/-r�. � i '(" �� •too' +y�•�c, / � / %i 1 NnO, ♦n.=L ��� �g �f3L aCA I a- x., i scan PLOT PLAN SHO~ PROPO4m N9L AT 122 CHURCH STREET WEST BARNSTABLE raFroim FM "HCFuca� MICHAEL HATFIELD ave-J[:-e4i -ed• 5%7©seas ARNE rf��\ MAY B. 2007 o N. down ca. 5 eRe.neerinq; %nc. u CIVf- £NGf,WTRS $MIS I'm LA sup,EMPR5 r 2 5J9 uc�n S:rcef — YFR,lfGu:HPCR:, AeASS DATE ARNE H. 4 P,la qo 20 40 So eo 700 FEET 07 55 L APPLICATION FOR PERCOLATION TEST AND OBSERVATION PITS LOCATION Z07- C'/�/�/zG/,/ STPzCyZrT NO. , 345-Z5 VILLAGE 1/SIC—s7'• B�IZ/tIST�}�L.E DATE A& f/ APPLICANT FEE6���-p ADDRESS TELEPHONE NO. (Non-refundable) ENGINEER EZ>I"t/,912-P TELEPHONE NO. 390- ZZ�� DATE SCHEDULED OGT ZS ��19 . �,�� SP (Applicant' s signa re) ASSESSOR'S MAP & LOT NO: /yAp .1S3 /O47Z04-`?_ /8 SOIL LOG SUB-DIVISION NAME AZ,,B/L: z87 DATE GAT. ' /��J� TIME /40.'004-V7 EXPANSION AREA: YES ,--'NO G�bV4/z1D G ENGINEER TOWN WATER PRIVATE WELL__ BOARD OF HEALTH EXCAVATOR SKETCH: (Street name, etc. ,dimensions of lot, exact location ofi, test holes and percolation tests, locate wetlands in proximity to test holes ) NOTES : 344" 00, 44 .ram"tea .� VI C, ' PERCOLATION RATE: �./ TEST HOLE NO: ELEVATION TEST HOLE NO: y ELEVATION: 3 3 4 4 1� 7 S/�T/h 7 8 8 9 "° 9 10 l o L�! 11 /� 11 12 " 12 � �44 13 13 14 /.h,.,-, -14 15 15 16 16 / SUITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELDi/°LEACHING PITS s/ LEACHING TRENCHES UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS: NOTE: ENGINEE�RING .PLANS MUST SHOW NUMBER .ASSIGNED ON PERC TEST APPLICATION ORIGINAL: COMPLETED IN ENTIRETY BY P . E . AND RETURNED TO BOARD OF HEALTH COPY: RETAINED BY APPLICANT