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HomeMy WebLinkAbout0429 CHURCH STREET - Health 429 CHURCH STREET WEST BARNSTABLE A 176-004 r i I Massachusetts Department of Environmental Protection Bureau of Resource Protection Well sport Completion Reports p Well Driller Please specify work performed: Address at well location: New Well � � Street Number: Street Name: �� 429 CHURCH ST Please specify well type: Building Lot#: Assessor's Map#: Domestic Assessor's Lot#: ZIP Code: Number Of Wells: 02668 City/Town: Well Location BARNSTABLE In public right-of-way: GPS C,Yes r No North: West: 41.69446 70.36910 S ubdivision/Property/Description: Mailing Address: WO click here if same as well location addres Property Owner: Street Number: Street Name: ELLIS 429 CHURCH ST City/Town: State: Engineering Firm: BARNSTABLE MASSACHUSETTS ZIP Code: 02668 Board of health permit obtained: re.Yes (-,Not Required I Permit Number: Date Issued: W2021019 04/02/2021 _� tJ' s Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program x Well Completion Reports(General) •y Well Driller - General Well Form DRILLING METHOD Overburden Bedrock uger Choose Bedrock— WELL LOG OVERBURDEN LITHOLOGY _ From(ft) TOM) Code Color Comment Drop in drill Extra fast or slow Loss or addition stem drill rate of fluid 0 15 ] J_SLlty Sand Brown �`Fast('Slow �_ u v YES NO Loss Addition 15 35 Fine To Coarse S' Light Gray�^ y C,,Fast(7 Slow --- — ... YES �.-� LLss Addition .. ......... ( Fast(.Slow t Li ht Gra l ��lo.] Loss Addition 35 50 Fine Sand LJ YES NO L � l —� ,�I t"Fast i Slow 70 Fine Sand �JLight Gray S NO —. Loss Addition � 70 75 Medium Sand ht Gray I--Jf"Fast' Slow -�_ LL. sAddition ......... f 4` LL. Addt,.r, Clay Light Gray YES NO r Fast f�Siow i 90 100 Fine To Coarse S? Light Gray ' f Fast t"Slow t" ...................._..... ....... .. NO.......... Loss... Addition....... WELL LOG BEDROCK LITHOLOGY Drop n 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 =YES'NO Fast Slow Loss AdditionChoose Code ��.� ADDITIONAL WELL INFORMATION Developed -Yes f No l Disinfected ( re Yes l 'No Total Well Depth 100 Depth to Bedrock Surface Seal Type None �racture Enhancement f"'Yes t•No CASING off;Is Casing above ground? From: 1 Ta 0 From To Type Thickness Diameter Driveshoe �� 96 Polyvinyl Chionde � J Schedule 40 � LYes -- .... ................. SCREEN ,No Screen From To Type Slot Size Diameter 96 100 Stainless Steel Well Point j 0.012 r4 WATER-BEARING ZONES Fr DRY WELL Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program Well Completion Reports(General) From To Yield(gpm) 10-7 100.-... - 12 7771 PERMANENT PUMP(IF AVAILABLE) Pump Description Wire Constant Speed Horsepower Submersible 1/2 Pump Intake Depth(ft) 40 Nominal Pump Capacity(gpm) 10 ANNULAR SEAL FILTER PACK From To Material 1 Weight Material 2 Weight Water Batches Method Of (gal) (count) Placement 0 [Choose Material Choose Material L—J �� —Choose One— WELL TEST DATA Date Method Yield(gpm) Time Pumped Pumping Level(ft Time To Recover Recovery(ft (HH:MM) BGS) (HH:MM) BGS) 04/27/2021 Constant Rate Pump 12 1:30 13 0:01 10 WATER LEVEL Date Static Depth BGS(ft) Flowing Rate(gpm) Measured ` — — --...--...-- --- ----- -... -- --._........ __...._.--- I 04/27/2021 10 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. Supervising Driller DESMOND THOMAS E Monitoring[M] Signature III, DrillerDESMOND III Registration# 764 THOMAS,E DESMOND WELL Firm DRILLING INC. Rig Permit# 0089 Date Job Complete o5/19/2021 NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion. ENYIROTECHLABORATORIES,INC. MA CERT.NO.:M-MA 063 8 Jan Sebastian Drive Unit 12 Sandwich,MA 02563 (508)888-6460 1-800-339-6460 FAX(508)888-6446 Client Name: Desmond Well Drilling Location: Address: PO Box 2783 429 Church St Orleans, MA W Barnstable,MA 02653 Lab Number: DW-211635 Collected By: DWO Date Received: 04/27/21 Sample Type: Well Well Specs: New well 10010' Analysis Requested Units Recommended Limits Analysis Result I Method IDateAnalyzedl Analyzed By Total Colifonn CFU/100ml- 0 0 SM9222B 04/27/2021 KF @ 17:30 pH pH units 6.5-8.5 6.17 SM 4500-1-1-B 04/27/2021 SD Specific Conductances umhos/cm 500 323 EPA 120.1 04/27/2021 SD _ Nitrite-N_ mg/L _ 1.00 <0.006 EPA 300.0 04/28/2021 SD Nitrate-N mg1L 10.0 <0.01 EPA 300.0 04/28/2021 SD Sodium mg/L 20.0 39 EPA 200.7 05/02/2021 KB _ Total Iron mg/L 0.3 5.43 EPA 200.7 05102/2021 KB Manganese mg/L 0.06 0.210 EPA 200.7 05/02/2021 KB Volatile Organic Compounds' ug/1- See comment. 47.65 EPA 524.2 04/28/2021 NEC' Comments: pH is below recommended limit and may have corrosive characteristics. Sodium level Is not a health hazard. '2-Butanone and acetone are found In the PVC glue used for well construction. *Limits:2 Butanone 4000 ug/L,Acetone 6300 ug/L Ccnsuit local Board of Health regulations concerning Iron level. All samples were analyzed within the established guidelines of US EPA approved methods with all requirements met, unless otherwise noted at the end of a given sample's analytical results. Wa certify that the following results are true and accurate to the best of our knowledge. Date 5/4/2021 Ronald J.Saari Laboratory Director BRL=Below Reportable Limits 'See Attached Page 1 of 1 oG'ert(fication is not available for this analyte for potable water samples.. a New England Chromachem ' 6 Nichols Street Salem,MA 01970 978.744-6600 Sample Information { EPA Method 524.2 Rev 4.1 Volatile.Organic Compounds in Water Lab ID: 5104415 Client Envirotech Laboratory,'-Inc. Client ID: DW-211635 State: liquid Date Sampled: 04/27/21 1 Date Received: `04/28/21 Date Analyzed:_ 04/28/21 MCL Re ulated.VOC's Results u 1L (u91) Unregulated VOC's Results(ug/L) Benzene. ND 5 Acetone" ND Carbon Tetrachloride ND 5 Bromobenzene ND 1,1-Dlchloroethene ND 7 Bromochloromethane ND 1,2-Dichloroethane ND 5 Bromodichloromethane ND 1,2-D.ichlorobenzene ND 600 'Bromoform NO 1,4-Dichlor6benzene .ND 5 Bromomethane ND Trichloroethene -ND 5 f 2-Butanone 47.65 1,1,1-Trichloroethane 3ND 200 N-Butylbenzene ND Vin. Chloride ND 2. Sec-But benzene ND Chloroberzene ND 100 Tert-B utyl benzene ND cis-1,2-dichloroethene ND 70 Chloroethane ND Vans-1,2-dichloroethene �ND 100 Chloroform NO 1,2-Dichloro ro ane ND 5 Chloromethane NO Eth Ibenzene NO 7.00 2-Chlorotoluene ND Styrene ND 100 4-Chlorotoluene ND Tetrachloroethene ND 5 Dibromochloromethane ND Toluene ND 1000 1 1,2-Dlbromo-3-Chloro ro ne ND X enes otai ND 10000 1,2-Dibromoethane ND 'Methylene Chloride NO 5 Dibromomethane ND 1,2,4-Trcchlorobenzene ND F70 1,3-Dichlorobenzene ND 1,1,2-Trichioroethane ND 5 Dichlorodtfluoromethane ND � 1,1-Dichloroethane ND Acetone Detection Limit=10 ug/L 1,3-Dlchloro ropane .ND ND=<Method Detection Limit I 2,2-Dichloropropene ND NA=Not Analyzed 1 1,1-Dichloropro ene ND cis-1,3-Dichloro ro ens ND + trans-1,3-Dicchloro ro ene NO Hexachlorobutadiene ND Isopropylbenzene ND P-1sopropyltoluene NO Meth I-tert-butyl ether NO Naphthalene ND N-Pro . Ibenzene ND 1,1,1,2-Tetrachloroethane ND 1,1,2,2-Tetrachloroethane NO 1,2,3-Tdchlorobenzene IND . Thchlorofluoromethane ND 1,2,3-Trichloro ro ane ND 1 .1,2,4-Tdmeth Ibenzene NO a 1,3,5-Trimeth Ibenzene ND Surrogate Standard Recoveries `Benzene-d6 _ 94 MCL TTHM's=80 ugA- 4-Bromofluorobenzene 100 ' Method Detection Limit=0.5 ug/L 1,2-Dichlorobenzene-d4 .102 Analysis performed per 31 OCMR42 I i Electronically signed and approved by Mr.Bruce A.Bornstein,Lab Director Date: 4/2912021 I No. � , Fee z1 5 q BOARD OF HEALTH TOWN' OF BARNSTABLE 0(ppricatiou j 'or Vern Con.5truction Permit Application is hereby made for a permit to Construct�4, Alter( ), or Repair( an individual well at: Location-Address Assessors Map and Parcel Owner Address Q �)j A&avy)d bell Or 11 NL. E O 160A 2 78 _,� Installer-Driller Address Type of Building Dwelling Other-Type of Building No./of Persons Type of Well 4 11 GWVj1PCapacity_ Purpose of Well OLD Y-S+-I G 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 Certificat o Compliance has n issued by the and of Health. Signed o asd- D to it Application Approved BC= �� Date Application Disapproved for the following reasons: \ ] Date Permit No. V`' �'' �/ Issued ' Date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed()Q, Altered( ), or Repaired( ) by 5M15ad Wtc,l tll1n4 , ( nC-- Installer t C. has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well rot ction Regulation as described in the application for Well Construction Permit No.W D0-t)/--0Zq Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector No. ll` 1—"/� Fee 5 + v l BOARD OF HEALTH TOWN 01F BARNSTABLE x Z.PPYtcation Ift. eYY Construction PermitrND Application is hereby made for a permit to Construct , Alter( ), or Repair( ) an individual well at: � r 2 G C h u r C h Si. u v. � 1 YtJ1 �Q I-1 (� � (��- iq Location-Address Assessors Map and Parcel .JuYWC, El )Ir. Lq z G C h u V C h sfi, yJ. _f 11A 6 Owner Address 2 mbnc VVel I bf I I 2 783 i00 M . Mh COG C 3 Installer-Driller Address Type of Building Dwelling J ,r. Other-Type of Building _ _ No. of Persons Type of Well �' ��C t LACUG Capacity Purpose of Well 6©n1 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 Certificate'-Of Compliance has,been issued by the Board of Health. Signed�-�- b�cf n 3, 30/J0,J l Date Application Approved BY\ `^-- Date Application Disapproved for the following reasons: 1 Date Permit No. V'�ap /""" „�'' Issued { r Date - - - - - - - - - - - - - BOARD OF HEALTH TOWN- OF BARNSTABLE Certificate of Compliance I� - THIS IS TO CERTIFY,that the individual well Constructed()0, Altered( ), or Repaired( ) by USMbnd Wg_- 11 Qf i III n/,i , I YlL. Installer f at Zvi C In LtfC h 0r rlS+rL.bIC has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Proterction Regulation as described in the application for Well Construction Permit No.wDj/ Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. ! Date Inspector BOARD OF HEALTH TOWN OF BARNSTABLE Vern Cou5tructton Permit J j No. ��a 1 —0Fee �`t Permission is hereby granted to U S YY1G nd Installer J to Construct`,O, Alter( ), or Repair( an individual well at: No. y Z q C.lA ffi dl s'S i . , Street 1 as shown on the application for a Well Construction Permit No. �l�Q' '�r_- Datedl. c�- Date / c ) Approved By • Y � �r-�/ y...,^L.:.i...--ram- _.�.� r /� Q DNS✓cc�sSFv� L�v� � LvCLL I l i4 4 I I I i I 1 2� 16�9 Q AGANDa�DEa, ?yrpTH L1M/7FD usl I 600 CAL., �EEcff i -Mv K 37•8 � I Doti GA I. Cfss P"L- 3" CCSS POOL CHURCH S TREE T Q R9 R s090. 35 L �g Q�zt. W q ` a .f04 rO CL — {y OF 8ANK ShS7 3084EW S.F. 9 d -,OFM S PAUL 9c�1 rW SXIS S7WCrURSS MERE L0CArSD 8Y AN R. N rrrNS bVSrRW'WT SMYSY ON !01%2 AAA DUST ON U * �a�"as y w BROUNO AS I- OAN., aa� Ago sr.i�, 0.4 TE - AROFESSMAL LA SINVEYMV PL GT' PLAN SHMING PROPOSED ADDITION 429 CHURCH ShREET, 8A9NS748L4,,' AAA SCALE 1 Ar w 40 ' OCTOBER 2Z. 2002 CANAL LAiVDF SURYEYIIVG " 306 OLD PL MOUTH ROAD, SAGAAME BEACH, AM LOCATION 4/ .g C /vu A c SEWAGE PERMIT NO. VILLAGE S %.. 3 A & B CESSPOOL SERVICE 128 BISHOPS TERRACE, HyANNIS, MA �@ 601 BUILDER OR OWNER J DATE PERMIT ISSUD DATE COMPLIANCE ISSUED fl q 2 4 r V c3 t \ I � J arrf' 1� 4 LOCATION SEWAGE PERMIT NO. 7 3-3�11 Z-/A g VILLAGE iN STAL,ER'S r-NAME & ADDRESS �'Yi �1 gyp-OU� A & B CESSPOOL SERVICE 128 BISHOPS TERRACE, HYANNIS, MA 0@ 601 BUILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUID 7-17 __ _ � ��y ` b 3 O \-� 7,, � c], �� r �� � � /` r i @ � VILLAGE A & B CESSPOOL SERVICE 128 BISHOPS TERRACE, HYANNIS, MA 02601 BUILDER OR OWNER o' . /, f/ 5� DATE PERMIT ISSUED DATE COMPLIANCE ISSUED � /�1 1 L i _ �� � �� �', �� \ 4 h �� `� i r <. �;. : } '�,-- pC��� I I d�tis�� d�N r �� I 10.00 PJo..83:....J 97 Fxs..........................._ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Town Barnstable -•----....................................0 F.......................................................................................... Appliration for Uhip as al Workii Towitrurtion ami# Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: 4.29 Church Street, W. Barnstable, Ma 02668 .........--• .._.. ................................ ..................... ................................................................................................. James Ellis Location-Address 4.29 Church St. W:r�°arnbtable, Ma 02668 ......................_.......................................................................... -••...-••--••••••...••----•........_............................................--............•... W A & B Cesspool Service 128 Bishop's TerrAd`j�annis, Ma 02601 ........................ ........ Installer Address d Type of Building Size Lot-----------------_---------Sq. feet U Dwelling—No. of Bedrooms............................. .Expansion Attic ( ) Garbage Grinder ( ) ►+ '_l Other—Type T e of Building No. of persons............................ Showers Q, YP g ---------------------------- P ( ) — Cafeteria ( ) Q, Other fixtures -----•-•••---------------------- . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total.leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.........--......... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.---.................--. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.................----- a --••-•-•---•-------------------------•------•---------------•--....••--------•-••...••••-•-•------....-•----------•-•-----•---•--••-.........------•-•-••---- 0 Description of Soil......sand-....................................................................................----............................................................... x U W __ UNature of Repairs or Alterations—Answer when applicable....Install 1000 gallon leach pit to exsisting system. -------------------•------------------....---•---•-•-----------------------.......----------.....--------•--------------------------------------------------------------------------•-•••......----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT1Z 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the boar of lth. ' 6/7/83 Sign --- .......................... Application Approved ,By..... .t----........................................................ 6/7M-e Date Application Disapproved for the following reasons-------------------•..........-----•--------------------•-----------•-----...................................... .................................................................................................................................................................................................. Date Permit No..83 ... 9.7------=--------••••...----........ Issued....6/7/83..................................... Date No..83.......r9-7 FsE.....$10.00...._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town- - .....---:--......OF.....Barnstable ApplirFa#iun for llhipoii al Vorko Tunitrnrtinn "unfit Applic tioiiris hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: 429 Church Street, W. B�armstable, Ma 02668 -•- __......_ --• - - ........................................... .......••-•-•-'---'•---•..............-----.....--•-------------•----......._...----------...---•- Location-Address 429 Church St. W 0 James Ellis t No °arnstable, Ma 02668 a A & B Cesspool Servrce . 128 Bishop's Terr:dVknnis, Ma 02601 ..----------•--•-'---'-'•••--••-------- .................................................................................................. Installer Address Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms..._ ...........................Expansion Attic Garbage Grinder p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 0.1 Other fixtures -------------------------------• - Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Septic Tank—Liquid capacity___.___.__-.gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No------_------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water..--_._--_--_-__-..-.--- (Z4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Q4 --•••••-•--•---------------------•-•-----•-••-•-..........-------•-................---•-•--.................................................................. 0 Description of Soil......sand........................................................................................................................................................ V ..............••---•--•--•-••--•••-•-•.......-------•'-•-•--•---•---'---•-•-••-••--....,_.......•----•'-'•--•••---••-•-......--•.....................--................................................. W UNature off RR 'airs or Alterations—Answer when applicable_-Install 1000 gallon leach pit to exsistng system., - ------------------------------------------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 oft�q '�tate Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of!1C:0mpliance has been issued by the b a of lth. . 6/7/83 Signe ----'•......•-•--....... .....-"------•-� ................................ Application Approved By.. 6/7/85e Application Disapproved for the following reasons-----------------•••--'-•--'•--•-•-•-------•------•---•----•-•-------------•--•--•-••-----------•._............ .....---'------------------------------------------------•-•-"-'-----•---------•-•......•-----••....•-----.........._..............--------•----•-•----•---•--•---••-----------•---................... `p 83— ,w : 6 8 Permit No----------------=--= ----.. Issued-----/7/3..---•--•-•'-•....._......au•----- - Date '4: ..,, THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable ......................O F..................................................................................... Calertif irtt#r of Tompltanrle TfW.1SCTC TIFY That th Individuah Sewage Disposal System constructed ( ) or Repaired (X ) by----------------b_-C-e p Service------2----Bishop .-s Teri Hyannis, Ma 02601 429 Church St. W. Barnstable Ma 0266EInstaller Ellis at...................................................................................................................................................................................................... has been installed in accordance with the provisions of T LE 5 of The State Sanitary 9de s described in the application for Disposal Works Construction Permit No.---� ........ ............. dated_-- /--7/13... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONST ® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...6�7/83 ........... Inspector....' ..r. THE COMMONWEALTH OF MASSACHUSETTS BOARD- DF`"H'EALTH Town Barnstable 83- ......... ............OF...................................................................................... $10.00 FEE........................ Biapoopt ' n l�rufit A esspool ery ce 1 �ish p s Terr Hyannis, Ma 02601 Permissionis hereby granted.........................................'•-.--.................----------._-•-• . ....---------........-•------....._-'-'•-.....---' to Corc� horS��pir Karn saie t ,668Disposal Syster> llis atNo.............•---•-----------••-----------....---•--..............__.........------•---•-------.---------------------------'-----------------------.....-----------------------.........---'-'. Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......6�7/$3 6/7/83 - -------------------- DATE..................................................................•............. rd of Health FORM 1255 A. M. SULKIN, INC., BOSTON LOCATION =--� 4/;L `} C /�u rc c S ; SEWAGE PERMIT NO. VILLAGE_ . W L / 7 A & B CESSPOOL SERVICE / 128 BISHOPS TERRACE, HYANNIS, MA 0@ 601 BUILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE IS SUID� _ i er -. i; ; c i