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1894 MAIN ST./RTE 6A(W.BARN.) - Health
1894 MAIN STREET West Barnstable A = 217 — 012 r a Page: 1 of � CERTIFICATE F ANALYSIS ;gf M,1 ' Barnstable County Health Laboratery`(IVI-NIA009) Report Prepared For. R©port Dated:, 9/2/2016 'mj Sally Desmond Desmond Well Drilling Order No.. G169641. 4,3 P O Box 2783 Orleans, MA 026.53 Laboratory ID#: 1696414-01 Description: Water-Drinking Water= CA Sample#:: Sample Location: U 4 Rt,6A W."Barnstable Collected: 08/31/2016 Collected by: DWD Received: 08/31/2016 =: Rootine_M ITEM RESULT : UNITS RL MCL METHOD# ANALYST TESTED NOTE Nitrate as Nitrogen 2 4 mg/L 0.10 10 EPA W0.0 LAP 8/31/2016 i iron ND mg/L 0,10; Ora SM 3111B LAP 9/2/201`6 i Manganese` ND mg/L 0.025 0.656 SM 3111B LAP 9/2/2016 6.4 PH AT 25G. NA 6.5=8:5 SM 4500-H-B DCB 8131l201$ pH Sodium 24 mglL 2.5 20; SM 3111B LAP 9/212016 Total Coliforrn Absent PIA o 0 SM 9223 RG 8,13112016 Conductance 220 umohslem 2.o SMn 251013 oc6 8/81/2016 Sodium level is above.the ma&m con miriant level.Those on a low sodium diet may wish,#o consult a physician. k. Attached please find the laboratory certified parameter.list. Approved By. (Lab Director) J 0� L� ND=,None Detected RL Reporting Limit MC,L.=Maximum Contaminant Level 3195 Main Street, PO..Box 427, Barnstable, MA 02630 Ph: 508-3.75-6605 CERTIFICATE OF ANALYSIS, { Barnstable Q'ounty Health Laboratory (11�-1VIA009) :ntftus �Recrptent:`; Sally Desmond Matrix: Water Drinking Water tDesmond Well Dulling Sampled:: 08/31/2016 14.30. R 0 Box 2783' Received: 08/31/2016 14:46 Orleans, MA 0?6.53 Collection Address: 1894 Rt.6A W.Barnstaple �;. Sample:Location: Order4k. r G1696414- Descriptioni Rtn_M+VOC-1894 Rt.6A Lab ID.: 1%696414-01 Date Analyzed: 8/31/2016 @ 16:04 Sample#: Analyst: yn Method: EPA 524.2 Dilution Factor: 1 I Comment: Sodium level is above the maxium contaminant level,Those on a low sodium diet may wish to consult physician.. ...._.. _.__.....:;„ _.:.:..- :........ EPA 524.2-.Volatile Organics by G'CIMS. ... _.. Result MCL MOL Result MCL MDL Parameter I ug/L ug/L ug/L Parameter ug/L ug/L ug/L !Dichlorodifluoromethane NO 0 50 3 Chloroform 4:2 80 0 50 _ _ -- - —.... _ — — Chloromethane NO 0.50 cis 12 Drchloroethene NO 70 0,50 0 50 Vinyl chloride NO 20 0.50 as 13 D(chloropropene ND _ _ _ 8romomethane ND i 0 5o Dibromachloromethane NO, 0150 t 1, , ,2 Tetrachloroethane. I ND NO 0 50 �1..1 0 50' Dibromomethane _ __ ,_ ..._. € �1 1,1 Trichloroethane ND 200 0,50 _ Ethylbenzene _ ..._ 0.50 Np —i—��o- 0.. ... �11,2 50 ,2-Tetrachloroethane ND 0.50 Hexachlorobutadiene. r 11,1,2 Tnchloroetharie _ ND 5 0 _0 50_ Isopropylbenzene I . ND _ o�0 1;1-Dichloroethane NO. 0.50 Meth lene chloride _ ND _ 5 0 ; 0 50 y —... Ii 1-Drchloroethene ND 7 0 0 50 Meth I tert bu (ether - ND _ -..._ Y ty -- 0 50 .. 1 1 Drchloropropene ND 0 50 Naphthalene' _O _....._ `J,2,3-Trichiorobenzene NO _ 0.50 n Butylbenzene ND o 50 ..... _.. ...—_.. 0 50 1.,2;3 Trich..loropropane_ ND i 0.50, n-Propylbenzene N.D r,44 Trichlorobenzene ND 10 0:50 p-Isopro,.pyltolue.ne NO - 5 r m — 1,,24 Tnmethylbenzene NO 050 sec-Butyl benzene NO 0.so: 1,2-Dlbromo-3 chlor'opropane ND o 50 Styrene _ N _ ... ._ :..— :. D i00 0 50 1,2-Dibromoethane(EDP)` ; NO, ; 0,5..0 tert-Butylbenzene ND 0 50 — -- 0 0.50 T.etrachloroethene 1;2-Dichlorobenzene;, r ND ND 5.0 0.so' 1;2-Dichloroethane NO 5.0 0.50 Toluene ND 1... 0 50., N 0:50 m Total NO 10000 o.so 1, ;5 Truneth (benzene NO xylenes: 2-Dfchloropropane N -- --- 100 0.50 ( y p 0.50 traps-1;2=DIChioroetliene ND L. NO 0.50 trans 1,3 D chloropropene. NO I o 50 °1,3-Drchlorobenzene ,^� _....-..._..... _ —.... —_._.._— . . I 0 50 1;3-D€chloropropane ND 0.50 Trichloroethene ND 5.0 1,4 Diclilorobenzene ^NO. — 5;0^„ 0.50 Trichlorofluoromethane— r_.. Np =-0 50 —. 22 Drchloropropane NO o 50 Surrogates. %Recovered QC limits ND 0:50 2 Chlorotoluene -... p Bromofluorobenzene 101%. 70�130 _�.. 4-Chlorotoluene NO 0.50 130 __. 1,_2_Dich..-io..r_—oben_ze.ne d _._ 1 ...__ 4. .. . ?Benzene ND 5:0 0 50 j Bromobenzene _ ND m, Bromochloromethane T ND r o s0 _ _.. Bromodichloromethane I NO o 50: — Bromoform ND 0 50,. �. iCarbon tetrachiorlde NO 5 0 0.50 IChlorobenzenie � NO. 100 0 50 Chtoroethane - ND. .. b50 i Approved By: ... ... VI.I..-........... Attached,pleaSe find the:.laboratory certified parameter list (Lab Director) ND 1.None Detected Rl:._ Reporting Limit MCL'=Maximum Contaminant Level 3195 Main Street, Po,.Box 427; Barnstable; MA '02630 Ph, 568-3754605 Page 1 of 1. o TOWN OF BARNSTABLE LOCATION /O 7�,A JE f** el�6A SEWAGE# VILLAGE +J?.eArt& ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO.OF BEDROOMS OWNER PERMIT DATE: 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 facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY �� ���4� �y s3 , �> ' �. �� i Massachusetts Department of Environmental Protection Bureau of Resource Protection Well Completion Reports Well Driller Please specify work performed: Address at well location: New Well i Street Number: Street Name: 1894 MAIN ST Please specify well type: Building Lot#: Assessor's Map#: Po mestic _ - 1 217 L Assessor's Lot#: ZIP Code: Number Of Wells: 012 02668 Citylrown: Well Location t2 BARNSTABLE In public right-of-way: GPS (`Yes i"�No ! North: West: 41.69686 69.34518 Subdivision/Property/Description: Mailing Address: ----- _._ 40,click here if same as well location address! Property Owner: Street Number: Street Name: WIRTANEN 1894 MAIN ST City/Town: State: Engineering Firm: BARNSTABLE MASSACHUSETTS ZIP Code: 02668 Board of health permit obtained: °_Ye s Not Required Permit Number: Date Issued: W2016 016 06/28/2016 ...................................................................................... dr LMassachusetts Department of Environmental Protection ..„ Bureau of Resource Protection—Well Driller Program Well Completion Repotts(General) Well Driller - General Well Form DRILLING METHOD Overburden Bedrock uger [-Choose Bedrock-- WELL LOG OVERBURDEN LITHOLOGY mm �Fr,m(ft) To(ft) . Code Color Comment Drop in drill Extra fast or slow Loss or addition stem drill rate of fluid ROCKY �� � �F0 Sil Sand And G Brown t"'Fast t Slow� oss Addition Sand And G +;' ROCKY ' =LossAddition Brown 'Fast Slow 25 45 Sand And Gravel Brown 4 Fast>'Slow YES NO � L oss�Add�t_, Brow.. n ! _ (..............................................T....F...................................................................................................... C` f 45 65 Fine To Coarse S .... (�Fast Slow ......................-............. ........................................ ......................[................... ...........-.1. YES NO f Loss Addition ....... ...........................................- .............. 65 69 Fine To Coarse S Brown _ _ _.__ ..__. ..... ........... ........... 'Fast f'Slow.....` ..._ ............._ ......................... YES NO Loss Addition WELL LOG BEDROCK LITHOLOGY ....................................................................._........................................................_.._................_....__..._..................._...................................__......_.._.._.........._...........................i...................................................................._.............._.................,...................._...__..__..... I Loss or Extra Drop in Extra fast or Visible Rust I From(ft) To(ft) Code Comment j 1 addition of I Large drill stem slow drill rate fluid Staining Chips p Choose Code F � � — YES NO I Fast Slow ; Loss Add_...ition I' �.—................4 i A.... _.._ ADDITIONAL WELL INFORMATION Developed �Yes('No Disinfected Total Well Depth 69 Depth to Bedrock Surface Seal Type None racture Enhancement r Yes�No ' ...._.. ...................................._.............._. ........_.................._............__... ..................................................................................... CASING asing above ground. From: 1 To: 0 ................................ _..............._._......................................._..............................................................................................................................................._.............................................................._.................. .......... From To Type Thickness Diameter Driveshoe 66 Polyvinyl Chloride � Schedule 40 F J.[........... Yes SCREEN No Screen �.......................... ......._ ._ _ ;_:............................................_.._.. _ ._................................................... ...._................._..- ___._........................... . . . .. I From To Type Slot Size Diameter 66 l69 , Stainless Steel Well Point '; 0.012 4 1.............._....._�. _..._._..__ _ WATER-BEARING ZONES r7 DRY WELLI From To Yield(gpm) j PERMANENT PUMP(IF AVAILABLE) rr% s 1 Vr Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program Well Completion Reports(General) I ' 2 Wire Constant Speed Pump Description Horsepower Submersiblei 3/ Pump Intake Depth(ft) 65 Nominal Pump Capacity(gpm) 10 ANNULAR SEAL/FILTER PACK i Water Batches Method Of From To Material 1 Weight Material 2 !Weight (gal) (count) Placement .._____--------------.._...................-.............................._......__.........................._..........._.,..._,.._..'_-Y__......_..........--___......_...._......._...........-__....._.._.._.._..__.................................Z_..,.__..,.-.._.............._........_...._......_......_..__................................_....._..-._.._....v. X. ........ ............... . ........ ........_........ ......... ........ ... v�................................«...... ......... ...... .................... ....... i( Choose Material Choose Material WELL TEST DATA _ Time Pumped Pumping Level(ft Time To Recover Recovery(ft Fate' Method Yield(gpm) I(HH:MM) BGS) (HH:MM) BGS) �08l31/2016 Constant Rate Pump _ 115 1:30 i 42 0:01 40 WATER LEVEL Date Static Depth BGS(ft) Flowing Rate(gpm) Measured —..._............ ......... ........................................................... {{— ........................:..... O8/31/201t� 140 ................................ , 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. DESMOND SEAN Monitoring[M] Supervising Driller III, Driller SignatureMORGAN Registration# 764 THOMAS,E DESMOND WELL Date Job Complete Firm DRILLING INC. Rig Permit# 023 (09I15/2016 NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion. No. ��, ��1 `F' Fee BOARD OF HEALTH TOWN OF BARNSTABLE 01ppYicatiou _for Yell Cou5tructiou Permit Application is hereby made for a permit to Construct(vh, Alter( ), or Repair( ) an individual well at: 0A wm'—'�k, —L I-1 ` 012 Location-Addres Assessors Map and Parcel o^C� c�'c�r2r cru z V. c"S-�" os;��oJb� " ozu g Owner Address Installer-Driller Address Type of Building Dwelling J Other-Type of Building No. of Persons Type of Well ?0 Ta b - $'C*A O Capacity I u 1°1' " Purpose of Well _bMyl\LAB L 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 Cert' cat!of Compliance has been issued by the Board of Health. Signed 21 DESMOND WELL DRILLING, I G. Date 5 RAYBER ROAD,BOX 2783 � �//� Application Approved B OR 08)AN ,MA 02653 Date Application Disapproved for the following reasons: ((�� Date Permit No. 1N L9 , Issued Date -------------------------------------------------------------------------------------------------------- DESMOND WELL DRILL-NG, INC. BOARD OF HEALTH 5 RAYBER ROAD,BOX 2783 TOWN OF B A R N S T A B L E ORLEANS,MA 02653 (508)240-1000 Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed(.Altered( ), or Repaired( ) Installer at cj- r G,q Wg-<35- has been installed in accordance with 4he provisions of the Town of Barnstable Board of Health Private Welt Prote tion Regulation as described in the application for Well Construction Permit No. /(9 ^ 0 f (o Dated 6 1—d-& THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector No. Fee — BOARD OF HEALTH TOWN OF BARNSTABLE F 0(ppYication _for Yell Conotruction Permit Application is hereby made for a permgit to Construct(vh, Alter( ), or Repair( ) an individual well at: Location-Addres Assessors Map and Parcel � ,� of r,4"A� IVY OZIc hR -Opw,ner t Address Installer-Driller Address Type of Building Dwelling J Other-Type of Building No. of Persons Type of Well pp�,VVl. 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 Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Cert' cate of Compliance has been issued by the Board of Health. Signed C 21 .I Date Application Approved B Date Application Disapproved for the following reasons: Date ff-- Permit No. �� I U '� c ( Issued �y /� lO Date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance i THIS IS TO CERTIFY that the individual well Constructed .r Altered or Repaired( b LU-L I) d-,l4,1— ,y � �yt c x�� � c ��'G-, Installer at has been installed in accordance with he provisions of the Town of Barnstable Board of Health lth Private Well Protection Permit No. '�C c G Dated ra Regulation as described In the application for Well Construction Pe t (� J(. / (o �9 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 Yell Construction Permit L _ No. Fee 1 Permission is hereby granted to 7bE2M og-A W iu . .C)ZIL-4 //V r' Installer to Construct( ), Alter( ), or p Repair( -) an individual well at: "� '� No. �) l Y ! r / tZ(� &W �� � t +C ICE tStreet S as shown on the application for a Well Construction Permit No. Q I,� iDated Date 62 J 1 Approved B Y MAP 7 \A AP 21 0 2 01 # 18 4 6 � / 78. 2 PRO OSED WEL 68, --v V\ v z1-Z) 00 0 193 / 79 . 2 �.� � �,tij� � OF" s� ARNE H. o ,Qom 1 ®GALA NoIVIL tA 30792 u� 54. 2 6 4. 0 1 /1 1 ��-S