HomeMy WebLinkAbout0115 MEADOW LANE - Health ~` 115 Meadow,Lane
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CERTIFICATE OF ANALYSIS Page: 1
Barnstable County Health Laboratory
St;tcH13 Report Prepared For: Report Dated: 6/19/2007
Lila Davidson Order No.: G0740865
P O Box 882
West Barnstable, MA 02668
Laboratory ID#: 0740865-01 Description: Water-Drinking Water
Sample#: Sampling Location: I l5 iVleadow_Ln,W.Barnstbale,MA Collected: 6/11/2007
Collected by: L.Davidson Map 133 Parcel 005-001 Received: 6/11/2007
Test Parameters
ITEM RESULT UNITS RL MCL Method# Tested
Chlorides 25 mg/L 1.0 EPA 300.0 6/11/2007
Total Dissolved Solids 100 mg/L 7.0 EPA 160.1 6/11/2007
Hardness ND ng/L as CaCO 0.1 SM 2340B &18i2007
Manganese 0.01 mg/L. 0.01 SM 311113 6/13/2007
Color ND Units 1 EPA 110.2 6/11/2007
Routine
ITEM RESULT UNITS RL MCL Method# Tested
Nitrate as Nitrogen ND mg/L 0.10 10 EPA 300.0 6/11/2007
Copper 0.13 mg/L 0.10 1.3 SM 311113 6/13/2007
Iron 0.11 mg/L 0.10 0.3 SM 3111B 6/13/2007
Sodium 24 mg/L 1.0 20 SM 3111B 6/13/2007
Total Coliform Absent P/A 0 . 0 SM9223 6/11/2007
Conductance 170 umohs/cm 2.0 EPA 120.1 6/11/2007
pH 6.8 pH-units 0 SM 4500 H-B_ 6/11/2007
Sodium-level is above the uzaximum contaminant level.=Those on a low sodium diet may wish to coltsult a physician.
Approved B J"(L'ab
irector)
3 O1.7
C3 r
F:3
M
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ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level
Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605
No.----Y�=-------
Fee----22._S- ---
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appiicat ion ArVeil Con!9truct ion permit
Application is hereby made for a permit to Construct ( ), Alter (,l< r Repair ( )an individual Well at:
-Qb�- ----------------- -- ----
�ocation — Address As sors Map and Parcel
to
Owner Address
------------------ ---
Installer — Driller Address
Type of Building
Dwelling #---- S e
Other - Type of Building---------------------------------- No. of Persons----------------------------------------
Type of Well—/�/,q--- of) "'' - ---- - -- - Capacity---------------------- — - - - - --—
Purpose of Well_ naTz ----- T ---------------------
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 --------
date
Application Approved By A:a
Application Disapproved for the following reasons:-------------------------------------------------------------------------_-----
------------------------- -- ------ --------
date
PermitNo. -- _____CO_ 0---— ----------- Issued--------------------------------------------=---------------------
— date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate ®f Compliance
THIS IS TO CERTAFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired (�)
by------ - -'JJ =- - - -------------------------------------------------------------------------------------------- ---—-
Installer
at-<-� M P4- vsJ L w--- �,,01-.1-------------------------------
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------------------------------------—--- -------------
• '"�:,i-t,,r�.�..,�:.:�4+�-,.cry-,•-�..rY+"G'�+•.•�,��:.:._►�rr9L%+'l.-a'�+4-�•tvR�-rR;.,�.rr�tl"'�G�'""'�+�e.��tl�r�.,k• �rf�.�i-r*°�tiAt•+�'°+i`i-�t�gp,/v.r.,-r..rurFt�?-�.c�.-��F.pv,�`•,-..
_ Fee-----;2-- - ----
BOARD OF HEALTH
TOWN OF BARNSTABLE
0(ppYication-*rIftl Congtructionpermit
Application is hereby made for a permit to Construct ( ), Alter or epair(1� ;R/lJ1(/ )an individual Well at:
$ - - 7 —- --- -— -------
ocation - Address Assessors Map P and Parcel
y-----------------
Owner Address
- --------- ------------
Installer - Driller Address
Type of Building
Dwelling /-/°" S
Other - Type of Building---------------------------------- No. of Persons------------------------------—---
s
Type of Well Capacity--------------------
Purpose of Well-&rcS?it--- � --- ---
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 I ---- --- ---- -
date
Application Approved By-
--- -- -- -- -`t°
Application Disapproved for the following reasons:----------------------------------------------------------------
- ------------------------ --- -------------------------------------------------------
-------------------------
date
Permit No. -- COO--- —-------- Issued----------------------------------------------
date
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BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate (Of Compliance
THIS IS TO CER That the Individual We11 Constructed ( ), Altered ( ), or Repaired(d) --
,"r / " ti- rY -
-.--------------------------------------------------- -
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 Permit No. ----Dated-------------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE- --- — —-- — — --- -- Inspector---------------------------------------—— ------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
U)eCC Conoruct ion Permit
` �.6d - --------No. -- Fee- —
Permission is hereby granted®• C d..,.�`
to Construct ( ), Alter ( ), or Repair ( ) an Individual Well at:
M r - ci.��
Street
as shown on the application for a Well Construction Permit
No. - — lL V v ---------------- - Dated--- -- - /- 1--------------------------------
--------'--------------------------- -
koard of Health
DATE---- — - ----- ---— --- -
i .
TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
MAP NO. lq-3 PARCEL NO. n
ADDRESS OF TANK: I 1 S e l 3 o'- V I LLAGE: to + 6412,4 Sf' �f v
MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) :
OWNER NAME: ), I I-,I A 1� u � 'o S o,-i PHONE: 3.0 V 3 6 a-3 V J-
INSTALLATION DATE: ' / BY:
I^!STALLER ADDRESS: CERT.NO.
*TANK LOCATION: �► Lr t t�
(DQOOR„IO TANK LOCATION WITH MMOMKCT TO wuILDINm) '�t�� O
CAPACITY JJ TYPE OF TANK L� AGE f q YRS. FUEL/CHEMICAL 4-F6'i�Y
TESTING CERTIFICATION C ] PASS C ] FAIL DATE
LEAK DETECTION [ ] CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION [ ] YES [ ] NO DATE TO BE REMOVED
FIRE DEPT. PERMIT ISSUED [ ] YES C ] NO DATE
CONSERVATION C ] CHECK IF N/A DATE
BOARD OF HEALTH TAG NO. C {/J/�//�y^� ] DATE
f 4✓ S C y
PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD