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HomeMy WebLinkAbout0033 WIDGEON LANE - Health 33 WIDGEON LANE WEST BARNSTABLE A = 133 049 0 t ,; 2034 �i . 'NASTINOls IIN xplt) Fee--- --------------- BOARD OF HEALTH TOWN OF BARNSTABLE ✓✓✓ Application-for Vell Cootruct ion 3permit Application is hereby made for a permit to Construct Alter ( ), or Repair ( )an individual Well at: Location — Address Assessors Map and Parcel Q�(t — v`, fib I U�2�'odJ _4._A9 _'— ^ / prOwner / Address -- a� /0 o X g 6a fu.0 t t� .A&_ rt k 0 5 G Y ----------------------------------- ----------- Installer — Driller — — — Address Type of Building Dwelling —-- - Other - Type of Building-- ------ No. of Persons--------------- ----------- Type of Well V t 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 ompliance has been issued by the Board of Health./ Signed c� G -- date Application Approved By -- -- - Q ---------- !/ date Application Disapproved for the following rea s: -----= ------------- - ---- ---- - Z�o — date Permit No. _J� -- Issued—_------ --- --- -- -_-- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( .! Altered ( ), or Repaired ( ) by _ ------�-�Sell "' ---- ---—�--— ---— -- —�-- -- Installer has been installed in accordance with the provisions of the Town of Barnstable B'Q/a' -j-f H�ea0Dated rivate Well Protection Regulation as described in the application for Well Construction Permit No.�L� i��1— ----THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--_ _ Inspector--------------—_ —__ _ v)idolD No.-- - - Fee------- - ` s BOARD OF HEALTH �. TOWN OF BARNSTABLE 01pplicat ion-for Vell Cootruct ion Permit Application is hereby made for anpermit to Construct (�, Alter ( ), or Repair (Q )an individual Well at: 41 —— Lo ation — Address Assessors Map and Parcel -- � v �C -- — '3�� G-� ��6co�� ��.y �� • �or.J .cru ----- --- - --- - /� n / Owner / Address b CjC4wrJr 11 c��i�l _IUD, (/. PO, o?r �60 /�tuf�� e ,dtv 0J6VF Installer — Driller — -- Address Type of Building Dwelling Other - Type of Building-------------- No. of Type of Well tr" A2 c — Capacity--------- Purpose of Well- Do"'`s Tr` I i 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 mpliance has been issued by the Board of Health. Signed _ _— _ date fi4l Application Approved By --___— date Application Disapproved for the following rea s: ------=------- ______�—_— —_ date Permit No. �'t-!� � — Issued-- __ -A--- date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate Of (Compliance THIS IS TO CERTIFY, That the Individual Well Constructed Altered ( ), or Repaired ( ) by--� �D A ScU�" // — -------------------------=-------------___--------- Installer at— has been installed in accordance with the provisions of the Town of Barnstable B / HaIaI vate Well Protection Regulation as described in the application for Well Construction Permit No, !��-Rated---------------- 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 Ivell Con5truct ion Permit �- . No. ---- ---- ` Fee- Permission is hereby granted D A to Construct ( ")'Alter ( ), or Repair ( ) an Individu�JN��' a c..� L w' i�,,/ No. — 3'. � D Goo-� -----�------------------------- -- ------------------ street as shown on t k plication for a W§111CWkstruction Permit No.-��� ---__ Dated- —A. --� ------------------ ----_--- - --------------------------------- DATE - �Board of ealth �/ __— NOTICE: This Form Is To Be Used For the Repair Of Failed Sepif SysteYns. Only: - CERTIFICATION OF SIMCH kN-D'APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERhIIT fW=QUF DESIGNED PLANS hereby certify tha4 the appGcation For di cis works comsu action permit sided by me dated /�. l�� concerninz `fie Proper— Ioc�ted:at 7j 3 1i✓fGf�'�G�/9 `�. /�t� y`-.s a1.of the t dowins criteria:. --le Lai SrZenl is conne=.-d to.a ralo-nCcl t?,4eihnQ oniv, _ner e "-e nc c01 Tl�er c.a l or 7Lsan ess the dw le T_?nQ_. SiL'S clz--zi -- SS ' . .i . _ .u"1..-2S [T ila..... 1.:.nu:ne ^er�iaClOn--ale :S .e5� .n^'1 ' ?•^I :0 �- �-r '`Re._ue no wedands wtt^.1i1 100 of lZe 7IDUQse�C'oLC=+SCe:1 s s�,,tic s-vae 1. are no.Prrvue—a--- is ne inc.Se in flow=- d/or.c:.=ae ;n ase proposed K Vie._ *e no v"�:ances.r�us_d ar n:=ded b' ne bottoro.of the roxsed Ie C=1a` T - e a..uty wt_1 not .ed less di;-:n five _t above the ::mum adjtste3,couad- att.table eie•,anon. (Adjus the ?-ound:.ater.tabie.usirz*1e 7-nmtnor etnod when a=iic2bI=1 - i/ ifreCac � t -_he S-A-S-will be 10=2 e;.itn_d0 fee:or axix vegetated wetiands, the bottom Of the-Drovosed l Ching mrility-iriII not be located I_s than fot'_reen(14)fe_:above the ttia:scum adnst- 4-oundwater table elevation, Pleas--complete the follomno A) Top of Ground Surface=Ievation(� 'Tff CIS information) 3) G:w:Ficvarion 2 -L.th-I X G.Fi�. Aeiu-meat. �-Jam= Z ✓. D r CBETI)VEEN A sad 3 �4 DATE: [Sk=.proposed pL n of s:M=on E2zJ. Massachusetts..Department of Environmental Management Office of Water Resources 104250 TYPE OR PRINT ONLY Well Completion. Repoli WELL LOCATION GPS (OPTIdNAL} �k, [ATITUDE w 4 1N {�.. Address at Well Location: Y Property Owner: ,po�.?`8�b Subdivision Name; Mailing Address: City/Town: City/Town: Assessors Map )3,2 Assessors Lot#: IM2 NOTE: Assessors Map and Lot# mandatory if no sheet address available Board of Health permit obtained: Yes 9?r Not Required❑ Permit Number w 20"( Issued (- :WORft°PERFORMED a.q 3 FR(1POSED tiSE , .. DRI � I �tU11ETHtsa ., _r . e .x :_ .m•_. ,m �_._ ❑ New Well ❑ Abandon C�'Domestic ❑ Irrigation ❑ Cable CAuger ❑ Deepen El Recondition ❑ Monitoring ❑ Municipal - El Ha"- « Direct Push Er Replace ❑ Other ❑ Industrial ❑ Other ❑ Mud Rota eu Q Other 5:'WELL LOG Unconsolidated Consolidated 6 SI1 E Slf `C� s a es aana€� r w#f4, l stance W Permeability co i H > w v m m m From (ft) To (ft) High Low m Other Rock Type a. k 3 ; � e 7 GiFELL CONSTRUCTION 8.�CASjNG� �� 771 Total.Depth Drilled From'(ft) To (ft) Casing Type, Material Size O.D. (in) Well Seal Type Date:Drilling Complete �� IJG b�a� 9 SGREEN: From (ft) To(ft) Slot Size _ Screen Type and Material Screen Diameter a >rLT t PACK 1 GRE3UT./AB,aNflf?NMEt T MATEl�L"� 11 AR 1TI€?fi 11111 LL INEC1RIlrlAT(t)C-C a - _. From (ft) To (ft) Material Des crption Purpose Developed? El Yes El No Fracture Enhancement? ❑ Yes El_No - Method. , Disinfected? ❑ Yes ❑ No LL TEST DATA{PRQC)UCT1O>N W�.l.S}# 1"IfiiC �'LEUl=1.IALL 1�tLLS)1 � 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) 7 14_ PERM►}xlENT PUMP(IF,:A1fAfLABLE) , ,., p , 1a NA3E01 ,t �Ai fats Ct}fPAt ' Pump Description Horsepower a e Pump Intake Depth S (ft) Nominal Pump Capacity - �6 (gpm) 16 COIVtMIf+1TS This well was drilled and/or abandoned under m supervision, according to applicable rules WELD.URIJLI.ER�S 3TAT�l1�ENTw�. _w �:, Y, P 9 pp• . and regulations, and this report is complete and correct to the best of my knowledge. Driller: - . Supervising.Driller Signature: Registration #: Firm: /) `r a l , /� �� r�. 1' r Date: D /J A —Rig Permit#: NOTE: Well Completion Reports must be filed by the registered well'dridler.within 30 days of well completion. BOARD'OF HEALTH COPY • TOWN OF BARNSTABLE LOCATION ae-w SEWAGE # VILLAGE �4? ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY Z LEACHING FACILITY:_(type)1�171.z (size) /d e 3B''42 NO. OF BEDROOMS BUILDER OR LMMiy— COMPLIANCEPERIvIIT DATE: . DATE: Separation Distance Between the: ¢ Maximum Adjusted Groundwater Table and 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) S� Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by lSGL �33 -71 0 0 I, n� } i No. //ly Feeiy 4j< / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: I/ es PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for Migool *pgtem Cottgtruction Permit Application for a Permit to Construct( )Repair( )Upgrade/Abandon( ) rvi omplete System ❑Individual Components Location Address or Lot No.33 /a,/1 AI, , Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. !/ Designer's Name,Address and Tel.No. 771-'?Ye Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(1� Other Type of Building G�o.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow �`„�� gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank `�7 00? Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) clg Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b is o of Hpalth. Signed Date 'em Application Approved by Date Q�� Application Disapproved for the following reasons Permit No. ' Date Issued gO , Z x �.�.. ' "' ma 's^- #�^ cz�, *.,- q .� --=�-"-d .^r .�•s. i"' �` i-� s; - pz TOWN OFBARNSTA&L;E: LOCATION SEWAqE 41,Z40�yJ� VILLAGE ; s� ASSESSOR'S MAP & LOT Ij � Pt 1STALLER'S NAME`&'PHONE N0. ` p ` SEPTIC .TANK.CAPACITY �. LEACHING FACILITY (ryPe)1r"��� � (size)-, -f f . NO: OF'BEDROOMS 3 BUILDER OR PERMITDATE:_' COWMAN. DATE Separation Distance Between the... Alazimum Adjusted Groundwaie"r'•Table and Bottom of Leactung.Facility Feet y Private Water S u 1 Well and Leaching Facili ]f any w PP Y tY ( y ells exist oa;site or;:w�thin'200 feet of:It facility) I SS® Edge`of Wetland and Leaclung:FaciL r" t5 Ufany'wetlands.exist within 300 feet of leaching facility) Furnished''by. Feet:Feet: i - a A No. �� Fee r- 6 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 1 2pprfcation for Migpont *pgtem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade(V)Abandon( ) L7Complete System ❑Individual Components Location Address or Lot No.33 W 1 PO4 /4, Owner's Name,Address and Tel.No. _ Assessor'sMap/Parcel �r�rJ��i�/�G' Installer's Name,Address,and Tel.No. S Designer's Name,Address and Tel.No. Bar 7`aloTl�i ©� / 7.7 --93 `1 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder(,Ali' Other Type of Building cf S of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow ,/W gallons per day. Calculated daily flow -3J0 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank � Type of S.A.S. 41" h`i9� � r Description of Soil Nature of Repairs or Alterations(Answer when applicable)_ riAll? : v r �� exlg Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system f in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b t,is oarchof H alth. L l Signed Date � Application Approved by s Date r ' .:77-4 l Application Disapproved for the'following reasons j �n Permit No. W4=1' Date Issued ---------------------------------- --- THE COMMONWEALTH OF MASSACHUSETTS 3? ` Q77 BARNSTABLE, MASSACHUSETTS I"-( Certificate of Compliance THIS IS TO CERTgY,that th On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( )by at ?i ZA111Y0 f0,0 Gf.� Drams has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit Wig 75- dated 40'�,-P7 -ewov�� Installer A—-CK c�tc <a���k Designer <.1t .� a C,, �a_c to Q� The issuance of)this permit shall not be construed as a guarantee that the system will function as designed. Date Rl 7)L l U\ Inspector C lilJf �,� —� --------------------13Z--��Fee---- No. . _ .. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migpogal *pgtem Congtruction Permit Permission is hereby granted to Constru ( )Repair( )Upgrade( Abandon( ) System located at J 3 W/" ©1�I Z� 4w, and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of thi p it. Date: Approved , L �� 3 =OF� Dpooms=,w_ii desi=e3 I-a _-no. sides JU_iL X T.riati Z X.ao. sides 2 = Z� Q - BO'� crida�X Ieng� �� =sa.z Bo s total a ta 7 V Z6(/ sq.= x , 7 _= dcsign� (ap�u: oz r::.e) _ailans/day 30 . 14�9 f i ,g -a5n1 off 508-362 foe 508 362--9880 ROUT •� ._ E 6A EXIST. DWELL ---_ down Cape engineering, inc. \�\ \ - --.._` \` --�'r # 40 n----- CIVT.L ENGINFE}ZS w \ EXIST. WEL / Q LAND SURVEYORS \\\ // 939 main qt. yarmout.h, ma 02675 .>\ \ WIDGEON \ LOCUS \ 0 MIKUTOWICZ \ / ' LOCATION MAP NITS ASSESSORS MAP 132 PARCEL. 49 O ' I f� v LP DU ao O r FxIST. pWFI_l. 0 # 10 rZ \ \ P OP. LP SITE PLAN - OF 33 WIDGEON LANE IN THE TOWN OF: \ I \ (WEST) BARNSTABLE PREPARED FOR: GERALD 8c PATRICIA LAMOTHE \ \\ 30 a 30 CD 90 or � L CRANBERRY BOG " °nd SCALE: 1 = 30 DATE: DECEMBER 18, ?_OOa 1 I # 195 00`303 ` � �� ARNE H. OJALA, P.E., P.L.S. DATE off 508-362-4541 \ fox 508 362-9880 \\\ \ ROUTE 6A EXIST. DWELL down cape engineering, inc. —�� # 40 CIVIL ENGINEERS EXIST. WEL LAND SURVEYORS 939 main st. yarmouth, ma 02675 \ \ \ WIDGEON \ \ LOCUS MIKUTOWICZ ` LOCATION MAP NTS ASSESSORS MAP 132 PARCEL 49 LP , DECK \\ \ r EXIST. DWELL 0 # 10 C \DECK \ ; P P. LL \ �� 150' L) SI-TE PLAN \ OF 33 WIDGEON LANE \ \ \ IN THE TOWN OF: (WEST) BARNSTABLE PREPARED FOR: GERALD & PATRICIA LAMOTHE \ 30 0 30 60 90 OF \ CRANBERRY BOG wet SCALE: — 30 DATE: DECEMBER 18, 2000 �ZNOFMA ARNE 14 �J # 195 00-303 A,R. ,.S. DATE i j I I I I I