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HomeMy WebLinkAbout0070 KERRY DRIVE - Health 70 KERRY DR. ,MARSTONS MILLS A = 060 023 a }y TOVN'NNOOF BARNSTABLE LOCATION -70 SEWAGE # { — VILLAGE�/ , I4�.)� � (. � ASSESSOR'S MAP &LOT OW q INSTALLER'S NAME&PHONE NO. i SEPTIC TANK CAPACITY Y, I r(,\L- LEACHING FACILITY` ("type) C. (size) Kt1 Y. X 35 NO.OF BEDROOMS 3 BUILDER OR 0 R � PERMITDATE: C + COMPLIANCE DATE: �I - i 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) ?� Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet. _ fteh�&facility) ( ( Feet Furnished by -w 1 X 35 7�7 I X 3 Xi dV j"A MID P- N N; _ � fJ ;i mow✓ o Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipplication for Digogar 6p$tem Conotruction Permit Application for a Permit to Construct( )Repair( )Upgrade ete Syste El Individ al' m e Location Address or Lot No. _Owner's Name,Address id Tel.No. '1® Ye-rry'br'.,rr vn5 fn I-S�mA Assessor's Map/Parce44 � r ` • Installe ,'s Name Ad�e ss,and Tel.No. t-- cJ�' r Designer's Name,Addres and Tel.No. aPl. ry-N .� Type of B 'ding: j welling No.of Bedrooms �3 _ Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.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 !�ac.. Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer w en $licable) e• T4� 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 provisip^of Title 5 of the Environmental Code and not to place the system in operation u til a ertifi- cate of Compliance has been d of Health. Signed ® Date Application Approved by ffluuDate t. Application Disapproved forte following reasons Permit No. VV=ia :3 Date Issued x.YNo. _ _ �Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 0(ppYitation for Mioogal *raem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) L❑Complete System i El Individual m o e Location Address or Lot No. Owner's Name,A ress d Tel.No. ' Assessor's Map/Pazce6 e Installer's Name,Address,and Tel.No.-'7 9)—Lj 3 1 Designer's Name,Address and Tel.No. u��1 ►car r� .i��r (t 5 (��vl )z'--I-� s If Type of Bulilding: ✓� l/Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title f Size of Septic,Tank ,' 10ob AA_ Type of S.A.S. Description of Soil Nature of Rppairs or Alterations(Answer=w en' Vlicable) /O V 'b 7vzt�,x� A t(9y ,, 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,provisi of Title-5 ofithe Environmental Code and not to place the system in operation until a ertifi- cate of Compliance has been u d of Health. Signed ¢ Date Application Approved by 4 Date t Application Disapproved forte following reasons Permit No. Date Issued ——————_ ——————————————————————————— 4 _ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY tat the On-site r1o ge Disposal System Constructed( Repaired ( )Upgraded( ) Abandoned( )by w'I/ �, � a ` aj- at 11 t_,, % -P, /�/f/r a constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer f Designer t /V tl Fj �, The issuance of this pe�}it.js all ot. a construed as a guarantee that the systt�e } '1.1 functi.n s designed�� /(v� /� J Date ��/ �� Inspector 11 J���� �� f '�4' �t1"— ` ' No. —1 —� ---------------------------Fee— THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migogar *pgtem Congtruction Permits Permission is hereby granted'to Cons ct ) pair �)'Upgra �( Abandc� ) System located at f and as described in the above Application for Disposal System Construction Permit. The applicant rec gnizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Con ction mtlst be mpleted within three years of the date of&prmn . Date: �J ✓ Approved by S. 116/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) <T L hereby c ify at the application for disposal works construction permit signed by me dated concerning the } %���of theproperty located at following criteria: • The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There are no wetlands within 100 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • There is no increase in flow and/or change in use proposed There are no variances requested or needed. r • The bottom of the proposed leaching facility will not be located less than five feet above the ma.,dmum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor method when applicable] • If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the ma-ximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W. Elevation the MAX. High G.W. Adjustment . I = D E BE A and B SIGNED DATE: ( �� (Sketch proposed plan of system on back]. q:health folder cent l 1 � c i i r .r TOWN OF B.ARNSTA3LE C f ' 70 LG SEWAGE # >A SON VILLAGE � �4L3ASSESSOR'S�MAP & LOT. 0 —V INSTALLER'S NAME&PHONE NO. � SEPTIC TANK CAPACITY i C LEACHING FACILITY: (type) \C; �. (size) x �5 NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: '17 COMPLIANCE DATE: 2f�. 00 1 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 j on site or within 200 feet of leaching facility) � _ 1 Feet Edge of Wetland and Leaching Facility(If any wetlands exist ell within 300 feet ale chi�g facility) Feet Furnished by A-I - � kl A•-7— 70' =• _ ew -34 L � • L C �L. YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost $30.00 for.4 years). A business certificate ONLY RE You must do by M.G.L.- it does not give you permission to operate.) Business Certificates are available at the Town C � Main Street, Hyannis MA 02601 (Town Hall) GIST YOUR NAME iJerk's Offic town (which e,, 1" FL., 367 "vF , ,W G�, • DATE: Z APPLICANT'S YOUR NAME/ Fill in please: . BUSINESS YDUR HOME ADDRESS: 70 •P �. yyxi ,et a rµ:. '� Uqihl TELEPHONE # Home Telephone Number f �.G i L NAME'`OF CORPORATION: NAME OF.NEW.BUSINESS is THIS:A HOME OCCUPATION YES NO. TYPE OF BUSINESS ADDRESS.OF'BUSINESS 7d: d- +^ MAP/PARCEL;NUMBER When starting a new business there are several things you must do in order to be in compliance with the rules and re (Assessing). ulation Barnste'ble. This form is intended to assist you in obtaining the information Rd. & Main Street) Main St. - (corner of Yarmouth you may need. You MUST GO TO 20❑ g s of the Town of . to make sure you have the appropriate permits and licenses required to legally operate your business in this town. I. BUILDING COM SSION R'S OF CE This individu I ha e ii me of a y ermit re irements that pertain to this type of busi SST COMPLY WITH HOME OCCUPATION COMMEN Aut ri e�Sign e** RULES AND REGULATIONS. FAILURE TO COMPLY MAY RESULT IN FINES. 2. BOARD OF HEALTH / This individual s en infcjr nyd cyf the 'rmit req ements that pertain to this type of business. Authorized ignature** COMMENTS: MUST COMPLY VM ALL 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has formed e licensing re uir ments that pertain to this type of business. Authorized Signature** COMMENTS: A'd TOWN OF BARNSTABLE Date0)/ate TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: lx2l� v1�r BUSINESS LOCATION: INVENTORY MAILING ADDRESS:rct�,S�©� TOTAL AMOUNT: TELEPHONE NUMBER: ® c���C(� �(�B / 2 CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER:,S� 620 0p/2 MSDS ON SITE? TYPE OF BUSINESS: INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The board of health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) 0Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt&roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes 2 2 Z Laundry soil &stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials lZ�,,, �G ot3 LOCATION -70 SEWAGE PERMIT NO. - 7 4 Z.- VILLAGE INSTA LLER'S NAME i A RESS 9 . U L D E R OR OWNER 9iATE PERMIT ISSUED DATE COMPLIANCE ISSUED ��� � - *, , '�, �, � ,�� M 3 �� '�' No.........y... ....... Fmc.................._......... �- THE COMMONWEALTH OF MAS`SACHUSETTS r BOARD OF HEALTH . C2l.tl....................OF........ ('.P1. :C? ��--........................................ Appliration for Mipatial Works Tnnitrurtinn Frrutit Application is hereby made for a Permit to Construct (✓f or Repair ( ) an Individual Sewage Disposal System at: `fi ►2 ��r d t'• __tZ c'r cal r,............CK n s o M Locati -Addressp1 ` or Lot No. ............A!��T.... .._.... .e,�R�S. �PJ���-�-A-�1.� ........---•..................................•-•---... `_p Rwner e^ Addfjess�� QC.l^. ._...®. .. S.�Q_-.._.Gi!1C_o......... i' ...ocb ...._"P/k......� Installer Address d Type of Building Size Lot-W.40?Q____....Sq. feet U Dwelling—No. of Bedrooms.. �.�?___________________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons......................... Showers ( ) — Cafeteria ( ) a' Other fixtures _____________------------------_.................... W Design Flow____......5Fv 55.......................... per person per day. Total daily flow..........3.3�Q....................gallons. WSeptic Tank—Liquid cap�acqityAQAD.gallons Length% .b._____ Width.4__._110. Diameter________________ Depth_S___..$__.. Disposal Trench—No._.-.1w........... Width.................... Total Length.................... Total leaching area------------------ ._sq. ft. x Seepage Pit No.......E------------- Diameter._._._.M Depth below inlet___.__..._...__ Total leaching area_ �. ......sq. ft. Z Other Distribution box (--,) Dosing tank ( ) Percolation Test Results Performed by.... ..�..AC(5�...................... Date..... 6/S4.1_.._.._ ,aj Test Pit No. 1_!Z_�._._._minutes per inch Depth of est Pit....1.7.......... Depth to ground water._AA.4\ _..._. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water________________-__.___. Description of Soil_... . ----_�-�° 'nn -r_._5�.... 50_% �A "' a 2-.._.. M � '' ..... x - U ..- ------------------------------------------------ W j" UNature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ -•----------------------------------------------•-•-----------------------------•---•--••-•---•----•----•------•--------------------•----------------._...------------------------------•---•-•••••_.... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with e rovisions of TITLE 5 f the State Sanitary Code—The undersigned further agrees not to place the system in o do a e tifi of Compliance has been issued by the board of Health. n .... __. Q.�4Z..................................... ..12.�.� :._..._ Date Tppplication ion Approved By--••••--•-••--• • -- •••••.......:.......................................•-••--•_----- Date ....-....... Disapproved for the f of in reasons: ................••••-•-•-----•-------..._..--•------•••••-•.........__.....--•--••••••...._..._.....__••••----..............._._.._..._....-••------•--•----••-.._...------•----•-••-•-•...----•----•--- Date PermitNo....................................................... Issued....................................................... Date 4 9,4'-7� No......................... FEa.............................. THE COMMONWEALTH OF MA$SACHUSETTS BOARD OF HEALTH .. OW.r l_...................0F........ ��.n.:��.t��� .......................................... AVV ira iou for Mipsal urk,; Tonutrur#ion Prrmit Application is hereby made for a Permit to Construct (../f or Repair ( ) an Individual Sewage Disposal System at: .�...b:: 1... .�;' c' g-•.._ .�.�..... ... ...... .....(.n.-3.1 1;...-------••--•--••---•-•--•-•--.. Locati -Address or Lot No. ..........._fZ ....2 ?.. 4�n .P>��_ c. . .���.................................•--.......----•-•---••-----.. Owner Address �_�.. __...._._5. c_ ...._�__S?_.:_....:-�=.n.c_ .......... . l_ t c- - - '�.......... ......... s..c.� Installer Address U Type of Building 1W. .. Size Lot._ -0j.04�0__.....Sq. feet Dwelling—No. of Bedrooms___.I._4 .0........................:..Expansion Attic ( ) Garbage Grinder ( ) `4 Other—Type T e of Building No. of ersons____________________________ Showers Ga YP g ----------------•-•--------- P ( ) — Cafeteria ( ) Q' Other fixtures -------------- '-- •----....-----._...._.. W Design Flow...........5.5..........................gallons per person per day. Total daily flow..........3.! __....................gallons. W Septic Tank—Liquid capacity_l_000.gallons Length a`_bld.._. Width.14'__10." Diameter________________ Depth_S_'__.00.1 . x Disposal Trench—No.____ ___________ Width.................... Total Length.................... Total leach ng area....................sq. ft. Seepage Pit No-------l............. Diameter.__._.l0........ Depth below inlet...k ............ Total leaching area..?_A? ......sq. ft. z Other Distribution box (,,,e) Dosing tank ( ) Percolation Test Results Per€brmed by... .l c v3b ...................... Date..... ............. a Test Pit No. 1. .......rninutes per inch Depth of Test Pit....1_2 .......... Depth to ground water..SA P��►.__._. Test Pit No. 2................minutes per inch . Depth of Test Pit.................... Depth to ground water........................ R.' Description of Soil ... ! ran..:.... '.-- `�.�_1.... !`� ``'� D P '� V ^ ,-......................•---....-----•---........--••------••-------------._._.....-•-•----------...-•----: ...---.._..-•---.._--•-------•----.....-•-------......._--•-•--•--••. W ----------------------=----------------- UNature of Repairs or Alterations—Answer when applicable....................._'_...:.................................................................... P 4 Agreement: The undersigned agrees to install the aforedescribed. Individual Sewage Disposal System in accordance with e rovisions of TITLE 5 f the State Sanitary Code—The undersigned further agrees not to place the system in o r do u a e�tifi of Compliance has been issued by the board of health. oSi - ,.� ..... Ll..............•.-------..__..._......_ .�?1 ` 4......_. Date pi on Approved BY-------------- •-•-•--•••--•-•--•---•-••••----••--•••------•-•--•-----•-------- Date pplieation Disapproved for the fosons:........................................... •-•-•--•••-•--------••- ";---•-••••----•--••---••••---------------- --------•-•--------------------------•---•---•---•-•----------------•----....------------................_..................--•-----•-•----••--•------•--•----•-t'-----••------••-----•-••--••••--_-•--- Date Permit No......................................................... Issued-.............................. ......................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . .41..1..............OF........ �z'_.'r1. ..� .................. Tn tifirtt#r of Tomplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal,System constructed (>G) or Repaired ( ) by.... © _FI.....Q.!.n.....Q -=�==='•` ..... S=----•---- -'�- =a......t:� Installer has been installed in accordance with th provisions of TI F _5 f The State Sanitary Code des a in the application for Disposal Works Construction Permit No.-- �_ _ y_______-____ dated__..... . .. ___ _______________________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE......................................... ............... Inspector------.... THE COMMONWEALTH OF MASSACHUSETTS 'BOARD OF HEALTH y- .....`.:......�...............0F F .E._......_.... a E.n. �-���.���...._.._._............ No:. ©C�? FEE.__..................... %i oual Vorkv Tonutr ion prmi# Permission is hereby granted--.Q' _.g.6- - ........Q.'J..C........................................................................................... to Construct (',>�r Repair ( ) an Individual Sewage Disposal System ........ Street as shown on the application for Disposal `forks Construction Permit No...., Dated.......................................... 31 ...••--•-•••---•--- •••---••--•••.. _ __________________________________ Board of Health DATE. ----••---• - r - . FORM 1255 A. M. SULKIN, INC., BOSTON Log Number: 4065 Bottle # D132 Dater 8124/84 04 SARI • BARNSTABLE COUNTY HEALTH DEPARTMENT SUPERIOR(COURT HOUSE VBARNSTABLE, MASSACHUSETTS 02630 DRINKING WATER LABORATORY ANALYSIS PHONE: 562-2511 EXT. 331 Client: - _. Jack,McKeon, • I. , Collector: .Fred -Clifford Mailing.,Address:, Great Marshl.Rd. Affiliation: Clifford -Well Drilling .,Uenterville, MA 02632 Time & Date. of • �, , . r a ;,, . .Collection: t 8/22/84, 4:30, p.m. • Telephone: Type of Supply: (. well water. Sample Location: Lot #12 Burnham Rd. Well Depth: 59' arstons Mills, MA Date of Analysis: 8/23/84 PARAMETER SAMPLE RESULT RECOMMENDED LIMITS Total ;Coliform Bacteria/100,.m1 0 0, H 55 Conductivity (micromhos/cm) 107, 500.0 Iron ( m) i i a 0.3 Nitrate-Nitrogen ( m) 10.0 Sodium ( m) 20.0 i- I . . Water sample meets the recommended limits for drinking of all above tested parameters. II . Based only on results of the parameters tested for this sample, the water is suitable for drinking ,but may present the problems checked below: A. ' `Water 'sample has higher',than average levels of'Nitrate. `�N ture'monitoring is recommended,.(2-3 time, s"per year) to establish any upward trends. B. The low pH of the water may shorten the useful life of the house's plumbing. C. xx Water may present aesthetic problems (taste, odor, staining) due 'to high iron , F j D. Water '`sample has •high levels of-sodi'um.�- -Persons 'on low sodium diets should• consult° their doctor: ' + III. Due to one' or more of the reasons checked below, this water sample is unfit for human consumption: A. High Bacteria B. High Nitrates REMARKS: r 1. CC: Barnstable Board of Health CC: Clifford Well Drilling Alel "4_", Laboratory DiplEctor 7/17/84 Explanation of-Test Results ' Total,Coliform Bacteria Coliform bacteria are an indicator of the sanitary quality of a water supply. Water supplies may become : contaminated from malfunctioning septic systems;cesspools and surface runoff. A total coliform countO,zero indicates that your water supply is safe,and approved for human consumption. A total coliform count of greater than zero is most often the result of accidental contamination of the sample bottle through improper sampling _Y methods. For this,reason, it would be advisable to retest ary_well water„that is;not approved. ; �,., U PH '... - pH is the measure of acidity or alkalinity of the water. On the pH scale, the number 7 is neutral, less than 7 is acidic and more than 7 is alkaline. The pH of water on Cape Cod.,tends to be acidic in.the range of 5.0'to 63 Conductivity - • - _ '- - ' • - __ _ Conductivity is a measure of,the dissolved salts in solution. Amounts in excess of 500 micromhos Icm are generally considered unacceptable and may have.a laxative effect upon users.. . _ i Iron . . The presence of iron in water in concentration of .3 ppm or greater may: give the water a bittersweet astringent taste, cause an unpleasant odor, often gives the water a brownish color and cause staining of laundry and porcelain. The average concentration of iron in Cape Cod's water is ,2- .6 ppm. Although the presence of iron in water may cause the problems listed above, it is not considered deleterious to health.. Iron may be removed by use of an iron removal system. k Nitrate-nitrogen The Massachusetts Drinking Water Regulations have set a.maximum contaminant level for nitrates at..10 ppm. Excessive concentrations may causemethemoglobinernia (an linfant`disease)'and have been'suggested to- form potentially carcinogenic nitrosamines. Contamination sources include',fertilisers, cesspoolsJand indt sthal wastes. e. ^' `:q Copper Due io,the acidic nature of the water on,C'apc'Cod.-copper,tends to leach from pipes. Thistnormally does not present a health hazard; however, concentrations in excess of 1.0 ppm may eause.a metallic taste and/or a bluish green stain on porcelain fixtures. Sodium A concentration of sodium over 20 ppm is only of concern to people who are on a low sodium diet. If the water supply has more than 20 ppm sodium, it is up to the people who are on such a diet to find another source of drinking water or contact their doctor to determine if consuming the water is advisable. Concentrations exceeding 50 ppm indicate that there may be ocean water or road salt runoff water vetting into the well. Department of Environmental Management/Division of Water Resources WATER WELL COMPLETION REPORT -WELL LOCATION Address46a�� �o� 4JiJ4`�1 h;� /[A City/Town G.S.Quadrangle,Map Grid Location Owner JWi < 1" C. ( An) A� Address Ix ,lira-*1 M 41=_ 9G M 6 . al., WELL USE n CONSOLIDATED WELL Domestic rx Public ❑ Industrial ❑ Type of Water-bearing Rock Other Water-bearing Zones Method Drilled toy-1- 1) From To 2) From To Date Drilled g'�3 �� 3) From To -- 4) From To CASING ar Depth to Bedrock Length S 4 Diameter Type ,—Rvc UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing Materials Feet below land surface Sand: fineL}❑ medium❑ coarse Date measured g7 -3^ Gravel: fine❑ medium❑ coarse❑ GRAVEL PACK WELL Screen: Yes El No Slot#length��fro:�to, 01 Split Screen(or 2nd screen) icy WATER QUALITY TESTS MADE S lot# length from to Chemical Biological ❑ Depth To Bedrock PUMP TEST Drawdown feet after pumping days hours at GPM. How measured Recovery o feet after hours. LOG of FORMATIONS COMMENTS: (On well or water) Materials From To o 3 DRILLER e Firm CLIFFORD WELL DRILLING Address 65 Blue Rock Road^.�,��,� City s.. 02664 'Registration No._ cal operators Signature Please print tirmly CUSTOMER C PY 15M-2 84-176471 A 2r` 5 V L.(j J l LOT Z o V o 4ORSE yr tN " L�p�GNa✓G` 0, tiS�Nc v No 951 O 0(? 0 —S,P' ,c+AfVI[ `D ra` or' /� G R aN 4 �v _Q q fit, /s o r u� Z NIt �'s�.�6a4 . ��j � NdfE.� A $�uM� LdI 1'RoiCT► PE?'+ 13Y Litw S b • � � , Off / �� f �V ID too A I P C" ,{ , t� ��N O F MISS 01 ROBERT /J/Ld/i05�'GdGU" J `i} BRUCE i GpGs�Tce✓ /'�'r`� �� �9 �✓ ryt�� 1 ELDRE rp CA oiv ago SUS 01LEGEND - `,. EXISTING SPOT ELEVATION +0u0 CERTIFIED PLOT PLAN 9..Xl.$TlMG CONTOUR - 0 41101SHED ; SPOT ELEVATION `oT iZ %"'ZI EE0 CONTOUR /V1�4 T % �� �I/-�" /4/ ' 'RVV "'The. location of any existing underground sewerage, {� r !, `., ' 'wa11s, or other utilities shown on tris plan is approx- N a T Imate only as determined from records and/or verbal JaA ��J _1A�la Z j A ASS* `r information. The contractor is responsible for the , per. fication of the existing locations in the field. SCALE / 'ram �%v DATE 1 k � _ M c 16F0 Al iZ4DREDGE ENGINEERING ca 1 I CERTIFY THAT THE PROPOSED EGJ.STERE REBISTER.ED JOS NO, 8 0 3 BUILDING SHOWN ON THIS PLAN I:1 CIVIL LAND CONFORMS TO THE ZONING LAWS DR.BY '� ' _ y ENGIN ERLJMRVgOF BARNSTABLE , MAS 712 MAI N•STREET• CH. By T� .l�, -71 8 . . IiYa►NN I S, MA$S. SHEETLOF � A E REG. LAND SURVEYOR IV 07 Z /F E/TMLSR THE.SEPTIC TA.-V l< OR r" 20 FT. M11V• L8rACNIiva P/T ARC. 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