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HomeMy WebLinkAbout0080 LAKE SHORE DRIVE - Health 80 Lake Shore Drive Nlarstons Mills A= 030 - 112 - `" ����3.Ofd1AR�'`s^ ti CERTIFICATE . OF ANALYSIS , ` Barnstable County Health Laboratory(M-MA009). I q RectpienE: $ally Desmond -Order No.: G.18110869 Desmond Well Drilling Report Dated:. 11/113/20.18 . P 0 Box 2783 Submitter:' . Well Driller Orleans; MA 02553 Description: 3 Day Rush.-80 Lake Shore .. . . Laboratory ID# 181.10869.01 Matrix: Water Irrigation Well $ample# Sampled; 11Y08/2018 By: DWD Collection Address: 80 Lake.Shore Dr.Marstons Mills Received 11/08/2018 12:17 By: PalmerP San-ple.Location: Turn Around: 72,Hr Rush Routine M .ITEM RESULT UNITS RL MC[.. METHOD#: ANALYST TESTED. TIME Nitrate as Nitrogen 5.4 mg7L 0.10 10< -' EPA 300.0 LAP 11/08/2018 14:02 Iron ND mg/L 0;10 0.3 EPA 200.8 CL 11/13/2018 12:39 Manganese U32 mg/L 0:025 0;050 EPA.200.8 CL 11/13/2018 12:39 pH 6.0 PH AT'25C. NA 6&8 5 SM.450.0-1-1 6' DCB 11/08/2018 14:52 Sodium 29 mg/L 2 5 20 EPA 200,8 CL 11113/2019 12:39 Total Colifbrm Absent P/A 0. 0, SM 922.3 RG- 11/08M18 14:41 Conductance 200 umohs/cm 2.0 SM:251013 DCB 11/08/2.0% 14:52 4V28' Attached please find the laboratory certified parameter list. Approved By: (Lab Director) It , bl ND=None Detected RL.= Reporting Limit MCL Maximum Contaminant Level .3195 Main Street,. PO.Box 427,. Barnstable, MA 02630 Ph: 508-375.6606 Page: 1 of 1 Massachusetts Department of Environmental Protection Bureau of Resource Protection Well Completion Reports Well Driller Please specify work performed: Address at well location: New Well Street Number: Street Name: . 80 LAKE SHORE DRIVE Please specify well type: Building Lot#: Assessor's Map#: Irri gation 030 Assessor's Lot#: ZIP Code: Number Of Wells: 112 02648 CityITown: Well Location BARNSTABLE In public right-of-way: GPS C'Yes f�°No North: West: 41.67274 70.44144 Subdivision/Property/Description: Mailing Address: r click here if same as well location address Property Owner: Street Number: Street SHName:_-D E PETER PLATTES 8� 1C1 1KE ORE City/Town: State: Engineering Firm: BARNSTABLE MASSACHUSETTS ZIP Code: 02648 Board of health permit obtained: r Yes (7 Not Required Permit Number: Date Issued: CW2018 029= 10104/2018_, � Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program (t: Well Completion Reports(General) Well Driller - General Well Form DRILLING METHOD Overburden Bedrock uger Choose Bedrock— WELL LOG OVERBURDEN LITHOLOGY From(ft) To(ft) Code Color Comment Drop in drill Extra fast or slow Loss or addition stem drill rate of fluid [: 20 Fine To Coarse S ; Brown + (" f~ rr Fast f`Slow Loss t" YES NO ���������� Loss Addition 20 40 Fine To Coarse S i, Brown r Fast r Slow =LossAddition — YES NO 40 45 Fine To Coarse S,* Brown !' C'Fast(" Slow YES NO � Loss Addition .............. WELL LOG BEDROCK LITHOLOGY Loss or Extra From(ft) To(ft) Code Comment Drop in Extra fast or addition of Visible Rust Large drill stem slow drill rate fluid Staining Chips P r r Choose Code �-.., - -- YES NO Fast Slow =Addt,.. ADDITIONAL WELL INFORMATION Developed ( Yes ("No Disinfected 0 Yes Total Well Depth 45 Depth to Bedrock Surface Seal Type None racture Enhancement 'Yes f�=No CASING Jr.Is Casing above ground? From To Type Thickness Diameter Driveshoe 42 �Polywnyl ChlorideSchedule 40_ � - Yes .. _ SCREEN No Screen From To Type Slot Size Diameter 42 45 Stainless Steel Well Point J� 0.012 WATER-BEARING ZONES r DRY WEL From To Yield(gpm) PERMANENT PUMP(IF AVAILABLE) Pump Description 3 Wire Variable Speed Horsepower Submersible 1 Pump Intake Depth(ft) 40 Nominal Pump Capacity(gpm) 15 y Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program Ate: Well Completion Reports(General) ANNULAR SEAL I FILTER PACK From To Material 1 Weight Material 2 Weight Water Batches Method Of (gal) (count) Placement 0 rChoose Material Choose Material —Choose One WELL TEST DATA Date Method Yield(gP m) Time Pumped Pumping Level(ft Time To Recover Recovery(ft (HH:MM) BGS) (HH:MM) BGS) 11/07/20 8 1 1 Constant Rate Pump 14—.....—� 1:30 30 0:01 28 WATER LEVEL (Date Static Depth BGS(ft) Flowing Rate(gpm) Measured 111/07/2018 28 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. WLLIAM Supervising Driller DESMOND, DrillerURQUHART Registration# 877 Monitoring[M] Signature PATRICK, DESMOND WELL Firm DRILLING INC. Rig Permit# 0551 Date Job Complete 12j14/2018 NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion. r Fee BOARD OF HEALTH TOWN OF BARNSTABLE 01pprication jFor Veft Construction permit Application is hereby made for a permit to Construct kl Alter( ), or Repair( ) an individual well at: Location-Address Assessors Map and Parcel Owner Address JkVI'l br( i (VIC U Installer-Driller Address (PS3 Type of Building Dwelling Other-Type of Building N+o. of Persons Type of Well 9 1' �Glj 'f() pVCj Capacity_ 1C Purpose of Well '1nd ga&4i W 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 Certi cate of Compliance has been issued by the Board of Health. Signed of 3 2Q18 Date Application Approved By ►� `{�/��L �� Lf I I s' ate Application Disapproved for the following reasons: Date Permit No.)a Qd 0 Issued Date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed/, Altered( ), or Repaired( ) by c Installer at l S� 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 SATISFACTORILY. Date Inspector Oaf c- Fee ;Y BOARD OF HEALTH TOWN OF BARNSTABLE 2pplicatiou f or Yell Cou9tructiou Permit Application is hereby made for a permit to Construct(V), Alter( ), or Repair( ) an individual well at: ?0 Cci t Shore.beICE�s I r�s 0,113 o / Ila Location-Address Assessors Map and Parcel 30 (-rjX o Shae- Dr. HgrS4-ons -111S Owner Address r I CI i�r� iCi kla�bx �-�`� 0v Wtn� Af-N Installer-Driller J Address �O G�f'53 Type of Building i Dwelling. Other-Type of Building �/ No. of Persons Type of Well Lf p Sc14 —1 Q pV CJ Capacity Qp t' yp 1 i p ty y�m I I Purpose of Well 'T t 1,qa h on ^. ;._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 Certi cate of Compliance has been issued by the Board of Health. r Signed o 3 2-ca y Date Ll I Application Approved ByG � 5 i a Date Application Disapproved for the following reasons: Date Permit Issued Date lc. Xy e-----aaoeee-----eaooamae=—eeee—dma------we=mocaoo—aee—m®eeaa®—vemews-------------------oeeeo+ ,------- BOARD OF HEALTH r n• TOWN OF BARNSTABLE Certificate of Compliance THIS IS TdY ERTIFY,that the individual well Constructed, Altered( ), or Repaired( by L51�� Ct_.�- ,-( � QV i l 111 ri , nC f Installer x 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 SATISFACTORILY. i; Date. Inspector -- -.. --- BOARD OF HEALTH TOWN OF BARNSTABLE Yell Cou5tructiou Permit No. W aV` Fee Permission is hereby granted to (�_��� r r " � � 1 I �1 r►�\ , I Yt C, . Installer to Construct l AlterRepair( 'Sir �( ), O, or Repair O an individual well at: No. �G�.� P �flfit/ —Dr . �'� C�.V.S-� )n s �'i+t 1 r14. Street as shown on the application for a Well Construction Permit No. r���,-D -� Dated Date �� 14 Approved By 3� pNs �-9q �f 'o � o 6�N 01 o R�OOg� 0� V r 06 SL \ � � n p N • � N —1 1 Q zm t p 1 � O m n V \ U% CT 7- '9v m O D N m p z - Z to z m c� N � -1 Gl / ^�_ z O m -u _ 5EW6,Aj PERMIT MO. (� 5 �o �— -ill TQLL.ER 5 U&NIE ADDRESS BUILDER f5 VJ ANIE �- ADDRE.-SS DINTE PER-NA1T 15SUED DATE COMPLI&MCE ISSUED : � Q �a��S P .e�,-e,�' � � /,`7 f �. 3� + �. � � i .� i � / �; / � 4 � ` ,i Flmim. s THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF ��"nwdrurfi L 63o '�/ -OF'..............�... ..for �spaua1 Mork, an it Application is hereby made for a Permit to C t/( ) Repa' ) an Individual Sewa e Dispo 1 Sy tem at: �d / -• ake . .._... ........................................ .................•... ........... racation A r Lot N.A.......-.-.-.----.J------. L �,c ar w•` .................. --- �o-IllA,r�a��►n_ <r: ic...... wn' Address-. Installer Address d Type of Building Cape Size Lot_AD,�ozb-----_---Sq. feet Dwelling—No. of Bedrooms:�tz&J...° .: ..............Expansion Attic Garbage Grinder ( ) p`L4 Other—Type of Building ............................ No. of persons----- _................... Showers ( ) — Cafeteria ( ) Q' Other fixtures -------------------------------------_--------- - W Design Flow............ .......................gallons per person per day. Total daily flow______---.�®0...................._gallons. WSeptic Tank—Liquid capacity/—gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Wick--- '- -- - o l I e :p --__._...---- Total leaching area....................sq. ft. Seepage Pit No..._...I._...____.. Diamete ____ _ _ __ _____ Depth below inlet...� �..• Total.l C}aia�g re a_. ¢�4sq. ft. Z Other Distribution box ( ) Dosing tank i '-' Percolation Test Results Performed by......Pflt -_.l�c__ `1-�?n..,,.-ZA5..... Date•._ '. L.9...1979.. aTest Pit No. 1.... .......minutes per inch Depth of Test Pit.....f L. _ Depth to ground water..17-olJ!9...9E Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.......................... 0 . � -- r . . -�-----•----------------.,--------- --- -------------------------------------�..... ��� 1 -•--- ------------- - . x --••----------------------•--•-•-•---- - ••• -•-•••-••-••--•-------••.....--------••--•---•-. •••••-•----•--•--•---••-......-••-- U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ------------------------------ --------------------------------------- ---------------------- •--•-•••••-••----.._.---••-------------------------------------------------------------------•--------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issued by the board of health. Date A lication Approved B .......... ..................... S+_ .._ ,�.____ PP PP Y••-•- �- • = = �. ate Application Disapproved for the following'reasons:............................................................................................................... •----......••-••----•-......---•-•••--••--•----•-•-•••-••-•-•----------••-----•----•--•-•--•---•-•-•-••-••--••----•--••--••-•-••----•------•-•....--••-•-•----------•-•---•--•----•-----•-••----•••••. Date Permit No............. , Issued....1�'-----. --� .�-- 4 Date No.. .....-- s:# FEE...l..I .. ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OR HEALTH .................................OF.....................:..................................................................... , A. Application is horeby made for a Permit to Construct (✓ or( epair ( " .j an Individual Sewage Disposal System at: `.4 ke Ssftorte..Qr�v�... = rNs a le. .............. ..................Z-...--------...........---•----•--.......--•---............................ ............. -ram i� ocat'ori• ddress r L. No. �L „, - .....:.....1.�1.Q............Q:f. ...1.�1t� : ........................ \ owner = o' > 3 Address Q a rY!__..... ' '�' ........... mar .. , �• Installer s _ Address Q. Type of Building CaP ee r Size Lot__....r2.�?.o aA...S feet U Dwellin No. of Bedrooms`;..._..3 C �r-?f_�A..........Expansion Attic ( �) Garbage Grinder( ) g— '� Other—Type of Building ?................ No. of persons...................... Showers — Cafeteria Otherfixtures/..-----•----•-•----•-------•----......--•--------------•--•..........------------............------------------•-•-----.......................------ W Design Flow........... .....................:.#gallons per person per day. Total daily flow..............3ea...................gallons. WSeptic Tank—Liquid capacit'./gallons Length................ Width-----______.____ Diameter................ Depth................ xDisposal Trench—No......_.........._.. V�� A.... :: To lL�e -_.._/� Total leaching area...................sq. ft. Seepage Pit No.......f........_. Diamete e helow7irt.... T ._.. Total 1 ac}��ng area. �Z`{S ft. Z Other Distribution box ( )` Dosing to 14. ) ~' Percolation Test Results Performed by....P A.... ...... .�/ ��.................... Date. aTest Pit No. 1......Z......minutes per inch Depth of`,Test Pit....1z.z?�t_ Depth to ground water/79/7G�. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-_._.___--_____._--_-. 4 �..� .5 ..................... ......... .... ''_......_ ....... .-.... ...................................................... t{ f{ _( {/ O Description of Soil �?.... L� � �: T`' 9� �e3Yt�lS x U 2-c/ . w ---------------------------------.......................................................:.......................................................... .................... V Nature of Repairs or Alterations—Answer when applicable..................................................................�............................. r , ---•------•-----------------•-----......--•-•----------••--•-••-•--------•-•-•--:........._: --......-:---- --- -_...- ............................................................. Agreement The undersigned .agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State,Sanitary Code-- ,The undersigned:further agrees noeto place the system in opera �i_?n until a Certificate of Compliance hassbeen issued by the board of'health. Date/ Application Approved By...- ,...... :L- ._ ...e; .. 3. .7 .Application Disapproved for the following reasons .........:........ "" .............. ; ------. -•-•-------- .....-•--••------------- ------ ....... ..........5.. --- -- Date PermitNo................. ..................... Issued.---•--•-----------•-••--•----=----••-••-------- ...... Date ti THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH 4" OF....... .. �`' ..--r^"ti ............................ f iratr of Tvntp anrr THIS IS TO CERTIFY;Dat the Individu' Sewage Disposal System constructed (k4 or Repaired ( ) b �lr�.l -� .a. : .,S_---•------....;. ...-•--••.....................•-•-- Y---------------------------------------- .=- , staller - /in _ �has een Install, ccordance with tl ov:lIons rt. e I of he State Sanitary ode s /EE 'bed in the application for Disposal Works Construction Permit No.�- -• dated__.. ,2_ PP P ;THE ISSUANCE OF TI IS CERTIFICATE SHALL NOT EE CONSTRUE® AS A GUARANHAT THE SYSTEM WILL FUNCTION 4SATISFACTORY. ,Rt DATE ------------ - = - 'In ............. ...................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � OF ..... /►3" / �vr ............ No. FEE / ......... t' ern tt; Works (t strur.tfia n ramit :. Permission is hereby granted-----. r;..<:�._ �.._eA........, !`4- ---------------------- ...................................... to Construct r ,pair ( ) an Individu Sewage Disposal S em r " at No. � f . ..GPI � .. .._.... Dated----- Str I as shown on the application for Disposal Works Construction Permit 0-J'Ak. . �., k ..................... . �• DATE............./� (' `S .. - FORM 1255" HOBBs &,WARREN, INC., PUBLISHERS - - 1 r T i , : 77. vi __ ,� � ' ti��Vie_ �,9 : 3��� • - . . r 102_p r ti ?v {/Ef7£!✓T ,l SOT 69 i V s CO r. tt _:.tom^+w'.�e�_ ... - __� _ _�. �_• q LDT 7(� 150' fiRAIJTA(sg rr - ' Nv . Nary r AS%U MeD PR crr*,L7 ro�1 +.f,L Or;/w,,�. CERTI IED PLOT 4Lp10 PAUL A. yN Z07- I/2 LAKE s ,{ BEVY 1�02e"`A21 of , \ENO. 10617 w —_..__�.LE-VT IN l SCALE, �l� � DIVE I �o ' 9 } a"} k li ELDREDGE CLATMINC, � oM �`=CEKTI�'Y."THAT THE .�' SHOWN, t�N '°TH13 PLAN' 13 L®CA:TI�A s::r ,rF l Orb Z r F ��-IrA QUA <d�aC ri `'k 1 , '� , •,�„�, .�,: ® 1 f°rM1� ,I.SROUND. A3 INDICAT1�� 4 ,y,� �,`tN irk. _�4�f�� t�y.Y �, r8� p 1 '"� p rht �.ar k`a+ t. �y r4g� 'F✓ ,x.S r e • ,f-, to t s s t f'L 9. �. el• Jh t N R L �. 4' `t`' �#" 'zriY ' a'a .S:�. t1 -K�,�'a�r'ki '� "+t n s�{,.a f• D ��y�r*'T� !�/p y a A3 • �� i + ��.- Sci 'r `° LSF,,pp���Rh�� 'rl�1W r�'�A�3h�9•'�r*7�a yr�s��' s r 1n { ;,.. .sr,._ � r'st.c'��+�w ',.' �.. ;ry t,' ��• �', �',� F n'•.' R...•.,' 2 4;t'-y'. r�rr,�:t �� �" R,^< " o' r,. �r -;1'',r.�t�a+u.:A>�e �.y ft :�t` a.tks i�,k`.^ Y "�` 'Vt i .��'"M� j•t 31'h y a{�C•+ a, � r , r 7 - N s CD c _8 W ' N h ; Q r a o o ' A . 9 = c.B F 3 N O L 9 39.10 W 6 4 a 3 ; o ,_ 3 S 7 3 0 SOIL LOG 0 E 5 SOIL DEPTH °. 2 ' p Q' I r 50, .. N 041 OA M 6 o i a F., 'COA RSE O t S 2 t v , GRAVEL LY to W 0 SAND 0 2 i I f :. CO WITH S E D T 0 0 0 N NG ALL, Z AC S E R N I 0 F U .� NO GROUNDQ?U WATEREN NT£RED 2 , y N T E E� Z e A RO PERC ATION RA TE E OL s 0 .._. 0 oIc BETTER A O va E 0 1 TT R TN N 2 M/N /NC'H Z O 5 P 0 E E S w 5 P O 0 P 0 P A PIRO G AL-1-0 L/ D. NOLM£S ENGINEER E K MURRAY rp UL U R Y w ,vESS 009 T C D E A R/ 9 6 � � L _/975 F P j N 5 D i v J1 f t SON 14 4 C f 6 t 3 3 w w r Q o t 3 , 1 6 o s LO PLOT PLAN n. + FOR r O _ RICHARD WILLIAMS MS ;Pool. REFSRENCE PLAN LAND /N N WTOWN BARNSTABL£ MASS . 1 i 1 _ 5 _ F TRUST S X R DUCK ND ASSOCIATES ES T U T 0 D O _ /N FEB. 1972 A Y .CHAR E N. SA Y .L. H NNIS M r B L S R R S. YA S _ N£WTOWN , d' 254 PA 6E 29 P BOOK A AND RECORDED IN PLAN 00 MSS. S T 8 L F . . S .4C / R W N LMJ �. ©ATE APRILl/ 1975 CHECK ED r , t w f t �c f J r H� o M s 1 D H L ; N APPLICANT PL T . -a L AND ENGINEER ER Y _ �.. 3ol M AIN STREET LMOU T S .�, .-. . .. - C ATE 5 7 DWG _ �JOB NO t7 1 t , .