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Home My WebLink About3261 MAIN ST./RTE 6A(BARN.) - Health 3261 Main Street/Rte 6A (Barn) Barnstable A = 299 018 B E N o i Massachusetts Department of Environmental Management Office of Water Resources 11 fi 6 5 5 +,5�� r� . . TYPE OR`PRINT ONLY Well Completion Report 1. WELL LOCATION GPS (OPTIONAL) LATITUDE 1 LONGITUDE Address at Well Location: /kilo Property Owner: t�CJd eq CW1f62)J? etq La Subdivision Nam / L �3 Xt7t .• �1 g = �`€ /�. 7� �- Mailing Address CitylLown: U� eN/:C,, &!�'Sb6le�. . Clry[Town. Assessors Map� 9 y =Assessors Lot#: NOTE: Assessors Map and Lot # mandatory If no street-,address available: Board of Health permit obtained Yes El Not Required Permit`Number Date Issued' r 2. WORK PERFORMED 3. PROPOSED USE `` - 4.-`0RILLING METHOD r New Well ❑ Abandon ❑ omestic ❑ Irrigation ❑ Cable a '❑ .Auger ❑ Deepen ❑ Recondition Monitorin ❑ Municipal ❑ Air Hammer ` p g p Direct Push ❑ 'Replace ❑ Other ❑ Industrial ❑ Other ❑ Mud.`Rota' ❑ Other 5. WELL LOG oC Unconsolidated Consolidated 6,SITE SKETCH (use permanent landmarks with distances) W Penpeability y ca I` From (ft) To (ft) •High pow m Other Rock Type C'.}: 7. WELL CONSTRUCTION'. 8..CASING f - Total'Depth Drilled' b f From:(ft).. To (ft) Casing Type,_,a and Material Size O.D. (in) Welli Seal Type = Date Drilling Complete !�+ Z�r 8. SCREEN From (ft) To (ft) Slot Size Screen,-type and Material Screen Diameter Z b iv oto - ti t v C', 10. FILTER PACK/GROUT I ABANDONMENT MATERIAL 11�AD.DITIQNAL WELL INFORMATION P pe s_ i � Developed? ❑ Yes ❑ No From (ft) To (ft) Material Description-�- Purpose Fracture Enhancement? ❑ Yes ❑ 'No_ Method Disinfected? ❑ Yes ❑ No 12. WELL TEST DATA(PRODUCTION WELLS) e �,: 13.STATIC WATER,LEVEL(ALL WELLS)_ Yield Time Pumped Drawdown to Time Recovery to Depth Below Date _Method (GPM) , `(hrsre&min) (Ft. BGS) (hrs & min)_ (Ft. BGS) Date Measured Ground Surface (FT) 14. PERMANENT PUMP(IF AVAILABLE) __ 15.NAMEIADDRESS OF Pump INSTALLATION COMPANY•, Pump Description -�°_ tt, rx . Horsepower rf�i Pump Intake Depth � `�. _(it) Nominal Pump Capacity (gpm) 16.COMMENTS `` 17.WELL DRI R'S.STATEMENTLLJ This well was drilled and/or abandoned u der my sup ision, acdo d ng'to=applicable rules + and regulations, and this report i comple n orr ct the bests my4nowledge. Driller: '~ / ' Supervising Driller Signature. Registration #J_ 0 1 6 Firm: "_ r/ je+N/ S Date: — Rig Permit#: I I J NOTE: Well Completion Reports must be filed by the registered well dri let within 30 days of well completion. �a q;e°• '3 4 z =xi !tl -.Y r- ,:J}�i�t e BOARD OF'HEALTH,COPYf ..} 4.,k F t ::4 v 4.5•, 4 i 5}�.a s F`- - TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: R :Di;�-s OF Olq RAC 5rA ,6� Board of Health MAILING ADDRESS: 3,W /y 1111 52Z / A 31� RNSTA 6(ETown of Barnstable TELEPHONE NUMBER: il ffS/ P.O. Box 534 CONTACT PERSON:T�-191V IA Hyannis, MA 02601�f) Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous characteristics and must be registered when stored in quantities totalling more than 50 gallonsliquid volume or 25 pounds dry weight. Please put a check beside each product that you store: Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid _Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) ►/ Disinfectants Motor oils/waste oils Road Salt (Halite): Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides P P 9 ) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) ��/1' 7'//U7_ Other cleaning solvents A7-S Bug and tar removers Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business ✓ Wit,.%yl C_L y.h.,p,!.. 4 '"" ,mil TO AL NEW BUSINESS OWNERS f DATE: t 13101 '`' �" i lease: � � rid° fE F�II P P. wn� K l c.N'AEt— a E s &#j APPf ICANT'S YOUR NAME: �"l BUSfNESSR YOUR HOME ADDRESS: �g i 4 21110 � -1 IN 4 -< '7 !7 o TELEPHONE Telephone Number (Home) NAME OF NEW BUSINESS 15A aAJ f fA,&4_C (.b a sj SEL•&J& A*sv Ct.AIWE OF BUSINESSC—o N S LI L4-I V IS THIS A HOME OCCUPATION? YES N.O Have you been given approval from the building division? YES= NO 0 t o 9 �tSf A C! S , JL 8 G• I g tits � M P/PARCEL NUMBER BUSINESS 'S NSA. ^! ,BA A 6 A ADDRESS OF U r re several thins you must do in order to be in compliance with the rules and regulations of the Town o When starting anew business there a p 9 9 9 Y Barnstable. This form is intended to assist,you in obtaining the information you may need. Once you have obtained the required signatures, .. listed below, you may apply for a business certificate at the Town Clerk's Office (Ist floor'- 9 Town Hall) or if you et the business certificate first P Y Y P Y you MUST go to.the following office to make sure you have all the required permits and licenses.. GO TO 200 Main St.— (corner of Yarmouth Rd. & Main Street) and you will,find the following offices.: 1. BUILDING COMMISSI ER'S O FICE This individual h rmed of y permit requirements that pertain to this type of business. Aut on ignature** COMMENTS: e 2. BOARD OF HEALTH This individual has b informe of the permit requirements that pertain.to this type of business. Authorized Signature // ** �� COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This.individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: Business certificates (cost $30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in the town (which you.must do by M.G.L. - it does not give you permission to operate -you must get that through completion of the processes from the various departments involved. **SIGNIFIES APPROVAL FOR A BUSINESS CERTIFICATE ONLY. QACONSUMER\Lois\CA forms\newbusfrm.doc YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates [cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. ` y DATE) ��.3 Fill in please: 3 r APPLICANT'S YOUR NAME/S: Phi 0/L BUSINESS YOUR HOME ADDRESS: Z D TELEPHONE # Home Telephone Number . NAME OF CORPORATION:' L NAME OF NEW BUSINESS TYPE OF BUSINESS Y IS THIS A HOME OCCUPATION? YES O ADDRESS OF BUSINESS Ztol MAP/PARCEL NUMBER fC� (Assessing) When.starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - [corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COM QbnjinfoFFm`ie 'S OFFICFq This individualof n pe mit a uireme is that pertain to this type of business. A h ized ignatare* — COMMENTS: 1)12. 2. BOARD OF HEALTH This individual has be i rmed of the p i equiremen that pertain to this type of business. uthorized Signature COMMENTS: - 3. CONSUMER AFFAIRS(LICENSING,AUTHORITY) This individual.has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: � II!I