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Home My WebLink About0435 OLD JAIL LANE - Health 035 Old Jail Lane A= 277—002 Barnstable r / D Fee No. W. 1 J / BOARD OF HEAL TOWN OF BARNSTABL. E 21ppYicatiou _for Yell Cou5tructtou Permit Application is hereby made for a permit to Construct( ), Alter( ), or Repair( ) an individual well at: -00o ` Location-,Address Assessors Map and Parcel Owner � / Addre s //N Installer-Driller Address Type of Building Dwelling Other-Type of Building No. of Persons Type of Well C(fxs Capacity Purpose of Well CV 1 C j 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 Certificate o o liance has een issued by the Board of Health. Signed Date L. Application Approved By cke Date Application Disapproved for the following reasons: Date /� Permit No. �✓o� ��'" C) Issued -G 2�I l Date ------------------------------------------------------------------------------------------------------ BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed W, Altered( ), or Repaired( ) by J!Q//0,4)QL L.,L.t U Installer at �', 4j ) 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 / r 1 7 . No. o`1 ;. FeeOF TOWN OFARD BARTNSTABLE 0(ppYicatiou _for Yell Cowaructiou permit Application is hereby made for a permit to Construct( ), Alter( ), or Repair( ) an individual well at: �— Location-Address Assessors Map and Parcel Owner Address rya � U�u Installer-Driller Address Type of Building Dwelling Other-Type of Building No. of Persons Type of Well �'j,''yi< j( '/4}14, Jf — Capacity Purpose of Well I I 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 Certificate of ompliance has been issued by the Board of Health. Signed Date Application Approved By -1.—Qe Vt5 Date Application Disapproved for the following reasons: i i - Date Permit No. ttJ,,) C) Issued —!. 2 2 Date BOARD OF HEALTH TOWN OF BARNSTABL'E Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed(-4;" Altered( ), or Repaired( ) by 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 SATISFACTORILY. Date Inspector BOARD OF HEALTH . TOWN OF BARNSTABLE Vern Conotruction Permit Fee %l C Permission is hereby granted to \ / t� Installer to Construct,(—),,-' Alter( ), or Repair( an individual well at: Street as shown on the application for a Well Construction Permit No. l,cJ a D 7r-' d l Z Dated Date Approved By Sao --0 c� o ld-�-A t Moms MAP No ro scut ASSESSORS MAP 2"PASSEL 2 ZONNO SUMMARY 2401R 01SMM RD RFSDERRAL OORWOT YDI.lAT SUM IS.Om B.P. RSQlTAB 20 LOGIION MRI.FROM DINOR t i0' VII.SIOfi SElOAIJI 10 IRIL REAR SEIRACIf 15 M.V.RINDO,O IR]fA1T Jd 9RE 6 WCA1E0 MRNPI A®W94 IMRRDROl OM]SAY msnam g 0 P num i VD EMMO WELL AND SEPTIC PLAN o �#435 OLD JAIL LANE BARNSTABLE, MA PREPARED FOR — - . KIM COTTO DAIS: AUlGLW IZ 2018 V lDwl10A(APPADK) Im,d arva�ors sma 110 arP Abh al.ee+f we.eA) rAAvw>«PORr w o2ex ��' iria mnoorc DCB /6-143 l5� -IY3 Town.of Bgwnstable Delpartiuent of Regulatory.Services k PublIc Heazth.�xvza%aza oats VMs 1017. 200 Main Street,Hyannis MA 02601 , rgo n+t�+♦' ' bate Scheduled- - T>lzte_.:/_ Fee Fdl, 9 . ,� f , bg r -- - -- Soil Suitability Assessment for >Sew • e ISP.OsLa�, ecPerformed•By: a I V,0 Witnessed Byn f E®dI A MT &GENER&L_,INFO ON Location Address �IJS Owner's Name Xs'a �.0p >> Address Assessor's Map/Parcel: Engineer's Name � `(/V, �e NEW CONSTRUCTION REPAIR p Telephone# C ve 36, � �v� ��• Land Use: t ,a''Q►bl Slopes Surface Stones Distances from: Open Water Body 1100 ft Possible Wet Area ,t ® ft Drinking Water Well t \DjDra.'IhAga Way >10® ft Property Line d ft Other ft SI "TCHo(Street name,dimensions of lot,exact locations of test holes&porn tests;locate wetlands-in pxoxirnity to holes) 43 e�2 Parent material(geologic) ,IR QL rP,� 14�, )opth tv Bedmak. -- Depth'toGroundwater Standing Water in Hole: lim.- Weeping from PltFflaz Estimated Seasonal High Groundwater ) lk D 'fieWA'X'J ON FOR.SEASONAL EaGH WATE T.BLED, Method Used: Depth Observed standing in obs.hole: _ -In. ,Depdttn 5,g11 Ip9ttIC6:. In, Depth to weepingfrom sido of obs,hole: In, GroundwatarAdjugtmant fr. Index WeII f# ltcading Dake: Indox WaI17aYol __., Ac�I.fa Mar,.,,,r•_.r.Adj,�givutttlwaterLavel RERCOLA.TIONTEST Data 9l'itna�� t Observation Hole# _ Tlm_ aat9" ()i�j � Depth of Perc. '•q Ca10 5 Tlme At G" StartPro-soakTima @ - 1 Time(9"-6") _. End Pro-soak `9 Rate Min./Iuch . W Site Suitability Assessment. Sito.Fassed ✓ Sitg Fallad: Additional Testing Needcd(.YM) Original: Public health Dlvlslon Observation Holt;Data To Be Completed on Back--------- ***If jpereolatibu test is to be coaadueted within 100' of wetland,you must first notify the Barnstable Couse)pvatlola Division at lest one(1)week prior to beginWng. Q:1S MIC1P13RCFOR.M.D O C DEEROBSER'V 7C]CO`N116Y,B LOG Hole# , Depth from Soil Horizon Soil Texture .Shcl Color Soil.. Other Surface(in.) (USbA) .(Munsell) Mottling' (Structure, Stones;Boulders, o i'ton cy.9C'Gravel) DEEP 013SE'k-VATION ALO -9 LOG 11618 � Depth from Soil Horizon Soil Texture Soil Color Soil -- Other 5urfacc(in) (USDA) (Munsell) 'Mottling (Structure,Stones,Boulders. Consistency,.C/6 G ve o- Z )Oy 6/ g 18 Y 9 IT/2 DEEP OBSER.''V'ATYONROLE LOG Hole 9'._3 _ Depthfror SollHorizon Soil Texture Soil Color Soil Other' Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. �q Corisisto c G a Z?1-Izo C "ITS DEEP OESE+R &&ION HOLE Lb Hole# Depth from Soil Hotlzon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones:Boulders. Ca si fen 6 0 YA. 41/q. ® 1 S s y x/ Flood Insurance Rate_Map Above 500 year flood boundary No— Yes Within 500 year boundary No- el. Yes Within 100 year flood boundary No•j[- -Yds,•:— Depth.of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all arwis obs6rved thrpughout the area proposed for the sail absorption systems YE-Is If not,what is the depth of naturally occurring pervious matdriall Ce tMcation (/, Z I certify that on (date)I havapasse'd the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required.training,expertise and experience described in�10 C M 15.017. Signature�'- �� :�� -" Data; Q . , :\si?ry aPlxl1CVORM.1)OC