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HomeMy WebLinkAbout0034 SHIRLEY POINT ROAD - Health (2) �bi Yl� ASSESSORS MAP NO: No C�YO-- -- PARCEL NO: Fee----` ------------ D OF TOWN OFARBARLNSTAB LE 4' , 0(ppritatiou,iorlVerr Con5tructiouf er i� A 1 cation is�ereby made for a permit to Construct ( ), Alter ( ), or Repair ( )an 1 W-1-dual Well at: lie Cli ocation — Address Assessors Map and Parcel ` ��� --------- - -- - -- - -- - - - ° --- Owne Address / -- -------------------- Installer — Driller Address Type of Buildi g DwellingeU '----------------------------------------- Other - Type of Building- ---------------------------------- No. of Persons--------------------------------------------------------- Type of Well-` s/d`'"' "d----------------------------------- Capacity- - - - - -='-- -------------------------------------- Purpose of Well-A-0 ------------------ 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 Vaer icate m ' nce has been issued by the Board of HeaSigne — -------------•------ e A lication A roved B - - � % - -- — -PP PP Y-'-- � date --- 7 Application Disapproved for the following reasons:--------------------------------____________________________________________________________ ---------------------------------------—— -- --—-- -- -- --------— - -- - — - -- - — -- - date �� --------7------------------------------ Issued------------------ / 7 ------------------------------------- Permit No. -------- ------- -- - date BOARD OF HEALTH TOWN OF BARNSTABLE Certifttate Of Compliance THIS IS TO RTIFY, T h divid Well Constructed (Altered ( ), or Repaired ( ) by--- - --------------------------------------- stal r ,�,4 r. at------- — -- -- - — - - - -- - l----------------------- ---------------------------------------------- has been installed in accordance ith 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 SATISFACTORY. DATE---------------------------------------------=---------------- Inspector —---------- ----------=----------------------------=-- 4 No. COS Fee---` -'t-~----�G----- BOARD OF HEALTH TOWN OF BARNSTABLEflip ���Citation,�or�Prr �on�truction�Prmit�� 'o , Application is hereby made fora permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: M �5-----G ',�t/ --------------------- - `focation - Address Assessors Map and Parcel ------------ --- - - ---------------------------- ---------------------—--_ Owner Address rInstallei- Driller Address Type of Building Dwelling; .�Y,45-.'---------------------------------------- Other - Type of Buildin No. of=Persons--------------------------- Type of Well ?/I, .,�G ___- - — - - - -------------- Purpose -- — -__---- — YP - -- -- --- Capacity of Well al-04�4® _—�: 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 Compliance has been issued by the Board of Health%, Signed, ---- -" _ ©�/0 ./cvl�ef ,foot Application Approved By— /date • Y Application Disapproved for the following reasons-----------------------------------------------------------_—_________ date Permit No.------s''���' ��- -77-------------------------------- Issued------------------- ---` ------ _ i/ date k BOARD OF HEALTH TOWN OF BARNSTABLE . �ertifitatP ®f �Com�riante �� . THIS IS TO -ERTIFY,}That the I dividual Well Constructed (�)�Altered ( ), or Repaired ( ) - J-�� �-� ------------------------------------------------------------------------------ -- - - b p; w yt ,r— - -- Installer - _ - � �� i----------------------- - - 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. - ti'9 Dated--� � � 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 r Vell Congtruct ion Permit No. ----------- ---------r Fee----------- Permission is hereby granted-- !!�'�J--- '�� �'!�r-�� -------------- to Construct (fir), Alter ( ), or Repair ( ) an Individual Well No. --� �= � A ' p1 — ,� ...T 1/r'i/� � .air _-1= ^- - - -- - -- — Street - ` as shown on the application for a Well Construction Permit No. ----------— Dated------- 1------------------- --- — / Board of Health DATE --- ''- -- ��— -------— ---- —------ PE-RC TEST DATA Tact bW. 3mhi Wktncss' S, Dvr,mihcj Ay jfto^fl bg1ei T�osnii £ 4N" VL0 Z4" - -4614 ZA - -38.0 - _ . 12� T SC�d lY IIIu'rl � o� I +JU INU G�Ijon INV $9nsy San 43,5z ^43.85 5.f#is 44.10 43.69 �3 43,32 -- - tTom o F_ _lSTEt11- VA1- -- - - --- *4"- - 33. 0 1 7,7 - i tius munAuaoltcr qG - - Ao,4 fl,�s. ,toun�- _!11 eer_ �fr �a.�d w` � vwJ�9irtc CobblFs ( - ----- ium Ka"_ .� —3l•0 -�bs�r-u I- T-akcc Ic�aiaon 114" i Ali =tli�l ICl/I —30,5 v _ -O-fo vC-4 G-r-O iv�ss��tr NO (IJq 7�Cr LIE- -DESIGN __DATA '•_ / 51r��c��mLls� - -5 BcArciii --IJo Gac-bo jc Grtncfe-Y- Z--- - y —moo- _ SSO g p�J �sf�-Ic-7'knit 5S"o iGo% z $ZS Gallons /0 3r - Q G I'I I ry 4 Fc,L c(��4 � Ss 1►c�c� 1-1� ,� Sf�t. 14 - - --- - o 7'0 �- pi pe 8 2 ��� '<if�tile S �t;Nv' tCC'y�7VCS to t \ -1, 70 _�11�_ 13 fc- -t irk 11cv of ►o4 =t xllbw -40ci to a uv�+la,1 , _ iM__lJty o 100 �•c.r.� foM c. resc.ryc GtK� t6 a _wc an �, �-___'S-n__a11ow Ili _�c� __ Iv1 licu o� 1SC__�cf_ _�ttrn•. a Icoc1'Iinc� �"ocili}-� -1•0 0 �Jc f1, ti 1 �= 31L WIN*5 off' . 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