HomeMy WebLinkAbout0765 MAIN STREET (HYANNIS) - Health F
765 Main Street
Hyannis _ _ ;.".. . S
1 A=290-098
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BOARD OF HEALTH
TOWN OF BARNSTABLE
Application-*rVeii CongtructionAermit
Applic io is ereby made for a permUtz
Construct ((/f Alter ( ), or Repair ( )an individual Well at:
Location — Address Assessors Map and Parcel
Owner a Address
Installer — Doler Address
- -
Type of Building
Dwelling----- •-G e-------------------------------------
Other - Type of Building ------------------ No. of Persons---------------------------___—_____-------
Type of Well— -C��-&`'-- ---— ---- Capacity--- � -— —--—
Purpose of Well - -�` �- -- ---—
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 u r ' i�te lia has been issued by the Board of Health.
Signed - -------------------- -7 a
---- - --- -----------
d e
A,
Application Approved By--: — -- -------—- -— —4 ---------
date
Application Disapproved for the following reasons:----------------------------------------------------------------------__________
-------------------------------------- ---------------------------- -----
- - ------------------------------------------------------
date
��/�'qy /��
Permit No. `'-Sty �L�j ---- --- Issued--- - - — — ------------
date
-- -------------------------------------------------------------------------------------------------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate ®f Compliance
THIS IS T-Q-CERT the Indivi ual Well Constructed (`�), Altered ( ), or Repaired ( )
bY----------- ------------------
------------------------------------------------------------------------------------------------
VL Installer
at- - � �_=i�!lv ------------------------------------------------
— - -- - - --- -
has been installed in accordance with the ovisions of the Town of Barnstable Board of Health Private Well P ote ttiion
Regulation as described in the application for Well Construction Permit Now -JOjchated—9-
*- 7
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS°A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE------------------—- — -- - - - --- — -- Inspector------------------------------------------------------------------------
-
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N o.
Fee---- --
BOARD OF HEALTH j
TOWN OF BARNSTABLE
ApplicationArlVell Con5tructionPermit
Applic do is hereby made for a permit t Construct ((/), Alter ( ), or Repair ( )an individual Well at:-- - .
2 Location — Address Assessors Map and Parcel —
Owner Address
Installer — D�Iler Address
_
Type of Building x� I
Dwelling----- F`-C e-------------------------------------- `
i
Other - Type of Building ---------------- No. of Persons-----------------------------_ -
C-_Sec — _ _ '
Type of Well---- ---— --- Capacity-------��-- �1- - - — --—
Purpose of Well------- d�R'f'Q — ---
i
Agreement:
The undersigned agrees to install the aforedescribed"individual well in accordance with the provisions of The I
Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to
place the well in operation until'a. C rWicate ' plia ee has been issued by the Board of Health.
Signed = --------------------------
Application Approved By -- -- -— -
date
I
Application Disapproved for the following reasons:---------------------------------------------------------------------_________
------------ -- - - -—- ---------——-— -------------------------------
date
Permit No. � - -=-=- ---- Issued-- - - ------------------------
date
--------------------------------------------------------------------------------------------------------
BOARD OF HEALTH
TOWN OF BARNSTABLE ` -
Certificate ®f Compliance
THIS ISERTI a the Indivi ual Well Constructed (�Altered ( ), or Repaired ( )
�'
Installer
at---- - - - _6-------------------------------------------------------------------------------------------------------
has been installed in accordance with the kbvisions of the Town of Barnstable Board of Health Private Well Pr tec ion 1
Regulation as described in the application for Well Construction Permit No. -- ----- -- -- ated------- --�-�� �
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THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
i
DATE---------------------------------------------------------- -- --- Inspector--------------------------------------------------------------------------
--------------------------------------------------------------,.�, ---------------- ------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Vell Con5truct ion Permit
No --� Fee-� ---
Permission is�ereby granted--- - - ---------------------------------------------------------------------------- -
to Construct Alter ( ), or Repair ( ) an Individual Well at:
Street -----------------—--------------------------------------------
as show�n�on the application for a Well Oonstruction Permit
No. -------------— — -
Dated-- '�
------------ - -
Board of Health
DATE-- - ----I --------------— ---
Health Master Detail p Page 1 of 1
-Health Master
E.,
Logged In As: TOWN\crockersh Health Master Detail Wednesday,September 26 2012
Application Center Parcel Lookup Selection Items Reports
-0
Parcel Septic Perc Well Fuel Tank
Parcel: 290-098 Location: 765 MAIN STREET(HYANNIS),HYANNIS Owner: SHOESTRING PROPERTIES LP
e• ,�a�ij�'Y(owo., Show .a ' Fuel Tanks
LTank 1,01/01/1977 Tank 3,61/01/1968 Tank 2 1 New Fuel Tank...
Tag number: 100581 Install date �MR Location: B(Below ground
Capacity(gallons) : 1000 Construction: SS _ Meets 326-8(d)standards: f-
Leak detection: F Cathodic detection: [ Not in ZOC on Split lot: r
Fuel stored: IFO Fuel storage reason: I"
Removal company: I Select company - Licensed Site Professional: ISelect name, Unregistered removal: r
Removal date : 12/16/1988 Removal notification date :I� Leakage on removal: r
Abandon date : Abandon status: I Select status
Variance date : � Variance granted: r Release tracking number:
Comments: 7 FILLED WITH SAND 10/13/88. ;I _Delete Tank
New Fuel Tank Test...
Notification date : Date : Result: Select result.=
Comments:
Save Fuel Tank Changes I Return to Lookup
http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=290098 9/26/2012
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OWN ;OF BARNSTABLE UNDERGROUND FUEL AND CHEMICAL STORAGE", REGISTRATION
OWNER AND INSTALLER INFORMATION
4 .L T l t
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(/t� MAP ..NO. PARCEL NO. : ...
ADDRESS: .
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OWNER :NAME: 1;�` .,t%r"�.r7�1/Z/L VILLAGE::, (v
INSTALLATION DATE �'Xlr 40',' BY: r�/+' .i: 2rn� PL ..;1` �r e'�
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ADDRESS '
, . CERT NO'
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TANK
'INFORMATION
LOCATION"OF TANK:
CAPACITY / D / TYPE r�l F&'' AGE FUEL%GHEM I CAL U�i t o
TESTING CERTIFICATION: C. ] 'PASS C °] FA
IL. DATE
LEAK DETECTION Nil- CHECK IF N/A TYRE/BRAND
.. .. `
ZONE OF CONTRIBUTION C ],YES ' . [. ]`+ NO DATE TO BE REMOVED C�'
FIRE DEP ITT. "PERM ISSUED NO
CONSERVATION C ] CHECK IF N/A DATE s
BOARD OF HEALTH TAG—NO.6 ]C ]C ]C ] DATE 1!
- ,r f
PLEASE. PROVIDE A .SKETCH SHOWING THE TANK LOCATION ON. THE BACK OF 'THIS CARD '
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� Health Master Detail Page 1 of 1
' 9IA4 1
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Health Master
Logged In As: TOWN\crockersh Health Master Detail Wednesday,September 26 2012
Application Center Parcel Lookup Selection Items Reports
Parcel Septic Perc Well Fuel Tank
Parcel: 290-098 Location: 765 M IN STREET(HYANNIS),HYANNIS Owner: SHOESTRING PROPERTIES LIP /�G� �i ���-S
�SUV . I Show E Ing Fuel Tanks
Tank 1,01/01/1977 Tank 3,01/01/1968 Tank 2 New Fuel Tank...
Tag number: 100582 Install date : 01/01/1977 Location: B(Below ground)'
Capacity(gallons) : 500 Construction: SS Meets 326-8(d)standards: r
Leak detection: F Cathodic detection: Not in ZOC on Split lot: r
Fuel stored: IFO Fuel storage reason:
Removal company: I Select company Licensed Site Professional: I Select name Unregistered removal:
Removal date : 10/04/1996 Removal notification date : F__ Leakage on removal: F.
Abandon date : � Abandon status: Select status
Variance date : Variance granted: f Release tracking number:
Comments: TIGHT/MASON 3 WELLS IN PLACE Delete Tank J
i Test 11/04/1994 1 New Fuel Tank Test...
Notification date : 09/16/1994 Date ::11/04/1994 Result:) I
Comments: Delete Test
! Save Fuel Tank Changes I 'Return to Lookup
http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=290098 9/26/2012
TOWN �OF BARNSTABLE. UNDERGROUND FUEL AND CHEMICAL STORAGE' REGISTRATION
OWNER AND INSTALLER INFORMATION
ADDRESS f `•
MAP, NOPARCEL NO
. (Al A i El��t�f� 1
;�-f VILLAGE:. �� /C�•� Y� ��
OWNER NAME 'i, Ft . .
INSTALLATION DATE BY. o
CERT. NO
ADDRESS
TANK INFORMA ON
LOCAT I or OF TANK,:
i _ .1:
CAPACITY
TYPE.. � F.s AGE FUEL/CHEMICAL
t
TESTING'CERTIFICATION C 7 PASS C ] FAIL DATE
LEAK DETECTION� HECK IF N/A TYPE/BRAND7 1
�j
ZONE OF; CONTRIBUTION U .3 YES C NO DATE TO BE, REMOVED. si
F IRE' ,DEPT. PERMIT ISSUED C DATE '
CONSERVATION C CHECK IF N/A DATE
BOARD OF
..HEALTH TAG NO:.'C C 7 C ]C- . 7 DATE
PLEASE PROVIDE A SKETCH SHOWING':THE :TANK LOCATION ON THE BACK^OF THIS CARD
TOWN OF BARNSTABLE
367 Main Street Feel__jZ&IQ_
In� Hyannis. MA 026 W
���� l�' CEBIIFi�AIF_QE_BE�I�IBAIi�I
1 DATE : _ZLZILQZ_
In accordance .wi th the provisions of Chapter ' 148. Section 13.
of th Massachusetts General Laws. the undersigned hereby certifies that
oil ........ Address Z��_�l8i�i_�I-------------------'
is the holder � of a license granted_____________3ook______Page______for the !
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lawful use of the building ( s) or other structure (s) situated or to
I
be si tuated at 765_12ALY-1I-------------------
Par ce t # Tag #
Tgtal ; capacityy i.n gallons: Q I�_------ Abovegground—_:_
und x
Kind of - fuel to be stored: F���_$
Received ----------------- 19---- ---------Z ----------
ay —------ --------------------------- - - -
(Owner. Occupant or Holder)
-------------------------- ------ ------------------------------
(Official Title) (Address)
NOTE: , This certificate of : registrations must - be signed by : the holder of = the
license.. if ,said = license was granted prior=_ to Juty _ i. . 1936, otherwise by
the= owner .or; occupant , of .the land Licensed.
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DEPAATMENT OF ENVIRONMENTAL I'HOTECTION I u►.t ilr:�rr,if. vvn.tlt. uu_uNI.Y
DIVISION OF: HAZARDOUS WASTE ' 1_ 01 IN• I A l r Vt,t]G I IWIW0
a2222 One Winter Street Boston, Massachusetts 02108 - (
la
Ploaeo print or type.(Form desipnad Ar Tu el 68'Cf7- it9R2•pilch)typewriter.)
UNIFORM HAZARDOUS 11. Generator's US EPA 10 No. Manifest Document No. . 2. Pogo 1 Information In 111a shodod areas
WASTE MANIFEST ' � of la not requirod by Federal low.
0. Gonart►lor's Namo and Mulling Addr s A. Slate Manliest Document Nunitlor
etrJ MA F 525878
92'7 7 /C. .. 0 State Gan.ID i
s. Gonarnlor's Phone �?��7�/� C. State T►an 0 U
6, Transporter I Comoan Naino 8, US EPA ID Number �
SAFETY-KLEEN ICORPe _ I,jLU 904900202 -�'� _ _ u
7, ?ranaponor 2 Company Namo - 0, US EPA ID Number O�Traans��itorw9 Phone 0 6�8 a- - a
k. State Trams.ID 0
9. 0aelgnpltid Facility Naino and Slta Acldtoee - 10. US EPA 10 Number .....- ...�-�
SAFETY-KLEEN CORPe 202202 F, Trallaportor'sPho11o1-- )
SOA 8RIG1iAM 0. State Facility's 10 NOT REQUIRED �
MARL60R0Iu6N•; MA 01752 MAD 088978' 4,3 Im. FaCORY$Phone S08 )48L-3116
12. Containers IF
—-14 I. \
11, US DOT Description(Ynctudiny Propar Sh/pplay Namo,Hazard Class and/D Number) Total 11nil Waste No. hr
No. Typo _ Quantity WIN _... ._._...._ a
MASTE- OILIMADEP MA011 MA01
(NOT, USDOT''MAYARDOUS MATERIAL 0001. TT G .'
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J.Additional Descrlptlons for Materials Usted Abaiii(ft4 do phY41109*rota and horrid code.) K,Handling Codes for Wastes Ueted Above 1
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• OIL WATER 3OGss.08
b. _ _ c.
Iri.Speclnl Hendiing Inslfuctlons and Additional Information 1
EMERGENCY RESPA708-888-4660 24HRe 2-022-73—��0;K-"0'PPM—
SKOOTS A: 1518 DS C: D:
10.OENERAMfl'0 CERTIFICA11061:1 hwahy doctors that ohs contanto at Woo conalanment are Itdly sod accuracoly described ebovs brr
propar shipping next end ors clessllled,packed,marked.and Iobeted,and aro In all respects In proper condition for transport by hlphway
according to applicable International and national gwoomma It ra,lUlatlatta,
If I ant a ladle quantilygonerator.I earply that I haw a prograrn In place to raduue the volume and tosiolly of waste gansrntod to thn dngroa I have dolormined to bit vcunrrnlceliv practicahla
and that 1 have selected Ilia practicable inothod of trastmont.storage.ar disposal currently available to me whlcll mlfuonites the pteaent ono fulure anent in human haalth omit tho onviton•
mnnl;On,If I am a small quantity peneratar,I have made a geed feilh affair to minimisa my wasp go noretlon and select tho best waste inanaYamanl fr000ln d that Is ovnllabin to ma and that I
con afraid.
Oslo
Prinrrtd/ryped Name 51gnarur a
1 I.
T 17,Trans prior 1 Acknowledgement ace tot Materials _ Oata
h Pdn d Name Sl9nartrre Moir 0 y
c� 18.Trans over knov mont o1 Flecel t of Malorlals D
-r PrJn(dd1fyPW Namo Signature Month Day yea
E _ r—
A
18.Discrepancy Indication Space
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f 20.Facility Owner or Operator•Certification of receipt of hazardous materials covered by this manifest except as noted In Ilom 19.
Dale
5 onf Nam l9nawr o
Yy e
Form 1plovad Mfl No.2050.0039,Expires 9.30.01 �
EPA orm 870m(Rev,me)Prevloua sdilluiw aro obaclolo.
M400002 COPY>1 : FACILITY MAILS TO GENERATOR
No. v V I Fee �.
BOARD OF HEALTH
TOWN OF BARNSTABLE
01pprication ,for Vern Con.5truction Permit
Application is hereby made for a permit to Construct( ), Alter( ), or Repair( ) an individual well at:
C2
Location-Addrer Assessors Map and Parcel
t�wn �� Address
Installer-Driller Address
Type of Building
Dwelling
Other-�e of Build g No. of Persons
Type of Well /-r�' c Capacity
Purpose of Well
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 Compliance as been-issued by the Board of Health.
Signed
Application Approved By """` �� i
ate
Application Disapproved for the following reasons:
Date
Permit NO. �����" Lj Issued 517, V08
Date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate of (Compliance
THIS I��C ERTIFY,that the indivi al well Constructed( Alt red( ), or Repaired( )
by
Installer
at C� ��
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private W 11 Protection
Regulation as described in the application for Well Construction Permit No. A�2018--61 l Dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORILY.
Date Inspector
i
No. V��`�' " 0`1 I Fee
BOARD OF HEALTH
TOWN OF BARNSTABLE
Tipplicatiou _for Yell Con!5tructiou Permit
Application is hereby made for a permit to Construct( ), Alter( ), or Repair( ) an individual well at:
Location-Addres�,a, Assessors Map and Parcel
y Owner Address
A.
Installer-Driller `l� Address
Type of Building
Dwelling
Other-Type of Buildinng\ No. of Persons
Type of Well Capacity
Purpose of Well
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 Certificaatte_�offrCompliance-has been-issued by the Board of Health. 1,A
ySigned �,�`�/ ! S—h
�••,/ �Date II
Application Approved By �1a
P Date
r
Application Disapproved for the following reasons:
r x
Date
Permit No. (/ti-/��� j I Issued
' Date
-v_>-®o —_er>—Qa_.._ao_o4ee--_. -----m—vavmm BO ..----------._o__ —__voe__....__.e...—__os_e4 eed
BOARD
TOWN OF BARNSTABLE
.. Certificate of (Compliance
THIS IS TO CERTIFY,that the individ al well Constructed Alt
red( ), or Repaired( )
by 1 1V 1�'? C�✓��✓�
y, Installer
at 'l�5 "'// I 'U A 1\jo�j 1 S
has been installed in accordance with the provisionsrof the Town of Barnstable Board of Health Private Well Protection
Regulation as described in the application for Well Construction Permit NoLA)2018—61( Dated �i���2oi l'
- i r
THEISSUANCE 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
Verr Coug,tructton Permit
No.0 201 C)( � Fee l
Permission is hereby granted to
Installer
to Constructs/, Alter(c), or t Repair( an individual well at:
Street \\**'�'�����tt,,
as shown on the application for a Well Construction Permit Nol,,) �CJI ?) JDated
Date Approved By
1
C/
No. -+�-✓ Fee----- "--BOARD OF OF HEALTH
TOWN OF BARNS-TABLE
A Citation-*0VPli Congtructionpermit
Application is hereby made for a permit to Construct ( ), Alter �A/oar Repair�jX)an individual Well at:
--- -�c3 rN 5 f 1 Q h1- �-f S l__ (O_=1
Location Address Assessors Map and Parcel
--PM L-L-Y 14 41V eta et fA �-'c'�-
`1- -- -, -7 S M .41 nr S+Y-e C-,e
fi-
-----------------------------------------------------------------------------------------------
Owner Address
/I7/-A MT I G by LL l LL 1 N 2-14 N7�t � 4,
- -----------------------_ --- ------------------ ----------------------
Installer Driller Address
Type of Building
Dwelling �'°t_`'�an4 - 0CL7- S/4� Qom'
- - -
Other - Type of Building ------------------- No. of Persons---------------------------------------------------
u " r E/
1 �I.� kJcLC
Typeof Well------------------------------------------------------------------- Capacity-----------------{-3-P-------------------------------------------
Purpose of Well--------,���_X''FTd`�M
-------------------------------------
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.
4 , /
Signed ` ------ - --2/27 C74- ---
-------------------
date �}
Application Approved By ---------- -— — -=X 5--=1- -
date
Application Disapproved for the following reasons:------—----------------------—-------------
-—- -------------------------------------------
date
Permit No. -=-----
-- —- L
�---------------------- Issued-----------------�-------�--'-�-^ --G----------------------------
date
T
Fee - -
o. -N F HEALTH O -J�
I
_ r
TOWN Of BARNSTABLEt
lication-*rMelt Construction rrmit s
Application is hereby made for a permit,to Construct ( ), Alter (��, or Repair X)an individual Well at:
Location — Address Assessors Map and Parcel
r _POP L L Y M�4 Nab fret�P+v� -��uc�0- ��5 -M A i-N -S-t2 9�e
,i Owner — Address
Installer — Driller Address
Type of Building
Dwelling ------- aUr Slcl< -4r-e�
Other - Type of Building--------------------------------- No. of Persons-------------------------------------------------------
Type of Well- ---—��' - - w��'�' ---------- - Capacity - - - - ---
p -
�1��� t�rl�nt
Purposeof Well-------------------`�--------------------------------------------
Agreement: f
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 �../a'�t,.`
date
Application Approved By-- -- - -------- = = -- - �-
- date ffi�
Y �
Application Disapproved for the following reasons:----------------------------=------------------------------------------=---------------
- —-- --=—=--------- - ---------------
-----------------------------------------------------------------------------------
date
Permit No. =--1C'��_-' —� _-------- .Issued-- -- -- -- 4�- ?6---—-----------------------
a date
MW
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certif irate Of Compliance
THIS IS TO CERTIFY, That the Individual Well Constructed (kt Altered ( ), or Repaired ( )
bY- -- --- -� -- -
-----------------------------------------------------------------------
Installer ——
at--------------Z� ----- -- -��------- ---- - - - - ----------------------------------------------------
has been installed in accordance with the provisions of the own of Barnstable Board of Health Private Well Protection
Regulation as described in the application for Well Construction Permit No.YJ--?j6- _Q:1---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 BARNSTABLEj
Certifi rate Of ComPhance
THIS IS TO CERTIFY, That the Individual Well Constructed (k<J, Altered or Repaired
by--------------- ---------- --------------------------------------------------
Installer'
at----------------7zoo, h -.0
---------------------------------------------------------------------------
has been installed in accordance with the provisions of-the-f(o---Town-o--f Barnstable Board of Health Private Well Pro' tec on
NA D a t e d
Regulation as described in the application for Well Construction.-.Permit
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
-
-----Vell Con5truct ion Permit
No., 1 D Fee
Permission is hereby granted -----------------------------------------------------------------------------------------------------
to Construct ( \—x)- Alter or Repair an Individual Well at:
No.
0�treet
as shown on the application for a Well Construction Permit
No. Dated —------ ----------- -------------------- -----
--- ------------------------------------
------------boaProf Health
DATE