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No.-w---` Fee-----
BOARD OF HEALTH
TOWN OF BARNSTABLE
ApplicationArIve[C Conwtruct ion Permit
Application is hereby made for a permit to Construct (")), Alter ( ), or Repair ( )an individual Well at:
16o( L c ri i GI Lw /'k S �o.�3 /1,r t S
Location — Address Assessors Map and Parcel
------�`� - - ---- -------- - _,✓e_� z- T---- �c „ ---------------------
Owner I / Address
0'�1/•� - - �1-1��r,����-`- ------�J n.c as l�,a u -
<<" -- - - --- ----------
Installer — Driller Address
Type of Building
Dwelling--------------------------------------------------------------
Other - Type of Building -------------------- No. of Persons----------------------------------------------
//
Type of Well- `y.- - -- ------------------------------ - Capacity - - --— —
Purpose of Well C-" r,----------—-
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 Complia rce has been issued by the Board of Health.
Signed-� •0__- - - ------------------------ -
�j Mes-
Application Approved By�� -'_!_—'- ----— -
date
Application Disapproved for the following reasons:-------—-------------------------------------------------------
-----------
—
date
Permit No.-- ----- -------- — -- - - --- - - /
_ s -- Issued------
---------�--- ---
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
C ertif irate Of Comphance
THIS IS TO CERTIFY, That the Individ^ual, /W/ell Constructed (�, Altered ( ), or Repaired ( )
bY- �h. 0 /_vo _ c�L NJ��— —Installer ——
at �Gw�� —/Uv6— 1 bG P /
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well P oten
Regulation as described in the application for Well Construction Permit No. c� - /---Dated- 5
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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Fee-----
BOARDOF HEALTH
TOWN OF BARNSTABLE
Application-*rVell C ongtruct ion Permit
Application is hereby made for.a permit to Construct (v), Alter ( ), or Repair ( )an individual Well at:
U n,�/fir /�0 G C c / un _— �/ —— - -------- ----------- --- ----
--- -- - ------ ------ —�'
Location — Address Assessors Map and Parcel
Owner Address
A J — '-^uGS�,F-
- -
Installer — Driller �—_ Address
Type of Building
Dwelling--------------------------------------------------------------
Other'- Type of Building ------------ No. of Persons---------------------------_--__—-----_________
� r
Type of Well-4,------ -- - ---------- 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 until a Certificate .of Complia ce has been issued by the Board of Health.
Signed --
--- ----------------------------
date
Application Approved By- ---
date
Application Disapproved for the following reasons:-------------------------------------------------------------------------
--- ---------------------------------------------- --------------------------------------------
date
f / 'S
� Permit No. ------------f-^----� `'�'� ---------- Issued-------�--------- ------------------------------------
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
(Certificate Of Compliance
THIS IS TO CERTIFY, That the Individual,Well Constructed (,-), Altered ( ), or Repaired ( )
by------------ — � _° ��-�' / ,D�,��_- - --- -- ---------------------------------------------------------------------------
Installer
at— c_v_n�--/_'�C�-- U G_P� G/S /�Ji. —M I-/_f- -----------------------------------------------------------------
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private. ----9�
Well P otect'�n
Regulation as described in the application for Well Construction Permit No --------------------Dated-Y/,//-��--�
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
Yell Con!5truct ion Permit
No. - ------------------ ` Fee---- -------
Permission is hereby granted-- -- ���_ /! wr -� .- - -----------
to Construct ( ), Alter ( ), or Repair ( ) an Individual Well at:
-- - --------------------------------------
street
as shown on the application for a Well Construction Permit
No. ---------- �-�- = -�-,rf- ------ - - Dated--- -
Board of Health
DATE-------o ------------- ---
OJ3 - v 0-1
�i
No.---
-- -- Fee------ -----------
BOARD OF HEALTH
TOWN OF BARNSTABLE
ZIppCicationArlVe1Y Conoruction Permit
Q Application is hereby/made for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at:
)
--------------------------------------
Location — Address Assessors Map and Parcel
---------------------------------------------
/� (� Owner /� �r /Address
- _ - - -- - ---------------------------------
Installer Driller Address
Type of Building
Dwelling---------------------------------------------------------------
Other - Type of Building-------------------------------- No. of Persons------------------------------ -------
Type of Well - - —---- - ----— -- - Capacity---— - --— -- — —--
Purpose of Well-��s`— 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_i -- ------------- -e'�'�A— _---
date
Application Approved By-—2Aea ---- ------ ---� _ = -
date
Application Disapproved for the following reasons:
-----------—-- -__——__-- ----— -- - - - - -----------—------
- - -
(� 7
Permit No. ------/ 'y ----- Issued--- -- /- - -- -date-----------
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate ®f Compliance
THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( )
------------
e �
at Installer
__ liM(/— r�G — G G — ti/$ j�v�—— =�' '+----------------
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Pr tect'.on
=ems`X L
Regulation as described in the application for Well Construction Permit No. ----- -----------Dated---� �r
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE- --- ——— - --- ----- Inspector--- - —------------------------------——— ------------
OC
No.--------- -- Fee---------------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Application-ftIverr Con5tructionpermit
Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( .)an individual Well at:
----------------------
Location — Address Assessors Map and Parcel
T o i --------------
Owner Address
--------- - - �---- - - -- -_ -
Installer Driller r Address
Type of Building
Dwelling------------------------------------------------------------------
Other - Type of Building ----------- No. of Persons--------------------------------------------
z /'
Type of Well-/------ -- -- - -------- - Capacity-------------------- - -- —- --- —
Purpose of Well_1"'�6 S�� "/L/-- - -----
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-",
—r -- -�- - ------------ - -A -
/� date
Application Approved By e ---...... ram date
---
Application Disapproved for the following reasons:-- --------------------------------------------------------
- —-- - ---- --- - ----- - - --- —----------------
- - - __
date
_ ---- Issued--- -- -Permit No. ------------------------- - - ----------------------------------
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate Of Compliance
THIS IS TO CERTIFY, That the Indiv'dual Well Constructed ( ), Altered ( ), or Repaired ( )
T
----------------------------------------------
----------------------
e //�� _—
- I nsta ll er
JL
at_G GM_/=I—/J�.�_--- C. - Z11—_ a/; ! v =— -- ,G_((----------------------------------------- —
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Pr tect'on
Regulation as described in the application for Well Construction Permit No. Dated Dated jTHE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE--------------------- - --— Inspector--- - ---'------------------------------------------
r
BOARD OF HEALTH
TOWN OF BARNSTABLE
Ivell CongtructionAermit
No. �--`-�-�- Fee
--`/�----
Permission is hereby granted
to Construct ( ), Alter ( ), or Repair ( ) an Individual Wel at: • //
�._� �, ✓,�0 6 �C c� f -�w_ �'`�,s��-c —r' `s'— --------------
No. - - -d -- ------- - ---
Street
as shown on the application for a Well Construction Permit �+
No. --------- -= ? -- - ------ - - Dated--- �- ` - - =5--------------------------N------!'
----------- ---------`_------------
/ Board of Health
DATE---- - - -- - -- ----—
CE[JTERY(LLE-OSTERVILLE-MARSTG;IS HILLS
FIRE DISTRICT
1875 ROUTE 28
CEUTERVILLE, NA 026T2
(508) 790-2380/F AX O(508) 790-2385
OIL/HAZARDOUS MATERIAL RELEASE FORM
LOC AT ION:
ADDRESS OF RELEASE: [: G• •v L%� rj PPu s,
DATE OF RELEASE'
PRODUCT RELEASED-
EST IM ATED QUANTITY: i A w r--
//CO'RRECTIVE ACTION TAKEN BY RESPONSIBLE PARTY•�v�i�rarv'I/wr J%
(/vGeG As2 ? J, de Cr.j 7 C�
NOTIFICATIONS: /
FIRE DEPARTMENT: YES( NO( ) D ATE: � 3 { �-K T IME:
NATIONAL RESPONSE CENTER YES( ) NO(wdr DATE:.--TIME-
DEPT.OF ENVIRONMENTAL PROTECTION YES( ) NO( SATE: TIME:
OIL SPILL COORDINATOR: YES( NO(«)'' DATE: TIME
TOWN BOARD OF HEALTH: YES( ) NO(-I- DATE' TIME:
TOWN HARBORMASTER: YES( ) NO( DATE:.--TIME:
OTHER AOENC iES.
P ;c ✓L , ,, e r1,74
COMMENTS' 1-4—try. 5D,. , ,l bti
/,As% h,-.,; v �C dA iv A �v�� iY1.✓K .
REPORTED BY: R, , !°s f ggi� ATE:
WHITE COPY-FIRE DEPARTMENT YELLOW COPY-D.E.P. PINK COPY-BOARD OF HEALTH
C-O-MM FORM #58
C
sv J�P+
CENTERVELE-OSTE# ViLLE-MARSTOUS MLLLS
FIRE DISTRICT
1875 ROUTE 28
CEPTERVILLE, MA 02632
(508) 790-23801F AX O(508) 790-2385
OILMAZARDOUS MATERIAL RELEASE FORM
LOCATION:
ADDRESS OF RELEASE L21 a l ( /c�G Je
DATE OF RELEASE. ZZ 2� ../5
PRODUCT RELEASED: �f` 4!' 0 /
ESTIMATED QUANTITY: -44 U G',y
CORRECTIVE ACT ION TAKEN BY RESPONSIBLE P ARTY:
NOTIFICATIONS:
FIRE DEPARTMENT: YES(-)'• NO( DATE: ��; -G,I S TIME:
NATIONAL RESPONSE CENTER YES(`-)' NO( ) IDATt. L��TIwIE:
le
DEPT.OF ENQVIRONMENTAL PROTECTION YESQ,) NO( )I DATE: ,T-ME Gj c
OIL SPILL COORDINATOR: YES( ) NO( ) DATE: ' � TM1E
I TOWN BOARD OF HEALTH: YES( NO( ) DATE:- /1�TIME: <`
TOWN HARBORMASTER: YES( ) NO(7) DATE ` -'TIME
OTHER AGENCIES-
COMMENTS
fezgc '
-�.,,�✓�La�� �.� C�F T'�bt �, ,� ,�/.,..i.r r ,L/,ra .nrm./> i d(��-•
REPORTED BY ° L t1, _ HATE 1l��. '
WHITE COPY-FIRE DEPARTMENT YELLOW COPY-D.E.P. PN K COPY-BOARD OF HEALTH
C-O-MM FORM 858