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Home My WebLink About0127 SPUR LANE - Health 1'!'lcc r S To n S l?`J, L �� :A� �a7 ✓' rl O,oCATION SEWAGE/ PERMIT NO. .VILLAGE I N S T A LLER'S NAME i ADDRESS Q U I Ly,D E R OR OW ER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED �� Surer Permit No. Name Location rJ Installer's Name and Address . � 144) Builder's Name and Address Date Permit Issued: Date Compliance Issued: I ' � a c. 4 1c) Ir ; d+ _7 S g I i � s e No.... �:.� L y - Fss............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH r Appliratiu�t fur Disposal Works Tian trurfiutt Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Location-Address or Lot No. -°� Y � �......�°�................ .........................•....Y�?! ANT!.-......_......_�t�/i�.A?P �f�►? Peg Owner Address �`-g T �J�r✓X�rc�l.� ........ - EKvie JZp Installer Address dType of Building Size Lot............................Sq. feet Dwelling J-�<. of Bedrooms..............2�..........................Expansion Attic ( ) Garbage Grinder (,v&) Other—Type e of Building I:�'fl.P_ No. of persons............................ Showers a yp g --- ---- �------------ P ( ) — Cafeteria ( ) GaOther fixtures ............... .....•------•------•--•--•--•----------•-•---•-•--•----.--------•----------•-•-•-•••-•---•--••- Design Flow-------------------------------- g P person P Y Y .gallons. W Septic Tank—Li uid ca acit 1�0.. allons eLen r h e-- da Width l daily ... Diameter- -_... P q � P Y g l� ._.__._ Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area...........---------sq. ft. Seepage Pit No------/............ Diameter...../D--------- Depth below inlet.......(a......... Total leaching area...R�a g.._.sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ----•-••-•------------------••---•••••----•-•••--••-•-•----..._....---•-------.....••..........-----......................................................... 0 Description of Soil........................................................................................................................................................................ x U -------•••••--•••-----------•-----------•-•••.......••--•-------------------•••••••--•--------••-----------•------••••-----•-•---------•-•---------------•-••••••-••--.._.....-----•-----••-•--•-•--••. w VNature of Repairs or Alterations—Answer when applicable.---------------------------------------------------............................................ Agreement: Yi The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITx U 5 of the State Sanitary Code—The undersignedkirther agrees not to place the system in operation until a Certificate of Compliance has been issued by th boar o ealth. Signed = ---•-----•• -- D to Application Approved BY---- = = -•---•-•••••......----- -----//�O.� ........-- Date Application Disapproved for the following reasons:................................................................................................................ ...........................................................--------•---.....-•-•••-----•--•--••---•------•-----•---•---•---•-••------•------•--•-----•--• •---•---••--............................... Cr r Date Permit No......`.�_�-s y ............ Issued. /..� fV Date No...., .L.:.! ..� �l FEs............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........._......................OF....................................... Applira#ion for Disposal Works Tontrnrtion thrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ----- ..?.._.....`........, -•-••-------------- --•-.....--•------------_= -....-`......------------------•---•-------------...........------. Location-Address or Lot No. F_......_4.?€!.ft-----ale "� r�t�?'�oc�X ............... 41x3_,Ot—:.—s_. Owner Address a ------..../�a.2 &-=L-----•-•--�s'2'o-r�-------------------•----........_ ..............................sp." .�?j.:1._.. .............. Installer Address Q Type of Building Size Lot............................Sq. feet Dwelling,-4;*go. of Bedrooms.............2n.........................Expansion Attic ( ) Garbage Grinder (rv4) Others-'Type of Building .../0M.?j------------- No. of persons............................ Showers ( ) — Cafeteria ( ) � Other fixtures -------------------------------------------° -------------•-•--•-••••----------•----------------•--------------- ................................... Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid'capacitytV9!?..gallons Length---------------- Width................_ Diameter................ Depth................ x Disposal Trench'`No. .................... Width.................... Total Length....___._...e------ Total.leaching area....................sq. ft. Seepage Pit No._'w./............. Diameter----A?. ....... Depth below inlet.................. Total leaching area.,W d.....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-, Percolation Test Results Performed by.......................................................................... Date.......................................... ,� Test Pit No. I................minutes per inch' Depth of Test Pit.................... Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground water._-----•__---__--_______ a ------------------------------------ ------------- •-------------------- ------- •------------------------ .---------•---------•--•- .-- O Description of Soil....................................................................................................................... .............................. W U ................----•-.....-•••••-•.......----•---------•--•----------------•-......------------......•-••-•--•-•--------•-=------••••--•--------•-••••••-•...------•••..........----•-------•------- W VNature of Repairs or Alterations—Answer when applicable...___j.......................................... --------•----------------------------------------------------------------------------•--•••--•--------•-----•-•....--------------------------•-••-----•-----•••-----•-•-•......---------------.....---• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned urther agrees not to place the system in operation until a Certificate of Compliafice has been issued th boar o w iealth. Signed. ,% ".' r -•...................................... Date Application Approved By--- =--------------- ............................... _j/ _.._.... aT) to Application'"Disapproved for the following re¢sons:................................................................................................................ ..............•------................----....---...------------------------------•------•--•---------..._..-------------••---------------------------••-.-------------- ............................... �q Date Permit No �6:�`.. .__. Issued-----. .. .... -•...�--��- ----------- EDate THE COMMONWEALTH OF MASS" ACHUSETTS <y BOARD OF HEALTH OertifirFatr of TonapliFana S. t THIS I�/T O CERTIFYr ,T the Ind wi u l Sewage Disposal System construc ted or Re ared 6„ ( ) . .......... .. - ----------------------•--------------.by �i --------------- ......................................... ry Installer at.....................------- '=`'_ -....... ..............I.....................---------- .....----------------------------------•---------------------------------....----------------- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the f appliation for Disposal Works Construction Permit No---- ........ dated____________________________________•-----_ "T THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE � SYSTEM WILL FUNCTION SATISFACTORY. DATE ---- ""' Inspector........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH p .............t� •`....OF....... -...-. . ........_........_................. No.....<!.Gt/D 2..i FEE.....f�....--...... io�roo l �a1rko Cho o lion rrm t Permission is hereby granted........... �_':-t:(,P,-*::..._..r� .:. . to Construct ( ) 'orf'�Repair ( ) ndividual Sewage Disposal System atNo..------. � • ......----- . .---------------.--•-... ------------------------------ -----•----------------------- �r� Street 1,�� as shown on the application for Disposal Works Construction Permit,N�o-..�................... ated.......................................... Board of Health DATE / --••----• •.. ----••--•-----•-•.................. } FORM 1255 A. M. SULKIN, INC., BOSTON LOT 84 1000D co VIAJA• LeAek Prr ZC�1 o30S�. - - �— S Po 5.A L PLACED IN �CGORDRNCE W ►Tip • O MPS h-t� Pc-*�� o � S�BD�vts�o \D O N o Cn Di ST-' f3ox 1 (000 GAL. S e Pr If- -f Ar.1 K- �. O r 38 F(z o P05e D 0 N 2 3F�>Roo o� �0 40- o+ N 9& q REGISTERED CIVIL ENGINEER OF MAs�gcti • O G WALTER o E. -� SMITH, #1! 28 FFSS/o AL L7 S POS A'L 4AAA SC-ALE I1'- 30' (3e-r 7- 9134. 1b2, 0 9G, 0 10 �� I D i sr.,gcK 98•IS 97:9a ia• 2�r J�S_ �.�,Wasti�. _.._ 100o 97,5 A e op GFi. D p lP,ivt. • Cont. Q AA CouC• LEAcNtI.lC� P,7r A AAA A GA A a z�r QI•o g�T ee 'a u II. A '�'.°i. wlnSJticd s4ne P1-r Euw T oPSoIL .DES 1c,N Svssoit._ ��ZCo�,ATIoN R ; 2 MjN111.4cw (]2o P 9a.0 TEST Pe12-'=-ORMED 5EPr, Ot lg8+ ZC3cDRoo/�tS >C. ilo C-�PD C-�2<,veL = 2z.0 C Pp LEAcN11.1C ��p 97,0 - 48" tJo CIArzEW;&E DIS PC,$AL ?3orT•, o f OHO CAC,.SEPj'fCT�.I•.1 �3a�--r o 1•!l Tf 'S Z x � ,COAC5C o SIDES = �8•s pD T' to be isx Z, 5 = 392, 7 C PP I oT/ . L C^pAc lT-j I�ZO�l1D� � 7 2G,pD fir\, � • lV oTE D c5POsa,t_ SYSTCI`ol I��SIcTNED 1 n( AGGORDANCE V%,t I Ti4 PROVISIONS O.F TIT S o TE-1�. ! 55 . ��! ►20�11t�E�tTAL S�•o i�8" -3,S �O GP-0uQ C) -A Ke VAp,4h N�C',Lzrso✓) �`M�rson M c (IS Department of Environmental Management/Division of Water Resources WATER WELL COMPLETION REPORT II WELL LOCATION Address L)+ 84_Spi h /x City/Town_ CAY`S`-p,,S G.S.Quadrangle Map Grid Location OwnerlUick-ersoh Address eo Ax a O WELL USE CONSOLIDATED WELL Domestic Public ❑ Industrial❑ Type of Water-bearing Rock Other Water-bearing Zones Method Drilled 1) From To 2) From To , Date Drilled 1A A n m 3) From To -- 4) From To CASING Depth to Bedrock Length Diameter Type las�T r_ UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing'Materials Feet below land surface -.37- _ Sand: fineVmedium2111,coarse❑ Date measured - Gravel: fine❑ medium❑ coarse[-] GRAVEL PACK WELL Screen: Yes ❑ No Slot# 14 length from to Split Screen(or 2nd screen) WATER QU ITY TESTS MADE Slot length from to Chemical i�Q,/ Biological'❑ - Depth To Bedrock PUMP TEST r, Drawdown feet after pumping dayshours at GPM. How measured Recovery feet after hours. LOG of FORMATIONS COMMENTS: (On well or water) Materials From To 0 (. m DRILLER , Firm h ,(� Q.� a Address P02 k e617 ` City Fare- .s fde IP. Y1119 OR(OLlu Registration No. perator s bignature Please print rrm y CUSTOMER COPY 15M-2 84-176471 Log Number: C087 Bottle # C087 Date: ll/.1/84 BARNSTABLE COUNTY HEALTH DEPARTMENT SUPERIOR COURT HOUSE BARNSTABLE, MASSACHUSETTS 02630 �1Asa DRINKING WATER LABORATORY ANALYSIS PHONE: 362-2511 EXT. 331 Client: Kempton Nickerson + Col-lector: .Edward P. Meehan Mailing Address: P. 0. Box 266 Affiliation: - Meehan Well Drilling W. Barnstable. MA 02668 Time & Date of . Collection:. 10130/840 3:30 p.m. Telephone: 428-4828 Type of Supply: well water Sample Location: Lot 84 Spur La. Well Depth: 63' Marstons Mills Date of, Analysis: 1013.1184 PARAMETER SAMPLE RESULT RECOMMENDED LIMITS Total Coliform Bacteria/100 ml 0 H Conductivity (micromhos/cm) 500.0 Iron ( m) 0.3 Nitrate-Nitrogen ( m) 10.0 Sodium m) 9 20.0 • h I • xx Water sample meets the recommended limits for drinking of all above tested parameters. II . Based only on results of the parameters tested for this sample, the water is suitable for drinking but may present the problems checked below: ' A. Water sample has higher than average levels of Nitrate. Future monitoring is recommended (2-3 times per year) to establish any upward trends. B. The low pH of the water may shorten the useful life of the house's-plumbing. C. Water may present aesthetic problems (taste,-odor, staining) due to D. Water sample has high levels of sodium. Persons on low sodium diets should consult their doctor. A III. Due to one or more of the reasons checked below, this water sample is unfit, for human consumption: A. High Bacteria B. High Nitrates 'REMARKS: CC: Meehan Well Drilling CC: Barnstable Board of Health ✓/� Laboratoty Director , 7/17/84 t , Explanation of Test Results Total'Coliform Bacteria Coli.form bacteria are an indicator of the sanitary quality of a water supply. Water supplies may become contaminated from malfunctioning septic systems,cesspools and surface.runoff. A total coliform count of zero indicates that your water supply is safe and approved for human consumption. A total coli form count of greater than.zero is most often'the'result of accidental contamination of the sample bottle through improper sampling methods. Forthis.reason, it would be advisable to retest any well water-'that is not approved. PH + .. pH is the measure of acidity or alkalinity of the water. On the pH scale, the number 7 is neutral, less than 7 is acidic and more than 7 is alkaline. The pH of water on Cape Cod'tends to be acidic in"the,range of 5.0 to 6.5 Conductivity Conductivity is a measure of the dissolved salts in solution. Amounts in excess of 500 micromhos'cm are generally considered unacceptable and may have a laxative effect-upon users. q Iron The presence of iron in.water in concentration of..3 ppm.or•greatet may: give the water a bittersweet astringent taste, cause an,unpleasant odor, often gives the water a brownish color and cause staining of laundry and porcelain. The average concentration of iron in Cape Cod's water is .2.- .6 ppm. Although the presence.of iron in water may cause the problems listed above, it is not considered deleterious to health. Iron may,be removed by use of an iron removal system. .Nitrate-nitro en The Massachusetts Drinking Water Regulatioris have set a maximum contaminant level for nitrates at 10. ppm: Excessive concentrations may cause methemoglobinemia (an infant disease) and have been suggested to form potentially carcinogenic nit rosamines. Contamination sources.include fertilizers; cesspools.and industrial wastes. Copper G`r _ Due to-the•acidic nature of the water on Cape Cod, copper tends to leach from pipes. This normally does not present a health hazard; however, concentrations in excess of 1.0 ppm may,cause a metallic taste and/or a bluish green stain on porcelain fixtures. Sodium A concentration of sodium over 20 ppm is only of concern to people who are on a low sodium diet. if the water supply has more than 20.ppm sodium, it is up to the people who are on such a diet to find another source of drinking water or contact their doctor to determine if consuming the:water is advisable. Concentrations exceeding 50 ppm indicate that there may be ocean water or road salt runoff water vetting into the well. 4 ASSESSORS MAP N0: --_F f -- ---------- NO.--- ----- pMCEL N0: Fee-- BOARD OF HEALTH , � TOWN OF BARNSTABLE rA Applicat ion jorVeil Conotruct ion Permit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair (4---�an individual Well at: w AA tM , Location — Address Assessors Map and Parcel - - ----------------------------------- Owner Address ---------------------------- ------------------------- Installer — Driller Address Type of Building Dwelling---"_c r---------------------------------------------- Other - Type of Building No. of Persons------------------------------------------ Type of Well — Purpose of Well_ a✓_^ f'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 Compliance has been issued by the Board of Health. Signed � ----------- ---_------- ---L - /7 �----- date �t Application Approved B --- ----- =— 17 date Application Disapproved for the following reasons:------- ----------- --------- ---- date Permit No. y//�--�' - — Issued-- =� ` --- - date BOARD OF HEALTH ASSESSORS PNO: 0 TOWN OF BARNST4@,6,. Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ---�by-- - -- --------------------------------------------------------- p Installer — at 4 r.., — or�.t '4A has been installed in accordance with the provisions of the Town of Barnstable(fBoard of Health Private /Well Protection Regulation as described in the application for Well Construction Permit Nb g�`��ated1,q-n ' THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE Inspector------ - -- --- —- -- No. -- -- --j I Fee---------`----_------ BOARD OF HEALTH , � � TOWN OF - BARNSTABLE v; App[icationArVe[C ConQrurt-ionVrr-mit Application is hereby made for a permit to Con truct ( ), Alter ( ), or Repair ( 1�an in ividual Well at: Location = Address -Assessors Map and arcel Owner po .✓Soy h'o ,u 4 pu 4 o a y p ---------------------- Installer — Driller Address Type of Building Dwelling ------------------------------------------------- Other - Type of Building----- -- -------- No. of Persons---------------------------__—_____________ >W X Type of Well_�<—� nvL ---- -� AN�2-- Capacity Purpose of Well_b o Agreement . The undersigned agrees tp install the afored`escribed 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`operatio until a Certificate .of Compliance has been.issued by.the Board of Health. Signed1�14 !t% -�--- date Application Approved B � -- - - . f --✓ Application Disapproved for the following reasons:—=-------- ------ —__—__�___-_ date --- l,w Permit No. — Issued--�V date .T4�xS49ix6 TL x4!.�xi%T4xaa�x4edeaa.:Ti%Tixi'�1aSiTi��Y!4+a13Talbx6TiT8iT�TYTBxaTa461obixi 4i!!aT090Pa9ixB4iTaxexbKT84846Tix'iLiC9�.ti9iTB.S448T�biw�xiT�BKNii2o!49�!L9A/i9�'Yine4�'i BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY,.That the Individual Well Constructed ( ), Altered ( ), or Repaired y-- JJ - --=----- -- ----- - �$ -Installer 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 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL .SYSTEM_WILL FUNCTION SATISFACTORY. DATE- --- -- —- -- Inspector--------- ---= - -- NitiwX94�MiPi1PY�i�6!LxIF!iS4��1!a!►�lPigtS!id�� YeMiT�TV!4TiTili?iH4V.°iTiY�i^1Pi�i!'D'S.�eBT�!.Y^OTi�Ni4MTimi4i4iTNV 3Y.!�TY.e�4T44f4L�Y94!?44.6 64!F?W�i84ai?!i�4W4^4mi�.1iM�.i�� BOARD OF HEALTH TOWN OF BARNSTABLE Well CongtructionA3ermit No. Fee Permission is hereby granted /0 1A S Ca✓liw �/ ____ =.,a AS o Construct ( ) Alter ( ), or Repair ( -J an Individual Well at: SESSORS MAP NO* - Z No. ' . S ,G!' At' A`" 01�—PARCEL NO: //Z Street — - —as shown on the pl' ation or a Well Construction Permit No.---/ '� ----— Dated -OF--- _- -- - T. Board of Health DATE /. — -- fJ SP01 L 'ti x Sv�.e Lvc No. ly_- -2�--- Fee----1-t2- --- BOARD OF HEALTH TOWN OF BARNSTABLE ApplicationArVell Con5tructionPermit Application is hereby made for a permit to Construct ( ), Alter ( ), or 4epair (✓)an individual Well at: -- - ------------------------------------------ -- Location — Address Assessors Map and Parcel L.14 &N-4&/4ra-S emu. Owner Address Installer — Driller Address ---------- Type of Building Dwelling--- .�—---------------------------------------------- Other - Type of Building ------ No. of Persons------------------------------------------- Type of Well '`a --- f"t -- -- -------— Capacit -- - -- — - ---— -- Y---------- 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 Compliance has been issued by the Board of Health. Signed- b r/I j----- date Application Approved By 10 N, � ---- __ date Application Disapproved for the following reasons:-----------------------------------_—________ ------------- — - ---- - ------ ------------------------------------------- s date Permit No.- \A—) 3 ----- Issued------------- --------------------------------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired (�) by --------------------------------------------------------- Installer at— S f u f j-— a" `rs--- -- --- --- ------------------------------------ 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.Wl -t5---Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. r DATE-------- ----- --- -- Inspector---------- --- --------- No.VAg_J-3----- Fee---- ---------------- BOARD OF HEALTH TOWN OF BARNSTABLE 01pplication-*rVell Con0ructionPermit Application s a reb_made for a permit t Construct ( ), Alter ( ) r Rep p it (✓)an individual Well at: PP Y P L --:- - --- ---- Locatwn - Address Assessors Map and Parcel p Owner Address --- -----��Y---- ----------- Installer a y - Driller Address - - - Type of Building I / Dwelling -HIP {e— t-y l A, Other - Type of Building ------ No. of Persons-------}--------------- ------___________ Type of Well—'_1 Capac tY ---------------- — —---— —--— Purpose of Well Qq- . s T s — ,�, Agreement: Ph �( The undersigned agrees to install the afo�t'edescribed-individual well in accordance with the provisions of The Town of Barnstable Board of Health Private WIE11 Pcrrotection Regulation,_— The undersigned further agrees not to place the well in operation until a Certificate .of Compliance has been issiied�by the Board of Health. Signe d-7—_ -------------------------— �-- _—/Ai/Y ------ date Application Approved By �� q— U ------ "date Application Disapproved owing rea ---------------------------_--________—__—_—_--_ ---- -------------------------- ---------------------------------------- date X Permit No. Issued------------- ------------------------------------- date +aT a!a!a!aei!aTaPaaiiea tl+Titla tlitli9ilalaeitdNe+!sSLlil�3Ta!aS69itlaea!GtlitlieiPiOifaKRi1i!aRNiifi9i eiR6 KIGOaIi.?a�9lLKATa/iNeiKKT�'I.itYTiAif a9illitobrl.i!af iNiLl�4lwl/rfi�.11w�Si!iYel BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired (�) by----- -------------------QA fGbrv"',---------------------------- {Installer -- — — — at—J'-�-� 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. }-�--f Y-11---Dated------------- THE-ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--------- ---- —- Inspector-- ----- - —-- tlaeatl+!.i!LTn!if.aTiNTi.tlti!aK!aKtla NtlL4aTi4atla4iTi9alalaTpTa!iTaTaeatlaeieaeaKlce6edTaKKIOtlPei9iRaeaYiTa!'B9ala?a�Raa;Ty.aOi!a!IjT�T4!W�'a1!d:4:4 awy^a}aTi9arw.+aVa!ii�GTYTPrTA+i^ �- r�BOARD OF HEALTH TOWN O.F. ,BARNSTABLE ,well Con5truct ion Permit No. — Fee— Permission is hereby granted /�� — — --- -- ---— to Construct ( ), Alter ( ), or Repair (f) an Individual Well at: No. --- ——--- / S/�u✓ w /hc, I° iL.t r l�f Street as shown on the application for a Well Construction Permit I No. -- --- Dated---- = -- y -- --------------------- Board of Health DATE-- — t �� "`' .. - J