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HomeMy WebLinkAbout0024 WILD WAY - Health 24 vi_ld wav wiaistons Mills A= 027—081 —TO1 Town of Barnstable Regulatory Services BABN5TAB1.£. ` Thomas F. Geiler, Director Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 HOMEOWNER-WELL DISCLADW12 FORM Please Prink• Job Location tl c2'z 1 House# Sved Address Map Parcel "HOMEOWMER" AG�Av l i_L T(5 &0j - 726 �y3� Name Home Phone Business Phone Present MarlingAddressc �0, m� l ,� , p Well Driller �Y15r�-�o�iJ �j�c��u� 1,�Driller Reg. # o�?Y q .W Please be advised that a well replacement has been requested in the ex locatn a the existing well. w "r r As a site,plan showing the proposed location of the well.in relation to th subsurface sanitary disposal system(s)serving the lot has not been submitted,you may be required to relocate the well at a later date in order to comply with the State Environmental Code Title 5 sand,_Local Regulations: (Current minimum separation between well and soil absorption system is 100`).„ � O Homeowner Signature Date f 1�r�sssacbusctts Office of Water Resources Well Completion Report 10-DEC-07 10:45:28 WELL LOCATION 250886 3PS North: 410 39.4151 GPS West: 700 26.6091 Address: 24, Wild Way Property Owner/Client: Allan Curtis Subdivision Name: Mailing Address: P.O. Box 1268 City/Town:Barnstable City/Town, State:Marstons Mills MA kssessors Map: Assessors Lot #: Permit Number:W0.7-041 Board of Health permit obtained: Y Date Issued: 11/30/2007 Work Performed Proposed use Drilling Method Overburden Drilling Method Bedrock New Well Domestic Auger CASING From (ft) To (ft) Type Thickness Diameter 1.00 -59.00 PVC Schedule 40 4.00 SCREENFrom (ft) To (ft) Type Slot Size Diameter -59.00 -62.00 Stainless Steel Well .012 4.00 Point WELL SEAL / FILTER PACK / ABANDONMENT MATERIAL From ,(ft) To (ft),--, •r, Material Description Purpose y...,. a WELL TEST DATA (ALL SECTIONS MANDATORY FOR PRODUCTION WELLS) Date Method Yield Time Pumped Pumping Level Time to Recover Recovery (GPM) (hrs & min) (Ft. BGS) (Hrs & Min) (Ft. BGS) 11/30/2007 Constant Rate Pump 15.0000 01:30 49.0000 00:01 47 STATIC WATER LEVEL (ALL WELLS) PERMANENT PUMP (IF AVAILABLE); •.a _ Date Depth Below Ground Pump Description:Goulds 10GS05422C < Measured Surface (ft) Type: 2 Wire Constant Speed Submersible Intake Depth: C� 59='0000 11/30/2007 47 � � +--• Nominal Pump Capacity: 10.0000 Horsepower: C-7 .5: 00 WELL DRILLER'S�TATEM�TT '=' ADDITIONAL WELL INFORMATION tra: N Driller: Patrick Desmond ;. ; Developed: Yes Fracture Enhancement:No Supervisor: Patrick Desmond11 lag 5 Disinfected: Yes Well Seal Type:None Firm: Desmond Well Drilling Inc. p CU Total 'Well Depth: 62.000 Depth to Bedrock: Registration #c)877 .Date Co plete-=/03ffD007 Comments: OVERBURDEN From To Description Color Comment Water Loss/Add Drill Drill (ft) (ft) Zone of Fluid Stem Drop Rate .00 5:00 .Silty Sand ; Brown No N/A` '`' 5.00 62.00 Fine to Coarse. Sand Brown Yes N/A BEDROCK From To Code Comment Water Drill Extra Drill Rust Loss/ # of (ft) (ft) Zone Stem Large Rate Stain Add of Frac op per ft CON H 1R r CERTIFICATE OF ANALYSIS Page: 1 /'7 r•$.• " Barnstable County Health Laboratory. �.95 s`;I=��; Report Prepared For: Report Dated: 12/5/2007 Sally Desmond Desmond Well Drilling Order No.: G0744341 P 0 Box 2783 Orleans, MA 02653 Laboratory ID#: 0744341-01 Description: Water-Drinking Water Sample#: Sampling Loco tion"24"Wild Way Marstons Mills`,MA w Collected: 12/3/2007 Collected by: Customer y Received: 12/3/2007 Roltttne ITEM RESULT UNITS RL MCL Method# Tested Nitrate as Nitrogen 2.5 mg/L 0.10 10 EPA 300.0 12/3/2007 Copper ND mg/L 0.10 1.3 SM 311 1 B 12/5/2007 Iron ND mg/L 0.10 0.3 SM 311113 12/5/2007 Sodium 14 mg/L 1.0 20 SM 311 IB 12/5/2007 f xal Coliform Absent P/A 0 0 SM9223 12/3/2007 } Conductance 120 umohs/cm 2.0 EPA 120.1 12/3/2007 pl-1 f.0 pH-units 0 SM 4500 H-B 12/3/2007 Water sample meets the recommended limits for drinking water of all the above tested parameters. Approved By t(Labirector�)�� �7 ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 _ -� _ -_ ( � f`t "'� r 1 � �s r .. r-- .�.. n.. ._ r _ �. �-.y. !� f � �-3 i �. F .. ., 9 .� - (i .. �� ... .... .. J�, t ..r. t .... � -. s %. .. c.-:- '�x k s 3 - � ' � /: s �`� J C% ! .. _. - t.. _ - � .,.. !' (f" t .. �f..:. .. - It� _ .. � — _ .� .. J .. -r. .. ... •; `'` 'tnN'` CERTIFICATE OF ANALYSIS Page: 1 1 Barnstable County Health Laboratory y,,a:j„• ��' Report Prepared For: Report Dated: 12/5/2007 Sally Desmond Desmond Well Drilling Order No.: G0744341 P O Box 2783 Orleans, MA 02653 Laboratory ID#: 0744341-01 Description: Water-Drinking Water Sample#: Sampling Location: 24 Wild Way Marstons Mills,MA Collected: 12/3/2007 Collected by: Customer Received: 12/3/2007 EPA 524.2 - Volatile Organics by GUMS ITEM RESULT UNITS RL MCL Method# Analyst Tested Note Dichloroditluoromethane ND ug/L 0.50 EPA 524.2 yn 12/3/2007 Chloromethane ND ug/L 0.50 EPA 524.2 yn 12/3/2007 Vinyl chloride ND ug/L 0.50 2.0 EPA 524.2 yn 12/3/2007 Bromomethane ND ug/L 0.50 EPA 524.2 yn 12/3/2007 1,1,I,2-Tetrachloroethane ND ug/L 0.50 EPA 524.2 yn 12/3/2007 1,1,1-Trichloroethane ND ug/L 0.50 200 EPA 524.2 yn 12/3/2007 1,1,2,2-Tetrachloroethane ND ug/L 0.50 EPA 524.2 yn 12/3/2007 1,1,2-Trichloroethane ND ug/L 0.50 5.0 EPA 524.2 yn 12/3/2007 I.I-Dichloroethane ND ug/L 0.50 EPA 524.2 yn 12/3/2007 1.1-Dichloroethene ND ug/L 0.50 7.0 EPA 524.2 yn 12/3/2007 1,1-Dichloropropene ND ug/L 0.50 EPA 524.2 yn 12/3/2007 1,2,3-Trichlorobenzene ND ug/L 0.50 EPA 524.2 yn 12/3/2007 1,23-Trichloropropane ND ug/L 0.50 EPA 524.2 yn 12/3/2007 1.2.4-Trichlorobenzene ND ug/L 0.50 70 EPA 524.2 yn 12/3/2007 1.2,4-Trimethylbenzene ND ug/L 0.50 EPA 524.2 yn 12/3/2007 Dibromo-3-chloropropane ND ug/L 0.50 EPA 524.2 yn 12/3/2007 1,2-Dibromoethane(EDB) ND ug/L 0.50 EPA 524.2 yn 12/3/2007 1,2-Dichlorobenzene ND ug/L 0.50 600 EPA 524.2 yn I2/3/2007 1,2-Dichloroethane ND ug/L 0.50 5.0 EPA 524.2 yn 12/3/2007 l,--Dichloropropane ND ug/L 0.50 EPA 524.2 yn 12/3/2007 1,3,5-Trimethylbenzene ND ug/L 0.50 EPA 524.2 yn 12/3/2007 1.,3-Dichlorobenzene ND ug/L 0.50 EPA 524.2 yn 12/3/2007 13-Dichloropropane ND ug/L 0.50 EPA 524.2 yn 12/3/2007 I A-Dichlorobenzene ND ug/L 0.50 5.0 EPA 524.2 yn 12/3/2007 2,21-Dichloropropane ND ug/L 0.50 EPA 524.2 yn 12/3/2007 2-Chlorotoluene ND ug/L 0.50 EPA 524.2 yn 12/3/2007 4-Chlorotoluene ND ug/L 0.50 EPA 524.2 yn 12/3/2007 Benzene ND ug/L 0.50 5.0 EPA 524.2 yn 12/3/2007 Bromobenzene ND ug/L 0.50 EPA 524.2 yn 12/3/2007 Bromochloromethane ND ug/L 0.50 EPA 524.2 yn 12/3/2007 Bromodichloromethane ND ug/L 0.50 EPA 524.2 yn 12/3/2007 Bromoform ND ug/L 0.50 EPA 524.2 yn 12/3/2007 ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph; 508-375-6605 �e ;;r a it. f• "�i .� •t t '� � =�> , r r�% q - 1 .`,5` /; �, r'.} � .� i .,. ., } �z J 5{ .J ,:.. ;.. ,. t_: C.J. ... .... �,. .. �. !/ 6t.' �s _ i;.'� f.. �. .. �. �,'- S:: - - r- r- '.. ._. .._ �` �`! e.,; - .a - - r� ! .., .:� r- Fes' .� _ _ _�. .. ., ._ 'R CERTIFICATE OF ANALYSIS Pale: 2 Barnstable County Health Laboratory Report Prepared For: Report Dated: 12/5/2007 Sally Desmond Desmond Well Drilling Order No.: G0744341 P 0 Box 2783 Orleans, MA 02653 Laboratory ID #: 0744341-01 Description: Water-Drinking Water Sample 4: Sampling Location: 24 Wild Way Marstons Mills,MA Collected: 12/3/2007 Collected by: Customer Received: 12/3/2007 EPA 524.2 - Volatile Organics by GUMS ITEM RESULT UNITS RL MCL Method# Analyst Tested Note Carbon tetrachloride ND ug/L 0.50 5.0 EPA 524.2 yn 12/3/2007 Chlorobenzene ND ug/L 0.50 100 EPA 524.2 yn 12/3/2007 Chloroethane ND ug/L 0.50 EPA 524.2 yn 12/3/2007 Chloroform ND ug/L 0.50 80 EPA 524.2 yn 12/3/2007 cis-I,2-Dichloroethene ND ug/L 0.50 70 EPA 524.2 yn 12/3/2007 cis:1,3-Dichloropropene ND ug/L 0.50 EPA 524.2 yn 12/3/2007 Dibromochloromethane ND ug/L 0.50 EPA 524.2 yn 12/3/2007 Dibromomethane ND ug/L 0.50 EPA 524.2 yn 12/3/2007 I't iylbenzene ND ug/L 0.50 700 EPA 524.2 yn 12/3/2007 1iexachlorobutadiene ND ug/L 0.50 EPA 524.2 yn 12/3/2007 lsopropylbenzene ND ug/L 0.50 EPA 524.2 yn 12/3/2007 Methylene chloride ND ug/L 0.50 5.0 EPA 524.2 yn 12/3/2007 Mcthyl-tert-butyl ether 12 ug/L 0.50 EPA 524.2 yn 12/3/2007 Naphthalene ND ug/L 0.50 EPA 524.2 yn 12/3/2007 n-Butylbenzene ND ug/L 0.50 EPA 524.2 yn 12/3/2007 n-Propylbenzene ND ug/L 0.50 EPA 524.2 yn 12/3/2007 p-isopropyltoluene ND ug/L 0.50 EPA 524.2 yn 12/3/2007 see-Butylbenzene ND ug/L 0.50 EPA 524.2 yn 12/3/2007 Styrene ND ug/L 0.50 100 EPA 524.2 yn 12/3/2007 tort-Butylbenzene ND ug/L 0.50 EPA 524.2 yn 12/3/2007 fetrachloroethene ND ug/L 0.50 5.0 EPA 5N.2 yn 12/3/2007 Tcluene ND ug/L 0.50 1000 EPA 524.2 yn 12/3/2007 Tctal Nylenes ND ug/L 0.50 10000 EPA 524.2 yn 12/3/2007 trans-1,2-Dichloroethene ND ug/L 0.50 100 EPA 524.2 yn 12/3/2007 trans-1,3-Dichloropropene ND ug/L 0.50 EPA 524.2 yn 12/3/2007 Tr chloroethene ND ug/L 0.50 5.0 EPA 524.2 yn 12/3/2007 Tr-chlorotluoromethane ND ug/L 0.50 EPA 524.2 yn 12/3/2007 Water sample meets the recommended llntits for drinking water of all the above tested parameters. Approved By: (Lab Di ctor)i ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 "mil 6. ;.:y i3 :.,:✓C5/2007 WED 15: 46 FAX 5083627103 Barnstable CTY Health Lab Barnstable-: 1i';a:...th 000.1/006 � I CERTIFICATE- - ICATE OF ANALYSIS Page. I f; �+� 1`r Barnstable County Health Laboratory Report-....Prepared--> or....____ __--- --Report.-Dated:-....-12/512007.... -- ..._..... .. . _-.._ .-. - - E Sally Desmond Desmond Well-Drilling Order No.: G07,113 11 1'0 Box 2783 ' Orleans, MA 02653 t Laboratory ID#: 0744341-01 Description: Water-Drinking Water i Sample#: Sampling Location: 24 Wild Way Marstons Mills,MA Collected: 12i3/2007 i Collected by: Customer Received: 12/3/200'' i Rollfbie ITEM RESULT UNITS RL MCL Method Tested Nitrate as nitrogen 2.5 mg/L 0.10 10 EPA 300.0 12/3/2007 ^opper ND mg/L 0.10 1.3 SM 3111E 12/5/2007 Iron ND mg/L 0.10 0.3 SM 3111B 12/5/2007 ? SoJiunl 14 mg/L 1.0 20 SM311IB 12/5/2007 i Total Coliform Absent P/A 0 0 SM9223 12/3/2007 Conduetanee 120 umohs/cm 2.0 EPA 120.1 12/3/2007 6.0 pH-units 0 SM 4500 H-B 12/3/2007 g Muter sarrrple meets dre recornnrended limits for drinking water of all the above tested parameters.Approved B : '14'Y (1 ib i ector) z 1 I i i i i ND=None Detected RL = Reporting Limit MCL=Maximum Contra i:nant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 i i i f oF1ME r Town of Barnstable ' Regulatory Services + BARNSfABLE, MASS. $ Thomas F. Geiler, Director 1639• 10 A'fo►^A,ta Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Certified Mail: 7006 0810 0000 3525 0953 October 29, 2007 Allan G. Curtis 981 Santuit-Newtown Road Marstons Mills, MA 02648 EMERGENCY CONDEMNATION AND ORDER TO VACATE Finding of Unfitness for Human Habitation and Determination of Immediate Danger In accordance with M.G.L. c.I 11, sec. 127A and 127B, 105 CMR 400.000: State Sanitary Code, Chapter I: General Administrative Procedures and 105 CMR 410.000: State Sanitary Code, Chapter H: Minimum Standards of Fitness for Human, David W. Stanton, R.S. Health Inspector for the Town of Barnstable, on October 26, 2007 conducted an investigation of a dwelling unit located at 981 Santuit Newtown Road, Marstons Mills (AKA 24 Wild Way). The owner of this dwelling unit is Allan G. Curtis. Based on the results of that investigation, the Barnstable Health Department finds that the dwelling is unfit for human habitation. Pursuant to M.G.L. c. 127B and 105 CMR 410.831 (D), the Health Department further finds that the conditions within the dwelling are such that the danger to the life or health of the occupants of the subject dwelling is so immediate that no delay may be permitted in making this finding. Conditions found within the dwelling, which give rise to the emergency finding of unfitness and determination of immediate danger, include: 410. 750: Conditions Deemed to Endanger or Impair Health or Safety 410.750 (A) Failure to supply potable water. 410.750 (N) Failure to provide smoke and CO detectors. Q:\Order Letters\Condemnations\981 Santuit Newtown.doc I A. Based upon these findings any and all occupants are hereby ordered to vacate and the landlord/owner is ordered to secure the subject dwelling within 48 hours of receipt of this order. If any person refuses to leave a dwelling or portion thereof, which was ordered vacated she may be forcibly removed by the local Board of Health(Massachusetts General Laws C. 127B), or by local police authorities at request of the Board of Health. Furthermore, anyone who fails to comply with any order of the board of health may be subject to fines ranging from $10-$500. Each day's failure to comply with an order shall constitute a separate violation. Once vacated this unit may not be occupied without the written approval of the Board of Health. Note: This is an important legal document. It may affect your rights. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, CHOIRS Director of Public Health Town of Barnstable Cc: Chief Farrington, COMM Fire Department Chief Macdonald, Barnstable Police Department Mr. Tom Perry, Building Commissioner Town of Barnstable Legal Department UPDATE: Condemnation lifted 1.2/1.4/07. Well permit pulled and potable water tests are good. Q:\Order Letters\Condemnations\981 Santuit Newtown.doc rn Er Ln Ul ru uI L . " m P c,A�A 02 postage S / 6a! 0 certified Fee 0 geturn Receipt Fee r (Endorsement Required) (3 p Restricted Delivery tree �AA1h� r-9 (Endorsement Required) 43 p Total Postage&Fees USP� -0 p Sent To /�1L I p r� Sheet Apt 1,r o 1 or PO Box No n . City State;ZIP+4 � � �' ✓V�r1 1 �n 'Ifs, cMYR DaWORM Certified Mail Provides: (eseneb)zooaeunCoose-ozisa 0 A mailing receipt a A unique identifier for your mailpiece a A record of delivery kept by the Postal Service for two years Important Reminders: a Certified Mail may ONLY be combined with First-Class Mail®or Priority Maile. o Certified Mail is not available for any class of international mail. m NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. 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Internet access to delivery information is not available on mail addressed to APOs and FPOs. I CvYPr ' OWl12 Ccp,l �Or 7 ( G r(J1 or �b o/ ke co j 3 Try 3z 7.28 '�• � 6 ,1io J� 41 r w �F Logged In As: Parcel Detail Monday, October 29 2007 Parcel Lookup Parcel Info Parcel ID=02 - Developer SLOT 2 Lot r,cRo,d 4 WILD WAY Pri Frontage?173 Sec FrontageMARSTONS MILLS Fire District jC-O-MM er Acct Road Index 2143 Interactive E ' Map Owner Info Owner 1CURTIS, ALLAN G Co Owner Streets ,981 SANTUIT-NEWTOWN RD Street2 city!MA RSTONS MILLS State`MA zip02648 Country USA _. Land Info Acres;0.94 Use=Single FamMDL-01 zoning RF_ Nghbd 0105 TcpographyL@v Road ;Paved ................................................ ......... .. .... ......... ....... - Util s-Public Water, s,Septic Location , v G47A _ Construction Info .... ........ Building I of .__ _- Year—,1965 Roof Gable/Hip- wall !Wood Shingle Built Struct Effect 1142 Roofj As h/F GIs/Cm AC Asff Area Cover p.. p_ Tv e _.._ .... _. n Style;Ranch Int=D wall Bed i3 Bedrooms __. Wall' rY_.. _.. Rooms ,....... , Int; Bath Model =Residential 1 Full Floor i Rooms= Grad!Average Minus Type Hot Water Rooms Rooms Heat _ Found- Stories?1 Story Fue11011 Poured Conc.. _ _ ._.__ ation= Permit History..... _,.. ._. ._.... f Issue Date Purpose Permit# Amount Insp Date Comments 9/1/1979 B21688 $0 1/15/1980 12:00:00 AM MM ADDN Vi it History Date Who Purpose 4/28/2005 12:00:00 AM Paul Talbot Meas/Est 2/10/1999 12:00:00 AM Donna Dacey Meas/Listed Sales History Line Sale Date Owner Book/Page Sale Price 1 2/15/1982 CURTIS, ALLAN G P60058 $0 Assessment History ............ ................................... ......... ......... .............................. ......... ......... . ..._._. ......... . _ ...._... .. .............. Save# Year Building Value Xr Value OB Value Land Value Total Parcel Value 1 2007 $96,600 $0 $0 $169,800 $266,400 2 2006 $85,100 $0 $0 $184,600 $269,700 3 2005 $92,500 $0 $0 $125,800 $218,300 4 2004 $75,100 $0 $0 $125,800 $200,900 5 2003 $67,800 $0 $0 $67,700 $135,500 6 2002 $67,800 $0 $0 $67,700 $135,500 7 2001 $67,800 $0 $0 $67,700 $135,500 8 2000 $53,600 $0 $0 $28,200 $81,800 9 1999 $45,300 $0 $0 $28,200 $73,500 1 C. 1998 $45,300 $0 $0 $28,200 $73,500 111 1997 $41,800 $0 $0 $28,200 $70,000 12. 1996 $41,800 $0 $0 $28,200 $70,000 1 1995 $41,800 $0 $0 $28,200 $70,000 14 1994 $43,400 $0 $0 $25,400 $68,800 1 E. 1993 $43,400 $0 $0 $25,400 $68,800 16 1992 $49,300 $0 $0 $28,200 $77,500 17' 1991 $54,600 $0 $0 $51,700 $106,300 18 1990 $54,600 $0 $0 $51,700 $106,300 19 1989 $54,600 $0 $0 $51,700 $106,300 20 1988 $41,700 $0 $0 $15,000 $56,700 21 1987 $41,700 $0 $0 $15,000 $56,700 22 1981 $41,700 $0 $0 $15,000 $56,700 Photos I Town of Barnstable Geographic Information System October 29, 2007 27021 ` 51 r"� ^ + 4v4� JF� ►._ r , �,,Ay` a Y390,53 � ,© �t r #25 23` '• --! S}r• *!r" } #11 - •^ 0#97025 LF S i 027024 of r 'r .. �f � !`� '•he'' ♦ •i r� �' �, 4. � '�) ytiy�. � -✓ �'� -�wi�••/�.. n[I� �•« i,e 1 •n hP� r. #140 .i �r� 1� r- "'.t'r ;°' r? ♦ k r `� +ram+ ti - i' -�,,,--01 r NAt 4 y-- 027005T00 • ka t r� - #59 �.` "'`a %� +...' 's •=T 4i?' ""s ""'.+ ` 027081 COl _ WN,�� - 027,120000 _ J04 027081 CO2 , 027,133C00 �¢�- ) - ' F �' �� ,,�„ �� M.!�, +s�'. � #981 •.i" #83 t' '' ` 027005C00 rn �. c Fray ' t+"y •., ,_ .. 1015 ■ `j yi r.� x - � . �h i.- 1000 DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:027 Parcel:081 CO2 Q boundary determination or regulatory interpretation. Enlargements beyond a scale of Owner:CURTIS,JAMES W Total Assessed Value:$45600 Selected Parcel 1"=100'may not meet established map accuracy standards. The parcel lines on this map are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner: Acreage:0.35 acres Abutters 'E. boundaries and do not represent accurate relationships to physical features on the map Location:981 SANTUIT-NEWTOWN ROAD / such as building locations. Buffer f f Ulf ------- - _ Fee�-- -------------- OARD OF HEALTH TOWN OF BARNSTABLE ZippCication i or Yell Conaructionpermit Application is hereby made for a permit to Construct ( Alter ( ), or Repair ( )an individual Well at: Location — Address/ e� Assessors Ma and Parcel -- -- -<I_-- 2775 __— �� tAo moll /a6 v �'y/��577�� 1271(, .S OaC Owner Address Installer — Driller _ -- Address Type of Building Dwelling - --- ----- _ _—---- — Other - Type of Building--=--_----___—_ No. of Persons_----._____ Type of Well /°Z'h 90 p✓�YP ---- ------- Capacity— Purpose of Well�6 610E_____ Agreement: (� 0 � g 1'� (at.G'� The undersigned agrees to install the aforedescribed individual well in accordanc 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 Certificate Compliance has been issued by the Board of Health. Signed - -------- ---- �� date Application Approved By __�� __—___— It_76 r v-2_._ date Application Disapproved for the following reasons: — ------------_---------------------.—____ date Permit No. -- Issued----- -— - - ---- — ----------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f CompUnce THIS TO CERTIFY, That the Indivi ual Well Constructed (�' Altered ( ), or Repaired ( ) 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 SATISFACTORY. DATE--__-- - Inspector-- ------ - - --—--- --— - AA?f4 Pc riv l/ - ----------- BOARD OF HEALTH TOWN OF BARNSTABLE Zipplicatiouff �on�tructton; ermit Application is hereby made for a permit to Construct ( L4, Alter ( ), or Repair ( )an individual Well at: Location — Address 77 pn ^AMap — — I V �V, � '' Assessors and Parcel i E Owner Address Installer Driller Address +l Type of Building Dwelling `'� � .i Other - Type of Building------___—_____________ No. of Persons---------------_-___—_.—_—__ Type of Well USG,/7 �%C� t �L --— Capacity--1C)aPih__--------- Purpose of Well �L?� Gc^— —_—�— � + I — Agreement: (i 1-cv� , c tt✓ �j4�+c� � rry 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 ..f,Compliance has been issued by the Board of Health. Signed 1_6 U Q date Application Approved By 64 !`- — 1 v U date Application Disapproved for the following reasons:----------------_----------------- —__---__ - -- — - ------------------------------------ ------------------- ------- date Permit No. —— — -- Issued----- - - - - -- — —--_--------- date -------------------------------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Certif irate Of Compliance THIS.IS TO CERTIFY, That the Individual Well Constructed ( /Altered ( ), or Repaired ( ) bye_/�F`�fJ'It� Installer at_—�� Cf 1/L /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. -----------__________Dated-------------------- T THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A)GUAI2ANTEE THAT THE WELL - _S.YS-T,.EM WILL FUNCTION SATISFACTORY. DATE----- -- -- - `-==-__Inspector----------- ------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Ivell Con0ruct ion Permit No. 4'j__1 2���1( Fee— Permission is hereby granted ` �Ij v_ �{"`-'z to Construct (y. ), Alter ( ), or Repair ( ) an Individual Well at: Street as shown on the application for a Well Construction Permit No.- U ! -- - rr) 7 - l/ -------- Dated-- r 3 o``�--7 A ----- - — _ ' ----------------- DATE— �3 / 7 ___ -_ Board of Health ? r