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Home My WebLink About1049 SERVICE ROAD - Health 1049 SERVICE. R.bp D _ N� A= 153 034 4' 1 1 i No. 4210 1/3 BLU psnd alqnsmo O 0 ® O TOWN OF BARNSTABLE � LOCATION � � a SEWAGE VILLAGE ; ASSESSOR'S MAP & LOT ' INSTALLER'S NAME,& PHONE SEPTIC TANK CAPACITY 10M CA4, LEACHING FACILITYAtype) — (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC- WATER BUILDER OR OWNER _T�42 DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No � � I �L W�,s A= �a � �, � a5 ; - �,T qI lot LOCATION SEWAGE PERMIT p0• VILLAGE A53 Weisi- I H S T A LLfWS WA E b ADDRESS 13UILDECI OR DATE, PERMIT ISSUED DAT E C.0rAPLIAWCE ISSUED r �ao3� S, �t'S.SFbp J � �e5s�o� ue� /COO 0 �-� No.— ---- ---- Fee--- --------- BOARD OF HEALTH io. TOWN OF BARNSTABLE �i licat iota r�� ,�io Well Cortgtruttton Permit Applicati4 on is hereby made for a perm' tc onst t ), Alt r -or epa� )an ivi ual Location — ress�1 Assessors Map and arcel dyes Insta ler — Driller Address .✓ Type of Building Dwelling Other - Type of Building----_—__—______ No. of Persons--------_______—__—_---_-_- Type of Well _— 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 Comp iance as bee issued by the Board of Health. Signe - -- _—.� Application Approved By _ date Application Disapproved for the following r ns: date Permit No. --- Issued----- N- An/-/0-----_-_____--------- datel - --- --- - - - - - - - - BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance Imp THIS IS TO CERTIFY, That the Individual Well Constructed ( ), flte�s ), or Repaired ( ) by ---- InsiGer _---------has been installed in accordance with the provisions of the Town of Barnstable B d of eal vate Well Protection �Regulation as described in the application for Well Construction Permit No. ------------_ ated------ -------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE__--- --— ___ Inspector------- - --- --------- No.------- -- ------- �� Fee---. ---------------- BOARD OF HEALTH TOWN OF BARNSTABLE 41 applicat ion-for Well Con5truct ion Permit Application is hereby made for a permit tot, ;o�n�str'u t �1), Alt r ( , or;Repair ( )an in ividual ll at: Loc tin — ` y/ / 1 a o Address Assessors Map and Parcel ` Owner Address instOr Driller Address iv-t Type of Building Dwelling- Other - Type of Building—=------__--___-__ No. of Persons------- Type of Well /t �__ �__� 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 as been issued by the Board of Health. Signe, y � �� ia§5k Application Approved Bye _ ____; ,T/l.//��//��// date Application Disapproved for the following rea ns: date Permit No. 3fl' -- Issued--- -� -------------- date a BOARD OF HEALTH TOWN OF BARNSTABLE 11 -- C ertif irate ®f Comph nre "'THIS IS TO CERTIFY, That the Individual Well Constructed ( ), A'Itered� );,or Repaired ( ) � Insdilerhas been installed in accordance with the provisions of the Town of Barnstable Bo rdo�ealt P 'vate Well Protection Regulation as described in the application for Well Construction Permit No. - 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 Ivell Construction ernut No. Fee ----------�-�� o o Permission is hereby granted to Con tr c , Alter g it ( a di i ualW 11 at: No. �� L_�L -\---------------------------------------- jStreet as shown o t e a plication fo a Well Construction Permit No.- -� -- !-----— Dated--- --f.= - - /Board of Health DATE /- ____ VI / I� �� ASSESSORS MAP NO. �E -- _ No.... .........�....... Fas......:... .........._. PARCEL NO: THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Apphration for Diipu!ul Hlurk,i Tonfitrurtiun VarAft Applica ' n is hereby made or a Permit to Coristr uct ( ) or Repair ( ) an Individual Sewage Disposal System at, f( > � cttio1 -A ess Lo No a � . Owner Address -- ---- ---.. . ------_-•------•------•- ..-----•-•--••.....-•.............. ........••--------•-•.......•-•.--.....--•- Installer Address Type of Building Size Lot............................Sq. feet �-t Dwelling— No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (UV aOther—Type of Building ............................ No. of persons-----..--..-..-.------------ Showers ( ) — Cafeteria ( ) dOther fixtures ------------------------------------------------------------------------------------------------------------------------------••-------............... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Width-----..--------- Diameter................ Depth................ x Disposal Trench— No. .................... Width.................... Total Length.........._......... Total leaching area....................sq. ft. 3 Seepage Pit No-------- ------------ Diameter.................... Depth below inlet.................... Total leaching area..................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.---.................... 44 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ P4 ..........•----.....-•------•---•-••••---------••--------•.....................•---.......--------......--------................-•--•.........-----....•----- 0 Description of Soil.....................................•----•--•---------•------------------•-----------------------------------------•-------------------------•----.....-----------•--•- U --------•-•-.......••--•...-----••----•----------------------•---------•-•--•••-•----------•---•-•-•----•-----••- -••-••------••------•--•--••-•---------•-----•--••--•-------------......--------.--••- ...--•----------------------------------------------------------------------------------•---•-•---•-----•. -• -- '--- --- . • >> \ U Nat of Repairs or rations—Answer when applicable... -- ..............(. VCI .................... _ . . �a ------------------------------------------------------------------------------ ........................................ The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Com ianc has bee ed by the board of health. Signed ... ...... �.. ..O�� Dace Application Approved By ....... ..... ... .......... -------.._._.f.......... ................ .. �' � ... Application Disapproved for the following rearons: ........................ ... ........... --.................................................................................. .................................... ............................... .. .................. . ... . .. ............................ .... Permit No. ........��.�"..WJ---------------------- Issued .:.............,.�... ..�..... e...... Dare f _ �,.wa. S,. .,..,..� �..,+'�+Kuh,+c:':.�'^i..i��iS..L.,^''*4:+.�J. .�'an,a�-.�'�..r".-i.,....1.,`,� •,...,3�'..�,�T.•ruitii.....�i. y��-..�r-�'n_,�'_'."`."` ..�--... ...,cam-�v L-\.-.r`�!'.� A ( D 0 No........................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiun for D!3p ial Warkii Towitrnrtion ramit Application is hereby made or a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: (Qu t !! Q................ ................,....... .:.,..� i .....-•------..•............---•---•--------•---•---.....-----------................--••---- Location:Ad ress Rem _ ti_. . --• •--- ress . �f Address Owner Installer Address co U Type of Building Size Lot.................... ......Sq. feet U Dwelling— No. of Bedrooms._....a...................--------------Expansion Attic ( ) Garbage Grinder (U()l a4 Other—Type of Buildill g ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures -----------------_----- --------_-------------------------------------------------...--.--------•-------------------------.----••--.------------- W Design Flow............................................gallons per person per day. Total daily flow---------_---------------_..................gallons. WSeptic Tank—Liquid capacity-----_......gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width-------------------- -Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No------------- ------- Diameter-----.._-_--.--__. Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed bY........................................................................... Date........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ C ..................................................•-•-•--............-•---------......-•------.............................................................. 0 Description of Soil........................................................................................................................................................................ x x •-•-••••••••----------•-----....•---------••--•-•-----••------------------------•••--•-......-•-•••......------ ---... - U Nature of Repairs or Alterations—Answer when applicable..__ . .. - .............. ._..... 7� a`1,...---•---••-•••.. .��s = -----------------------•-----•---------------------------- ............................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Com-Banc• has been—issued by the board of health. U\ n Signed ..... 9JJ�`l....�4� � r - .. .............. .................0� ..... "1� Dace Application Approved BY ..... / /G .� ........ �..........;................ .. / � Dale Application Disapproved for the following reasons: ....... ............................................................... .... .. ...................................... ... ........................................... . ........................ .... ..................' ....... . ...... ............................. .................. Permit No. ........�C ......................... Issued ............... --.,�,�..'...... `tea Da[e ----------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Complianre IS-IS TO GF-R-TIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( l� by........ �`.�� - � _......._..............._,r-- ...._...- ----------------...--------- .-------------.......----------------*----------.......... ie5 fit, 1ncr.Jlcr has been installed in accordance with the provisions of TITLE.5 of,The State Environmental Co-ed asc�'escri d in the application for Disposal Works Construction Permit No. S_..._ .,,3...... ...... dated f c-.......�L. ..��...__. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..... �i. j........... ........ Inspect r�..�� .._.._._.:._- ..._......<:�...............-................ ------ ---_--_ -- _ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � TOWN OF BARNSTABLE �� v FEE..............•-•--.... Ropi at Workg�-� - nitrnrtinn ramit Permission is hereby granted------ -----i-�.� __---------- tiJ . to Construct ( ) or Repair ( an Ind' ideal Sewage Dtsposal S stem at No......... ..--- g L �` �_ � =... ... it- street tom. as shown on the application for Disposal Works Construction-Permit No,5 _4/:�Da ed___�jf. 5�.:�e..t.C/f4..)..... Zg 5...............................• Board of Health FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS w 1 _ 03 [/ No. 8 -. ��•-A FEE....$....S N........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH /0 Town-- --..OF...........Barnstable ------- --------------------------------•-•-••••---••--•... Appliratiou for Utsp aal 19orks Tumitrn.rtiun ermit Application is hereby made for a Permit to Construct ( ) or Repair ( x) an Individual Sewage Disposal System at: 2 Q2 6 Location Address or Lot No. Robert Ranta 2039•-Old Stage _Rd,;,,.-West larnstJDle,••_02668 - ..__......-•--.....-----•------•--------•--....---•----••--•----•----•... Owner Address A _&__B Cess Pool__Service................................................. 128__Bishops_.Terra.ce.,_Hyannis,__MA 02601 Installer Address Type of Building Size Lot------------------..-------Sq. feet U Dwelling—No. of Bedrooms...........3................... .Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons.......... ................ Showers — Cafeteria a Other fixtures .----•--._...---•--------------- -- - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Ix Septic Tank—Liquid'capacity............gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by........................................................................... Date........................................ ,� Test Pit No. 1................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 -------•--•-----••-•••••••----•---•--••••.......................................•---••••••-•-•-•.........•••-•-•---••---••-•---•-.............---...._----- ODescription of Soil.........Sand-.................................................................................................................................................... U -•-------•-------------•-•---------------••-----•--••-•--------.........---..........--•-•--•-•-•-•------------ w •----•-----------------•••---•----------------------•--•••--------•---------------------•------•---•-------------•---•----------------------------•••------•-------------•----•---------......---.-•---- UNature of Repairs or Alterations—Answer when applicable.in ta..11 tion..of.a-1•,000__gallpn,_..prp.-cast stone._pp gked-,leach Dit (overfla),............................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TILT L' 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board �of li th. O ' Signed---lL h-C � rrr . .... ........5AV§ •----•-- . Application Approved BY r-,. ---- ............................. ...............5/��........ Date Application Disapproved for the following reasons:------•--------•--------------------------------------•-----------------------------.....--•-,------•--•--...... .............•----------......--------••-•--------•------------•----------•-----......_..-----------...--•------•---•--...----------------•-------------------------••••--••••------°--...........--•-- Date Permit No........82---•--....-----•--------------•---......... Issued---•----...---•------------5/17/82........._._ Date No....... 2-..!23,R Fizz....$....r,•00........ THE COMMONWEALTH OF MASSACHUSETTS . BOARD OF HEALTH .......................To!FTC---.....OF............PanBtAble.-.---------._...........-----..........----....---- Appliration for Bispuiittl lgorkii Tnnstrnrtiun ermi# Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: 20JL9...Qld..Staga..Ed......Wast-_Pa riwtable.,.02.66P-- ......._-•-••-••-------------•---•----•----•-•--------------•-•--......--------------------------- Loration-Address or Lot No. RQ xt..aant�a............... • .....w.............................................. 20�9..Md.B:tage..Rd... Wasi...ga.rnsttbla,...D2�8. Oner Address A &.B..G� p44a.._S�rxica................................................. 128..Blshopa..T.arra.cla,..Hyannis.,..M:A.....A2601..... Installer Address d Type of Building Size Lot............................Sq. feet U g— .Expansion Attic ( ) Garbage Grinder ( )Dwelling No. of Bedrooms.__.._.._.3______________________________ Other—T e of Building g ____________________________ No. of persons.........3................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ......................•-._...----------•---•-- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ W Test Pit No. I................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........................ •..............•-•--•-----•--------------------•-----•----..........--•----•----.....------------•--......................................................... DDescription of Soil.........Sa rA.........................•........................._......-----------••-•----•--------•--••--•••••----•••----••-----------•-•--•--•-•.....--•-------- W U W ---------------•--------------------------•------------------------•---•------------•-•-----------------------------------------------•------------••-------------•-•................................. U Nature of Repairs or Alterations—Answer when applicable.tnatal.la.t an.._of._a._1,000...gallon,...pre-.caat ...sto lie..JAQk0d..20.a.h_.pit-.. 0xeTfI0.x...............................---------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TI T S,i. p of the State Sanitary Code—The undersigned further agrees not to place the system in. operation until a Certificate of Compliance has been issued by the board of health. Signed... . ... --. Ile....�.......5/171`2..__.._. �j ,,,�+ Date Application Approved By---- -. -----••- ..I.. ..!....,/... 0 -•-------------5ffl'1�2--------- Date Application Disapproved for the following reasons-----------------------------------------------------------------------------•--•----------------------....--•-- ............................•-••-••-------•----••---•••--._...----•---•-------•••........----------•...•••-•----•---------••-•-----------•---------•--••-•••---•-•--•-------•---•-•--------•-•--------•- Date' Permit No.......82---------------------------•--------....... Issued....----........---•-----5/17/82 Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................T own...........O F........Larnstle....................................................... (Irrfif iratr of (I nntplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (X ) by...A..&..B..Ce &pena1_.aervic-e,...128..Biahaps._Terrace,---Iiya.nnisr--Y'A-----w6ai.......................................... Installer at.....2039..Qld--Stage... ------0266B--- --Robert...a.nta.............................................. has been installed in accordance with the provisions of TITLE j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No----g2-.......•- ?_.t ........ dated----...-.5/17/$2---------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 5 1 82 .....•-••...... Inspector..--•--•-------•-•-•..•... . i Vl DATE--------..�..7�...............................•-•--•--••---- ------------•-•-- /-.�..�..............-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 82- ..................T own..............OF.............Ba?.ns..able $ 5.00 No......................... FEE...-.....--............ Disposal Workii 0.1nnstrudion anti# A & Cesspool Service Permission is hereby granted -- -- -- -------------------------••-••-•--- to Consr y GjdorStrlX l S , Oln System Rantaat No.. .... a e , es ?arnstabl •-------•---•-------•---.....-•--•-•................•------------•.---------------------------------------------------•--------------------- Street as shown on the application for Disposal Works Construction No......82...........-�D°ated. __..5�17�$2.................. DATE....................VIM?.........-•...............•- -••-•--• Board o lth FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS ..- 12/29/2010 10:29 FAX 508 888 6446 ENVIROTECH LABORATORIES 1a0001/0001 ENUROTECHLABORATORIES,INC. MA CERT.NO.:M-MA 063 8 Jan Sebastian Drive Unit 12 Sandwich,MA 02563 (508)888-6460 1-800-339-6460 is FAX(508)888-6446 y ,S Client Name Meehan Well Drilling Location Ranta,1049 Service Road Address PO Box 616 W.Barnstable,MAJ Forestdale MA 02644 Sample Date 12/20/10 Collected By Ed Meehan Sample Time 10:00 Sample Type New well Date Received 12/2otio Lab Order Number DW-103668 Well Specs 8V -� Location.Source °Date Collectedd.` Tune Ca(lecteu( Cottements, - - :.... Analysis Requested Units Recommended Limits Analysis Result Method DateAnalyze Analyzed By Total Coliform /100mi 0 0 SM9222B 10/2012010 RS _... .._._.... _._....._.._............. ... -._...._..---------- --- ..__ .. -. ._...._....--- - -- - -.._..... _ -._..._....._..........-- --- - -------------.--..._........_ pH pH units 6.545 6.39 SM4500-H-B 12/20/2010 ILL Specific Conductancen umhos/cm 500 111 EPA 120.1 12/20/2010 LL ._...._... --......._...._....---- ._.................. .....:... -- ........._.__...._... ... ......----------------- - ....._... Nitrite-N mg/L 1.00 <0.004 EPA 300.0 12/20/2010 LL Nitrate-N mg/L..- _...-__.-. - - -10.0- 0.53......._...._...__EPA 300.0 ...12/2012010------- LL ......_ Sodium mg/L 20.0 13.5 EPA 200.7 12/27/2010 MC - ..._.._...... -- ---------_-----------......_....._._- ...._ - ........- --...._...._..__........................ .............. ....._..._._..._.—...--- -- Total trona mg/L 0.3 <0.01 EPA 200.7 12/2712010 MC Manganesen -- mg/L 0.05 <0.008 EPA200.7 12/27/2010 MC Comments: pH is below recommended limit and may have corrosive charecterlatics. • Water meets EPA standards and is suitable f r drinkfng forporameters tasted. ed.� J . .2� ��Lf Date �a,��t Ronald J.Saari Laboratory Director • BRL=Befow Reportable Limits *See Attached Page 1 of 1 ❑C'errylcation is not available for this ana0e for non-potable water samples.. L rt _ i NO.!''lam Y Fee--------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Application for lVell Congtructionpermit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair (&Ian individual Well at: - -� ---Y 9 S el u r c e -- �'°`�`—'a— -— - ------ --- - - -- -—- -- ---- Location — Address Assessors Map and Parcel 1%4/ u %q C 9 S P/u!c r /✓�c� fJ •�Jo r,v �Lt 4 --- - ------ - - - ---------------- -- J --- - - - - ---- - - ---- - (� Own/ Address /� /� J([c �tiv C/ A ! ( .�/�X n6. �oX l��G -/t.i.vs��- - �`-a q ---�(JA - _ — ---------------- - - F Installer Driller }—_ Address Type of Building 1,, Dwelling---INGA S P Other - Type of Building -------- No. of Persons------------------------------------------- Type of Well--2�� -------_-- -- ------- - 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 .00fCjmpliance has been issued by the Board of Health. / Signed !J—�•n"�Cif__=— -------------------- - - �7/f -- -- date Application Approved By `� " -- -—- ----- .- --F.F -- - date Application Disapproved for the following reasons:---_—________________---- __________________________________ ------------------------------------ ---------------------------------------------------------------------------------- ,ems .date Permit No. —/!rv". t- �?--- -- -- Issued--- - 4 - - date — BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate ®f Compliance THIS IS TO CERTIFY, That/the Individ/ual Well Constructed ( ), Altered ( ), or Repaired (�) bY-----------j0A-' T u l ------------------------------------------------------------------------ p 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 Nobles-L��/- �ated-ems---- -- � THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--------------- —— -- - ---- Inspector------------------------------------------- --- "S, +..•`f '•Net. A; ... ... F .. iR; a ,3q- yk � it")t",�'�'S' -.' "-`Pdw'w°try ''„�, ^a: .Etr� '• �-,..*"elµ -►di..y*`-ir�:.%�•'�taJ�,yf-'�t�q`'�"1'h'*�,'lL.."'Y7•rr'.,�"'1� r'')r-s}�{Ft�y,.,!'rvy�t�y►rq'.�T�'�+h►'�+ "'+c.�y,.,�.e�'`F'��/''� r �' :4. No `'� _ Fee--- -- --- BOARD'OF HEALTH TOWN OF BARNSTABLE Applicat ion-*rWell Cori5truction ermit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair (t.)an individual Well at: . Location — Address Assessors Map and Parcel M/ �' Tq h 1aY SAiu/c• I?� tj •/jof M Owner Address Installer — Dnllet _,-� Address Type of Building g ----- S � Dwelling—boo--o — ----------------------- -";---------- Other - Type of Building ---------- No. of Persons-------------------------- ----___________ T Well - Capacity------- -- - -- - - -- - --Type of We ;.----------------------------------- ----------- --- Purpose of Well---&-k 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 C,mpliance has been issued by the Board of Health. 7 Signed � '(_ — - -- - ------------— - �? F/----- date Application Approved By -- ----- -------- date --�--- Application Disapproved for the following reasons:----------------------------------------------------------______—_ ------- ---------------------------------------------- ------------------- date Permit No. --- ---------- Issued---------------------Y.— date BOARD OF HEALTH TOWN OF BARNSTABLE C ertif irate Of Comp[iantce THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired (�) by-----------0-A� �� -Az-----�° _ _Z _ZILI a' ---------------------------------------------------------------------------------- Installer f q Q i at--------/A—t �/�/ C P /� —— 6/t� has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection L ' Regulation as described in the application for Well Construction Permit No ' -"---24ated------------------------� f 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 Well Con0ruct ion Permit No. --------------- Fee-------------_ Permission is hereby granted-fin- ----------------------------------- to Construct ( ), Alter ( ), or Repair ( e1 an Individual Well at: - _ ----------------------------------------------------------------------------- Street as shown on the application for a Well Construction Permit No.- `---- - -- - Dated---6�_'' _r. -------------— ---- - DATE Board of Health ---�--�--- �--