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Home My WebLink About0006 CAPES TRAIL - Health � C4uts i t --7 l�11- ern i TOWN OF BARNSTABLE QQ LOCATION "T Zj� �Q��s�� r ��S SEWAGE # r VILLAGE �7A►C1/L f a��( ASSESSOR'S MAP 6i LOT16v- po INSTALLER'S NAME 6: PHONE NO. VAC%S CIO 77 1- 16 ct d SEPTIC TANK CAPACITY 1,000 c a LLev�S LEACHING FACILITY:(type) ��" Q (size) ( ,060 a lLa�s NO. OF BEDROOMS PRIVATE WELL R PUBLIC WATER BUILDER OR OWNER Go, 4 11 DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No `� o--—_ Sri�9 r `7 7 ��is �3g'�u .�« Z�� , �a-� � ��' No... ... Fizz. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH I. ........OF.......... a i .tl � _ .................................. , ppliration for Bioposal Works Tonotrnrtion prrutit Application is hereby made for a Permit to Construct ( &�or Repair ( ) an Individual Sewage Disposal System at; CD z o �..... C_ ......................�.--•1�---!�-_`--........-•-- --•--------------------------------- ... - °1- ............ L."ati Ad s L or.. ..E!6�1.. -- W caner 1� ?/%C ...Address ,� j.._........ .................................... ---•-•--•-••----•-•--••------ Installer Address Q Type of Building Size Lot... V Dwelling—No. of Bedrooms.....__.. ... Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons____________________________ Showers — Cafeteria a Other fixtures .............................. W Design Flow_....................S.S.-..-....__._gallons per person per day. Total daily flow..........................33t ....gallons. W Septic Tank—Liquid capacity. I12G2_gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width....... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No----------i--------- Diameter........._..... Depth below inlet................ Total leaching area...._�P$!?..sq. ft. Z Other Distribution box (v� Dosing tank ( ) Percolation Test Results Performed by...... --..........0.v:.................... Date----------- Test Pit No. 1....... ....minutes per inch Depth of Test Pit.......17....... Depth to ground water----------_—..._.. (i Test Pit No. 2................minutes per inch Depth of Test Pit........_........... Depth to ground water........................ P4 ------ } -- -------- ------- -----------------------------•---------------------------------- ------ ------------------------ Descriptionof Soil--------------Q i28s 1-L--••-•----•------•----•••••••---•-•---••---•••-•••-•••......•-•--•--•-------•----- W ---------------------------------------------"��.- �2 1 tit----------5-"(, -)--------- ---- ----------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------•-----••- U Nature of Repairs or Alterations—Answer when applicable-----------------------------------------------------------______............................... -----------------------------------------------------------•----------------------------•------------------------------------------------------------------------------------...•---••-•.._.......---•-- 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 j system in operation until a Certificate of Compliant as been issued by the board of health. Signed . .. . . . ..... .............................................. ....-........ ...... --- -------- Application Approved By -- Date Application Disapproved for the following reasons: .. .................. ............. ..... .. . .............................................. . .. . .......... -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- D.,te PermitNo. -------------7/--"-----3--------------------------- Issued ------------------------ --------------------------- ------ Date fit_ r No........................ FxJ/.._..C.?3 THE COMMONWEALTH OF MASSACHUSETTS — BOARD OF HEALTH .. ..:`.........OF.......... )A 1 N_?r�G.-� Q.,.. .................................... Appliration for 14opootti Works Tattaz-ttr#ion thrutit Application is hereby made for a Permit to Construct ( �or Repair ( ) an Individual Sewage Disposal System at: T .... .---...._......... .....•-• ---..................------•-•--•-----•-••---...... _. ... •-- .......................... ! LA`aSt AdcJ _s 76-,, ''yq �o P • -=------------------••----------•-- ......... ... ----•-•-----.................................. - Address Installer Address Type of Building Size Lot.................... .....Sq. fW v Dwelling—No. of Bedrooms................................ .....Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) al Other fixtures ............................................... W p -._per --ay. Total daily flow------------•-•--------•......�...3.........gallons. �: Septic Tank—Liquid capacity-IRVgalloo ss Length.. er d Width................ Diameter................ Depth................ Disposal Trench—No. .................... Width.................... Total Length...............b... Total leaching area....................sq. ft. Seepage Pit No...........I--------- Diameter.......... .... Depth below inlet......... "....... Total leaching area------ 2.sq. ft. Z Other Distribution box ( _� Dosing tank ( ) _ Percolation Test Results Performed by-------------x_:-- "' ----.:--___----��.__..._..__......._. Date__._..._..."_��. =f�.�..__. .. Test Pit No. 1......_7 ...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--------f --....----•........I---------------------•••-------------------------•-----•-----------------•-----------------•------ O Description of Soil..............(' ? :#rt!t ° � E t ---------------------------------•-..-...............-.......................... -----------------------------------------------•--------------------------------...------------------------------------------------------------------------------------------------------•---------•--- U Nature of Repairs or Alterations—Answer when applicable................................................................................................ 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 Compl' nce-,baas been is5 edd by the board of health. Signed• `-------------------- "` ' "� ... A lication Approved B Daze Application Disapproved for the following reasons- --------------- -- ------------------ ---------------------- -------- --- --- -- --------------- ----- --- - ------------------------------------------ --------------..._...__...------------- ...... ...................... /. --.. ......-.._....--.............. Date 73 PermitNo- -------------------------- ------------------------------------ Issued ..------------------------------------------------------------------ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............................................................... &r#tftratr of Chum lt�trcce THISj5 TO CERTIFY, That the Individual Sewage Disposal System constructed ( X.) or Repaired ( ) by --,o'IJ 1/: -- S C(� ............. I II --. ..................................................................................... nsta er at .----p 0 7- - �" � ........ r`�t L � r; i' •.� ............. ...W�/_ 1`)i<14. - ----------- ------------ -- . --........--.......--------...--- --- ------------------ ...--.......... has been installed in accordance with the provisions of TITLE V The?S3e Environmental Code as described in the application for Disposal Works Construction Permit No. ................................................. dated ------------------------------------........... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..----------'��--p-�'-------et---`�------------------------------------- Inspector -- ................ ----- ............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................. ..�'! ':� .._OF........ .J`�+�'e"✓ ....... No......................... FEE/ Roposal or ono rt ion �ermt` Permission is hereby granted........ °......_ _ r.. i 5...... to Construct ( `k) or Repair ( ) an Individual Sewage Disposal System, at No.....4.0-7...........Mf.......' !i r"6:. .7A:0.1� ......._.._.. 1�` r�i�' A/ .•-- -• ............................................................ Street I as shown on the application for Disposal Works Construction it o................. D ---------_----_--------------------------- ....../r -----.----- •• .................... - DATE............ -/---�-'--•---•------•--/------------------------•--•---- Board of Health FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS l I 0 , l oocp A L G P.D SPos;at P j�twnu. At?EA lS.ot �'" 89 1 L TOT I 'f!076 t- orz ULIS Ila O 4 .;.i BAXTER �: SULLI.VAN Lho. 40as, .r r "' No 29733 �' It i. a t , 772J ; ; ; I Tor.Truo'= PL s�nso,� G P.Pe loco I� tuv• 1�3 Z' 4'Pp� a • n r �>�w. I'll 5 •.TartK to �: ;LAN. I M s T .A S w 1C/ITL1 i 1 ! i I , t 2 EL•l Gd L oC.,L TI o l / �QN�ir �. Lr Syo�vu t�6! L�IJL_1�1J � �c�tZ�►�1C� � lS W t'Y'I--! TI-1�.; 51 L�C.t_l►-�E: ' �uD Acl< QEQJ I czEIV :1�1 E r4wU::-:c:= T�A2�1hTA�3GG Ty of TNC —p L-rr/ .3 v. w.t-clllhl THE Fiocyp PLAtANC� lS N0� LcL,GZ-gD is P11-L�Stlr2� iZ<�c RCGIStt2�DSUevcYoiz� L:Q>CC7 . Ub.� AaJ T11L� Ut=�`�: T�, OSTEtZVkLL.E _.__...__ Tom, i�r.: 1'L• t`Mt►lL- Lo'T 1_it� ApF?t: �-, - . . k , I ! Z7, tt .. ' ,•_— _') _ 4. , _ ...1 14 .(Tyr ! +•,i.�i '�_I.ti i_S j _I—}� �� 7 � f i � _� t I t� r � � � �. ... I � � I �_ f f I • , � , IIFPUR sualvAN 733 j � ��'- { ; \��\ \ �� fir= ��•. � i... � f 'j'"f"`" �r""1:"•f'" rf-, --t-fi ��r Z� '� f T`�"`�! a• I`�...�\� �:t '�� / � I � t.- I ,--i ! � 9 \' P?O��oS c� .� � •\ eta, � z r' f i I_Z + \ 173.1 }� : r , CS. �,\ y HI^.HAHD . Unen _ I , j 1 t � t �' ri F 9 a tto I� • f t ��Log Number: Bottle # BC935 gate: March 18, 1991. BA J?, �a BARNSTABLE COUNTY HEALTH AND ENVIRONMENTAL DEPARTMENT SUPERIOR COURT HOUSE BARNSTABLE, MASSACHUSETTS 02630 J e AfAs`�' DRINKING WATER LABORATORY ANALYSIS PHONE;362-2511 �_Ext. 337 Client: Bayside. Building Collector: C: Stiefel Mailing Address: 1645 Route 28 Affiliation: BCHED Bayberry Square Time & Date of Centervi-lle,' MA 02632 Collection: - 3/13/91 4:45 p.m. Telephone: Type of Supply: well Sample Location: Lot 39 Cape Drive Well Depth: West Barnstable. MA Date of Analysis: 3/14/91 12:30 p.m. PARAMETER SAMPLE"RESULT RECOMMENDED LIMITS Total Coliform Bacteria/100 ml 0 0 pH 5.6 Conductivit .(micromhos/cm) 370 '500.0 Iron ( m) 9.3 0.3 Nitrate-Nitro en ( m) <.1 10.0 Sodium m) 36 20.0 Copper m) <.1 1 .0 I . Water sample meets the recommended limits for drinking of all above tested parameters. I1. XX 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. X Water may present aesthetic problems (taste, odor, staining) due to -iron D. X Water sample has high levels of sodium. Persons on low sodium diets should consult their doctor. III. Due to one or more of the reasons checked below, this water sample is unfit for human consumption:i A. High Bacteria B. High Nitrates-' REMARKS: Iron removal systems are available to reduce the iron level in this sample. The Barnstable County Health and Environmental Depar'ment shall p6t er orse y statements, CC: Barnstable Board of Health interpretations,a on ' one CC: else concerging these res s wit out wr Yen consent. 1 /7/85 La oratory irector LV Explanation of Test Results =t. Total Coliform Bacteria Coliform 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 col.iform count of greater than zero is most often the result of accidental contamination of the sample bottle through.improper sampling methods. For,this reason, it would be advisable to retest any well water that is not approved. PH PH is the measure of acidity or alkalinityof 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. Iron The presence of iron in water in concentration of .3 ppm or greater 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. y Nitrate-nitrogen The Massachusetts Drinking Water,Regulations 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 nitrosamines. Contamination sources include fertilizers, cesspools and industrial wastes. Copper 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 advisable. Concentrations exceeding 50 ppm indicate that there may be ocean water or road salt runoff water getting into the well. d ei ;� RECEIPTN° 18851 'N•••' Envir nmental Health $ rvices From: Z� For:(specify service) L �- Amount: 4 et Signed: Date: � sau BARNSTABLE COUNTY HEALT14AND ENVIRONMENTAL DEPARTMENT Telephone Superior Court House 362-2511 Barnstable,Mass.02630 Ext.337 =� BARNSTABLE COUNTY HEALTH AND ENVIRONMENTAL DEPARTMENT LABORATORY REPORT VOLATILE ORGANIC CHEMICAL ANALYTICAL RESULTS Client : BAYSIDE BUILDING Collection Date: 03/13/91 Mailing Address:1645 ROUTE 28 Date of Analysis:03/14/91 BAYBERRY SQUARE Type of Supply: WELL , CENTERVILLE, MA 02632 Well Depth (FT) : 20 Telephone: Sample Location:LOT 39 CAPE DRIVE LAT. (DDMMSS) : Not Given WEST BARNSTABLE LONG. (DDMMSS) : Not Given Collector: C . STIEFEL Map/Parcel: Affiliation: BCHED Analytical Method: 502 . 1=1 , 502. 2=2 , 503 .1=31 504=41 524 .1=5 , 524 . 2=6 , 502 . 1/503=7 --------------------------------------------------------------------- Contaminants Anal . Result MCL Detection Detected Meth. ug/l ug/1 Limits (ug/1) --------------------------------------------------------------------- *** NO COMPOUNDS DETECTED *** 7 Only those compounds listed above were detected. Attached is a list of compounds for which this sample was analyzed. NOTE: Contaminant levels equal to or exceeding the Detection Limits are reported. MCL means Maximum Contaminant Level for EPA-regulated compounds . (ug/1 = micrograms per liter = Parts Per Billion) The Environmental Protection Agency has set Maximum Contaminant Levels (MCL) for the following compounds . This sample compares as follows: COMPOUND MCL (in PPB) Benzene 5. 0 * level not exceeded * Carbon Tetrachloride 5. 0 * level not exceeded * 1 , 2-Dichloroethane 5.0 * level not exceeded * 1 , 1-Dichloroethene 7 .0 * level not exceeded * 1 , 4-Dichlorobenzene 75 * level not exceeded * 1 ,1 ,1-Trichloroethane 200 * level not exceeded * Trichloroethene 5. 0 * level not exceeded * Vinyl Chloride 2.0 * level not exceeded * Comments or additional compounds found: Bernard E. Bartels , P La ratory Director s� .,�8AtRNSTABLE COUNTY HEALTH AND EN.,VIROtWENTAL DEPARTMENT SUPERIOR COURT HOUSE BARNSTABLE, MASSACHUSETTS 02630 0J M TABLE 1. oun Com ds Detectable b EPA Method 502.1* p y PHONE: 362.2511 EXT. 330 LAB 337 COMPOUND D.L. COMPOUND D.L. CLINIC 340 Benzene 0.5 1 ,1-Dichloroethane 0.5 Carbontetrachloride 0.5 1 ,1-Dichloropropene 0.5 1 ,1-Dichloroethylene 0.5 1 ,3-Dichloropropene 0.5 1 ,2-Dichloroethane 0.5 1 ,2-Dichloropropane 0.5 para Dichlorobenzene 0.5 1 ,3-Dichloropropane 0.5 Trichloroe.thylene 0.5 2,2-Dichloropropane 0.5 1 ,1 ,1-Trichloroethane 0.5 Ethylbenzene 0.5 Vinyl Chloride 0.5 Styrene 0.5 Bromobenzene 0.5 1 ,1 ,2-Trichloroethane 0.5 Bromodichloromethane 0.5 1 ,1 ,1 ,2-Tetrachloroethane 0.5 Bromoform 0.5 1 ,1 ,2,2-Tetrachloroethane 0.5 Bromomethane 0.5 Tetrachloroethylene 0.5 Chlorobenzene 0.5 1,2,3-Trichloropropane 0.5 Chlorodibromomethane 0.5 Toluene 0.5 Chloroethane 0.5 para Xylene 0.5 Chloroform 0.5 ortho Xylene 0.5 Chloromethane 0.5 meta Xylene 0.5 ortho Chlorotoluene 0.5 Bromochloromethane 0.5 para Chlorotoluene 0.5 . Dichlorodifluoromethane 0.5 Dibromomethane 0.5 Fluorotrichloromethane 0.5 meta Dichlorobenzene 0.5 Hexachlorobutadiene 0.5 ortho Dichlorobenzene 0.5 Isopropylbenzene 0.5 trans-1 ,2 Dichloroethylene 0.5 n-Propylbenzene 0.5 cis-1 ,2 Dichloroethylene 0.5 Sec-butylbenzene 0.5 Dichloromethane 0.5 Tert-butylbenzene 0.5 D.L. is Detection Limit in micrograms per liter or parts per billion (ppb) . This table lists our normal limits of detection. If we report a smaller amount, then our detection limit was lower for that analysis. *A photoionization detector is used in series with the electroconductivity detector, thus allowing for the analysis of most of the compounds listed in EPA Method 503.1 as well . TABLE 2. Compounds which have Maximum Contaminant Levels (MCLs) set by the Environmental Protection Agency. COMPOUND MCL (in ppb) Benzene 5.0 Carbontetrachloride 5.0 1 ,2-Dichloroethane 5.0 1 ,1-Dichloroethylene 7.0 para Dichlorobenzene 75 1 ,1 ,1-Trichloroethane 200 Trichloroethylene 5.0 Vinyl Chloride 2.0 Total Trihalomethanes 100 Chloroform, Bromodichloromethane, Chlorodibromomethane; iand Bromoform comprise the total trihalomethanes. , € j ; s No.- -��-= -- BOARD OF OF HEALTH TOWN OF BARNSTABLE Zlpprication-*r3Verf Congtructionpermit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: Loca ion — Address yAssessors Map +,and Parcel CJ_(AS1P_�ttt- %"j ------------------- �G��5- rD— �vil C'/�)r�G+ �'t-� ----------------- / J�wnei / Address - ------------------- -------------- Installer — Driller Address Type of Building Dwelling �--`;-- Other - Type of Building -------------------- No. of Persons----------------------------------------------------- i Typeof Well--Y------- ------------------------- Capacity----------------7--------------------------------------------------------------- Purpose of Well-1�L2i41�S rC------------------------------- 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 omplian as been issued by the Board of Health. } Signed- ` G `—---- ---- --- - `3r - date Application Approved By----------- - ------------- 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 Individual Well Constructed Ye�, Altered ( ), or Repaired ( ) A - __------------— ----- - --------------—----------------------------------- by- —-�---�-- �-- Installer 41 - has been installed in accordance wirovisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. -W--7/--/a Dated------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--------------------------—--------------------------------------- Inspector---__ —---------------------------------------------------------- Fee- BOARD OF HEALTH e TOWN OF BARNSTABLE s Zppri ation,forWell ConstructionPermit Application is hereby made for a`,permit to Construct ( ), Alter( ), or Repair ( )an individual Well at: Locca/tion — Address Assessors Map and Parcel - ,� r� CP1 �/C!//! ------------------- / wner. Address Installer — Driller Address Type of Building Dwelling-/t�o S 2 Other - Type of Building------------------------------------ No. of Persons----�----------------------------------------------------- � �t �TYPe of Well- �---- - - -------:------------------------------------- Ca Capacity - - --------------------------------------- Purpose of Well-- f ---------------------------------------- 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 omplian a/has been issued by the Board of Health. Signed- )----------- -c - ------------------------ ----` 1,f 1- -------------- r� date Application Approved ------------------ ------ _ — -- date Application Disapproved for the following reasons:-----------------_-------------_-------------------------___----------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- date Permit No. --------- - --. ------------------------ Issued------------------------ ------------------------------------------------------------ - , date BOARD OF HEALTH i . TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed Altered ( ), or Repaired ( ) bY--------- ---------��` - Installer at-------------1"/)-�--•� r - =. t } - b'-1` _ _ _ '�. — --- has been installed in accordance witl�the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. -- -t�l= 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 BARNSTABLE Vern Con!6tructionPermit No.JIAZ 9-.1=---�--� Fee--�=—�-----r Permission is hereby granted-----------�1-=----A=--v------�-d��- '/' �'-�' ---------------------------------------------------------------------- to Construct (,><-), Alter ( ), or Repair ( ) an Individ�}a'l Well at: NO. --------------t - = c! 1� � -A ern :_�U f -- ."_= . U-�--------------------------------- ^ J r r — .—�� Street as shown on the application for a Well Construction Permit No.------------------------------------------------------------------------------------------ Dated------------------- --'----------------- ----------------------------------- --------------------------- - {- ---------------------------------------------- oard of Health DATE----------------------------------------------------------------------------------------- ' FL�u/ t10 - 1 0 . rr , SAL, � I 5P054L'--,p IT I I I. Al 1 .t AtzEA DIA l � 3'7SGPD ISPom ' { 1 t2 < f i L� ,'1O-T"ALIdlf FLDW 3306PD I , 'to i : T U ,SZ A , 2 ASS i Rt"I�flU 1 �, �M1 � _ i . T , 1 c`3' ! i BAkTEFi� SULLIVAN ado' 29733 " r IPE1? A I N- 11 , r , t -_1-' { , 1 Fo Ot��ff Iy I + T�s=t-, 1 Z/ !9�I r I ! � { I I r_ I 3 ,: I � i 1 y • dot (�S. W Tor I-uD'= Fl IDS .< , ot1aH 4''�ivb •_Y ,. -r - -SV�iOlC_ � •• .�-�, i .. :.: .��//P� �OoO � ILJV.` �1� �I 2' !� i tW: 6AL. 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Pt-T R SULLIVAN r 29�,r Gt°' t J r f— r f t f # d t tA � , a � t F , I r RCHA r fi I I_i t t j A. f r I r S �AxTEH o� r r N0.24049 rr -� T-I ,'t w � , I'_i-} i. 1_._.1-.- t t -L, ��_1. r� /�s. ! r . . 9� •'7j�(/ ��°+j T .itill...r,... -��r-j--t—r r•-T-`t-'r'` ( N.. .- c..-;. fG�F"C�"V" j ,-� .� � � � -- '.tom" . _ +