HomeMy WebLinkAbout1815 FALMOUTH ROAD/RTE 28 - Health � .
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No.- - ---� Fee-
BOARD OF HEALTH
TOWN OF BARNSTABLE
Applitationjor'Ve[r Congtruct ion Permit
Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at:
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-----=-------------------------------------------------------------------- ---------------------------------------------------------------------
Location Address Assessors Map and Parcel
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- -------------------
Owner Address
f}/� M7'l c' -W 88( -a0�2B /eft 99 L l C 7 0 j� VG l!-e t'�i
f-- -- - - ------------------------------------------------I------ - ----------------
Installer — Driller Address
Type of Building
Dwelling1 �� "� ---- u� L
- --------------
Other - Type of Building -- - 5�-��-�'-----. No. of Persons--------------------------------------------------
Type of Well -— �-(—-—lot
------------------ Capacity----------D?` /-° ------------------------ _—_—
Purpose of Well--------1-° r°-- _` -TL 0vA/
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.
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Signed— ----=- — - =`- ---- - — --- -- - -'
date
Application Approved By- -- ------- - -- --- — ---"- �
date
Application Disapproved for the following reasons:------------------------------------------------------------------—-----
------------------------ ---------------
----------- ----- - --- -------------------------------------------
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date
Permit No. -- -_L� -® --— -- Issued ----E� -- -� - — -
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certifitate ®f Compiiance
THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( )
by-------- --- ------- ----------------------------------- ----------------------------
------
---------------------------------------
nstaller
at-----------/- - -- AA
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 Dated-------------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE--------- —— — - ---- __ Inspector--------------------------------------------------------------------------
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No. - --- ---� Fee---
BOARD OF HEALTH
i
TOWN OF. BARNSTABLE
Appticat ion jforWell.Cootruct ion Permit
Application is hereby.made for,a permit to Construct ( ), Alter ( ), or Repair ( ')an individual Well at:
do,-ry Sir N __ =-
Location — Address Assessors Map and Parcel
05so I-lol1,, -h/IuL �T _ / y ---------
Owner F - --- �Q -
ss
(4TL_,jAO-1< WGt� 041Ll/�i7 Ll� � C',ut�e./- vi/! Aire '¢' ,
- ---------------------------- -------------------------------
Installer — Driller Address I
Type of Building
Dwellin 1 r'r 1 of ']'_/o✓✓ U C
+ N
Other - Type of Building-- G4 tS1 -f No. of Persons---------------------------------------------
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Type of
Well
- - �� -----
Capacity 9S------- p
------------
Purpose of Well --- uy / - --------
'Agreement:
------------------------ i
The undersigned agrees to install the aforedescrbed 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
z �
date
Application Approved By
y date
Application Disapproved for the following reasons:---------------,-----------------------------------------------
---------------------------------------------------------------------------------------------------------------------------------------------------------
date
Permit No. -- - �-® — -- -- Issued ----E .,� ---5-c------------------------------
date
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BOARD OF HEALTH
TOWN OF BARNSTABLE
C ertif irate Of Compliance
i
THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( )
--------------------------------------------------------------------
nstaller
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.V1--?4----Cd?-Dated------------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
i
DATE- --- ------ - - --------- Inspector--------------------------------------------------------------------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
)VeYC Construction ermit
No. - ---
1�2= � Fee ----�".-..
��-' - '
Permission is hereby.granted--- _ - ---------------------------------------------------------------------------------------
to Construct (�,) Alter ( ), or Repair ( ) an Individual Well at:
No. - - ------S A--- ---- - ---5«eei----------- -------- -- ------------------------------- ----
as shown on the application for a Well Construction Permit
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No. ---------------- --- ---- --- - -------- - Dated--- — - -----------------------------
-------------
----
- --- - ------------------------. .. -
Board of Health
DATE---��---'-_ -_— --�-