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Home My WebLink About0467 IYANNOUGH ROAD/RTE 28 - Health E4:67lyannough Rd., 1 Q p e II l f �A No. y" tl( Fee BOARD OF HEALTH TOWN OF BARNSTABLE 01pplication jfor Verr Pw6truction Permit Application is hereby made for a permit to Construct( Alter( ), or Repair( ) an individual well at: r. Locatio A dress Assessors Map and Parcel >2 (2- 9 ��f� S'fcc�r��s o2c�/ Owner Address .tea ,zG 3tr�ws. �� Installer-D ller Address Type of Building Dwelling Other-Type of Building LWl fl a� ;` No. of Persons Type of Well ---1W1 r bye aY5 'A h Capacity Purpose of Well Agreement: The undersigned agrees to install the afore des ibed individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Pr tion Regulation- he undersigned further agrees not to place the well in operation until a Certificate of C 1' ce s sued by the Board of Health. Signed 115121 NIJ r, .,.... at Application Approved By _ L� Date Application Disapproved for the following reasons: Date Permit No. W W)1. ms— Issued Date -------------------------------------------------------------=------------- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed VXA tered( ), or Repaired( ) by nstaller at has been installed in accordance with the provisio of the Tow f 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 SATISFACTORILY. Date Inspector Fee BOARD OF HEALTH TOWN OF BARNSTABLE 2ppYtcatton _for Yell Cougtructtou Permit Application is hereby made for a permit to// Construct( \) Alter( ), or Repair( an individual well at: 0 82— Locatior�Address Assessors Map and Parcel Owner U Address r Installer-Jiller .—� e / Address h Type of Building Dwelling t i } Ot her;-..Type;of Bull''ding, oYYl dY1QYC t C� :. t No. of Persons ,Type of Well -vim 1� C, C-.k t a`(1 \ 7 Capacity " ti Purpose of Well Agreement: The undersigned agrees to install the afore d scribed individual well in accordance with the provisions of they Town of Barnstable Board of Health Private Well Pro Ition 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 ' Date? Application Approved By7� I Date Application Disapproved for the following r asons: i Date VV l 1 i � � / Permit No. W � Issued , Date BOARD OF HEALTH -}' TOWN OF BARNSTABLE . �Certtftcate`lpf Compliance 4a _ THIS IS TO CERTIFY,that the individual well . 'Constructed(.1)/Altered( ), or Repaired O by 'A Installer at has been installed in accordance with the provisiols of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. Dated THE ISSVIANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector ----------_----------------.-_____________m-- BOARD OF HEALTH TOWN OF BARNSTABLE Vern Cougtructtou permit No. W W r 6� Fee Permission is hereby granted to ? Installer to Construct(�)'�XAlter( ), or Repair O an individual well at:. \ Street f /as shown on the I application for a Well Construction Permit No: Date � 12� �� Approved By OFTHE 1p� DATE: FEE: BAMSrABLE, + y MA88. 1639. `0� REC. BY Town of Barnstable SCHED. DATE: Board of Health 367 Main Street, Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,M.S.P.H. Ralph A.Murphy,M.D. VARIANCE REQUEST FORM LOCATION ` / &1111,A Property Address: �1 . Yaitt-1 i� �C t� Assessor's Map and Parcel Number: Size of Lot: f-31 Cacr& Wetlands Within 300 Ft. Yes Business Name: F %h,a trz s 1/1=�✓ ✓��'7 No Subdivision Name: APPLICANT'S NAME: G�Xry i a y� ,-- Phone c27S �'�/7 1790-=3y74/ Did the owner of the property auth rize you to represent him or her? Yes No PROPERTY OWNER'S NAME CONTACT PERSON n Name: ��. n is ,F- Tkort 4T 000-51l --'3' Name: Address: 7 Z m_RJ Ay�nn l li _ Address: PSTx.:�l -17- /7 x;**,n/4 Phone: Phone: _ 52'-3P 7 Z VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) i rA i -c -mac e L - -Se,e.-h -• b 2 — Qt Su(lttivS -3Mpk.,t ri Otl FaOt�rS wi j'� xWR Checklist(to be completed by office staff-person receiving variance request application) Four(4)copies of engineered plan submitted(e.g.septic system plans) Four(4)copies of floor plan submitted(e.g.house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/leasee only],outside dining variance renewals[same owner/lessee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan G. Rask,R.S.,Chairman NOT APPROVED Sumner Kaufman, M.S.P.H. REASON FOR DISAPPROVAL Ralph A. Murphy,M.D. Q:/WP/VARIREQ KV MAP GALE: I11J.= 3o G t pEc �- DATE: AUG.IS.1982 Tp DR 69: N.E.AMDV-Q50N AlL 8`1: A.K.M&RNEY F ROU-['E PubLIC 2g o %0 5CA 5 Sqe 24 18"E a 150.Op h-3 c ! TOWN of 6ARNSZA6lE ��1 �� coBB-TRUSZ o r o Sss F 5 59e 24 18��E �- UI S1^l� • --- . a I Oo.oo_ -- -x �Y TOWN OF BARNSTA6l.E or O GOB6 -TRUST �\ 1.754 ACRES M.VA. SE4EL (TRS) W Cj) BK.222Z gK. 3G �,�8 =0 cr d Z ` f a ez �� - ,� 3" SCALE ��.LA>4 F JON$- ., ''CERT Ne.146Sg ., •t. . . . . ....> u�:en no..>�.,r• . f Becamj-effective-November 19, 1983, after being published in the Cape Cod Times. Xr vised-June '.3,1986. TOWN OF BARNSTABLE -- �'rP .w OFFICE OF "`U' rL BOARD OF HEALTH 039. 367 MAIN STREET HYANNIS, MASS. 02601 REVISED REQUEST FOR VARIANCE PROCEDURE The Board of Health, of the Town of Barnstable, Massachusetts, in accordance with, and under the authority granted by Section 31, of Chapter 111 of the General Laws of Massachusetts, adopted the following revised rules and regulations after a public meeting of the Board of-Health held June 3, 1986. The original rules and regulations were adopted after a public meeting of the Board of Health on November 1, 1983. (1) All requests for variances from the Board of Health or State Regulations will be submitted fifteen (15) calendar days prior to the scheduled Board meeting. The variance hearing may be held at a later date if the Board has scheduled eight (8) hearings prior to submission of the request. (2) The variance request shall be made on a form prescribed by the Board of Health. (3) Plans clearly showing the details of the request must be attached. Plans for onsite sewage disposal systems must be prepared and certified by a Professional Engineer or Registered Sanitarian for all new construction. (4) No variances from 310 CMR 15.00, Title 5, of the State Environmental Code, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, shall be granted for a new sewage disposal system, nor for an enlargement to an existing system which increases capacity to accommodate additional flows except after the applicant has notified all abutters by certified mail at his own expense at least ten (10) days before the Board of Health meeting at which the variance request will be on the agenda. (5) A non-refundable filing fee of $•65.00ls required. No fee will be required for filing a variance request upgrading existing onsite sewage disposal systems unless the g involves approval of a building permit. Tiradiin beiso &ffect on the date of publication of this notice. rert L. Childs, Chairman 1 11 ICLUC ldff Ann ne shb Grover . Farrish, M. D. BOARD OF HEALTH TOWN OF BARNSTABLE 6/3/86