HomeMy WebLinkAbout0106 EAST BAY ROAD - Health (2) o
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�r ASSESSORS MAP N0: �'� ��
F
No.- -�'-- " i� PARCEL NO: ,J14�'- ":Z Fee-�S----------- - -
BOARD OF HEALTH
TOWN OF BAR.NSTABLE
Application forlVell ConstructionA9ermit
Application is hereby made for a permit to Construct (v, Alter ( ), or Repair ( . )an individual Well at:
/O '�I s 7- �Q H �ap� tV sT�rv�c�
---- ------- - - - Y - -- --- �=- - - - - ----- --- - -- ----------------------------
Location — Address Assessors Map and Parcel
/�j�clQ a /�ie�le /aG 6WSr j% �P9 Gu'� �rtcc
- - - ---------------- - - ---- --— --------------------------------------
Owner [ Address
��cc.rh T �'® a 7 w as G
-_ ---- -— - - ------- ----------- `-------- _3----- - ----
Installer Driller Address
Type of Building
Dwelling — — -----------------------------------------
Other - Type of Building --- No. of Persons-------------------------------------------------------
r`aSc/ ~0(D �y� ----------------- Ca acit IS-1' ''PA5
Type of Well— --7',e ----;-------- - -— Capacity--— --------------------------------------------—
a---rosc�
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 Certificate .of ompliance has been issued by the Board of Healt .
Signed -- — -------- -- -- - --- - — - - -� �-��-- --
date
Application Approved By e ` -
date
Application Disapproved for the following reasons:------------------------------------------------------------------------------------------------------
--------------------------------- - ---------------------------------- - --------------------------------------------------------------
/// date
Permit No. ------------- Issued ---- -- ---------5 —------------
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
(Certificate Of Compliance
THIS IS TO CERTIFY, That the Individual Well Constructed (,%� Altered ( ), or Repaired ( )
Installer
at--1 -b �.� V l -L 1 CJ + l _ [/<_���--------------------- - --- --
----
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-------------------------------------------------------------------------
I ( '
BOARD OF HEALTH
TOWN OF BARNSTABLE
Applicat ion-*r Vell Congtruct ion Permit
Application is hereby made for a'permit to Construct (v, Alter ( ), or Repair ( )an individual Well at:
- - -- - v- -=-- —
Location — Address Assessors"Ma and Parcel
- - --------- - - - - - y
........ --------------------_--
Owner C Address
Installer — Driller Address
Type of Building
' Dwelling — — ---------------------------------------
Other - Type of Building ------------- No. of Persons------------------------------------------------
Typeaf� ti JG Ji C5 °C_.__ i1�." f�17t S
,� r�,2_c�Q ridsv apacity-- �----------------------------------— -----of Well----------------.-�--:------------------------------ ------ C
Pu. ose 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 ar Certificate .of 5ompliance has been issued by the Board of Healt .
Signed - — -- -- - --- -----
date
Application Approved By.
date
Application Disapproved for the following reasons:--------------------------------------------------------------------------------
-- --- ------- ---- -- ----------------------------------------------------------------------------------------------------------------------------------------
date
Permit No. --------- Issued --- -- - s "- --'Grf
date
....+r,+i�..a.rw.w..r...Iwo:Iw+•,00tw<�•..w�na.os.r....w.�r.i►wir�arawacrnrt�rer .. _ - ...... .. .... �x...r.-K+�r'- r � ...+.r...�' ..
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certifirate ®f Compliance
THIS IS TO CERTIFY, That the Individual Well Constructed (d Altered ( ), or Repaired ( ).
by---------- ' Via`=-. --------------------------------------
Installer
at- _ - `--- - '= ' +�/°/�r --------------------------------------------------------
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection
"-I -`- ` Dated Regulation as described in the application for Well Construction Permit No ------ --- -- f
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
f
DATE--------- ----— — -- Inspector-------------------------------------------—— ------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Ivell Con5truct ion Permit
No. �
h
Fee--
�' -! -�
Permission is hereby granted--- ��---���-�----�- --------------- ---- -------------------------
to Construct ( Alter ( ), or Repair ) an Indii4idual Well at �+' f
Street
as shown on the application f r a Welt Construction Permit
No. Dated--- "� � ".'- -----------------------------
Board of Health
DATE
Desmond Well Drilling, Inc.
Cape Cod Test Boring
5 Rayber Road P.O. BOX 2783
ORLEANS, MASSACHUSETTS 02653
(508)240-1000
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