HomeMy WebLinkAbout11-12 FLUME AVENUE - Health LA
= 12 FLUME AVE
RSTONS MILLS
=
No. - ---- --- ----- BOARD OF HEALTH Fee--- -----------------
TOWN OF BARNSTABLE
Applicat ion-*r Melt Congtruction3permit
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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ner
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Address
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Installer — Driller Address
Type of Building
Dwelling-------------------------------------------------------
Other - Type of Building----------------------------- No. of Persons-------------------____—__—_—__
Type of Well—�� �J C —-----------J----— -- - Capacity-— - - —-- -------------------------
Purpose of Well--!!it�o °''`---°— --�'-------
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.
Signed — At
Signed
te
Application Approved By — ---
/ date
Application Disapproved for the following rea -------------[-------------------__--___—_
— ---- - - —-- -- — ------------------------— - -- _ __--__-
date
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--- Issued—=— -- -—
Permit No. —RJR - ----------------_—_--
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
C ertif sate ®f Compliance
THIS IS TO CE 4IFY, That the Individual Well Constructed (�, Altered ( ), or Repaired ( )
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by----------- ( ",----//--- ------------------------------------------- —-----
-
Installer - - —_--- ----
has been installed in accordance with the provisions of the Town of Barnstable Boar of ea rivate Well Protection
Regulation as described in the application for Well Construction Permit No.W-7 --- - -Dated----- ------
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 z ,N
TOWN OF BARNSTABLE
Applicat ion-for Vell 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 --- —— --- ----
r 'L sensors Map and Parcel
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n ( caner ' /� p q Adddress
l�__Installer — Driller. ,—--=�— — /_" 1 w, %'C o /Lt G{h 1't e
l -- - --- ---------- ----Address----- -------------------------„---
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Type of Building +
Dwelling,----- ----------------- - =-------------------
Other - Type of Building'•-,-- _____--------------- No. of Persons---------------------
Type of We11-�r �J c _ __ Ca acit
Pu ose of Well a—_,o
Agreement:
The undersigned agrees Ito'install the afore'described 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.
W Signed - ------- ------- Ai -�------
Q J date
Application Approved By _ - I'
------
date
",Application.Disapproved for the following rea
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„ Permit:No: - _^ Issued----- ------------------- ---= ---------- I
date
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BOARD OF HEALTH
TOWN` OF BARNSTABLE
Certificate ®f Compliance �
THIS IS,TO.CE TIFY, That the Individual Well Constructed (v), Altered ( ), or Repaired
by. - -0.A- --
Installer
at o ,
.has been installed in accordance with the provisions of the Town of BarnstableBoar ofjerivate 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 SATISFACTORY.
DATE—------------ -- Inspector-- —-- - _----------
[ BOARD OF HEALTH
1�
TOWN OF BARNSTABLE
Well Construct ion permit
No.. ------- - Fee- � --
Permission is hereby granted /Q A
to Construct (✓ ), Alter ( ), or Repair ( ) an Individual Well,at:
{ No. ICL�MA r GfJ !
k _
Street "
as shown o ,the plic for a.Well Construction Permit
No.-
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Dat ------^,-�a-------------------
DATE
Board of Health
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