HomeMy WebLinkAbout1575 MAIN ST./RTE 6A(W.BARN.) - Health 1575 MAIN ST.
WEST BARNSTABLE
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No.VO l_y - f. Fee---- --------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Applitation,forVell Con5truttionpermit
Application is hereby made for a permit to Construct Alter ( ), or Repair ( )an individual Well at:
Location — A dress Assessors Map and Parcel
Owner _ — Address —
-----
—Installer — Driller Address
Type .f-Bttrldirtg�
Other - Type of Building-- ------ No. of Persons------------�__---_-___
Type of Well A40h12/E --- Capacity-----------------_--
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 a Certificate .of Compliance has been issued by the Board of Health.
Signed
_--L ate e
Application Approved By ` -— F! 7- _-��-
te
Application Disapproved for the following reasons: -------------- -____-- -_-
_ date ----
Permit No. -- Issued--- ------------------ - -----
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate (Of Compliance
THIS IS TO CERTIFY, That the Individual Well Constructed (-), Altered ( ), or Repaired ( )
by-- - ---
InstallAr
at ZVALI�l
Z
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. ---------------Dated----- --------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE - Inspector------------------- -------- -
No. V0 ° Fee---
BOARD OF HEALTH
TOWN OF BARNSTABLE
�I [icationlorVeii ConoructionVermit
Application is hereby made for a permit to Construct Alter ( ), or Repair ( )an individual Well.at:
1 Locatio dress --- — Assessors Mae and Parcel —
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-------- ------- ---- --------------------------------------- ---- -------
Installer — Driller Address
Typ,of-Buii-din
( Dwelling— — ---- -- --- --
Other - Type of/Bui`lding— ------ No. of Persons----
Type of Well Awls U/�L_— — 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 Compliance has been issued by the Board of Health.
Signed - —t -� --- -- ! --
�,Q ate .�
Application Approved By ` J r
to Si
Application Disapproved for the following reasons: ------------- ------- --
- -- -- -----_---- date --_-
Permit No. — Issued------------- --------- -----------
date
` BOARD OF HEALTH ,_
TOWN OF BARNSTABLE
Certificate Of Compliance
THIS IS TO TIFY, Th the Individual ell Const cted (Altered ( ), or Repaired,(by
)
�" ell I
In al e',
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. ---------------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
Well Con5truct ion Permit
No. 4(jd l-4(3 Fee— `—,—�--
Permission is hereby granted
to Construct (/),"Alter (" -), or epair ( ) an Individual Well at:
No.
street
—
as shown on the application for a Well Construction Permit
r/ ,
No.- (.t/ &W /-y3 — _ Dated ------------------
---- -
DATE ZG/T.Q7J� -- - - - — Board of Health
__
Barbara A. &
BARNSTABLE Donald . o ers k 1293 240
Laid1» ............................................. .. ..................... 8elonging to ............................. .... ............ Deed in Boo ............... Page ........
Barnstab Registry..Certificate No. in Book Page. On ..
of.Deeds
Land in Barnstable by Nelson Bearse & Richard Law,p urve ors Sept. 27 960
RecordedPlan .............:.................. ...... ..... .... ................... ... ate of Man .................
Barnstable of Deeds, in
in ........................ Registry.............................plan Book...185.......No. ........... Piled Plan No. .....................................
t
MORTGAGE INSPECTION PLAN THE MORTGAGE COMPANY OF THE -,CAPE 8 ISLANDS
Loan No. Donald S. & .Barbara A. Rogers
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LOT 3 . . LOT . 4
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f Oct. 27, 1986
J.4 50913
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CERTIFY THAT THIS PLAN WAS PREPARED
IN ACCORDANCE WITH THE COMMONWEALTH
OF MASSACHUSETTS PROCEDURAL AND
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