HomeMy WebLinkAbout0139 MEADOW LANE - Health ezAcQou-> btl
No.— _ Ty 1 S Fee——2
a
BOARD OF HEALTH
TOWN OF BARNSTABLE
Zppritation-for Vell Con5truttionpermit
Ap lication is he eby made for a permit to Construct (k�, Alter ( ), r R pa' ( )an individual Well at:
1-7
Location — Address Assessors Map and Parcel
a ;� 2---,5-
Owner Address
Installer — Driller Address
Type of Building
Dwelling— - - - -—-----------------
Other - Type rBuilding No. of Persons------ - --- --—---
2 —_—_-- --Type of Well_�!��'--- - - - ---------------------- Capacity----------------------------------------------------
Purpose of Well--�k��`-- -r----------------------
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 u a erti�t of o liance has been issued by the Board of Health.
Signed - -- -== --------------------------------------- �� to- —
—� -
Application Approved 13 — ' 4
------- —_----- — -- 3
date
Application Disapproved for the following reasons:--------------------------------------------------- --- -------
date
Permit No. �_ _ -- -- - - Issued---------------- - --- -- -------- —
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certifirate ®f Compliance
THIS IS TO CE*TIF)�,Zh t e I dividual Well Constructed ( tered ( ), or Repaired ( -
bY— — ��JJ_ _ __!' '�� —- ----------------------------------------------------------------------------------------------------------------
J Installer
at 13n ^ea 'v)
------ --— —
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Pr to' nU
Regulation as described in the application for Well Construction.Permit No.W CC y-/=5-Dated Iq )
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE Inspector-----------------------
------------------------------------
No.-� - Fee--
BOARDOF HEALTH
TOWN OF BARNSTABLE
Application-ftVrIt Con6tructionpermit
Application is hereby made for a permit to Construct (�), Alter ( ),_or Repaii ( )an individual Well at:
�, ---------------1 11-I-----------
----------------------
Location — Address Assessors Map and Parcel
Owner Address
0 tT`C.�
- - -- ---- - _- ------------------ - - - - -- - - --
Installer — Driller � Address
Type of Building
Dwelling------ - -------------------------
Other - Type of Building -----____------- No. of Persons-----------1------------------___________________
Type of Well_ e''d __ -- -
Purpose of Well----l� --- Capacity---------------------------------------
'-----------------------------
� 1�- - ----------------------
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 erti ' at of o pliance has been issued by the Board of Health.
',�
Si ned -- - - ------------
Tate
Application Approved By e- -- =-- - - =--- - — /�131 f9-----------
/- date
Application Disapproved for the following reasons:---------------------------------------------------------------------------------------
-------------------
---------
--------
---------
----
---------
----
---------------------------------------
----
-----------------------------------------------
+ date
Permit No. -——! Q - �j - - Issued -------- / '3 -1 f - ------- —
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
(Certificate Of Compliance
THIS IS TO CE TIFF•i hat e dividual Well Constructed (LZ/Altered ( ), or Repaired (�)—
e --� 5 _ �_�' ____ _ -=--------------------------------------------------_-------------------------------------------
_ Installer
at-------- -3 �Q vJ -La v- -htj Sa-- -_` r`�` > ''-- —------------
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Pro tectione�
Regulation as described in the application for Well Construction Permit No.w-c1 y--/5----Dated-----�-�3��--- f
e
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
Ivell congtruct ion permit
No. ------1--�s- Fee------�r------------
�J;- b
Permission is hereby granted -------------------------------------------------------------------------
to Construct (—);Alter ( ), or Repair ( ) an Individual Well at:
No. ---3-�� - M�� �_41�-1_— , „�'_ t—----- G_r/lSi ----------------------
------------------------
Street
as shown on the application for a Well Construction Permit
No.-- - - 1—�`�------ ---------------- Dated--------L/ -13 T - - - - - -
`- - ---J -� ----------------------------
3�C� Board of Health
DATE--------�------!--7--------------------------------------------------------
TOWN OF BARNSTABLE
LOCATION mtc-t�g,-O L.,;i SEWAGE #
VILLAGE ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY ' SO
LEACHING FACILITY:(type) l (size) ��k q6 ,
1C�
NO. OF BEDROOMS / PRIVATE W_ LL OR PUBLIC WATER
BUILDER OR OWNER `am k�e,
DATE PERMIT ISSUED:
4
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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TOWN OF BARNSTABLE
BOARD OF HEALTH
C ROL OF TOXIC AND HAZARDOUS MATERIALS - SPECTIO SHEET
FIRM Ad
ADD G. RE3S-_.�
Major types of materials: 1) 2) 3)
4) 5) 6)
I. Description of material(s) use: .
II. Storage (denote product by number list above) _
A. Containers metal glass paper -. lastic
cans,bottles,jars
l
Ar
drums,barrels C
aboveground tanks ]y 7"
underground tanks \,
bags,boxes
open,loose,uncovered
inadequate labelling
B. Storage -Facility ✓or"# Remarks/Recommendations
1. Indoor
a) separate, contained room
i b) stored in general work area
inadequate ventilation
ii)--floor drains i0
inadequate: fire- protection
2. Outdoor
a-)�: uncovered, exposed .to weather
1 j4 pervibus-surf ce cat H?basins:
III-. Disposal- '
A. Reclamation/Recycling unit
B. On-site disposal
1. Town. sewer
2. Regular septic system �. !
3. Separate holding tank
C. Off-site disposal
1, hauled by own firm
2, hired hauler '
a) name of hauler
b) address or disposal site
Person(s) Interviewed _ 4 Inspector- .. 41V
� ',. '�" Date � D - - - --- - - - - -
. 1- - - - - -