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HomeMy WebLinkAbout0441 PARKER ROAD - Health 441 PARKER ROAD f I West'Bdmsiable A 176_ 025 t N a j 4 , 1 d No. 4210 1/3 SLU C1 psndo a--Dvosm ESSELTE 10% a 0 v o 0� �-( No. � Fee BOARD OF HEALTH / TOWN OF BARNSTABLE V/ Ytcatiou ffor Yell ougtructiou permit Applications/is hereby made for a permit to Construct Alter( ), or Rya/ir() .. an in3i-,v-idual well at: Location-Address Assessors Map and Parcel l I 1 acn\,c (-vs u i CV k !�. 1� e Owner Address I staller-Driller Address Type of Building �J Dwelling Other-Type of Building No. of Persons Type of Well �y� ��"� / Capacity Purpose of Well t4 " Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well yasn Regulation-The undersigned further agrees not to place the well in operation until a Certificate o C m ian aiss ed �1he Board of Health. Signed �� Date Application Approved By l;-- 3 (`f Date Application Disapproved for the following reasons: Date Permit No. ldV �G I �! Issued Date --------------------------------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individuV),Ak ell Yonstructed( ), Altered( ), or Repaired( ) by // Installer �� at y`� �C ��,�/ d,) has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protect'on Regulation as described in the application for Well Construction Permit No.W aoiy- 03°1 Dated la -3--1 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION (N SATISFACTORILY. Date 2 _ '`) Inspector No. V'' y"61 Fee LI BOARD OF HEALTH TOWN OF BARNSTABLE ZIPPYication -for Yell ott.5truction Permit � Application is hereby made for a permit to Construct Alter( ), or Repair( ) an-individual well at: q)aV Lov�12ocl Cl -_76, - O_�2_� Location-Address --Assessors Map and Parcel Owner Address �111 C CA-10--o �.��,I staller-Driller Address - \ Type of Building (� Dwelling , Other-Type of Building No. of Persons YP g 4 Type of Well �y 4b -� / Capacity Purpose of Well " Agreement: I The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private W Signed Protectio'�Regulation-The undersigned further agrees not to place the well in operation until a Certificate of COMD1>ann ee h1ass b n issuedIby the Board of Health: 10- "7 4 Date Application Approved By ' 3 " (/ -_, Date Application Disapproved for the following reasons: Date Permit No. r'o I L( -I Issued Date BOARD OF HEA-TH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed( ), Altered( ), `or Repaired( ) by ( >n_� Q , /I Installer at Y`4 ( r has been installed in accordance with the provisions of the To of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No.W d oiL(- 039 Dated 1� -3-1` THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date 2 _ 3 ' , ( Inspector _._ P BOARD OF HEALTH TOWN OF BARNSTABLE Velr �Cougtructiott PermitNo. WOO�� �� �63� Fee -I Permission is hereby granted to /_ �, t staller to Construct ), Al No. q qter( ), or Repair( an individual well at: Street '' II 2 as shown on the application for a Well Construction Permit No.Wa 0 O- 031 Dated '3 / Date 3 ��� Approved By 0 c, v 0 V- VACANT Q , / 4" I 0 `� Ln DRIVEWAY EASEMENT I 1 � I 1 � PROP. WELL— � I I I .\ / L I I EXIST. DWELL. #441 EXIST. WELL TO BE ABANDONED CP 0 \ �o \ POOL AREA \ \ EXIST. i . • C MAN CB FN D ��TH� SITE PLAN SHOWING PROPOSED POTABLE WELL FOR 441 PARKER ROAD WEST BARNSTABLE .- tiN of�r ----�s + PREPARED FOR ','''CL G\a JILL JENKINS off 508-362-4541 `� fax 508-362-9880 41 C�LI;`!_A u, I downcape.com © NIA.4..-j;:'c0 g DULY 23, 2014 down eepe engioeefing ioc. ;. o civil engineers I-,���2�►`I Scale:1 "= 40' land surveyors 939 Main street ( Rte 6A) DATE DANIEL A. OJALA, P.E., P.L.S. 0 YARA40UTHPORT MA 02675 20 40 60 80 100 FEET