HomeMy WebLinkAbout0459 WIANNO AVENUE - Health (2) rYtaf
No. Fee
/ BOARD OF HEALTH
TOWN OF BARNSTABLE
-=-
Ti ppricactiou -for Yell Cougtructiou Permit
Application is hereby made for a permit to Construct( Alter( ), or Repair( ) an individual well at:
ocat,on- ddress �� ( R Assessors Map and Parcel
ner / Address
Yv j '� 1t-1r.1S k ►J1Lla�7S
, ✓� Add �Cr��Installer-DrillerOri + Try
Type of Building /
Dwelling
Other-Type of Building No. of Persons
Type of Well PVC-1 C14 Capacity
Purpose of Well 2 adA-r100
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 Protection Regulation-The undersigned further agrees not to place the
well in operation until a Certificate of Com liance has been issued by the Board of Health. �
Signed �—�--
Date
)J)
Application Approved By '-W /� Z
Date
Application Disapproved for the following reasons:
Date
Permit No. Issued
Date
------------------------------------------------------------------------------------- -------------,I'
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate of Compliance
THIS IS TO CERTIFY,that the individual well Constructed(Altered( ), or Repaired( )
by1✓ � ,--
, i Installer
at '09 ')t kq Q tJ7 Ay
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 SATISFACTORILY.
Date Inspector
t
No. Ar�I d '� —� FeeOF
/
TOWN OFARD BARTNSTABLE --
2pplication or4err Construction permit
10
Application is hereby made for a permit to Construct Alter( ), or Repair( ) an individual well at: S
114
Wt �)QQ0 Rove ry�-P i La�;) f7
r-�
Location-Address I �' t ,� Assessors Map and Parcel
Address
Installer _
Installer-.Driller t Address o
X)r ) t i
Type of Building
Dwelling
Other-Type of Building No. of Persons
Type of Well ,,• Capacity
Purpose of Well �.�
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 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
Date '
Application Approved By _
Date
ti
Application Disapproved for the following reasons:
Date
Permit No. Issued
Date
ti
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate of Compliance
THIS IS TO CERTIFY,that the individual well Constructed(t) Altered( ), or Repaired( )
by
b r Installer
at 1 1 1D NJ—)
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 SATISFACTORILY.
Date Inspector
-----. - -- .�-.-.- -- -` +J�-----.---'.-.----------.----.--.-.--..-----.--.-------- ----.-V.-.-.-
BOARD OF HEALTH
TOWN OF BARNSTABLE
Ivell Con!6tructiou permit
No. .�nta °c� ? .�1� Fee
Permission is herebY.g ranted to . G�)~ ty, AAP ✓l.�_
:
Installer !
to Construct( ), Alter{ ), or Repair( an individual well at:
No.
Street
as shown on the application for a Well Construction Permit No. t; u)) L/ Dated f �
Date '" >1 :� Approved By °L--'
t . n LTV-
4
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Total Area
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Elev. 22.51'
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Water and Sewer Lines �
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/ �- w I,
Sept+e-= PSI pressure pipe.
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