HomeMy WebLinkAbout0315 WINDSWEPT WAY - Health (2) M//O
.
No.-- - -- Fee---em-- ----------
BOARD OF HEALTH
TOWN . OF .BARNSTABLE
Application-*rVell Congtructionpermit
Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( /an individual Well at:
A/ r it u)LL- - � -------------------------------------------------------------------------------------
Location — Address — Assessors Map and Parcel
— �iA — — Ma
-Q-i --y — -------------- �` =- L'— r? --------r�---- -jy 41_ima.am'
/VIF,6-4 Owner ^ l/ Address
MEEHAN WELL DRILLING
Installer — Driller + TT 9 e — —
Type of Building _ SANDWICH/C8)SACHUS 888 5458�S 02�6
---- ��' ----------------� Dwelling--------- ---------
Other - Type of Building------------------------------------ No. of Persons------------------------------------------------------
Typeof Well -� f� �� ------------------------------ 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 ertificate of Compliance has been issued by the Board of Health.
Signed- — - `" = --------- ------- --- ---- ---- -
date
Application Approved By--------- -- - --- - ` tte
Application Disapproved for the following reasons:---------------------------------------------------------_---------___--____________________—__
-------------------------------------------------------------------------------------------------------------------------
--—-------date - - --
Permit No.-------------------------------------------------------------- Issued-------------
— - -- ------ - - -- —-
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
(Certificate ®f Compliance
THIS IS TO CERTIFY .That the Individual Well Constructed ( ,'Altered ( ), or Repaired ( )
by - --- - - ----- C -- - -- --------------------------------------------------------------------------------------------
T7C' Installer-------
has been installed in accordance ith the provisions t e Town of Barnstable Board of Health Private Well Pro ection
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----------------------------------------------------------------------------------
Fee--
-
BOARD OF HEALTH
TOWN OF BARNSTABLE
ZipplicationArVell Congtruction Permit
Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( t4an individual Well at:
A ^ Location 2 Address Assessors Ma and Parcel f
--i.4 f/Z G+--- m L4 V'r k- ---- - t- �-- ^A 1l—_� f l`� Address
6 e� le&l:
A2 fJs !F
Owner
,c1/VE-60+
------------ - - "' f<r/�w, = J^t�-1� `� --------------------------------- - --— __——------
Installer - Driller v Address
Type of Building j /
Dwelling Building_______
S- --------------------------
Other- Type of Building------------------- No. of Persons-------- ------
Type of Well------Y-"---h l------------------------------- Capacity---------------------- ------------- —___-
Purpose of Well- a 'p- ,v M�----------- --
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- off Compliance has been issued by the Board of Health.
Signed
date �
--
Application Approved B � late ��--
Application Disapproved for the following reasons:------------------------- — ----
----------------- date- --`
- -- Issued- - --- -- -- - --— -Permit No.-----------------------------___________-- _
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate ®f Compliance
THIS IS TO CERTIFY n That the Individual Well Constructed Altered ( ), or Repaired ( )
bY- - - �.c �c------------------------------------------
---- - - - -- -- - ---
Installer
� --------------------
�Git -
has been installed in accordance h the provisions o the Town of Barnstable Board of Health Private Well Protection
Regulation as described in the application for Well Construction Permit No. - ,f�—��--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
Vern Con5tructionpermit,
No. ----�=- ---- - tJ Fee- _
n
Permission is hereby granted
to Construct (k, Alter ( ), or Repair ( . ) an Individual Well at- _
No. -_---_- _ w -t-j --
— m \ Street
as shown on the application for a Well Construction Permit
No.--- ---------- --- -------- Dated - --- ------ — -
Board of Health
DATE-----------------------------------------------------------------------------
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