HomeMy WebLinkAbout0074 NYES NECK ROAD - Health (2) 714 TA e5 V�e-CY- Road
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No. Fee
BOARD OF HEALTH
TOWN OF BARNSTABLE
01ppYication ,for Yell Construction Permit
Application is hereby made for a permit to Construct , Alter( ), or Repair( ) i an individual well at:
23'316t1
J Location-Address Assessors Map and Parcel
Owner Address
Nsm" \f-40\ D A� k h(- 9-0 a 8OL 20 15-3 h-V\ o?-GS3
Installer-Driller Address
Type of Building
Dwelling
Other-Type of Building No. of Persons
i1
Type of Well LA S Lj 0 Capacity I
Purpose of Well Pdm)o
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 Certifi ate of Compliance has been issued by the Board of Health.
Signed KU
i3 zZ
Date
Application Approved By
Date
Application Disapproved for the following reasons:
Date
Permit No. W 9 Issued ✓�
Date
------------------------------------------------------------------------------------------------ -
/ BOARD OF HEALTH
VVV TOWN OF BARNSTABLE
(Certificate of Compliance
THIS IS TO CERTIFY,that the individual well Constructed, Altered( ), or Repaired(
.V V )
by k _mo d 1 1` "��IVU_
y, � ` (' _ Installer
at y Iv ltvS JiQ_c� y CI)n&tV\\\P,
has been installed 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
No. _„ Fee
BOARD OF HEALTH
`n
TOWN OF BARNSTABLE �t
01ppYicatiou _for MeU Construction 3permit
Application is hereby made for a permit to Construct( Alter( ), or Repair( an individual well at:
Location-Address Assessors Map and Parcel Q
a,\\6 �Arcmbo t,�,2 .t\1Q D f',
r
Owner e `� Address
Installer-Driller J / Address 1
Type of Building
Dwelling
Other-Type of Building No.;of Pers w-onsl/
tt �j �—
Type of Well LA S OA H 0 INC., Capacity qpwl\
Purpose of Well P65' 6l —
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 Protectlon,Regulationf-Theunderslgned further agrees not to place the
� I f�R f
well in operation until a Certificate of Compliance has been issuedrby the Boardrof•Hea. h.
Signed �� i t �o 131 2e
4�l Date Application Approved By CO/, f q 27•.`
Date
Application Disapproved for the following reasons:
�A� Date
Vv
Permit No. 7,0 -""- r Issued ("
Date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate of Compliance
THIS IS TO CERTIFY,that the individual well Constructed°(v), Altered( ), or Repaired(
` J Installer
at U.p C �t�t �c . cjg=C - C'j\, \Q. 5 `;
has been installed-ill 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
----_------___---------______. --- --------- a ----_ ------------- --.--_ --------- ---_ --- --------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Yell Cori.5truction 3permit
No. Fee
Permission is hereby granted to A>P,A1-n t1 I p-(� r'i �'q I Y\<..
Installer
to Construct'( , Alter( ), or Repair( an individual we:11.at:
No. -1 4 N VX,( L�4ck IRA, C P-�t'y i\\,L
e Street
as shown on the application for a Well Construction Permit No. 2p7, Dated
j r
Date rc) 1 ILf Z Approved By
W
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13 �
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VILLAGE C,rz'i�<Tci��= ASSESSOR'S MAP & LOT 23 - b I1
INSTALLER'S NAME & PHONE NO.
SEPTIC.TANK CAPACITY:.
(size)
LEACHING FACILITY:(type)�' I�
NO. OF BEDROOMS o PRIVATE WELL OR PUBLIC WATER
BUIL
DER OR-OWNER �'_ �-� �� 60Is
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
rt 74 N es Neck Road
Property Address
Mary Jane & Richard Bettis
Owner Owner's Name
information is Centerville MA 02632 5/13/15
required for every State Zip Code Date of Inspection
page. CitylTown
D. System Information
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
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t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17