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Home My WebLink About0265 COMMUNICATION WAY - Health 265 COMMUNICATION WAY Barnstable A= 314 - 044 a i No. W Q0 1 Q Fee J BOARD OF HEALTH TOWN OF bA-RO`NSTABLE 01ppYicatiou _for Yell n5truction Vermit Application is hereby made for a permit to Construct( , Alter( ), or Repair( ) an individual well at: - 6 A 315 two vL 1 _ Location- ddress Ass ssors Map and Parcel Mc�c Owner rAddress Z'VZ � h�fl yyI n ION IAII & 0--e �O �� ►2� Yew S� k►� Ins er-Dri er Address V L I Type of Building Dwelling Other-Type of Building No. of Persons Type of Well �/�� v L Capacity 136 6 P►' l Purpose of Well ?V ri 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 P tectio Regulation-The undersigned further agrees not to place the well in operation until a Certificate of Comp is a as n issued the Board of Health. Signed Date Application Approved Bc� Date Application Disapproved for the following reasons: Date Permit No. W� �c)( Issued �` I Date -------------------------------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed �, Altered( ), or Repaired( ) by AL(_ AE& JillF— L� Installer at 2� e-e)yw1nu—n1'cC,,J1 !S has been installed in accordance with the provisions of the Town of Barnstable Boa of Health Private Wel Prp tection Regulation as described in the application for Well Construction Permit No.\;' � 0— Dated D Il0 I I q THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector No. W Fee r BOARDfOF.HEALTH TOWN OF SAVONSTABLE Zipprication ff or Yell 0onfStruction Permit Application is hereby made for a permit to Construct(0 ` Alter( ), or Repair( ) an individual well at: Location- ddress / Assessors Map and Parcel MC',t t o yT nV p r! Val Owner Address HPV4_V tIarvl+?Cl n / f/1�� -PO .• k��y Installer-DriJl'er Address Type of Building Dwelling Other-Type of Building No. of Persons r Type of Well �/" 7 V C- Capacity Purpose of Well 7^Y Y l q C,_ -4 V1 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 Comp ianEe�h`as b/&n issued y the Board of Health. Signed ( GrC,Qr, ` Date c� Application Approved B Date Application,Disapproved for the following reasons: Date Permit No. q. �' - �.. Issued Date '> —om_se-o veo----- --Q =—_m_.._--_. B------HEALTH ----------------..wee=_e-4-4a—o4—__4---- --- OARD OF TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed(_,);" Altered( ), or Repaired( � by ALL e A E E I MAi r- 1-�--' Installer I l at 02( l c�✓Y711'1Gt i7� ( �c_t`: c, `'t Vl//,c fJ has been installed in accordance with the provisions of the Town of Barnstable Boareof Health Private Well Protection Regulation as described in the application for Well Construction Permit No.X Y a Dated Q hD THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector .+,►�..........m.....,��...�iw..r..m.�..rry,>�.►r.+w�.oy.�eAr+wee-..w.+pw�a!�rnt..s..mo-r�ar®®�-...ram,»ra..6.a.mw«owd..w.a*r .s,.�.� ...�w ..�r.i•.+.�...r�or�.:e:.�.s. j BOARD OF HEALTH TOWN OF BARNSTABLE Vern Construction Permit No.' Fee 1 ) Permission is hereby granted to / ,! 11 &(_1)r_ We e v Installer to Construct Uy Alter( ), or., Repair( ) an individual well at: -` 1 No. f'1!CGL_ 4t6Vj 1A�� fJuV/1 �s��. Street J c I[[ •° as shown on the application for a Well Construction Permit No. ti € '- C � Dated t 1 PI Date I Approved y -�r `�, `'.t% �Gn y°�v-}✓ �gtNbE'�;,�*�c t 1 ,Kc a.a� � \ ��_ � rF' " �'. � r t ..� t�SgyCi 7��•,6 S:t ^5 � ,�\ _ t � ��it i.. *tS .,• 1.. .ate c•,.ac:An .�� 5 9�L•l YNG,zssJ `otsG cuss " 44 vu a,. -txc tPrtef,w tY.�55�tE.As��N ,'`.. � tea t G t �knr PA+J �, •�,� .. 1 {• 2;C a F i ✓ r �1 ,'} t � '+. \ �."". .•�. `��moe.i�R.r_.nx: tnFii�rb..io�as:.�Nar i t4 ` A/ - s• s.T: �,:. ., :va.e^tee x�ut: uR+ru+uk trt5 t s x _•_. ^2�G L '�vrea�v `.;r dz '.�: ,. ` vx�-Ermw: �vra=,r�vF i• ... - „,3"�`.4r:-. .._.,._,_ ' X5G vYcic ru ��"t'ti a 4 C''�•4a�F��r �� - � a,,,tcSD�P��p��Gti:. ... �.. .> . _ ... a ;t Wednesday, Feb 06,2019 08:59 AM MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM *In accordance with M.G.L.c. 186, §22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation (State Sanitary Code Chapter II),the following dwelling unit is eligible for the imposition on the tenants of a charge for ! 1W water and/or sewer.service.. PROPERTY INFORMATION Address. cdi� Unit# IrD #Of units in NJ Git /,ToLvn: M9...... i ':,Codpt EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition ontenants of a.charge for water and/or sewer.-T'he devices must-meet the following specifications - m Showerheads with maximum flow rate not to exceed 2 Y' allons.per minute(2. ;gpm) Faucets with maximum flow rate not to exceed 2 vi gallons per minute.(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6/10 g'almns per flush(.l.6 gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A licensed plumber must install the water closets and submetering equipment. Submetering equipment information:;; 17 t/,✓srx Manufacturer........ Model#. .:._.. Licensed Plumber Certification rC2 Print:Name of Plumber License# I certify that(check all that apply): KI have installed the submetering equipment listed above in accordance'with accepted plumbing standards. I have installed`one or more water closets not exceeding 1.6 gallons per flush. 4 Determined that existing water closets do not exceed 1.6 gallons per flush. ,•• 3 The plumbing permit issued by the city/town,if required,is attached. Dwelling unit is connected;directly to:a meter installed by.°a water company and,in accordance with M.G.L.c. 186, §22(p),does not require thd.in"stallation'of a subtheter Signed under the pains and penalties of perjury, Si natufe'of Licensed Plumber Property Owner Certification I certify that:(1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186,§22);(2)All showerheads,faucets,and water closets in this dwelling unit are water conservation devices that meet the standards specified above;(3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above,or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in M.G.L.c. 186,§22; (4)The water meter or submeter measures the water usage exclusive to this unit;(5)I will provide to the tenants of this'dwelling unit,prior to occupancy,a written rental agreement that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification form;(6)That all information included on this certification is true and accurate to the best of my knowledge. Signed under the pains and penalties of perjury, Gary Kerr- Vice President 5/22/2 19 Print Name of Owner. .: Date. , .. . Date S �, The property has been transferred to owner above and the unit Received ZZ 19 remains,in compliance with the requirements of.M.G.L..c. 186,.§22. Date: BOH: 1/61 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBM ERING MDPH-CSP Submetering Form,Rev 1T 4-16