HomeMy WebLinkAboutFieldstone Dr. #46 - 10/28/2014MANSFIELD BOARD OF HEALTH
APPLICATION FOR PERMIT TO DRILL WELL
CT 2 7 2014
v �y _
Address; (�1 ` C 0,5 e J'9✓' Telephone
Location: °'9C -4 4�?T -F rc.'" e-e-c' 6
Registered
Well Driller:
Address:
TYPE OF WELL:
Domestic Potable (for household use)
_ Domestic Auxiliary (for watering, pools, etc.)
_ Industrial/Commercial Potable (for human consumption, including food processing)
Industrial/Commercial Auxiliary (for manufacturing, etc.)
Agricultural (for irrigation of land in the business of agriculture) _
Fee: _ Domestic $75.00 Industrial/Commercial $75.00 grriicuu tu�ral $75.0
Date: 6 Applicant Signature:
PERMIT TO DRILL WELL
The above applicatio ;has tleen approved and permission is granted to drill a well for the
following use at
_ Domestic Potable (for household use)
Domestic Auxiliary (for watering, pools, etc.) .
Industrial/Commercial Potable (for human consumption, including food processing)
_ Industrial/Commercial Auxiliary (for manufacturing, etc.)
_ Agricultural (for irrigation of land in the ess of agriculture)
Dater 'Ll 'Z "), ( Approved by:
r the Board of Health
NOTE. Electrical permit required, underground cable trench must be inspected.
Upon Installation of well, call Department of Public Works office at
261- 733 0 to be added to well list.
NOTE.- +
WAIVER FROM COVAANTS REOUIRED
FOR CUTTING OF TREES 8 VEGETATION
WITHIN /O' OF THE PROPERTY LINE.
.'' 139.60'
q.ERTIFY THAT. THE PROPOSE
DWELL;Wr, CONFORMS TO THE /. WN
O;t; iNANSFIELD ZONING -BY-LAWS
Of
LOT 36
30,014 S.F.
�' r
�
I'b.20?xS /
flFclsrEa�°
FSSIpNAI CN
µ OF 44s�
JL
yw
3
t
N
40'
24'
i
J I28:
O
28- PROP. HSE,
GAj�24
.�
J
`
I
I
� 3
1 M Top of FND-
oJ
/134-5
i
70'
� I
17.7 • c>
EDGE OF PAVENEN7'-)L 139, 60'
FIELDSTONE(5o' WIDE)
DRIVE 4 1 9Z- t23. 4
SEWER LATERAL AS INDICATED
.ON APPROVED SUBDIVISION PLANS.
OWNER:
0 BRIEN 8 MEEKS CONSTRUCTION
- SCALE:
1" = 40'
DAT£,•
7116193
�q4 NY.p1�ER
-A$2_048
P.O. BOX 2159
PLAINVlLLE, MASS,
Hutchins Trowbridge Associates Inc,
ASSESSORS MAP; 34
QIVL ZWK M MW BLRVEYORS 'L4W PL4AWR5
PARCELS: 103, 104, 106 8 /07
HU.TC1jNS-,.fR0*49RIDGE. ASSOCIA.TES..INC, .
.
20p .CHAUNCY S'7'REET MANSFIEL.D,MASS
TYPE OF WELL
Domestic Potable (for household use)
_ Domestic Auxiliary (for watering„ pools, etc.)
_ IndustriaUCommercial potable (for human consumption, including food processing)
Industrial/Commercial Auxiliary (for manuf during, eto.)
,Agricultural (for irrigation of land in the business of agriculture)
f+ee: _ Domesfle $75.00 Industrial/Commercial $75.00 gricu tural $75.00
Date: 6 7i Applicant Signature:
PERMIT TO DRILL WELL
The above applicatio has bemt altpm ved and perriaissiarI is granted to drill a well for the
following use at n: itSG tTisti`CC `
Domestic Potable (for household use)
] / Domestiio Auxiliary (for wAtcring, Pools, dc.)
Industrial/Commeroial Potable (for human consumption, including food processing)
_ Industrial/Commercial Auxiliary (for manufa ng, etc.)
_ Agricultural (for irrigation of land in the as of agriculture)
Dato, Approved by:
r the Board of Health
Nt)TE. E'ec&kat permit required; underground cable trench must be ii "Wcted. .
i7pon Installation of well,. call Department of Public Work,F office at
261-7330 to be added to well list
aadaNVIS 3QOW
NO i-inS3N
Z0 (S)39Vd
99:00:00 N0I1vNna
GZ99VVGIBLIB 3WVN/'ON Xtld
6b:b1 8Z/0T 3WI1`3iVa
50PZZENE000LZ9n ft'd3S
_131
Xdd
3WCN
09:bT PTOZ/8Z/OT 3WI1
1NW38 NOI VOIdId3A NOISSIWSNVdi