HomeMy WebLinkAboutLorraine Way #3 - 5/1/2019�0
Commonwealth gfMassachusetts
Town of Mansfield
Mnse6 Park Row
Town qafild
f Mansfield, MA 02048
Board of Health
Application for Permit to Drill Well
NAME OF OWNER: G��s� l�G'c�7�i /Jf �J« R GISTERED
WELLDIRLLER: PAO
ADDRESS OF 0NER: MA LIC #:
Il s ✓� c.1 a L�� �-,�� L L �t _
TOWN / STATE / ZIP: �j /� % �� BUSINEADDRESs 5
TELEPHONENo:
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.)
U4eAgricultural (for irrigation of land in the business of agriculture)
FEE: ❑
Domestic$75.00
❑ Industrial/Commercial$75.00
❑ Agricultural$75.00
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DATE:
P%
APPLICANT SIGNATURE
'
Permit to Drill Well
The above application has been approved and permission is granted to drill a well for the following use
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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)
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DATE: I �\� \ APPROVEDBY^
111 Fo the Board of Health
NOTE., Electrical permit required; underground cable french must be inspected.
Upon installation of well, call Department of Public Works at
508-261-7330 to schedule an inspection.
PREPARED FOR: WALSH BROTHERS BUILDING, CO.
Boy Colony Group, Inc)
11 SADDLE WAY
Professional Civil Engineers &
WALPOLE, MA 02081
Professional Land Surveyors
508.668.3434
L-45.91"
d-8]'41'IB"
L=4.19'
53. 77' c=la>.JT
576' 26' 00
~_ R=3a0.00'
v / L=320.55'
L 4=61'1374"
b
R AINE WAY
R=250. 00'
I [�lbeb2, L=26Z 13'
4=6P1J'14'
L=9833'
d=9278'42"
10.0•_20'
Y—dabs 29' o ,✓0.
LOT 1 M CONc
34,681 ± sf
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LOT 2
32,826± sf
FOUNDA TION AS -BOIL T
PLAN OF LAND FOR
#3 LORRAINE WAY(LOT >)
MANSFIELD, MA
U Y4A S"
AUGUST J1, 2016 SCALE 1" = JO' J
2a�a`lN
alcr�nep l
BAY COLONY GROUP, 11VC
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PROFESSIONAL CIVIL ENGINEERS & LAND SURVEYORS
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FOUR SCHOOL STREET, P.O. BOX 91J6
FOXBO07035
(508) 508f 54 543-3939J9
l hereby certiry to the hlonspeld Buddi,, Comm/,boner that to the best or my ,of ..lon.l knowledge,
/Normalloo, and belie{ that the dwelling is /.toted on the ground os shown hereon and Mot it complies
with the svtbock re9uirements or the Zoning By —Laws of the Town or kf ns9eld
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