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Home My WebLink About0020 GREELY AVENUE - Health 0 Greely .Avenue Centerville P 246218 .,. III//(.GLiW `J�RFCYCIEO�,O � °1PC 12543 Ho.53LOR HASTINGS, MN �.r 2 3Zo COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS ' d DEPARTMENT OF ENVIRONMENTAL PROTECTION � i AUG 0 9 Z004 !off` TOWf,; .j. .,:,.. ABLE TITLE 5 1 HEALTH H _-r_I T. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION 5 Property Address: � L9 Glee Le 9 er✓, o— Oo2 G 3� Owner's Name: Ta r,e W Z ul ro h i t j, Owner's Address: I,✓es �� ,1Po� ,9 oa 6 9a2 Date of Inspection: r— Name of Inspector: lease print) GT✓ �S w rn Company Name: 4if-111/1 EG Mailing Address•• 0 O.X /ot �A thc,✓� Telephone Number: 5-0 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to.ZttawI5.340" of Title 5(310 CMR 15.000). The system: ses Conditionally Passes Needs Further Evaluation by the Local Approving.Authority Fails Inspector's Signature: Date: L110 i Lk� The system inspector shall sub a copy of this inspection report to the Approving Authorit y(Board of Health or DEP)within 30 days of completing this insp ection.If the system is a shared system or has a design flow of 10 000 gpd or greater,the.inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. 1 Page 2 of 11 ' OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address- O Cr r e e l re Owner_ A Z in o✓t 1 S Date of Inspection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. Sy asses: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist Any failure criteria not evaluated are indicated below. Comments: R- System Conditionally Passes: One or more system components as described in the"Conditional Pass"section n repaired The system, upon completion of the replacement or re need to replacedor pair,as approved by the Board off Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain:. Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain_ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: L0 N ✓ Owner: o h r Date of Inspection: C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is faihng.to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordancewiith 310 CMR 15.303(1)(b)that the system is not functioning in a.manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the.SAS is within 50 feet of a private water supply well. The system has aseptic tank and SAS and the SAS is less than.100 feet but 50 feet or more from a private-water supply well**..Method-used to determine distance **This system passes if the well water analysis,performed at a.DEP certified laboratory,for coliform bacteria and volatile organic,compounds indicates-that the well is_free.from_pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered A copy of the analysis must be attached to this form 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: v� ff- Owner. 6i Z'-1 ",715 Date of Inspection: // D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No ckup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or gged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or spool quid depth in cesspool is less than 6"below invert or available volume is less than'/z day flow _ l/ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number ,of tunes pumped . ,Any portion of the SAS,cesspool or privy is below high ground water elevation. v/ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface .water supply. �/_/An portion of a cesspool or privy is within a Zone 1 of a public well. �/_portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) no — th stem is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—I WPA)or a mapped Zone II of a public water supply well If you have swered"yes" to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: / eo 4 Owner': pf Gi Z !✓�h�f Date of Inspection: Check if the following have been done.You must indicate`!yes"or"no"as to each of the following. Yes o Pumping information was provided by the owner,occupant,or Board of Health Were.aay.of the-system,components pump oUin.the pious two weeks �,�Has system received normal Bows in the previous two week period — Have large volumes of water been introduced to the system recently or as part of this inspection Were as built plans of the system obtained and examined?(If they were.not avadabk note as N/A Was the facility or dwelling inspected for signs of sewage back up Was the site inspected for signs of break out Were all system components,excluding the SAS,located on site Were the septic tank manholes uncov ered,opened;and the interior of the tank inspected for the condition of"es or tees;material of-construction,eons,depth ofhiquid,depth of sludge and depth of scum _ Was the facility owner(and occupants if different from owner).provided.with.information on the proper maintenance-of subsurface sewage systems The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no sting information.For example,a plan at the Board of Health- _ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 OAR 15.302(3)(b)j f Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 0� Owner. AZ vt n #t� Date of Inspection• W CONDITIONS RESIDENTIAL Number of bedrooms(design):_,? Number of bedrooms(actual): DESIGN flow based on 310 CMS 15203(for example: 110 gpd x#of bedrooms); Number of current residents: �— Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no):/O [if yes separate inspection required] Laundry system inspected(y/�r:no):, !!O Seasonal use:.(yes or no):�v Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no):&O Last date of occupancy: ��✓`� COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15203): Qpd Basis of design flow(seats/persons/sgft,etc.y Grease trap present(yes or no):— Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records �/ Source of information: / L!0111 d a2O0.12— O cti!nv r Was system pumped as part of the.inspection(yes or no):" If yes,volume pp roped____gallons—How was quantity pumped determines? Reason for pumping: F SYSTEM Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool • _Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) InnovativelAltern Live technology-Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach,a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source ofr- ormation: ✓r ci i ✓t `J/U f Q SI' Were sewage odors detected when arriving at the site(yes or no):zt�D CC) Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) erty Prop Address: C�/ eel// Owner: Date of haspection: HUH DWG SEWER(locate on site plan) Depth below �� /Materials of constn&-tioa:_cast iron 40 PVC other(explain): Distance from private water supply well of suction line: Comments(on condition of joints;venting,evidences of leakage,etc.): SEFnC TANK: (locate on site plan) Depth below grade: O � Material of constnution r/concrebe_metal fiberglass_polyethylene If tankis metal list age:_ is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) / Dimensions:. X Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle:. d29 Scum thickness: / // _ Distan 4om-top:ofseum-to-tnpaf-ou&tt=0 baffie: Distance from bottom of scum to /p_f outlet�or I e: How were dimensions determined: 0/e /'�G c Comments(on pumping recommendations,inlet and tlet tee or baffle condition,structural integrity,liquid levels ayplated to outlet invert,evidence of _l 1 ,etc.): // _ H vh �,� ✓Io� ✓Iec�e c �e� GN 4✓ Coin -flow. 0 L eC- s- GREASE TKAP loocate on site plan) Depth below gee:— Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffie: Date of last pumping Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): f Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property.Address: Q 6;rlm( rr� ,.e Owner. 0 nr Date of inspection: 7 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below ode: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions_ Ca : gallons Design Flow. gallons/day Alarm present(yes or no): Alarm level: Alarm in worldng order(yes or no): Date of last pumping. Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX�(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note ifbox is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage inn pr out� x,etc.): �y i n� / Ci 0c � - � / PUMP CHAMBER:A/_(locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): i Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued} Property Address: 0 reG// q�� e C), Owner. WGi2H i vvv Date of Inspection: / G SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Typ leaching pits,number: ' leaching chambers,number: S// �O 0 leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Typetname of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): / v✓1 �e- CESSPOOLS:&(/ (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY:"0 to on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Page 10 of 11 - OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 920 �fer,, kvvi Owner. 7-A ko.� Date of Mspectiow /—/1 Q SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a stretch 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 budding. Fr0✓i4 /71 /7 1 kle Q� Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: "Z H �►�y yi I 1 Date of Inspection: / SITE EXAM Slope Surface water Check cellar Shallow wells Q Estimated depth to ground water// feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed ed site(abutting property/observation hol�,9�'ithin 150 feet of SAS) Checked with local Board of Health�xplain d''/Gj oe s Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: To You must describe hqw yo established the high ground wa r el ation: to A h c� V is o►^', o S j A3 , S i 1415 Li lo" v, ter" 6;--,cL ,0 o p/0 ti poop c o I� , booms �poo a 000 O �/ it �l f e� THE COMMONWEALTH OF MASSACHUSETTS BOARD�F H A TH ................OF.......... .-. _.- ........ ---...-.-........-.......--------- Appliratiun -fur Disposal Works Tunuitrurtiun Vrrniit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: � ,�o� �.y. � R1l j� 1 i ......................... _._.._ Location-Address or Lot No. lN�lfe ��---•-------------- ------------------- •------._...---•-•--------------•---•----•-•---•---- W Owner Address . Q .Z._.._-•--- Installer Address U Type of Building Size Lot__�20 -347q. feet �-, Dwelling—No. of Bedrooms------------3................_---------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons.--------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures -------------------•_._.._..__. . . d -------------------......................... ------------------- ------------------------------------ 'DesignW Flow________ __ _........................... allons er erson er da Total daily flow_._.__.��®_________-_ _---___--gallons. �� g� P P P Y• Y --- g� WSeptic Tank—Liquid capacitvl�—gallons Length................ Width-____-__._-_-- Diameter_-....--_-...... Depth-.---_____-__--. x Disposal Trench—No_ ____________________ Width----- Total LenZh-------------------- Total leaching area-------------------_sq. ft. Seepage Pit No-------%- p '�"'� '��'r� g< 1_._..._._.. DiameterC B®g.��De elow nlet...__..._'_-_______ Tot leaf�m trea-_.__-_________..sc it. Z Other Distribution box ( ) Dosing tank ( )— � �` �"?'�6 �',I aPercolation Test Results Performed bY-------------------------------------------------------------------------- Date_-----------------------------------._.. Test Pit No. I _______________minutes per inch Depth of Test Pit.................... Depth to ground water........-____-_____-_-_. �rq Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........----_..__--_.___ Description o Spil U G .2 - ----•-- -- -----. 7 w ----------��-- ---------------------------------------------- x ------------------------- --------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------- V Nature of Repairs or Alterations—Answer when applicable..---------------------------------------_--------------------_.........._______________________ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. ned----- -•----•• v�z ................................ ---- —----- e-------- Application Approved BY------------ - - ------- -------- --- -- --- Date Application Disapproved for the following r asons-----------------------------------------------.................................................................. ---••------•----•--•••----------•-------------------------------------------•-•-•------•-•----------------------------------------••-----•----------------••---------------------------•••- ............ Date PermitNo......................................................... Issued........................................................ Date FlcH..... ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA 4TH . ....-.-..._.....OF............... ... . ........... ............... Appliration -fur Dispogttl Workii Tomi#rurtintt Vrrutit Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System at: Gu Jilt .............................................�. .. /yin li"..`Jartc t T- /} r�� / Location•Address or Lot No. ------------------ •---------------•-•-------------•-------•--------------•---•-•--•..................------------. w - Owner Address r ` +` -------- Installer Addresses UType of Building Size Lot___________________ Sq. feet Dwelling—No. of Bedrooms_____________ __________________________Expansion Attic ( ) Garbage Grinder ( ) PLI Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures --•--------------------------- ------------ -•-------------•--------- Desi n Flow---------- ........................... Mons per person per day. Total daily flow________--�__.�_'�__-.--__--_-__-_._-.__. Mons. w g /Urrr, g P P P Y Y g WSeptic Tank—Liquid capacity----------Agallons Length................ Width---------------- Diameter-----....------- Depth___-______------ x Disposal Trench—No-____________________ Width-------------------- Total Length.................... Total leaching area_.____--_..____--.sq. ft. Seepage Pit No--------/----------- Diameter_ '7 .rt'LDepth below inlet__________ ________ Total.eac ng area.__.____-___.._.sq. ft. z Other Distribution box ( ) Dosing tank ( ) - Ob, f' `7-�G r�� aPercolation Test Results Performed by---------------- -------------------•--------------------•--------•----•-- Date.......................------------- Test Pit No. 1................minutes per inch Depth of Test Pit_.................. Depth to ground water.-___-______--____.-___. (Xq Test Pit No. 2................minutes per inch Depth of Test Pit-_______-__-____.-_. Depth to ground water-------------.--___-.__. 9 ------- - r-- I ........ -- ... -- O Description o Soil U� - c�s � G " 7 ` - �� `7�. i� �/ - c.� 1152,� ��-� <Z- -=---------------------------------------------------------------- ---_--------------------- w V Nature of Repairs or Alterations—Answer when applicable.____________________________________________-----------------------------------------_........ _ -------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------=--------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. --....__... -- _ "".-. _ Date' W. 7 77— Application Approved BY---.----- �_.-::' _..... . ... Date Application Disapproved for the following tIions: ................ --- .................................................. -••--------------•-------•--------•-------••--•---------------------------------•------------------------•-------•---• -• --------------------..---- Date PermitNo......................................................... Issued...................... --------------------------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF ALTH ........ ,�/�`. ..OF...........� �^l!......' :..... Trr#if iratr of 0111,11ntplitturr THI,cS)IS/TO CE `fIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) Installer / ...... ..... �--- °_ f has been installed in accordance with the p ovisions Art le XI of The State Sanitary C de as des. ib d in the application for Disposal Works Construction Permit No-----____________ s ----------- dated------ _•_—----- ................ THE ISSUANCE AP THIS CERTIFICATE SHALL NOT,BE CONSTRUED A GUA ANTEE THAT THE SYSTEM WILL F NCTION SATI FACTORY. DATE �-------------------- Inspector------ ........................................ THE COMMONWEALTH OF MASSACH S BOARD OF HEALTH 1.. .....� ......of............. l �� 'r�-------------------------------------------------------- No .--•-••--� 4�..... FEE-- &-........ Permission is eby granted.....s;,..._,c---------- ------ ------.---.----• ................... to Construct ( or Repair ( ) an,Individual wage is os lam- ystem CJ� t_r as shown on the application for Disposal Works onstruction P -No._f:..__ r - � ------•------------ � a -- Board of Health DATE------------------------------------------------------------------------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS LOC&.TION ' 5EW&(:GE PERMIT 1.10. IW TALLER 5 U&M DORESS BUILDE Q &"F- ADDRE SS DfITE PER"VT ISSUED DATE COMPLI &MCE ISSUED " (Ac_),A g �a-C, . s 7,E_57 R17 ZD.7i9. 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