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HomeMy WebLinkAbout0329 LAKESIDE DRIVE WEST - Health (2) ri 329 Lakeside,West ' , A 232-051 r's. Centerville; TOWN F p:e RNSTABLE �. N O LOCATION `tl 1��(E S DE W a7- SEWAGE # f Var.LAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. ��0 DSEf SEPTIC TANK CAPACITY I ZACHING FACILITY:(type) )5ila (Size) NO. OF BEDROOMS___,�PRIVATE WELL OR PUBLIC WATER w. BUILDER OR OWNER G S� DATE PERMIT ISSUED: DATE .COMPLIANCE ISSUED: ✓� VARIANCE GRANTED: Yes No ax�ST�tis _ 3 1, IS ' ram 76�e ��• f . ASSESSORS MAP NO: PARCEL.NO: Fimlic THE COMMONWEALTH OF MA.SSACHUSETTS c-- OAR® OF HEALTH �p 1 �.................OF...... ............................................... Apptiration for Disposal Murky Tonstrnrtiun "trnni# Application is hereby made-for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal. 't System at: _.A _z_----_--Lwe... .( . t+. 5.�`r G P�"v�1lfw... -----•--------------------------------------------•-----------._..-_...---•-------•--..........._. Loc ion-A d es ✓ or Lot No. �EI_.......i-t-�L.l�, �;u- -----------------------------------------------------_------•--•--------------------------------- COwner Address... Installer Address U Type of Building Size Lot____________________________Sq. feet Dwelling—No. of Bedrooms...--S............................... Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons____________________________ Showers — Cafeteria p' Other fixtures _________________________________ _ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 04 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--_---------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------------------------------------------------------------------------- Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit____________________ Depth to ground water_-_____________________- G%, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •--•----•----------------................................................................................................................................... 0 Description of Soil__'____________________________ x t, W -•-•••-•--------------------•-----••---••••••••••••••--•••-•------._...••--•----•-...••----•-•--••-•-•-••••-• - ................. ---------- i UNature of Repairs or Alterations—Answer when applicable___: n ___ __� t� f r_ " ...............•-••--•=: I-.........................................••. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i i;i.a:p }of the State Sanitary Code— The undersi tied further agrees not to place the system in operation until a Certificate of Compliance has been.iss d by the r of h th. l-/ ate Application Approved BY -•--•--••--•-•---••-••• ----•--•-•--•••f� --�'-1 Date Application Disapproved for the following reasons___________________________________________________ ." --•••-••••--•••••---•••......-•••----•.._..•••••••---••-...•--•----------------•.....•-------•••....----••--•---•----•--•-•-•-•-•••-•--•••...__....•-----••----•---------•-----•----•••••-••••••--•-•--- Date PermitNo............................................. ...... Issued_....................................................... Date THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA THE COMMONWEALTH OF MASSACHUSETTS ,------,.---BOARD OF HEALTH ........,1 O+vtJ....................OF..... � ---'...........................-......................................... AVVfiration for Bispviial Warks Tutor rnrtinn thrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: I" .s.:f .!,*I... .L t:.'Tu1��.... ...........•....--'--------•--•---•-------•----------•------•......•------•---•--•---............. Loc lion-Ad ress 7 or Lot No. I, Owner AAA Address...........- ...............'--•'-"---•----__._._...__....._I nstansta :......_ . -•"ez-•-_--•-~`-----•-•---•_•--•------•---.. ............-•------••---_-........_......... _.....-•.---•-------•------------•-••-----•_• � Lo„ Address Type of Building Size Lot----------------------------Sq. feet �-, Dwelling—No. of Bedrooms-----__�-•-s�..................................Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ___________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area...-------.---------sq. ft. Seepage Pit No-------------------­ Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) '-� Percolation Test Results Performed by.......................................................................... Date-----------------------------------..... Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 -••--•--•---••-------•--------. = -------------- 0 Description of Soil........................................................................................................................................................................ -------------------------------------------------------------------------------------------------------------- ... .... r------------------- -------------, -=................. U Nature of Repairs or Alterations—Answer when applicable......�_.'l:r __i '` .-.,` -�,_W�= :k-t :') • -----"I',"-,,,,IT---------------------------- ............................................................ = _• -•....................••--•--....---- •. - ... •----...L_���= - Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T_:LE' 15 of the State Sanitary Code—The unders ned further agrees not to place the system in operation until a Certificate of Compliance has been is ed by they of Ii alth. Signed---.. .--- ��` f---- �.__.�%� / _ I � - � fz ,r•^'; � � � t•._ - --Date,- � APPlication Approved By == --- -------------------------`'---.......- .. - ........-........-. ..................I............-. Date Application Disapproved for the following reasons-----------------------'----------•---------------------•------•-----------------•------------------------.....-- -•........................-•-•-•-----------------'•-----------------------------------------------.•-- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........................................OF.........t................ .............................................. Trr#ifiratr of Tontlrfiatta THIJ� ZS TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired ( } • 4 • by .. .C..`'...._.r .. �-_------------------------ ----------------- ------------- -'---•--•---•--------•------.--•- Install --------------•-------.__...._ at. - t S / 6 ��/�r.d y tL} has been installed in accordance with the provisions of TIME j of The State Sanitary Code as described in the w4 application for Disposal Works Construction Permit No....m:_(.-_'.�...__�_'_` �t_�.. dated___' ___- __1 _:__-,<................... . THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO STRIDE® AS A G RANTEE THAT YHE SYSTEM WILL F CTI Npp TISFACTORY. DATE �. .... -LS.. Inspector � L�­ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -7 NO t _,., FEE....:.......... %yosal Works Tat'nstrnr#ivrt prrutit Permission is hereby granted.................................... � .. to Construct ( ) or Repair ( ) an Individual Sewa a Disposal System Street .Permit _ Dated_.`_%_____...._:j__................. - ! Board of Health �! cS- l -� DATE------------------............................................................ FORM 1255 HOBBS & WARREN. IN IC,,.,PUBLISHERS „'V:- t No........................ Fzc$.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....-. ............... .............OF...................................... .-------------...--------------•----------------- Appliration for Uh4poant Workii Tomuurtion Vami# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ................_................................................................................ --.._.....-------•----•-•.._..---•-----'--'...--------•-••---•--.._.._......--•-••------'-'-'--•-- Location-Address or Lot No. ........ -- ---..-.--------------------------------•------- --------- -----------•------------•-------------•--------•.........•--------------------------------------- yOw'�ner 1 J/M� �,J`I`''p�+/ / +T�` Addres�sj�!/� ............ ..... ... _y_V...-.'---"_�T_�!__li_�✓_FYJCY.S:I...... __L.�__.s�c_tG1i__>.../.tc�7.?J.��V��(/��_!i-:.C%_eY___!l"��YY'1C7.....__. Installer Address Type of Building Size Lot............................Sq. feet �-, Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) PL, Other—Type of Building No. of-persons............................ Showers — Cafeteria Q' Other fixtures -------------------------------- . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liqui`d capacity............gallons Length____-__--__-_-- Width................ Diameter................ Depth___-___-_----_-. Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No--------------------- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test-Results Performed by.......................................................................... Date........................................ Test Pit No. 1________________minutes per.inch Depth of Test Pit.................... Depth to ground water_-_-__-______-_•_-- --. 44 Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground water----_______-_-_..._____- -------------------------------------------------------- -----------------I................................................................................ Description of Soil-------------------------------------------------------•.•..- d' x l ---------------- --- U Nature of Repairs or Alteratio s—Ans h n applicable._ _-_ _4 _l_____ .C�.... .�-_-___.__ ........... -•-----------------------------•----•-----1=�.... �°�t� Q... .--•---...................---------•----------..........-•-----------------------------•--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with T!•iT^ the provisions of 'f"I T:� 5 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 t oard of health. Signed.....a/f -•-------------.---•----------..........------------------. ---- Date ApplicationApproved By.................................................................................................. Date Application Disapproved f orl"the following reasons-------------------------------------•------------------------------------------••----------••-••---------....... --------------------•-----...---------------•--........................-•----------------..........-•---•-------------------•------•-----••-•-•------•••--••-------•-----------•-•---•--•-•------..--- % Date PermitNo--------------------------------------------------------- Issued--------•----------------------------------------------- Date i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF........................__......................................................... %Trrtifiratr of Toutpfianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by.................................................................................................................................................................................................... Installer at...................................................................................................................................................................................................... has been installed in accordance with the provisions of LITIE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated_............................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector-.:i-*------------...---------------•-•----.....•....--•---....-•------•---......-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.....................................................................................NO......................... * FEE........................ Ehiipoiia1 Works Tonotrttrtion rrutit Permission is hereby granted............................................................................................................................................ to Construct ( ) or Repair ( ) an Individual Sewage Disposal System, atNo............................................................................................................................................................................................... Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... ..........-•---...--•---••----------•'----------•---------------------------------------------••--....._ Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS } �IItt2t f& SSIItttIPB John A Cohan ATTORNEYS AT LAW Telephone 749-8877 Sr.Partner 190 LINCOLN STREET—3A Area Code 617 Maureen McGahan P.0.BOX 409 Peter M.Dempsey HINGHAM,MASSACHUSETTS 02043 June 18, 1987 Office of The Board of Health Town of Barnstable 367 Main Street Hyannis, MA 02061 Attn: Nancy RE: Letter of Certification Gentlemen/Ladies: This letter is to provide certification of the usage of the proposed extension to our existing residence at 132 Lakeside Drive - West, Centerville, MA. The new eating area, first level, is used to provide an extension to our dining room not to provide quarters or housing. There are .no doors, it is a room adjacent to the existing dining room and kitchen. The garage that is proposed is simply an enlargement to the carport. The items we have kept in our carport, have become rusted and corroded and we want to enclose it. The second floor extension and deck is simply a modification adjustment to the existing bedroom known as the master bedroom.. Its usage is to provide a changing and sitting area and small deck exit/entrance. There will be no beds added to this room. The extension is to provide an additional changing and sitting area. I would also like to say this certificate is intended to be a guarantee that these two rooms . and garage are not to be used as sleeping cuarters. At 'this time there are three occupants and the residence is a summer occupancy. i s Page Two June 18 , 1987 Den and Bathroom Extension Proposed: If the decision is made to go ahead with the den and bathroom, we will follow procedure requirements and apply for variances, in accordance with the Town of Barnstable, at a separate time. We are currently evaluating the engineering and other additional costs before the application is submitted. Hopefully we will make our decision quickly. Sincerely, phk a kson ed Peluso Project Management/Agent A. Susa a kson COMMONWEALTH OF MASSACHUSETTS PLYMOUTH, SS. JUNE 18, 1987 Then personally appeared the above named Joseph Falkson and Susan Falkson and acknowledged the foregoing instrument to be their free act and deed, before me. Notary Public - My Commission Expires:j0-,j=190 • 1 1 r COMMONWEALTH OF MASSACHUSETTS JUNE 1987 Then personally appeared the above named Ted Peluso and acknowledged the foregoing instrument to be his free act and deed, before me. Notary Public My Commission Expires: PHILOMLNA R. GRIFFIN 1,1y commission expires Dec. 14, 1990 AsBuilt Page 1 of 1 TOWN OF BARNSTABLE LOCATION %4,l SEWAGE # 57-790 VILLAGEofAe GV ASSESSOR'S MAP LOTa -/JS/ INSTALLER'S NAME 6i.PHONE NO. "p!*} Gaowteoy OSa/ SEPTIC TANK CAPACITY — G�Tx�Srin/b-- ArnOc6+0 ,A F[owr�vCi✓saw LEACHING FACILITY:(type)_ f., 3 5 rdA-e (size) ?00 s,- NO.OF BEDROOMS PRIVATE WELL OR PUBLIC WATER 7aw" iBUILDER OR OWNEIR / ',gtA,5cAj DATE PERMIT ISSUED: lr�� i DATE, COMPLIANCE ISSUED: VARIANCE GRANTED: Yes NO 97-7SG i yous, lto�..s OLD o i � r A "AM ova* !S!6 n rg —� TVAAC VWr!LC' af! q' q d'i �7l� 7. i • f /3e? C AKFS iOF T�9Ii�E" c�.cCSr http://issgl2/intranet/propdata/prebuilt.aspx?mappar=232051&seq=1 4/30/2013 LOC&.TION S 5EW&6xE: PERMI' �C _ 5 s - - - - WST- LLER 5 U y&�N`AE� .D�D.RES - - - I,. BUILDER 5- [ M-F- t, ADDRESS- - --.- --DL�►�I'E PERKA T ISSUED-=`L=3v�-� DA.TE- COMP_LI.b l,.ACE _ ISSUED .__7_ �9'- 73`_ { L -------- now CP LQr-'Gti F��ty�� a O� (�ottn &' g�nritt#e� John A.Cohan ATTORNEYS AT LAW Telephone 749-8877 Sr.Partner 190 LINCOLN STREET—3A Area Code 617 Maureen McGahan P.O.BOX 409 Peter M.Dempsey HINGHAM,MASSACHUSETTS 02043 June 18, 1987 Office of The -Boat- of Health 67 Main Street , Hyannis, MA' 02061 aP, Attn: Nancy RE: Letter of Certification Gentlemen/Ladies: This letter is to provide �cert' fication of the usage of the proposed extension to our existing residence at 132 Lakeside Drive - West, Centerville,- MA.. The : new eating area, first level, is used to provide a:i extension to. our dining room not to provide quarters or housing. There are no doors, it is a room adjacent to the existing dining .-roo n and kitchen. The garage -, that is proposed is simply an enlargement to the carport. The items we have kept in our carport have become rusted and corroded and we want to,enclose it. The, second floor extension and deck is simply a. modification ad,jus,tment�, to the existing bedtai m kn:own as the master bedroom. • <;0 fi , a , c- r _.s o pro r1:�?e: - chG:. � , no �; �+. Sit* � :; 'arca ,and- syma,1.<_1- deck exit/entrance. There wi '''.j. be no beds added to this room. The extension is to provide an additional changing and sitting area. I would also `like to ,say this certificate is intended to be a ;t guarantee that these two rooms and garage are not to be used as sleeping quarters. At this time there are three occupants and the residence is a summer occupai?,jr. Page Two June 18, 1987 Den and Bathroom Extension Proposed: , If the decision is made to go ahead with the den and bathroom, we will follow procedure requ:Lrements and apply for variances, in accordance with the Town of Barnstable, at a separate time. We are currently evaluating the engineering and other additional costs before the application is submitted. Hopefully we will make our decision quickly. Sincerely, 4ph kson Ted a use Project Management/A ent ST P A Susan` Fa kson ^,7$� c THEBC®AO�NW�EAL�THCOFLMASSAC Tu TS 'TH #/ e X� 4 � ...........0F.... -. .... -- �C ApplirFa#ion -for Di-qVviial Workii Cnowitrurtioaa Vrrmft ` Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: - �p� � ` ` G �... ------------------------ ! 1 i..------. ........................ Location-Address or Lot No. ................ -•-•-----•-----------------••---•---__...-•-•---•---•'------•-•-•---••-••••--•-••---•----•----••-- ��'' � Owner Address a - ­ -----­---••--- ---•-----•-------------•----------------- ------•---••-••-•-----••--------------------•-------------------------------------------------•--- Installer Address Type of BuildiIang� Size Lot............................Sq. feet U DwellingZNNo. of Bedrooms_-._-___-.:�............................Expansion Attic ( ) Garbage Grinder ( ) per, Other—Type of Building ............................ No. of persons--------.................... Showers ( ) — Cafeteria ( ) p' Other fixtures ------------------------------------------------------ W Design Flow............ per person per day. Total daily flow---------- ©_o________________________gallons. WSeptic Tank-L Liquid capacitvJAO g---gallons Length---------------- Width---------------- Diameter--------------- Depth---.______.__... x Disposal Trench—No. .. ....... Width----------- ------- Total Length.................... Total leaching area...... 'O_o.___-_sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inl ____. ______._____. Total leaching area __.______ _sel. it Z Other Distribution box ( ) Dosing tank � � � ' aPercolation Test Result Performed by-•--------------------------=..................--•------ -------•------- Date............................;1------.... l Test Pit No. 1....'.A-------minutes per inch Depth of Test Pit____________________ Depth to ground water---- --_-______-__-- (%, Test Pit No. 2................minutes per inch Depth of Test Pit--------------------- Depth to ground water-----------------------1. °a ---- Description of Soil---� . ......... W -------------- -------------- --------- _ �" s = f ------ s ',�- ='z" -----------------_---- ........ U Nature of Rep-sirs or Alterations—Answer w en 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 bee issued by the board of health. Date Application Approved By---=.. ..... ......' °e 1^ .. Date Application Disapproved for the following reasons:._ =_...__ _______'_-------------- Date PermitNo......................................................... Issued........................................................ Date -A, ir, THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH c1,1 OF r. .�...:.... ... L.. .......... ApplirFatiuu -fur Ii,4puiitt1 Workii Tomitrurtivu Vrrulft Application is hereby made for a Permit to Construct (; ) or Repair ( } an Individual Sewage Disposal System at: -, r.,�......... .......`..� i Location.Address or Lot No. Owner Address e F r- {. Installer Address Type of Buildin Size Lot--------------_----____-___Sq. feet Dwellings No. of Bedrooms._..__....-�-3_--------------------------Expansion Attic ( ) Garbage Grinder' rinder ( ) aOther—Type of Building ----------- --------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures ---------------------------------------------------------------------------------------------------------=------------------------------------------ W Design Flow.......... .. ..........................gallons per person per day. Total daily flow-_---_---.s_�-S-_____--------_....._._gallons. WSeptic Tank J Liquid capacity ®_p___gallons Length................ Width................ Diameter................ Depth..._.____-_--- x Disposal Trench—No. *- t ------- Width------------ ------- Total Length...................- Total leaching area....` %_! ------sq. ft. Seepage Pit No..................... Diameter_.-______________--- Depth below inl t_..._;.__...._.___. Total leaching area.- ---- ,_;_.S( ft., Z Other Distribution box ( ) Dosing tank aPercolation Test Results+ } Performed bY.......................................................................... Date--_------_--------- ------ Test Pit No. 1... ;;_._____minutes per inch Depth of Test Pit____________________ Depth to ground water__- --------------- �14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--.--.---____-.-___.. WK 1 p_.._.._.._ Description of Soil .. �"'✓�_... ------ ----C 7-� •-• _...... �` s ---------- ° ' '` --=`-------------�-� --------_=` - �-' ��_ .� ��t z4,V1.....i --- ..------.---------.---------------------------...................off-__-_S-;:.f........ ---------.-.----------_--______------- U 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. Signed:/-.L�_-=f1,t,l-•..-------=h.....X'•--- ........................ ................................ ✓ ` /' f Date Application Approved B e ' - ►-�........f___....../'... ' *� " Date Application Disapproved for the following reasons-------------------------------Z........................................................................... ----••------------•---------•-------•-----•-•----•-----------•--•-.......---••-------•-------•---------------------------•-•---•••---------•-•---•-•------------•-•--...-•--------•----------------•-•-- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS ! BOARD OF17- HEALTH 1-'�..r�!k........OF...........f O.rrtifira#r of f1,Ampliatta TH S IS'",'TO Cif-T-EFV, T t e Individu e Disposal System constructed ( �orRepaired ( ) a Y . ..f T� A Installers /' .✓ j has been installed in accordance with the provisions of _ •r icle;X�of The State Sanitary Code as describ d > the F application for Disposal Works Construction Permit No.=.__'..:�...._f_:7.................... dated....zX/....� ....____�'.............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE-------- -------------- !�- Inspector. ------. .............................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH i .... A ........ ..OF........ ...:..w n �............... No. ........... FEE_ Permission is eby granted____ :.. �"`_:. ?%"- to Construcco(�,/ or Repaip-( / an Ind dual Sewage Dtspossal Systu f at No.... <` '--------- _ i re Jl: a l' 'r '-" '... --..... -----err------ - .� Street as shown on the application for Disposal Works Constructiormit Nb'"?.....11......... Dated............................ -- DATE................................................................................ Boar d of He.alt FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS �; • .. _ 5 !�/ �-y A� .f �� � � F� 4L� ^r_. 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