HomeMy WebLinkAbout0408 SEA STREET - Health 400 SEA ST., HYA
A=306 - 183.002
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Town of Barnstable
Regulatory Services
Thomas F. Geiler,Director
&UWSTABLE
9�A .• Public Health Division
Thomas McKean,Director
200 Main St,
Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
June 13, 2003
Michael & Denise Holyoak
11 Turner Road
Berlin, MA 01503
IMPORTANT NOTICE
RE: Map & Parcel 306-183-001
Dear Addressee:
You are directed to connect your building locafed� at c400 Sea.,Sir_eet, 14yannis, __�
Massachusetts, to public sewer on or before De4mber 13, 2003.
The Department of Public Worr
Engineering Division, has notified us that your
property abutts recently installed va sewer lines. The lines were extended because of
the density, and the size of the lots in the area, and the potential for serious health problems.
Failure to comply with this order will result in a complaint against you, in a court of law,
due to your failure to comply with a Board of Health Order.
If you should have any questions, please telephone me at 862-4644.
PER ORDER OF THE BOARD OF HEALTH
Thomas A. McKean, R.S. CHO
Health Agent for:
TOWN OF BARNSTABLE BOARD OF HEALTH
Wayne Miller, M.D., Chairperson
Susan G. Rask, RS.
Sumner Kaufman, M.S.P.H.
Return receipt requested
Cc: Barbara Childs, Water Pollution 96ntrol
Mork Giordano, Engineering V
Q:Sewerorder.doc
Town of Barnstable
INKE Regulatory Services
Thomas F. Geiler,Director
► BAMFrAMAM
BI.E •
9�A1639. ,•�' Public Health Division
QED MA'S A
Thomas McKean,Director
200 Main St,
Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
June 13, 2003
Michael & Denise Holyoak
11 Turner Road
Berlin, MA 01503
IMPORTANT NOTICE
RE: Map & Parcel 306-183-001
Dear Addressee:
You are directed to connect your building located at 400 Sea Street, Hyannis,
Massachusetts, to public sewer on or before December 13, 2003.
The Department of Public Works, Engineering Division, has notified us that your
property abutts recently installed vacuum sewer lines. The lines were extended because of
the density, and the size of the lots in the area, and the potential for serious health problems.
Failure to comply with this order will result in a complaint against you, in a court of law,
due to your failure to comply with a Board of Health Order.
If you should have any questions, please telephone me at 862-4644.
PER ORDER OF THE BOARD OF HEALTH
Thomas A. McKean, R.S. CHO
Health Agent for:
TOWN OF BARNSTABLE BOARD OF HEALTH
Wayne Miller, M.D., Chairperson
Susan G. Rask, RS.
Sumner Kaufman, M.S.P.H.
Return receipt requested
Cc: Barbara Childs, Water Pollution Control
Mark Giordano, Engineering
Q:Sewerorder.doc
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MaKea Thomas v 40
From: Childs, Barbara
Sent: Wednesday, June 11, 2003 9:47 AM 3rT
To: McKean, Thomasjytd
Cc: Schlegel, Frank
Subject: 306-183-001
Hi Tom,
In November of 1999,Artemis D Warburton was sent a letter to connect to town sewer. The property now
appears to have changed hands and is now in the name of Michael &Denise Holyoak their mailing address is 11
Turner Road, Berlin, MA 01503.
The property that needs to connect to town sewer is 400 Sea Street
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1
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I - -
Check list for unconnected parcels:
Name: Artemis Warburton
Map/Parcel: 306-183.001 (508) 771-3693
Prop location: 400 Sea Street
Mailing address: 400 Sea Street
Hyannis, MA 02601
Visually check property location
check for any past pumping records As of 7/11/2000 no record of any pumpings
since 1985
check water company for water use 63 ccf per year
check with engineering for permits and if they are within the bounds of connecting
As of May 17, 2000 no record of any permit taken out.
Notify Board of Health to send letter to connect
Date BOH notified: Nov. 17, 1999
Date BOH copy received: ?
Date BOH letter sent: Nov. 30, 1999
Date BOH letter expires: May 30, 2000
Sent to Tom McKean 11/7/2000
CHKLIST.DOC
°ft"ET°� The Town of Barnstable
n' _ ;M 9T,M Department of Health, Safety and Environmental Services
16M39a,�� Public Health Division
367 Main Street,Hyannis,MA 02601
Office 508-790-6265 Thomas A.McKean
FAX 508-775-3344 Director of Public Health
February 15, 2000
Artemis Warburton
400 Sea Street
Hyannis, MA 02601
Dear Mrs. Warburton:
Please take this Board of Health Variance Decision to the Barnstable County
Registry of Deeds and have it recorded at your earliest convenience.
Sincerely yours,
Thomas McKean
Director of Public Health
Town of Barnstable
TM/bcs
I
} TOWN OF BARNSTABLE
C� ��F TN E Poi
p OFFICE OF
BAZNSTABLI, : BOARD OF HEALTH
MAE& pj
°0 1639• ��� 367 MAIN STREET
nMav� HYANNIS, MASS.02601
February 3 , 2000
BOARD OF HEALTH VARIANCE DECISION
On or about January 18 , 2000 the Petitioner, Artemis
Warburton, received an order from the Board of Health to
connect the premises located at 400 Sea Street, Hyannis, Ma,
to the public sewer. Due to her limited income, the
Petitioner applied for a variance to waive the requirement
that her home be connected to the Town of Barnstable sewer.
Based upon the application for a variance and other
information submitted, the Board of Health finds as follows :
1 . The Petitioner stated that the on-site sewage
disposal systems located on the subject premises
are currently functioning properly.
2 . The Petitioner has vary limited income and is of
advanced age .
3 . If the Petitioner is required to incur the costs
attendant to connect to the Town of Barnstable
sewer, she will be forced to forego basic
necessities causing her severe hardship.
4 . Based on the representations by the Petitioner
that her on-site sewage disposal system is
functioning properly, the Board of Health finds
that the risk of environmental damage will be
acceptable if the Board of Health temporarily
waives the requirement that the subject premises
be connected to the Town sewer until such time as
said premises are sold, transferred to an
individual or entity other than the petitioner or
the Petitioner permanently vacates the premises .
WHEREFORE, the Board of Health, grants the
Petitioner a variance, waiving the requirement for
the aforementioned Petitioner that the subject
premises located at 400 Sea Street, Hyannis, MA.
be connected to the Town of Barnstable sewer,
subject to the following conditions .
RIDECI
w :
1 . This variance shall expire within five (5) years
from the date of issuance .
2 . Immediately upon the sale of the premises, the
transfer of the premises to an individual or
entity other than the Petitioner or the permanent
vacation of the premises by the Petitioner, this
variance shall be rendered null and void and the
order that the premises be connected to the Town
of Barnstable sewer shall be in full force and
effect .
3 . Nothing in this variance shall be construed as
limiting the Board of Health' s power to revoke
this variance should it determine that the on-site
sewer disposal system is malfunctioning.
4 . The Petitioner shall record this variance at the
Barnstable Registry of Deeds within thirty (30)
days from the date of the issuance of said
variance and shall provide the Board of Health a
copy of the recorded variance .
BARNSTABLE BOARD OF HEALTH
Susan G. sk, R. S .
Chairperson
Barnstable, SSG:
On this day of January 2000 personally appeared the above-
named Susan G. Rask, R. S . , Chairperson of the Town of
Barnstable Board of Health, and acknowledged the foregoing
instrument to be her free act and deed.
N Public
My commission expires ZQD/
VARIDECI
�F tHE l� DATE
F
9 �
BARNSTABrF
MASS.
D MA'S REC. BY
Town of Barnstable
SCHED. DATE:
Board of Health
367 Main Street, Hyannis MA 02601
Office: 508-790-6265 Susan G.Rask,R.S.
FAX: 508-790-6304 Sumner Kaufman,M.S.P.H.
Ralph A.Murphy,M.D.
VARIANCE REQUEST FORM
LOCATION
Property Address: �r
Assessor's Map and Parcel Number: Size of Lot: I, Acly e�
Wetlands Within 300 Ft. Yes Subdivision Name:
No
Business Name:
APPLICANT CONTACT PERSON
Name: l�i E i`lf i �(I�4 R f3 J �'T�� Name:
Address: �� E�+ c�� p¢�/�//S Address:
Phone: 2 :2/ 3 G 9 3 Phone:
FAX: FAX:
VARIANCE FROM REGULATION(List Res.) REASON.FOR VARIANCE(May attach if more space needed)
�jT/GL �lIiliT`r� / ZlcUAel�E
Checklist(to be completed by office staff-person receiving variance request application)
Four(4)copies of plan submitted(including septic system plans and/or restaurant floor plans)
Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting
date at applicant's expense(for Title V and/or local sewage regulation variances only)
Full menu submitted(for grease trap variances only)
Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/leasee onlyl,outside
dining variance renewals[same ownerileasee only],and variances to repair failed sewage disposal systems(only if no expansion to the building proposed])
Variance request submitted at least 15 days prior to meeting date
VARIANCE APPROVED Susan G. Rask, R.S., Chairman
NOT APPROVED Sumner Kaufman, M.S.P.H.
REASON FOR DISAPPROVAL Ralph A. Murphy, M.D.
Q:/WP/VARIREQ
" TOWN OF BARNSTABLE
CE TH E rot
OFFICE OF
! BaBa9T i BOARD OF HEALTH
MAIM
70o
A39 � 367 MAIN STREET i639 `�
MaT HYANNIS, MASS.02601
Artem Warburton
400 Se Street
Hyannis, A 02601
RE: Map & arcel 306-183.001
Dear Mr. Warb on:
You are directed t connect your building loca d at 00 SEA STREET, HYANNIS to
public sewer on or be re May 30, 2000.
The Superintendent of th Department of ublic W rks has notified us that your property
abutts town sewer lines. a lines wer extend d because of the density, and the size
of the lots in the area, and th otenti for serio s health problems.
Acting under the authority of Cha r 83-11, of the General Laws of Massachusetts, and
Regulation 15.02, of 310 CMR a Enviro mental Code, you are hereby directed to
connect to the town sewer syst on befo e May 30, 2000.
Failure to comply with this der will resu in a court complaint against you for failure to
comply with a Board of He Ith Order.
4 If you should have any uestions, please eleph e me at 862-4644.
4: PER ORDER OF E BOARD OF;HEALTH
' } Tho k as A. Mc an, R.S. CHO
" Health Agent f r
TOWN OF ARNSTABLE BOARD OF HEALTH
Susan G. R sk, RS., Chairperson
-=# Ralph A. urphy, M.D.
Sumner ufman, M.S.P.H.
copy: Peter Doyle
-
Return Receipt Requested
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Y=n
BOOK 8008 FPGE 064 27690
Q�oFT►+Eto�f TOWN OF BARNSTABLE
OFFICE OF
• e9T&U BOARD OF HEALTH
y MAas. �
ap i639. �0
D MAY b` 367 MAIN STREET
HYANNIS, MASS. 02601
May 1 , 199?
BOARD OF HEALTH VARIANCE DECISION
Z -o
On or about Jan y, 0,-4-942, the Petitioner, Artemis
Warburton, received an order from the Board of Health to
connect the premises located at 400 Sea Street, Hyannis, MA
to the public sewer. Due to her limited income, th(�
Petitioner has applied for a variance to waive thca
requirement that her home be connected to the Town oC
Barnstable sewer. Based upon the application for a variance]
and other information submitted, the Board of Health find:
as follows:
1. The Petitioner, stated that the on-site sewage disposal
system located on the subject premises is currently
functioning properly.
2 . The Petitioner has very limited income and is oC
advanced age.
3 . If the Petitioner is required to incur the costa
attendant to connect to the Town of Barnstable sewer, she
will be forced to forego basic necessities causing her
severe hardship.
4 . Based on the representations by the Petitioner that her
on-site sewage disposal system is functioning properly, the
Board of Health finds that the risk of environmental damage
will be acceptable if the Board of Health temporarily waives
the requirement that the subject premises be connected to
the Town sewer, until such time as said premises are sold,
transferred to an individual or entity other than tho
Petitioner or the Petitioner permanently vacates tho
premises.
WHEREFORE, the Board of Health, grants the Petitioner
variance, waiving the requirement for the aforementioned
Petitioner that the subject premises located at 400 Se;3
Street, Hyannis, MA be connected to the Town of Barnstable
sewer, subject to the following conditions :
1 . This variance shall expire within five (5) years from
the date of issuance.
r BOOK8008 FACE 065
2 . Immediately upon the sale of the remises, the transfer
-•y Y P P
of the premises to an individual or entity other than the
Petitioner or the permanent vacation of the premises by the
Petitioner, this variance shall be rendered null and void
and the order that the premises be connected to the Town of
Barnstable sewer shall be in full force and effect.
3 . Nothing in this variance shall be construed as limiting
the Board of Health's power to revoke this variance should
it determine that the on-site sewer disposal system is
malfunctioning.
4 . The Petitioner shall record this variance at the
Barnstable Registry of Deeds within thirty ( 30) days from
the date of the issuance of said variance and shall provide
the Board of Health a copy of the recorded variance.
BARNSTABLE BOARD OF HEALTH
►�-
Barnstable, ss: OD
On this day of .�4 �' °92 personally appeared the
above-named, Joseph C. Snow, Chairman of the Town Of, ""' rip;
Barnstable Board of Health, and acknowledged the foregoin;'q*,,,\0.•••'••• '
instrument to be his free a and deed,+fr' Q, '
Notes Public- aj• Z ��-
My Commissio expires O ••:,'�,�.��'
�.,, •l.°�
•.i.i'' is
fltl,l�itU�l� Y' 7 92
a
i
February 3, 2000
Artemis Warburton
400 Sea Street
Hyannis, MA 02601
RE: Map & Parcel 306-183.001
Dear Mr. Anestis:
You are directed to connect your building located at 370 OCEAN STREET, HYANNIS to
public sewer on or before June 21, 2000.
The Superintendent of the Department of Public Works has notified us that your property
abutts town sewer lines. The lines were extended because of the density, and the size
of the lots in the area, and the potential for serious health problems.
Acting under the authority of Chapter 83-11, of the General Laws of Massachusetts, and
Regulation 15.02, of 310 CMR State Environmental Code, you are hereby directed to
connect to the town sewer system on or before June 21, 2000.
Failure to comply with this order will result in a court complaint against you for failure to
comply with a Board of Health Order.
If you should have any questions, please telephone me at 862-4644.
PER ORDER OF THE BOARD OF HEALTH
Thomas A. McKean, R.S. CHO
Health Agent for
TOWN OF BARNSTABLE BOARD OF HEALTH
Susan G. Rask, RS., Chairperson
Ralph A. Murphy, M.D.
Sumner Kaufman, M.S.P.H.
copy: Peter Doyle
Return Receipt Requested
sewe=2
TOWN OF BARNSTABLE
AF THE TO
OFFICE OF
y •n
i HAHHSTABLX o BOARD OF HEALTH
NAG& of
pp 039. 367 MAIN STREET
HYANNIS, MASS.02601
February 3 , 2000
BOARD OF HEALTH VARIANCE DECISION
On or about January 18 , 2000 the Petitioner, Artemis
Warburton, received an order from the Board of Health to
connect the premises located at 400 Sea Street, Hyannis, Ma,
to the public sewer. Due to her limited income, the
Petitioner applied for a variance to waive the requirement
that her home be connected to the Town of Barnstable sewer.
Based upon the application for a variance and other
information submitted, the Board of Health finds as follows :
1 . The Petitioner stated that the on-site sewage
disposal systems located on the subject premises
are currently functioning properly.
2 . The Petitioner has vary limited income and is of
advanced age .
3 . If the Petitioner is required to incur the costs
attendant to connect to the Town of Barnstable
sewer, she will be forced to forego basic
necessities causing her severe hardship .
4 . Based on the representations by the Petitioner
that her on-site sewage disposal system is
functioning properly, the Board of Health finds
that the risk of environmental damage will be
acceptable if the Board of Health temporarily
waives the requirement that the subject premises
be connected to the Town sewer until such time as
said premises are sold, transferred to an
individual or entity other than the petitioner or
the Petitioner permanently vacates the premises .
WHEREFORE, the Board of Health, grants the
Petitioner a variance, waiving the requirement for
the aforementioned Petitioner that the subject
premises located at 400 Sea Street, Hyannis, MA.
be connected to the Town of Barnstable sewer.,
subject to the following conditions .
RIDECI
a
1 . This variance shall expire within five (5) years
from the date of issuance .
2 . Immediately upon the sale of the premises, the
transfer of the premises to an individual or
entity other than the Petitioner or the permanent
vacation of the premises by the Petitioner, this
variance shall be rendered null and void and the
order that the premises be connected to the Town
of Barnstable sewer shall be in full force and
effect .
3 . Nothing in this variance shall be construed as
limiting the Board of Health' s power to revoke
this variance should it determine that the on-site
sewer disposal system is malfunctioning.
4 . The Petitioner shall record this variance at the
Barnstable Registry of Deeds within thirty (30)
days from the date of the issuance of said
variance and shall provide the Board of Health a
copy of the recorded variance .
BARNSTABLE BOARD OF HEALTH
Susan G. d
k, R. S .
Chairperson
Barnstable, SSG:
On this day of January 2000 personally appeared the above-
named Susan G. Rask, R.S . , Chairperson of the Town of
Barnstable Board of Health, and acknowledged the foregoing
instrument to be her free act and deed.
N Public
My commission expires /D OS` ZQD/
VARIDECI
ASSESSOR'S MAP NO. PARCEL
L0CATION SLVy4G VEKMIT N.O.
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P WEE)
1 H 57 A. LLkR'S 11 AN1E A ADDRE �
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DATE PERMlT 11-SSYED
DATs C0MP1. 1AHCE ISSUE?
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i ASSESSORS MAP N0: ------
PART NO.-.
N.H�------ Fms ..............
A THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
77�. O Farnsl42,
--------------------------------------------------------
,gyp irtatuan for Bi-qp.aiial Works Towitrurtinn Prrmit
Application is hereby made for a Permit to Construct (3(-) or Repair ( ) an Individual Sewage Disposal
System at:
..•-•---..GO---- sd�.._5�.�t-- .1._. ........................ .....•--••--•-•----------..__........--------------•-••----...----•------------
Lo lion-Addr ss o Lot No.
tcsxn-------------------------------------------- `.. o '��5,�-r.. +---1 ain i s.....................................
A� Owner ddress
Installer Address
d Type of Building Size Lot............................Sq. feet
V Dwelling—No. of Bedrooms.......................(-...................Expansion Attic ( ) Garbage Grinder ( )
U
`k Other—T e of Building No. of persons............................ Showers — Cafeteria
Q' Other fixtures .--------------------•-•....-- .. .
W Design Flow............................................gallons per person per day. Total daily flow.........___.___...__.................._....gallons.
GG 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........................................
Test Pit No. I----------------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........................
---••---•--•-------------------•--•---•---•---.......--•---•----....----.....---•-------•--••-•---•-.........................................................
0 Description of Soil....................................................................................................................................................................
W --------------------------•-- --------------------`------
UNat re of Repairs or Alterations—Answer when appli ble��t��_ + l d d�_ �._�G�. S+PCd?____..
Agreement: U
The undersigned agrees to install the aforedescribed Indivi ual Sewage Disposal System in accordance with
the provisions of iT 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 o" health.
Signed----- .�_ o • -------•-•-----•-..... ..... :. ......
D�
Application Approved BY - �` � `--- ---------T _
ate
Application Disapproved for the following reasons------------------------------ -------------••--••••--••-•-----•••••-----------------•--•---•-------••--•----•--
Date
PermitNo ---•-• ------ Issued---------------------------•--i_--•-----------•--------
Date
�y
t
I� ... Fps..` :._-. ....._
THE COMMONWEALTH OF MASSACHUSETTS
BOARD Oft-` `HEALTH
_ 1a.+71.....................OF... lrfrl:.its�CZIG�'
Appliration for Eligpoiial Works Tontitrnrtion rrntit
Application is hereby made for a Permit to Construct -W) or Repair (- ) an Individual Sewage Disposal
Sy
ttstem at: ''``
...............................�•••••---•----......................... -_.._....-•-...•-•----_.�.......•-•--•--_--•---•---•-•-----...•••-•-----•-------••-•-••-_...._-••
Location-Address or Lot No.
L-Y � ��RT�ti �'�lltigrt� 4/oG &C(.,Srr-,,, r:t�/�>7iII :
---------•--------•-----•----•----... ....................................•-..r....................................................
Owner j_ Address t
a 1�`f �u�Yco . r_ 41eclrl -1-rwrT, tc+w, trr.rt],.a�.t�R
.............................................. .......................................
Installer Address
QType of Building Size Lot............................Sq. feet
aDwelling—No. of Bedrooms_____________________ _____________________Expansion Attic ( ) Garbage Grinder ( )
p., Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures ..................................
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
9 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........................................
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water-----------____-__----_.
r%, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Pi •-•----•••-•--•---------•---•-••••••-•---•••---•-••---...•--••-••••-•-••-----------•-••-•-_••...............................•-•----••••--...----•...---....--
0 Description of Soil--------------------•-•--•-•----------------------------•----._....-------•-----•--------------------------------------• ..............................................
x
U .._..-----•--
W -------------------------------------- ------------------ ----- ---------------------------------------------- ------------- - ----
Nature of Repairs or Alterations—Answer when a li ble-!x 3_ «�( I b r, r c�� _'. __ - .........................
U P PP ~
}— n
M + �Jtl _l"' :a tOr�C}-•t S rPL,u,l4-vet---------------•- �zxa -�-=.-.n v_��.aJ C x r
Agreement:
Ul
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of<<'t.E: 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 the board of health.
l•
Signed.....
=; j ........
Application Approved BY--�=== - ��----•-•-,�/!�/... _ ............. V �--------
.�
' ate
Application Disapproved for the following reasons-----------------------------------------------------------------•------------------------------•-•••--•••------
•-•-••••-•-•-••-••--••-••...-••••--•-•••••-•••-•....••--•••-•--•--••••••------•--•-.........-•-•-•-•-•--•.......•------------••••-••-••-•••-••----•-•--•--••-•-••--•-•---------•------•-•--••-••---------
Date
_ c
PermitNob __._.-___�-------------------- -�--------------- Issued--•------...-------------------....------ -----------
Date
THE COMMONWEALTH OF MASSACHUSETTS`_
�tr`jv BOARD OF HEALTH
��Y 1 vwr�...............0F.....�1 r1l�.frr.10tC.._...................._......................._.__
%Trrtifiratr of Tontplinnrr
THI,��JO CERTIFY, That the Individual Sewage Disposal System constructed (4) or Repaired-( )
by............. _JI t'`r !J....................................
---------------------•--•--.....- ..........
-----•--•----------•-------...-----••-----_•-----------......................-----
____ Installer -------•-----.._..--
has been installed in accordance with the provisions of Tr^Yr' " of The State Sanitary Cad d -bed in the
application for Disposal Works Construction Permit No���....-----•--•-- dated_...--- -----6'--yam'------------------
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CO�UE® AS A GUARANTEE THAT rHE
SYSTEM WIL....... CTIQN SATISFACTORY. //��
DATE.............. ��'/J _ .................................... Inspector.......__-"____i-..................................................................
�«� '�v THE COMMONWEALTH OF MASSACHUSETTS
r BOARD OF HEALTH
v-�T'.,,.........,................................OF.... _.
FEE._..l. . ...
lioposn Vorkg Touo#rnrtion rrntit
Permission is herebygranted lU/D.oj......-•--.-------------•---------------•-----••------•-•---------._.........._..._..-•-•-...--••---....__
g I
to Construct �16
or Repaiir ( ) an di`�idual S . Vage Disposal System
at \'o- U -- `1- -C1�'1'r�------------------------------------------------------------------------------------
--------•-• -•--•- = J
Street c5 q/_
as shown on the application for Disposal Works Construction Permit No Date�d.;__ � � ��__.__......
.
Board of Health
DATE------------------------tlm�-------------------------------•--------
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS