The URL can be used to link to this page

Home My WebLink About0064 WOODBURY AVENUE - Health i 64-66 WOODBURY AVE. , HYANNIS A=307-204 h } No. V ` Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es 01ppYication for Disposal *pstrm Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon(X ❑Complete System ❑Individual Components Location Address or Lot No. 6q LVC>CbjBUR-y <L,-45 Owner's Name,Address,and Tel.No. Assessor's Map/Parcel ® 7 ,:;�o L4 76E/,ms YA x/j Installer's Name,Address,and Tel.No. 50q—(;6-r7-9S?l Designer's Name,Address,and Tel.No. CtAIoEwoc_ E Q,19,5S NM Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) A69fiDw 0 f 6'76 x& Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Sign Date (g'0-01 Application Approved by Date "(��r t/ Application Disapproved by Date for the following reasons Permit No. �d ("� '3 yS Date Issued 4 y No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es 01ppYication for Misposal 6pstetn Construction 3permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon(X ❑Complete System ❑Individual Components - Location Address or Lot No. 104 W0ae VRy a4L)6 Owner's Name,Address,and Tel.No. ,,JJYf' R�a�-T KcYwo��d Assessor's Map/Parcel 0 2O fT PPS (o x/l Installer's Name,Address,and Tel. o. 5C09„Y-77_gS n Designer's Name,Address,and Tel.No. r Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title I Size of Septic Tank Type of S.A.S. I� Description of Soil i j i Nature of Repairs or Alterations(Answer when applicable) i Date last-inspected: Agreement: ` The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. ' Sign Date Application Approved by Date G Application Disapproved by Date for the following reasons I i Permit No. O (� - y S/ Date Issued ------------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned(u)by 6A9Et,V1D6 &��X I CEC 1Z _ at t tk in o L! Avg YS j has been constructed in accordance _ with the provisions of Title 5 and the for Disposal System Construction Permit No.DI)(y-3 'l i�dated G,^ - l/ Installer d A1Q9 I b& LLC Designer NIA #bedrooms Approved design flow / gpd � i DThe issuance of this permit all not be con trued as a guarantee that the system w' 1nct on as esi . ed.Date tip; Ins ectorN . r'(,�;i? �� V' L p U ----------------------------------------- No. )o I l/ — J 1 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal 6pstrtu Construction 3permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon(�) System located at(, 4 W( cq)i�,u guv Aue [yA w&)I !� and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constructirjj�/f mu t be completed within three years of the date of this permit 1 . Date " L� Approved by AsBuilt Page 1 of 1 ASSESSOR'S MAP NO. PARCEL L0CAT10N, SEWAGE PERMIT No. AGA INSTALLE 'S NAME A ADDRESS B U I L D E R OR OWNER DATE PERMIT ISSUED 7_3 _ Tcl DATE COMPLIANCE ISSUED J� 5 � { h http://issgl2/intranet/propdata/prebuilt.aspx.mappar 307204&seq 1 9/19/2014 SENDER:'�'.C'61APLETE!This ■ Complete items 1,2,and 3.Also complete A. Si ture item 4 if Restricted Delivery is desired. ❑Agent ■ Print.your name and address on the reverse 1 ' ::;� Addressee so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from Rem 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No I I - I I ROBERT A. KEYWORTH, III 64 WOODBURY AVE HYANNIS,AMA 02601 3. Serv' a Type WoCergfied Mail ❑123press Mail ❑Registered UKeturn Receip r erc andLN ❑Insured Mall ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 012;;1010 0 0 0IO i2 8 4 8 ; 13 2 2 (transfer from service labeQ i s I PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-154o I UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LISPS I Permit No,G-10 I I I • Sender: Please print your name, address, and ZIP+4 in this box • I I - I Sewer Connect Public Health Division 4 Town of Barnstable 200 Main Street Hyannis,MA 02601 k ti m ra s OFFICIAL Postage $ ru P\�NIS M,9 O Certified Fee O 0 Return Receipt Fee Postmark �(p Q (Endorsement Required) �AAI�yHere p r Restricted Delivery Fee 28 2013 4 p (Endorsement Required rq / C3 Total Postage&Fees $ i�P N �/ _ - ra ROBERT A. KEYWORTH, III a N 64 WOODBURY AVE HYANNIS, MA 02601 Certified Mail Provides: o A mailing receipt o A unique identifier for your mailpiece e A record of delivery kept by the Postal Service for two years Important Reminders: ' e Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. n Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. e For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a LISPS®postmark on your Certified Mail receipt is required. a For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"RestrictedDdlivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT.Save.this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 -.1 Town of Barnstable Barnstable Regulatory Services Department AFAmericaC j BARNWASM MAC - �-�63 - -- ��D 200 Main Street, Hyannis MA 02601 2007 Office: 508-862 4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7012-1010-0000-2848 -1322 March 28, 2013 ROBERT A. KEYWORTH, III 64 WOODBURY AVE IMPORTANT NOTICE HYANNIS, MA 02601 Map & Parcel: 307- 204 The Department of Public Works informed us that public sewer lines are now available in your neighborhood. According to our records, your property has a septic system. This letter directs you to connect your dwelling, at 64 Woodbury Ave., Hyannis,MA, to public sewer on or before 3/30/2015. The old septic system must be either removed or filled in due to future safety concerns. This may be done by the same contractor who connects you to the sewer. Septic Abandonment Permits ($ 25) are issued at the Public Health Division, 200 Main Street, Hyannis. Failure to comply with this Board of Health Order may result in a complaint against you, in a court of law. For additional information pertaining to the sewer connection, please see the reverse side of this page. PER ORDER OF THE BOARD OF HEALTH omas A. McKean, R.S., C.H.O. of-the-Board-of Health-- Cc: Barbara Childs,WPC/Ro_ger Parsons, Town Engineering, DPW Enc. QASEWER connectUtters Stewart Creek Sewer Connects\MAU-ING LetA Sewer 2Pgs Merged 3-28-13 Yr2015.doc --------Public Health-Division-----___ ---_-_---_.__ __. _,..____ March 28,-2013____._-------_—.— - - ADDITIONAL INFORMATION AND REMINDERS FROM OTHER DIVISIONS: SAVINGS AVAILABLE/GRINDER PUMP: A reminder to those of you who need a grinder pump for your connection: Department of Public Works (DPW) sent you a letter in December 2012 stating the town, for a limited time of two years only from the receipt of the DPW letter,would provide you with the pump at no charge. (This can save you thousands of dollars.) Please note: You must pay the installation cost through your own contractor. Please make your contractor aware of this, if interested. Also be aware: this is a shorter deadline than .the Public Health Division's deadline on the reverse side of this page. SAVINGS AVAILABLE/PERMIT FEE: The Town offers a waiver of the residential sewer connection fee of $420.00 for those properties that connect within two years of the receipt of the DPW December 2012 letter. LOANS: For loan(s) available,please see the enclosed brochure, or see the town website: http://www.town.barnstable.ma.us/cdbg (under the "CDBG Programs", see "Sewer Connection Loan Program). For loan specific questions, you may contact Kathleen Girouard, Growth Management, at 508-862-4702. CONTRACTORS: Information on Licensed Sewer Installers is available on our web site at www.town.barnstable.i-na.us/PubIicWorksTech/sewerinstallers. Contractors, approved to perform sewer connection work in the Town of Barnstable must obtain and file a Sewer Connection Permit with DPW-Water Pollution Control Division, 617 Bearse's Way, Hyannis—contractors,please call Dave Anderson at(508) 790-6244. _._.. .._ .. -----FOR ANY-QUESTIONS/-ASSISTANCE:..._____.... Len Gobeil at the Town Manager's Office is available to provide you with direction you may need in reference to the Stewart Creek Sewer Connections. You may contact him at 508-862-4701. QASEWER connecALetters Stewart Creek Sewer Connects\MAIL,ING LetA Sewer 2Pgs Merged 3-28-13 Yr2015.doc Z 3.4A 659 � 922 Receipt for Certified Mail No Insurance Coverr<ge Provided srre5 Do not use for International Mail rosru sertr� (See,Reverse) Sin o) t S t d No. A � P t e and Z e C) Postage $ M y1 E Certified Fee L O U Special Delivery Fee N O. �Restn�i€�D'eliU�i'�'Fed' Ali@ R66A`1q 8WRIRY 1 to Whom&Date Delivered Return Receipt Showing to Whom, Date,and Addressee's Address TOTAL Postage /7 &Fees ��/ Postmark or Date --`�- 97 STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front). m 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address 12 leaving the receipt attached and present the article at a post office service window or hand it to your rural carrier(no extra charge). � 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return rn address of the article,date,detach and retain the receipt,and mail the article. 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed co ends if space permits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. CS tb 4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee, t'9 endorse RESTRICTED DELIVERY on the front of the article. 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If U- return receipt is requested,check the applicable blocks in item 1 of Form 3811. d 6. Save this receipt and present it if you make inquiry. 105603-93-13-0216 j CF tN E T04 The Town of Barnstable y Desa9TesL i Department of Health, Safety and Environmental Services 39 k,�� 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 3, 1997 Marianne Sullivan 76 Mistic Drive Marstons Mills, MA 02648 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE II MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE BOARD OF HEALTH NUISANCE CONTROL REGULATION NUMBER ONE The property owned by you located at 64-66 Woodbury Ave., Hyannis was inspected on January 30, 1997 by Edward Barry, Health Inspector for the Town of Barnstable, because of a complaint. The following violations of the Nuisance Control Regulation Number One Regulation and the Sanitary Code H were observed: 410.602: Rubbish and debris scattered on the ground. You are directed to correct the violation of 410.602 within twenty-four(24) hours of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Health within seven(7) days after the date order is received. However, this violation must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. You are also subject to non criminal citations of$40.00 for the first violation and $15.00 for each additional violation. Tickets will be issued daily until the violations are corrected. PER ORDER OF THE OARD OF HEALTH o as cKean Director of Public Health .y �oFIM( The Town of Barnstable w Health Department 1 .,un.n 1 367 Main Street, Hyannis, MA 02601 .N11 �e�o• �A r�r► Office 508-790-6265 �YL �L,t - z urn Thomas A. McKean FAX 50t-j7ptJ344 . j ` � Director of Public Health jj� ' NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.001 STATE SANITARY CODE II, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION The property owned by you locateds inspected on VW4,' 1'41 1997 by,o�iPw,4r� iPIOAI �Z-?� Health Inspector for the Town of Barnstable, because of a complaint. The following violations of 105 CMR 410.00, State Sanitary Code II, Minimum Standards of Fitness for Human Habituation were observed: zo ,�tX *�4 You are directed to correct these violations within twenty- four (24) hours of receipt of this notice. You al r 7orr7 s/ fyourswie. o r, cei t no t You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order 'is received. However, these violations must be corrected "regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health ASSESSOR'S MAP NO. PARCEL LOCATION SEWAGE PERMIT NO. I - - VILLA to a is I N S T A LlE 'S NAME i ADDRESS s R UILDE R OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED -- �s�� X "\ �0 1 �ti� �M �. � . a , � r � - . � �.�� - � `�F � �' P � R w � � � j ;r a C`. g E@; V ■Com a items 1 and/or 2 for additional services. I also wish to receive the 'a ■Comple a items 3,4a,and 4b. following services(for an y ■Print your name and address on the reverse of this form so that we can return this extra fee): card to you. m 4) ■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address 0 permit. y ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery N ■The Return Receipt will show to whom the article was delivered and the date a delivered. Consult postmaster for fee. 0 v 3.Article Addressed to: 4a.Article Number02,2 2— d a c,PJ �S 9 S 4b:Service Type t° -7/ ❑ Registered Certified tr tM Cn t ' ❑ Express Mail ❑ Insured y ❑ Return Rec'feipt for Merchandise ❑ COD a7.Date o Delivery � O 5 5.Received By: P' t 8.Addressee's Address(Only if requested c t .' and fee is paid) g 6. ture (Ad ssee or ent) O T ' N PS Form 3811, December 1994 Domestic Return Receipt UNITED STATES POSTAL SERVICE n Mq ---First-Class Mail, �p p� -Postage-&:,F,ges:Paid PA.4 v =" ., ..�. =USPS�..,.. ��— F "' -- tea , -Permit-No.,Gr10_ r; • Print your name address, and ZIP CodeXin this box 0 Pub11c Health oiVision Town of Bamstabie P.O.Box 534 1 Hyannis,Massachusetts 02601 ` 'a.x ........._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH oGSrt................O F.. !71. I.P�.......................................................... Appliration for Dhipwial Works Tomitrurtinn Vamit Application is hereby made for a Permit to Construct ( ) or Repair (ek) an Individual Sewage Disposal System at: ................ •-•-.....•--•-••-•-••-••...................•-••-----•............----- .............----•-••. ,.a n-Address ... QsdRtsj . ............--- . Owner Address ,�4 -#f .C��!n. ........-•-•------------------------------------------------------ 1 !,►_. r.�..T...lua .[ -•----------..... Installer Address d Type of Building ,/ Size Lot.................... Sq. feet Dwelling�No. of Bedrooms . J..............Z_:___.____.___Expansion Attic ( ) Garbage Grinder ( ) aOther—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. 3 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. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �+ ••••---•-•--...••••---------•...............•••••-•••••-••••---........................-•-•••................................................................ O Description of Soil ............................ -----------------•---------------------------------------------------------------------•--•-----....----------------------------•-------------------•--•------••--.�, -•---• .............. 0 Nature of Repay' s or Alterations—Answer when applicable..?w.6 4t. ............................................................ .. Q),1 .. _. Q... -lr .- ---- ,�1�-- -•--�"---�'! a�_.G� _� tt 4rl..Cl�s!t- ,Cad Agr e : The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with the provisions of TITLE 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. ApplicationSipe Approved B ......_.__ I Date Application Disapproved for the following reasons:.............................................................................................................. ........----•-....-----•••---•-•--•-•---••-••-•-----••••••••-•...................•--•--...-•-•-.....-•••••••--•--•---•....._........._.......••--••---------•-•-••-•-••••---•••-•---••-•-••--••••••••••- Date PermitN A....L............. Issued....................................................... Date `.- -- -------------- ----------------------------------------- - - -- / Wo .&.... :Z/ Fss...� :_...._..__ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TU(s .......... ....... Appliration for Disposal Works Tonatrnriion 11rrnti# Application is hereby made for a Permit to Construct ( ) or Repair ( •) an Individual Sewage Disposal System at: ?�i.!:..5 re ..... � xws................. ...........•--•-••----........---•---•--•-...........................-----...._......_.....- �Location-Address 1 or Lot�No. .412 S euS:r... ..suer..................................•-.... . So„C"�eve�Q.,rcl.-- r`• .-f-.r_.A�or cs�. ;._. A...._........ Owner Address Installer Address f Type of Building Size Lot............................Sq. feet DwellingI No. of BedroomsAvkl�.............&/..............Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers a YP g -------------------•-------- P ( ) — Cafeteria ( ) dOther fixtures .-•-•..........................................•--•---...........--------.........-•--•-•----..................-•----.........------••--•-------...... Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area...................sq. ft. 3 Seepage Pit No._____••-------_-_- Diameter.................... Depth below inlet.................... Total leaching area..................sq. 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........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P+ ----------•-••••••-••••••-•--......--••..............•---•-------...•-----•..........----._.........._..........----•---•-••--•---......._------........---•- 0 Description of Soil........................................................................................................................................................................ W V -... ---------------------------------- --------- •----------------- -------------------- •----------- ---------------- •----------------------- ----------- -•-------------- W UNature of Repa-rs or Alterations—Answer when applicable_TwAu l�-_..-� Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 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. Si ned&.: � a... �� ---------------- �................._ .w.rr D. ApplicationApproved By....... . . ........... ...--•----•................... ..........-••------•--•• ............��"�Da -------------- Application Application Disapproved for the following reasons:........................................................................................................... ...--••-•----------•-•---•---------------•...............----•-•-----•.....•-•••--•--....•-----•...•-•--.....-•------------••••....•-•-•-..........----......---•--........-----•.........-•---•...._.._ Permit No..e•• .._T_...1......... ...... Issued............................................ ...._ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Ta ifiratp of Tomphaurr THIS IS CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired (�) by.................... --------------••. ••---------•---•- •-•-••......------_-- ......--------------•--...........-•---................ ._...._ _ - .... { 11��. Installer at... .._.y...�. ----_.._..�.1S.�C?. t - �h n ri1=` has been installed n accordance with the provisions-e ITLE 5 of The tate Sanitary Cod as esc ibed in the = application for Disposal Works Construction Permit No application dated .. .................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GO RANTEE THAT THE SYSTEM WILL� UNCTION SATISFACTORY. ` DATE................IC .................................................. Inspector- -- .. ` --..,.: j - a THE COMMONWEALTH OF MASSACHUSETTS 1 BOARD OF HEALTH � - o►.�W�.................. F....8...............: : C ..----.........................................Noy .. q , Fay.... .: .......... Disposa arks Tonshmaian Vrrnti# • I Permission is hereby granted.................. �I ..... ............•----••--........----•----.......-....------..................._---..................._.... to Constru(c,t.,�) or epair ( ) an Individual Sewa a D-s oral System at No....... J.--l--�. D. J-`�-_:-C Y1/11 ........................................... Street as shown on the application for Disposal Wo_r�S Construction,Permit N ��Vted.. ._. .............. -- ;, c �+ Board of Health DATE............. / ..................................... FORM 1255 A. M. ULKIN, INC., BOSTON