The URL can be used to link to this page

Home My WebLink About0130 ABBEY GATE - Health 130 ABBEY GATE COTUIT A = 021 055 TOWN OF BARNSTABLE LOCATION,AD SEWAGE # VILLAGE,-- ASSESSOR'S MAP & LOT 02/ OS� INSTALLER'S.NAME&PHONE NO. SEPTIC TANK CAPACITY /d00 LEACHING FACILITY: (type) -,f,00 tool r(e twgC11 (size) _2,3-X !3 NO.OF BEDROOMS BUILDEROR OWNER i vc�oh PERMITDATE: &hhqCOMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or witrun 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leachin facili ) Feet Furnished by v FhoNT R. A. Bousfield Backhoe Service 17 Burbank Street Sandwich, Massachusetts �C j O 02563 IVti� Name .l .t ekn 0 Sewer Permit No. Location: T �. �� N� G i e k" CC-1 0 ;r . Builder's Name and Address�SR-M C- Date Permit Issued: a-)- -741, Date Compliance Issued:.- '� �' r � I eel f 24' r loset I CV Finished Area Sewing and Craft room N Mechanic.als Stairs and Storage Closet 16' 32' 700, 40 Op �y A&G1 (97 RO (wutF + DRAWN BY: DRAWING NAME: Vo mer And 5or Construction Peter Vollmer Basment Floor 13uMincl & Femo&e in DATE: REV: _ SCALE: �� Al 2/14/1 1 3/1 6 =1 SHEET 1 of 3 i 62' Dining Kitchen Living Bath N tairw y 91 21' 10 Bedroom Formal Living 32' 17— Vollmer Ark 5on Construction DRAWN BY: DRAWING NAME: Peter Vollmer First Floor A2 ,: 13ui �in� & �emo�e ink DATE: 2/14/1 1 REV: _ SCALE: 3/16"=1 SHEET20F 3 12' 12' Bath Bedroom °O Bedroom 0 N it (O N � Stairway 32' Vollmer / U IJ /on ConSLruction DRAWN BY: DRAWING NAME: Peter Vollmer Existing Second Floor Q C�uil�inq & r\ernoJe inq DATE: 2/14/11 REV:_ SCALE: 3/16"=1 � SH.Er3OF 3 / \ -AsBUilt Page 1 of 1 TOWN OF BARNSTABLE LOCATION-90 4Z Y3s¢rF ,SEWAGE # VILLAGE l'r,lvlT ASSESSOR'S MAP&LOT02/ OS `} INSTALLER'S NAME&PHONE NO. /1 J-03y9 c�ss ei4'� r�`•ros SEPTIC TANK CAPACITY %002 LEACHING FACIL=: (type) ra Ui41Z (size)1 X-!3 NO.OF BEDROOMS BUILDER OR OWNER A i ° PERMITDATE:` LEI q COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leachin facili ) Feet Furnished by http://issgl2/intranet/Propdata/prebuilt.aspx?mappar=021055&seq=1 1/6/2012 ' No. � � �r- ..' Fee ,�v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUS.ETTS Application for Mtzpozal *potem Comaruction Vermit Application for a Permit to Construct(4-fkepair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 15" 4�b ,�� G Owner's Name,Address and Tel No. / Assessor'sMapTarcel LpTu%r ,5,gA1, 14 DAtI/Gfso� b B4� 0 Installer's Name,Address,and Tel.No. q 77- O:5 S/9 Designer's Name,Address and Tel.No. t&-"Pt/ 0"/3 HNaS ,l0se,04, 'a--A -w-a�5 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 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank / Type of S.A.S. Description of Soil Nature of Repairs or Alter ions(Answer when applicable) sz5124g X— S0O 601 17 c✓ Z.t/l l�S 4W&_ noo�- 1417nelH ?" p. 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 Certifi- cate of Compliance has been i sued by this Board of Health. Signed ;� fi1 Date_r Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued TOWN OF BARNSTABLE LOCATION /SO SEWAGE # VILLAGE �r�TvtT ASSESSOR'S MAP & LOT 02/ OS� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /d00 q LEACHING FACILITY: (type) (size) 1,f X / 3 NO. OF BEDROOMS_ BUILDER OR OWNER it PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: ! Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet /� '✓/ //�� i Prvate Water Supply Well and Leaching Facility wells j ty (If an y on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist Within 300 feet of leachin facili ) Feet Furnished by li i a I� j H •/ i +n5' i II v aJ -No. / Fee �. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISI-ON - TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for -Mizpozal *patent (Congtructiorn Permit Application for a Permit to Construct(4-1'Repair( )Upgrade( )Abandon( ) ❑Complete System O Individual Components Location Address or Lot No. 1,30/��b oyV G14T� Owner's Name,Address and Tel No. Assessor's Map/Parcel (..OTV�r / ✓��`^�p ��V��5�� Q?OS"� b 2 ash Installer's Name, Address,and Tel.No. 5/7T�.-0 J 4/Q Designer's Name,-Address and Tel.No. Jos` h Y-a IJ al"rMs ''f ✓D.5�l��i °�.G./3K►!�'a"rl'S Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder( ) 1 Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow` gallons. Plan Date Number of sheets Revision Date-. Title Size of Septic Tank {,' '` Type of S.A.S. a Description of Soil 5 tii ` Nature of R�airs or Alter tions(Answer when applicable) sf+o��' 2 �S"OU �`a (��u a//=��s ✓lr�iT� 4' 5,om-G /4ea444 Sr&2& Date last iected:p 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 Certifi- cate of Compliance has been i sued by this Board of Health. 1 Signed Date 9.'17 . ' Application Approved by Date Application Disapproved for the following reasons - Permit No. 0 Date Issued '� 1 --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed(4--)-Repaired ( )Upgraded( ) Abandoned( )by .& ro� J2,e ac at efaral,rhas been constructed in accordance with the provisions of Title 5 and the for Dispo al System Construction Permit No. dated -! '6 r 9 Installer yl5 e�6 / e 13,0~495 Designer a The issuance of this pe t sh t be construed as a guarantee that the syste w'.1.1-function as despised. Date Inspector �,` ——————————————————————————————————————— No. / / - ®�l 0�� Fee 3V t THE COMMONWEALTH OF MASSACHUSETTS ` PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS wi5po!5ar *pgtem Construction Permit Permission is hereby granted to Construct(L.�-Repair( )Upgrade( )Abandon( ) System located at 6 7-a r and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this&,I. Date: �� / / Approved by ^ t i 1;6199 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERNIIT (WITHOUT DESIGNED PI A 9,-S �v5 , hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at /-Ta 6,*r _ meets ail of the following criteria • The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. (� There are no wetlands within 100 feet of the proposed septic system !f IT-ere are no private wells within 150 feet of the proposed septic system ff There is no increase in flow and/or change in use proposed d There are no variances requested or needed. • The bottom of the proposed leaching facility will nat be located less than five fe:t above the mxcmum adjusted groundwater table elevation. (Adjust the groundwater.table using the Frimptor method when applicable] • If the S.A.S. will be located with 250 feet of any vegetated wetlands,the bottom of'the proposed leaching facility will ngt be located less than fourteen(14) feet above the macimsun adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W. Elevation +the MAX. Fligh G.W. Adjustment DIFFERENCE BETWEEN A and B SIGNED : Ll,� u�Ll.�s- DATE: [Sketch proposed plan of system on back]. q:health foider.cen yr . ,�� 0 0 0 S � � � CC1 O • r C h O . � i 0 ��\ No........i..7...... Fas....l....�............... THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEA TH o-wy1.... Appliration -for Biiipuitti Vorks Towitrurtion Vrrui t r Application is hereby made for a Permit Yo Construct ( or Repair ( ) an Individual Sewage Disposal System At: ......... . �- �!1"'` i ............. ........ GAT `' ...... Location•Add ss or" , ............ ..... . ........... . �O r es s 7. Installer Address Q Type of Building Size Lot-..?O..".--Sq. feet U Dwelling—No. of Bedrooms------------\3........... . . .Expansion Attic NO) Garbage Grinder WO) �J1A16 No. of persons............................ Showers — Cafeteria p., Other—Type of Building >�-... . .. p - - ( ) ( ) Q' Other fixtures -------------------------------- - W Design Blow...............�0...................gallons per person per day. Total daily flow--.........&Q-0..................gallons. 9 Septic Tank 7L Liquid capacity/e9OQ.gallons Length................ Width.......-..-..-.. Diameter-----_------.- Depth.--------------- W x .Disposal Trench.—No- -------------------- Width-------------------- Total Length.................... Total leaching arca-------------- -----sq. ft. 3 Seepage Pit No.'--/-------------- Diameten/0-00-SeDepth below inlet -. _- t........ ...... Total leaching area------------------sq. ft. Z Other Distribution box ( ) Dosing tank a Percolation Test Results Performed /bY Date.... a Test Pit No. I.................minutes Pei,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.........-.-.-..-.....-- G ....•--.........-•-;t ------ �.. - -- -- ------- --- - -- - Description of Soil--- ----0 �� --- - --`�----�- - - - -- ---- -- - ram--' - -- ' -- -- x r --- Lard ' ------- -------------------------------------------------------------- W UNature 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 en i ed y th board of heal . Sied- - ------- ---•-- -- ------- .......................•..... .... ------4 D e Application Approved By---... 4 ..... ..-- ..�� _------------------------ ----- ......If....--7._4.---- Date Application Disapproved for the following reasons:----••--------•-•-•-------------•----..-..-------------•---•-•------------------------------•------------------ --...-•-•--•--•-••-•-•------------------------------------------•---.......-•-•-•---------•--•------•--•----------------------------------...--•-•-•-----•-•----•----....--•-•----------------......... Date Permit No......................................................... Issued. . .......... 3••-- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD F H EA (1 ........ ......... .. ......... ............................•--- ............................ ApVftration -fur UhiVoiittl Workii Towitrurtion Vautit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System' : Location-tAddr ss�. ... �_.......- uL .................... .......e: i C®T �r ress Installer Address U Type of Building Size Lot... feet Dwelling—No. of Bedrooms___________________-------------------------Expansion Attic Wo Garbage Grinder (� pa., Other—Type of Building Ll (;No. of persons____________________________ Showers ( ) — Cafeteria ( ) a' Other fiat it res ----------------•-•------------- _ w Design Flow..............:S __________---•...gallons per person per day. Total daily flow-_-----------&Q—-------- WSeptic Tank--Liquid capacity/aOOgallons Length----------------- Width-----_.......... Diameter...------------- Depth.--............. x Seepage Pit No..... Diameter__/�0O•- ----- Total Length------------_------ Total leaching area--------------......sq. ft. ol Trench—No /o. _-----_.__ is -_-_ Width-___-----$/;;'Depth below inlet _______ Total leaching area___._....__..._.sq. ft. Z Other Distribution box ( ) Dosing tank ( ) o�• 7G C ' ,,;? °/•- 7 aPercolation Test Results Performed by-------------------------------------------------------------------------- Date----•-----•--------------------------... Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water--------.----_-__-._--- fs, Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water_-._.-_-_-__--_---_----- . /e �....... ----•-- Description of So - - ✓ ` = 6' ---------------- -- -- ------------ x ---- •-- ------------------- i_ _ _�?`e %. - w --- -- --- '-. 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 \I of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be is� ed thh board of heal S Pre -f� ........ ................ -- --- ---------------------------------- ...... ----------- Da Application Approved By-----` GG - 1f/!/_)-..... ......�- Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------- -•-••-••••••-•----------•-••••--••-••-••-•------------------•-----------•••••------•------............................................---------------------- ------ Date PermitNo......................................................... Issued..................... ---------------------------••---• Date 1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH -�� ............ ✓.......OF..._.................11i.... ! fC� .. ..................................... Qrrtif iratr of W"I'lWhaurr i THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( 1<0r Repaired ( ) f1 , b y ' has been installed in accordance with the provisions of Ar of The State Sanitary Code as described in the - application for Disposal Works Construction Permit No.................e-l--_-__--__-_-- dated...... .................. THE ISSUANCE OF THIS CERTIFICATE SHALL, NOT BE CONSTRUE® AS A GUARANTEE THAT. THE SYSTEM WILL FUNCTION SATISFACTORY. 1 1 DATEfr .r..... ----------="---------------------- Inspector.......... r *,_ ?_4 THE COMMONWEALTH OF MASSACHUSETTS .6nd BOARD Of HEALTH . :.............o f......s✓ - ..!-:1..-(c.......................... No.....-I/Z.---- FEE........................ �i��>a�tt1 grk,� (��n��rttc�i>att rruti� Permission is hereby granted---------- ----- `' `.C'S --•---------------------......--------.....--------••-----......._.....-----•----- to Construct ( �/�r Re it ( ) an In ' idual Sewage Disposal ystem at No._X�_L 1-- -------r7�`= .L.i-----/J.�_� :�...._.:..._/`., �a:�"'' trcet as shown on the application for Disposal Works Construction P it No. ..:.......... ated.__.__7------y�__ `----------- DATE........................................--...................................... Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS t1 _____ -_- ^..,..^.'.....•.�".' -_ ____w...r....w.w�.+•.rM✓++.. w..w._.r.r...+.+�.-^.ri+-.w.r,..we�..�r�r _�r.�-.�.�._-. O>C T `` .° i 00 V1 o 70 � /ona Q .� T,�sr �r� ��- IS � r ��'p�. ,/fir � i ��111117 l: !Z'30 15 r f .r A. N4 tr�48 A LOGA rl o N C-o TU iT I raASeE UL LoE-- M 4 5S N007........... r !i F�$....��................... 1 THE COMMONWEALTH OF MASSACHUSETTS BOARD QF HEALTH ........OF........ 16 ... ------------------- Appliratiun -fur Bhiposal 10orkii Tunitrurtiun Vrruiit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: � y�� oc 'on• ess ! , oror Lot�V" . < �,l''t� ^/,,, ...................... •----�<•- %-••G /. ) jLKJ.. el 0 a _......_� �6•Le_,�...._ id-J.eaZ Installer C/........................... .....w�-l.�fi.L..�1..5,_.--.3`-•"••••Y +tid ---------------------------------------- Address d Type of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms___________________�,-----------------Expansion Attic (--) Garbage Grinder ( (�H Other—Type of Building ___________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures ---------------------------•-----•--------------------------------•---------------------------------------------- W Design Flow................70...................gallons per person per day. Total daily flow__________- ___._____-_.__..___gallons. WSeptic "Dank I Liquid capacitv_) _gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.:..__....._ Total Length.........._......... Total leaching area--------------------sq. ft. Seepage Pit No......../----------- Diameter__-/ _ epth below inlet.................... Total leaching area------------------sq. it. z Other Distribution box ( ) Dosin,tanlc 7- 2 d 7 V aPercolation Test Results Performed by------------- --------------------------------------------- ---- Date--_-------------------------- -------- Test Pit No. 1----------------minutes per inch Depth of "Pest Pit_-______-________- Depth to ground water-------..__-__-______- �14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ----------------------T..._.....i .__ ....___. 4 O Description of Soil -:�•_J-�. r�l_ 1 -- ----------- x ------------------------ ----- �. �� JCS �C=� --•----------•----•.... ---------------------------------------- •---••----------------------•------• -------------------------------•-----------------•------------------------•--=--••-•---•--.........----•------•---------•-•---....--•----------------------------- 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 ' 7d by e b and o healt Signe = / 1 Date Application Approved By----- --- -___ "_.. ...... ... ._. . Application Disapproved for the following reasons:----- V Date ......................................................-.................................................................................................................................................. Date PermitNo......................................................... Issued........................................................ Date No......... FRiz ................- THE COMMONWEALTH OF MASSACHUSETTS BOARD 9F HEALTH /I-r!v.��........OF......... .. l/�s� ...::................... , pphration -for Uhgpoiiat 10orko Tonitrurtiou ; rrotit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: y� ---•---- �. C?r7�<' ,A''. t r) f 1__-`-------•----------- -----------------------. �J..... _ . oca n-Aaadd��ess or Lot N ry ---------------- - y- - W Own Y ( ddress ,-a --Zl7 � ��?? z , 1, / / r}�I vy = .-� - ----------------------------- -------- Installer Address Q Type of Building Size Lot............................Sq. feet UD3M 11iP--ng—No. of Bedrooms....................G.?.Z-------------------Expansion Attic (—) Garbage Grinder ( (� p.., Other—Type of Building ............................ No. of persons_-------------_------------ Showers ( ) — Cafeteria ( ) a'' Other fixtures ...................................................... W Design Flow.................�`0--._.---.--------..gallons per person per day. Total daily flow...........Z!_1 ..................gallons. WSeptic Tank 4 Liquid capacity..MADgallons Length---------------- Width................ Diameter........-------- Depth........_- x Disposal Trench—No..................... Width....-....... Total Length-------------------- Total leaching area--------------------sq. ft. Seepage Pit No....---- --.--- Diameter...f11�}�_11/I p th below inlet.................... Total leaching trea---------.._.----sc ft. , P gt 1 z Other Distribution box ( ) Dosing tank ( ) d C 7` v- 7 L Percolation Test Results Performed by------------- ........................................................ Date---------------------------------------- Test Pit No. 1----------------minutes per inch Depth of "lest Pit...-..-.---_-_.--_- Depth to ground water....---- -----..--.----- GT, Test Pit No. 2................minutes per inch Depth of Test Pit...------.-__-_._--- Depth to ground water.........--.---..------. O --•-•-•-••-•-• -- ' Description of Soil 1 ` - �` s ` �'� �--- Gas,�� 1 != rr r P S/, / �-rtf `------- Gam_-r's .. V --------------- -• Sf 1 a � �iF'�-e%Le�'s ��/�L/- �-� � "t �i6n�:_.f ----- W UNature 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 aid by e b rd o healt Signe -- -- /, ---------------------•--------- Date ``Application Approved By------- - J_—1� . ." � `.e L� Date Application Disapproved for the following reasons:........................................................................•------...._... ...................... .............•--••-.......•-•--------•------•-------•----••-----•---••---••-••-----------•-••-----------.-------•----------•---..............-•••••••---•------•---.•----._...--------......--------•--- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O�Fj HEALTH j............OF............ J..G/lr'+ ............................................. �rrtif iratr of (�omplioatrr THI - TO,, E " IFY, That e.In Ni ual Sew ge Disposal �S�ysst m constructed ( or Repaired ( ) ` In aller has been installed in accordance with the provisions of Article XI of The Staje 99de as described in the application for Disposal Works Construction Permit No...---- ..................... dated----0-- �--.---..------. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.... ..._^ Inspector0 --- -------- ---- -` ................. THE COMMONWEALTH OF MASSACHUS TS BOARD O HEALTH �71 . .........OF.......... -- ---------- ------- -- -- -- No. .................... FEE... �±-k� �trortioa r ; it Permission i reby granted------------- � --- -- -'1--- ,-:- ........................................ to Co $,ruct ( 7ph Re ( ) an Indiv' tza ewa e Dispos y em at No ! r :l�ft�r_ '�.......�� Street as shown on the application for Disposal Works Construction Per o.............. ... ed... =.�-----_- -- .......... -------�- ,. ----- I/J_ 7Z { Board of Health DATE....... --- .-- �j--------4----------------------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS I ` Jr _ I W 40-W Yet. 4tos A • AL NA'ILL F`%