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TOWN OF BARNSTABLE
LOCATION SEWAGE
VILLAGE l* ASSESSOR'S MAP 6z LOT
INSTALLER'S NAME & PHONE NO. co
SEPTIC TANK CAPACITY 1
LEACHING FACILITY:(type) aj{ P � (size)
NO. OF BEDROOMS PRIVATE WELL OR UBLIC WATER
BUILDER OR OWNER O Z
DATE PERMIT ISSUED: d y `f 7
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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No... FEs...... �S....._
THE COMMONWEALTH OF MASSACHUSETTS
BOARDF HEALTH
.............T.. . .. ../��I..OF.. .. .. ...... .. ..
f. tom`i..^'
Applirafiun for Uiipuaal 19arkii Cnunitniutiun rrrmit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at
'••.^-••_.-... �Onn
i1a� � L1.. 1��iW•••• .._,or Lot No..........................».»....».....
Owner Address
a .. .... is.. . . . .......................... •.........---•-----....................---.._...........-•---......._.............................
Installer Address
Type of Building Size Lot... ....Sq. feet
., Dwelling—No. of Bedrooms................ ..................... Attic ( ) Garbage Gander ( )
a'4 Other—T e of Building No. of persons............................ Showers
YP g ---••-------------•-•------- P ( ) — Cafeteria ( )
Other fixtures -------------------•---.
Q ......
W Design Flow._..........•• L --•..............gallons per y. Total ily eow........... ...................8aljons.
WSeptic Tank—Liquid capacity. .gallons Length..�?.�j.... Width: ...lfl.. Diameter................ Depth....,.a�..
x 1
Disposal Trench—No- -------------------- Width.................... Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit No.........'----------- Diameter......1.Q...... Depth below inlet........G...... Total leaching area..ZJ6_1k.��, q. ft.
Z Other Distribution bo�� Dosing tank ( )
a 0-4
Percolation Test Results Performed by.....c�.UVME( Date--- 14. .............
Test Pit No. I......G.-_.. mutes per inch Depth of Test Pit....f.Ra f.. Depth to ground water... .
0)6�
fs, Test Pit No. 2.._..2. 7Z:.-minutes per inch Depth of Test Pit....�.5�..... Depth to ground water... ......
Ix ........... •-----... ........
Description of Soil....` .- •-•---' DU ----�....-..�. (a----- .� ......$1tR!��...................
. .....................P .......
W es— .. .
0....................
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 MITI.:. 5 of the State Sanitary Code— The undersigned further agr t to place the system in
operation until a Certificate of Compliance been issued by e b d of health.
Signed. .. . ..... .. .................. ......_....
Date
Application Approved By------ . . ..........
..............
Date
Application Disapproved for the following reasons:..........................................................................................................
»»..
....................................................................................•-•-•--•-----.........--•-•-.............-•----------.....---...---------------........--•-----...............-•-•--
Date
Permit No........•-•-7=....7.5..y..---------•----- Issued.............................................-_........
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
I •ter
)!0Zt 2"L_..............OF..............: -v..... .......................................................
Ott G ENGINEER MUST SUPERVISE
(ff of irate of �ullt;4N_ I L CION AND CERTIFY IN WRITING
THIS IS TO CERTJkY, That th ndividual Sewage Disposal kNST4Ljkp iedST(RI�T
by.................... ._...... . .........................•-••......-••--•--- RDNCE7.Q.PLA..................................
Installer
at......... � - ..=..W.. ................ ..
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No......6. ..y..... dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector....................................................................................
362-4541
939 main street rt 6a
yarmouth port
mass 02675 down cape engineering
civil engineers& land surveyors
structural design
Arne H.Ojala P.E.,R.L.S.
land court Richard R.Fairbank P.E.
surveys
site planning May 19, 1988
sewage system
designs Board of Health
Town of Barnstable
Town Hall
inspections South Street
Hyannis, MA 02601
permits Re: Lots 111 & 112 Forest Glen Road
To Whom It May Concern:
During construction Down Cape Engineering staked
locations for the proposed septic system to conform to
setback requirements of Title V and Barnstable Board of
Health Regulations.
The system has been placeiin locations as staked.
Ver ruly yours,
Carol A. D. Yo ng
Project Engin er
Down Cape En ineering, Inc.
cc: Bayside Building
i. -
No... . FEs..... ...._
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEALTH}} // ��r--
............... lv..OF..� ......1 ./ .. .. .0
A
Applirntion for Pubip sal Workii Tonstrurtion JJA mit
Application is hereby made for a Permit to Construct Y ' or Repair ( ) an Individual Sewage Disposal
'24 System at 'l........... .... 1... - C]. .....:..........
---. .
Loc;�+' nn-Addy or Lot No.
.. .. !. �... t.(a 11 . --•-••------•------•......................................•--......-----.........._......._.....
Owner Address
......................... .. .........................0............................
Installer Address
Type of Building _ Size Lot...2.,,�.3.1.. ....Sq. feet
a Dwelling—No. of Bedrooms................... .....................Expansion Attic ( ) Garbage GnndeU( )
aOther—Type of Building ............................ No,. of persons..........._....:_._.__.___. Showers'( ) = Cafeteria ( )
Q �...Otherfixtures ..._...... -----------------------------•------------------------.-.--•----•-..-----------.-----.
..
W Design Flow.............. .................gallons per F A efr day. Total daily flow.......... Q....................gallons.,,
WSeptic Tank—Liquid capacity.±COO_gallons Length.. . � p.(,g__.. Width:..___.� . ... Diameter................ Depth
x Disposal Trench— o. .................... Width.................... Total Length.................... Total leaching area-__--...............sq. ft.
3 Seepage Pit No......... ........... Diameter......�.� ...... Depth below inlet.............. Total leaching area..?6_7 s.(sq. ft.
Z Other Distribution boic—�/__) Dosing tank ( )
Percolation Test Results Performed by..... -- �4' �(�1 ... �I?.l r:................. Date... .............
►.]
,.a Test Pit No. 1................minutes per inch Depth of Test Pit....f je�v....... Depth to ground water...�..�.
44 Test Pit No. 2......�.Z:minutes per inch Depth of Test Pit....L.6 _ Depth to ground water... .....OL
.
W ............ ... ......
............
.• ----...•------- ..............................................................
O Description of Soil,�-0 24,......._rn tj: ....._7t�__. ...�. ..[ems. "1�...... _
................................................. .. ... . ........f.::._._..._. _.. D. .
.....
_. ..--•-----•-•--------.. -. :::_ t-----
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 TITLZ 5 of the State Sanitary Code— The undersigned further agr s •t to place the system in
operation until a Certificate of Compliance has been issued by e b. d of health.
Signed. _�.. . ... . ----• -• ........
--•............. ------
Date
Application Approved By.........._ x` _...a_.. ��,,.----,�...
Da................
Date
Application Disapproved for the following reasons:---------•.................................................•-------------------•-•-------•-----............. ..
....................•••--.....---•-..---•---•--.......•------•--••---•------•----•----........------..................-•-•--........................----------------•---...-•--------........_........._
Date
-t
Permit No........ ..7= 7 .................
Issued_--•-•-----..........------•---•-:.;........._.._.._...
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
rf:t...............OF.....................................................................................
Tntif irntr of Tomplinnre
THIS IyQ fERTI- Y, That t Individual Sewage Disposal System constructed ( ) or Repaired ( )
by ...................................................•-- --•---•----•---•--------......--------.........-----.........•--...............................
I ,wuer L,
at. -----•---------------------------------•------ .......------•... .. I! s?...._..
" .-•• -•--....--
has been installed in accordance with the provisions of TIT P 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.....t _..75..` _.... dated............... _....._._................_.....
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.........................................................•--•-----...........--- Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
c� BOARD OF HEALT�JH,
U77 t ..............� r......OF.......-- `:�-. .....................................
No..............:7 f Fn........................
Disposal Works To ixrtion Permit
Permission is hereby granted....... � ....................................•--------•-------------------•--..........---------......................
to Construct ( or Repair (( ) a. Individual ew g Disposal System
at No...........`�7 2.y....................
..' ...
street
as shown on the application for Disposal Works Construction Permit No�7` -<.... Dated..........................................
�j� t�
DATE. ward of Health
-
--•-•-. • -••-----------------------------•-------•--.....
SECTION - SEWAGE - vv��tj_o.cEl WI L-L
SErs� �S l01 i�tiL] t Ee, 1I uc -ro co0E__Tpj0-
-2- THIS GAR\( " ON A
2 -SEPTIC TANK - 4- ( .IFp'f�•�-S 7A'� ���TNT�1-
Cj - "O"80X - -LEACH �tT 24_ 2-
OF LDS
TOP FDN
n,gp(MS u• 41, � z1-0 T='\/G `-C) L•I�--c.- WASH"OFEDSTO E j ;IS Yf O E�T�� U.�� tt 1
NoI-IT �ySTr t�i f A TDtti!�. c +5A1�.►��-rar:>Or-
(l�- 3� WATEI' �G�taec�-e tasTz�T.
3,5 Nt�J I� GoVtr� 134 S t� E F.c�
OUT• I N- OUT• i N• '�E''.,''.,.'�` \ \`
sElrrtc r 31 `\
TANK 3O� O pit
ELEV.
ELEV. ELEV. ELEV. _PC"
r�Pr4 of Ft.o1,.W= �F( ELEV.l ELEV. o
�" col uv Id' 24� tt� •�'�� it : 'r�� `
0UTTLET TES 2�J' 6;' LLP; 14 COW a F w»
F I�T Zt OF I. �.i WASHED STONE
PIPE DU-1 OF earrom TiA 209
F-L, 19,o
TEST HOLE LOG P�2rc14 , P6'2o9� LEVEL-
lo`'� L. J IS-0
TEST BY E�f pzfp
WITNESS Q. Is'
� �
TEST DATE _��? DESIGN BEDROOM HOUSE O '\'� t�\
T.H. 4 2D`15a T.H. 2M5 6 C'.';, .
ELEV.'xF,o 6 y \. ,
24, ToPr '' 6 .p PERC RATE Z MIN/IN. DISPOSER OIS�S`ER NO P \` \ 6 ' S\
FLOW RATE 1 =I-�r l� --- 2aiScL L
µES' SEPTIC TANKa (I,cl
AND REO'O SEPTIC TANK SIZE
i
LEACH FACILITY
t I. SIDE WALL ►C7TC6 - 1 .'_ (7c�) - 4"ll . ?- G
r
15to �I. G1.O BOTTOM (;(,hz)!7r 7a C;' ( �,01 - �l3. S G/D. ?t �k.0 l
-Z 4, 1
j JF_LL AI W Z30 TOTAL - G9-7 Z�6 25 -I1� SF 1
TV-LAC,Y
USE: b1.6E 'f'T-2EGdST LEACHING p T C 9D°{9l D o 1 �1
¢��I
� IDI GAF 'I7tA•M Y+ (ol Gi'--F. T�P..,F''�a ``" I s � �J�� � O f � r
_WATER ENCOUNTERED O �-
Op r
I
NOTES: (UNLESS OTHERWISE NOTED) I 3 } r lc 0
i. DATUM (MSL)=TAKEN FR M _iY �_((__5____..OUAORANGLE MAP / 1
1.1 , I
2. MUNICIPAL WATER eVAILABLE TOM I �11`g Zb ZZ Z j!)
!.PIPE PITCH: �"PEA FOOT ' ., ��y G Z > E i
4_DESIGN LOADING FOR ALLPRELASTUNITS:-AASHO- "� r t Qr �Z T40MA.S E.� PADI,O f
S.MIN.CROUIVD COVER OVER ALL SEWAGE FACILITIES:(1) FT. ee� 3 I C.55 �
r
S.PIPE JOINTS SHALL BE MAOEWATER TIGHT $� ARNE H. ��� ('
7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. DJALA �L SITE PLAN
STATE ENV$RONPAENTALCODE TITLES VIL '
a-fHt6PLM 0RPF;OI-`-e I-.Iovy- G*J�tAQ2 4�7J�►�p o. //��`VA Of y� � . LOCUS: LvTS it1 .4..vlo lIZ C�o��t£ I�1A�1
:;OR Ut,l= �'AICI►JC� ,r EC - _ :/o�' ARNE s��yc 1T�Id 1.1tSIS
E Re�Sl NGINE �O N. � ZZ8 —
(� 0JAL4 Z�I REF:
J #26 a c� -
t�wn cope :engineering ,^ PREPARED FOR:
CIVIL £NGINEERS
' �� �in St. LAND SURVEYORS REC. EYDa III - �, Ib DATE,
• 80ARn0 OF HEALTH SCALE— 8� - /t / /
(EXISTING)----------•--- APPROVED _ DATE IF* I�CJTdf3LL MA Ylil��W C/ 4-6, 0
CONTOURS (PROPOSED)-0 O-O_O_ !
py�ETHETp�r TOWN OF BARNSTABLE
OFFICE OF
ssaaSTss>: �ri►sa BOARD OF HEALTH
0o,e�r639. 367 MAIN STREET
'EO MA'S k`
HYANNIS, MASS. 02601
November 5, 1987
Mr. James N. Bowes l
Bayside Building Company
P.O.Box 95
Centerville, Ma 02632
Dear Mr. Bowes:
You are granted a variance on behalf of your client Robert Gold, from the Board of Health
Interim Groundwater Protection Regulation limiting sewage flows to 330 gallons per acre
in certain Zones of Contribution to public water supply wells.
This variance will allow you to install an onsite sewage disposal system at Lots 111 and
112 Goldie Way, Hyannis, Mass., with the following conditions:
(1) The septic system must be. installed in strict accordance to the submitted plan.
(2) The designing engineer must be onsite and supervise construction of the onsite sewage
disposal system and must certify in writing to the Board.of Health that his design has been `
strictly adhered to prior to the issuance of a Certificate of Compliance.-
(3) The dwelling cannot have more than three (3) bedrooms. Sewing rooms, dens, lofts,
mudrooms, enclosed porches, finished cellars and similar type rooms are considered
bedrooms according to the Department of Environmental Quality Engineering:
(4). It shall be recorded on the deed that the onsite sewage disposal shall be pumped every
three (3) years and written certification submitted to the Board by a licensed septage hauler.
(5) The dwelling must be connected to public water.
(6) The dwelling must connect to town sewer when the Board determines its availability.
(7) Varimice expires November 15, 1988.
This variance is granted because the applicant combined two lots totalling 33,719 square
feet. These lots are of the few remaining vacant lots in a developed area.- It is the opinion
of the Board that the installation of another septic system in the area will not significantly
alter the poor quality of the groundwater in the area.
Ve my yours,
Grover C.M. Farrish, M.D.
Chairman
BOARD OF HEALTH
TOWN OF BARNSTABLE
JMK/bs
-57 DATE lT � 7
pyo iN r�N TOWN OF BARNSTABLE FEE ' p9.J Q�
y� +�
t »�� OFFICE OF RECEIVED BY
{ 1Ae)l7lDL1 1 MAGI E30ARD OF HEALTH
�
367 MAIN STREET
MAY�' 1
HYANNIS, MASS. oteol ..� U'
VARIANCE REQUEST FORM
►11 variances must be submitted FIFTEEN (15) days prior to the scheduled Board of health
ieeting. ,
TAME OF ,APPLICANT ,� (.� • TEL. NO. 7 7/ —/0 �/U
►)DRESS OF APPLICANT O 1&t- �S �� ��G UaG 3—
IMIE OF OWNER OF PROPERTY /� JUZ�
'UBUIVISION NMIE BATE APPROVED
ASSESSORS MAP AND PARCEL 11 BER 'gob o2 GO �G7/l ' G"`d a ";
,OCATION OF REQUEST 6 w a�eGy
IIZE'OF LOT 3�� 7l % SQ. FT. WETLANDS WITHIN 200 FT. OF PROPERTY: Yee ✓ No
'ARIANCE FROM REGULATION(List Regulation) 4
b_v &4 Im- 'e a-,,e
Ii,EASON FOR VARIANCE(May attach letter if more space is needed)
'LAN - TWO COPIES OF PLAN MUST BE SUBMITTED CLEARLY OUTLINING VARIANCE REQUEST.
ARIANCE APPROVED
OT APPROVED
EASON FOR DISAPROVAL
Robert L. Childs, Chairman
Ann Jane Eshbaugh
Urover C.M. Farrish, M.D.
BOARD OF IIEALTII
TOWN-OF BARNSTABLE
DATE D a�
pyo,;xi,off+ TOWN OF BARNSTABLE FEE
l OFFICE OF RECEIVED BY
1 DAMTl71DL1 1 DOAad OF HEALTH
3e7 MAIN STREET
HYANNIS, MASS. oteol
VARIANCE REQUEST FOR11
11 variancea 'must be submitted FIFTEEN (15)- days prior to the scheduled Board of Ilealth
eeting.
n
ME OF ,APPLICANT 15.. TEL. NO. 7 W l0 yo
DURESS OF APPLICANT
UIE Ot OWNER OF PROPERTY
U6DIVISI6N HAHE DATE APPROVED
5SESSORS MAP AND PARCEL NUMBER
gCATION OF REQUEST aa�4Ll
IZE`OF LOT 3�, 719 _SQ. FT. WETLANDS WI'T111N 20U FT. OF PROPERTYI Yee ✓ No
NRIANCE FROM REGULATION(List Regulation)
iASON FOR VARIANCE(May attach letter if more space is needed)
,AN — TWO COPIES OF PLAN MUST BE SUBMITTED CLEARLY OUTLINING VARIANCE REQUEST.
1RIANCE APPROVED
a APPROVED
:ASON FOR DISAPROVAL
Robert L. Childsp Chairman
Ann Jane Eshbough
' Grover C.M. Farrish, H.D.
BOARD OF uFALT11
• TOWN•OF BARNSTABLE
Bayside Building Company, Inc.
3 Bayberry Square•Centerville,MA 02632 (617)771-1040
(617)771-0894
October 20, 1987
Board of Health
Town Hall
Hyannis, Ma. 02601
Dear Board Members:
Mr. Gold has been a town resident all of his life and for the past few years
has owned and operated the Italian restaurant located on the corner of Main and
Ocean streets here-in Hyannis (331 Main Street - Penquins Go pasta). Three years
ago Mr. Gold purchased lots 111, & 112 of Forest Glen Road in hopes that he would
build a rental unit and his own home on the two lots. When he took title to
these lots they were and still are valid building lots under the town zoning
regulations.
Mr. Gold is requesting this variance from the interim groudwater protection
act so that he may build his own home. One which will beAreasonable distance
from his place of work as the restaurant business requires many hours of work,
and A��_home'nearby".will allow�,,Mr. Gold to make it home in the summer traffic more
than once a day.
In consideration of the towns problems with it's water quality Mr. Gold
is willing to combine the two lots to make one large one, where he will build
his own house. In the process he will be giving up a potential rental income
of $800.00 per month from the other..,lot mhich he was going to build a 3 bedroom
ranch on. The home Mr. Gold plans to build will have three bedrooms and will
follow all Title 5-'State codes which allows for 330 gallons per day or. 55 gallons
per person and there will only be Mr. Gold and his wife living there. In taking
all the above information into account we hope you will find in our favor and
grant us the variance in a timely manner. Thanks for your anticipated cooperation
in this matter.
Scerley�
aine�s N N. Bowes
DATE October 20, 1987
o INS roe 'TOWN of BARNSTABLE FEE
t
y OFFICE OF
RECEIVED BY
t 11AD7971DL 1 B O A R D OF HEALTH
3a7 MAIN STREET
HYANNIS, MASS. 02601
VARIANCE REQUEST FORM
ill variances must be submitted FIFTEEN (15) days prior to the scheduled Board of Ilealth
teeting.
1AME OF ,APPLICANT Bayside Building Company, Inc TEL. NO. 771-0894
►DDRESS OF APPLICANT P.O. Box 95 Centerville Ma. 02632
IAP1E OF OWNER OF PROPERTY Robert K. Gold
:UBDIVISION NAME N/A DATE: APPROVED
ASSESSORS MAY AND PARCEL NUMBER Man 290 Parcel-, 24 1 24-2
.00ATION OF REQUEST Lots ill, & 112 Forest Glen Road . Hyannis, Ma. 02601
:IZE of LUT 111'16,988 Sq. FT. WETLANDS WITHIN 200 FT. OF PROPERTYI Yee X No
'ARIANCE FROM REGULATION(List Regulation)Interim regulation for the protection of the ground
wat'er quality within the zones of contribution to public supply wells.
'.EASON FOR VARIANCE(May attach letter if more space is needed) See attached letter.
'LAN — TWO COPIES OF PLAN MUST BE SUBMITTED CLEARLY OUTLINING VARIANCE REQUEST.
ARIANCE APPROVED
'OT APPROVED
EASON FOR DISAPROVAL
Robert L. Childs, Chairman
Ann Jane Eshbaugh
Grover C.M. Farrish, M.D.
BOARD OF IIEALTII
• TOWN-OF BARNSTABLE
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fective November 19, 1983, after being published In the Cape Cod Times.
camp of
vised June '.3,1986.
TOWN OF BARNSTABLE
oftHf Tp�
OFFICE OF
} BOARD OF. HEALTH
BAR
Mika& 367 MAIN STREET
M��L
�p t679•
k` HYANN IS, MASS. 02601 .
REVISED REQUEST FOR VARIANCE PROCEDURE
Barnstable, Massachusetts, In accordance with,
Laws of
The Board of Health, of and
the Town Sec B n 31, of Chapter 111 of the G public meeting
ranted by regulations after a p
under the authority g revised rules and reg tons were adopted
Massachusetts, adopted the following
nd
of the Board of Health held June 3, f Health onrNovemlier 1a ulat
1983 g
after a public meeting of the Board
variances from the Board of Health or State Regulations will be
(1) All requests for
s rlor to the scheduled Board meeting. The
submitted fifteen (15) calendar day P
e held at a later date if the Board has scheduled eight (8
variance hearing may b request.
hearings prior to submission of the req the Board of Health.
} (2)
The variance request shall b� made on a form prescribed by
in the details of the request must bttacgrofessional Engineer
(3) Plans clearly show g and certifiedy
sewage disposal systems must be prepared
or Registered Sanitarian for all new construction. the State Environmental Code,
for the Subsurface Disposal of Sanitary Sewage, shall be
(4) No variances from 30 CM lie
15.00, Title 5� ° enlargement to an existing
Minimum Requirementsstem, nor for an g
granted for a new sewage disposal sy expense at least
Increases capacity to accommodadt mail at his ownexp xse a after
system which certified
the applicant has notified all abutters by at which the variance request
ten (10) days before the Board of Health meeting
will be on the agenda.
required. No fee will be required.for filing
fee of $25.00 is req a disposal systems unless the
(5) Anon-refundable filing rading existing onsite sewag P
a variance request upg permit
p rading involves'approval of a building p
f publication of this notice.
T s r ul tion is o
ffect on the date o
pert L. Childs, Chairman
Ann ane shb
Grover . Parrish, M. D.
p HEALTH
BOAR OF BARNSTABLE
TOW
6/3/86 '