HomeMy WebLinkAbout0829 MAIN STREET (OST.) - Health 829 Main S -i /
117-101 Osterville
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THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
pplication for 33igozal 6potem Con0truction Vernut
Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) D.Complete System Individual Components
Location Address or Lot No. ea l N1;,1P -TI. Owner's,Npme, d s,and Tel.No.
aS�er�'►O�C tfP� -en —o ysi��
Assessor'sMap/Parcel 1
Installer's Name,A dress,and Tel.No. Designer's Name,Address and Tel.No.
rVC4Z_ t1CLCCR-1l,slc
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 7����'�� Type of S.A.S. e; T Cam/ vo,
Description of Soil
_ l �I
Nature of Repairs or AlM
s(Answer when aapplicable) Act, C �/! rd m �C' i9,
,e O ° Ir- /wUl
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 b this oard of Health.
c--
S* ned Date J U 0)_0069.
Application Approved b Date 7 O
Application Disapproved by: Date
for the following reasons
Permit No. �� Date Issued / O d
No. . D El '30 1 Fee DQ
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Zipplication for Migpogar �bpgtem Con0tructton Permit
Application for a Permit to Construct( ) Repair P1000.Upgrade( ) Abandon'( ) ❑.Complete System V Individual Components
Location Address or Lot No. 801 1 1 W f 15r- Owner's Name,Add s.and Tel.No.QSTer-V►1� �Q���� i-�i���JJ ?t'eA/C -/A/c'
Assessor's Map/Parcel� "7 d p c�,(, A �►;�j, a® -/006
v 6 J�
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
a`vice tuc-o' ��•sIcc` ��H
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
y Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank 4,000 G R � .Type of S.A.S. ,`T C-.r 00
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) �/ w Sl°��C 7O
o d -o
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 oard of Health.
Si ned Date J VI aoLOUi
Application Approved b Date
Application Disapproved by: Date
for the following reasons
Permit No. ;�J ^3� Date Issued �J
——————————————————————————————————————————--
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS ( - o
Certificate of Compliance 4
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( � Upgraded ( )
Abandoned( )by rS G?c 4 (A( t C)n.1(,.
at A j, ', 5 t er r has been constructed in accordance I
with the provisions of Title 5 and the for Disposal System Construction Permit No. caw • 3 09 dated 7
Installers('t,CC Designer
-bedeo Approved-design flo. ��/"� gpd
The issuance of this permit shallof be c `nst_ued as a guarantee that the syt�will fu�iic 'on s designed.
—Date- / Inspector
i ---------?—�--------------------- ------------------ _
I'l No. cp• p 7S '' l Fee U
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS
lwigpogal �&pgtem Construction Permit
Permission is hereby granted toConstruct ( ) Repair ( Upgrade ( ) Abandon ( )
System located at apt Nt4 t u C AeJAg-ald-
I and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title S and the following local provisions or special conditions.
Provided: Construction musl be completed within three years of the date o this p .
Date / Approved by �
TOWN OF BARNSTABLE
LOCATION 8 a 9 JVA/IA/ S SEWAGE #o208-M
` ':'v9LLAGE OS./!e ASSESSOR'S MAP &LOT
'-INSTALLER'S NAME&PHONE NO. / OG CQ.d e-11— sva-ym--1,sn
SEPTIC TANK CAPACITY /i DOO Gal. C15 S 11/1 C) �
LEACHING FACILITY: (type)Cs:Swcxl f OyC-FluCJ (size) 64 /� 0A_
NO.OF BEDROOMS—
BUILDER OR OWNER er��✓�Ce/Jc•r
PERMITDATE: /—QR-06 COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the 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 leaching facility) Feet
Furnished by
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E O CAT ION . �4 ` SEWAGE PERMIT NO.
VILLAGE
INSTA LLER'S NAME i ADDRESS
i U I L D E R OR AWN ER
tic con
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED /
LILt�y
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TOWN OF BARNSTABLE ���✓ S��
LOCATION 829 IVI� S ' SEWAGE #o�DB"•3
LAGE Os f ert,;i e - ASSESSOR'S MAP &LOT
STALLER'S NAME&PHONE NO. G,I ,S%— 6V-Y -SS-a
SEPTIC TANK CAPACITY 1,600 G!1'I 661L 11,01
C)
LEACHING FACIL=: (type)�'r�s•�ucaI t OVe�T�uGJ (size) /X06,'4 13 k, 0A .
NO.OF BEDROOMS
BUILDER OR OWNER /� c���/x!09`z
PERMTTDATE: -COMPLIANCE DATE: ?—
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
i
Private Water Supply Well and Leaching Facility (If any wells exist Feet
on site or within 200 feet of leaching facility)
Edge of Wetland and Leaching Facility(If any wetlands exist:
within 300 feet of leaching facility) Feet
Furnished by
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a c e ess�
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O C+t Cess ew to ftr •=Y
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NO.. ��- -•--- yam' A_ q `" �` FTcs.....''d.
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
.................................... .....OF.......................................
Appliratiou for Bhipaaut Vurkg C outitr Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
System at:
...641!1__1814i m...I.: ................................................. •---•-•----•--------------------------------- ---------------------..._......-----------
----------
-.—Location-Address or Lot No.
r..A7&= 1 Y ------------------------------------- --------------------.........................------.
/ Owner Address
..................................................... ..... :__ 5'� L.. .............................................
Installer Address
d Type of Building Size Lot............................Sq. feet
Dwell
Grinder
a, Others—Typeoof Building gms......................... No. of persons nsion Attic--(.....)Showers (GajbageCafeteria ( )
1
Q' Other fixtures --------------------------------
W Design Flow............................................gallons per person per day. Total daily flow.............................................gallons.
W Septic Tank—Liquid capacity,/::_..____gallons Length................ Width................ Diameter................ Depth................
r.
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq..ft. p
Seepage Pit No--------------------- Diameter.................... Depth below inlet-................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by........................
----------- -----------•------•----------------- Date........................................
a
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........................
a -----------------------------•---------.....--•--•-------------------•--••------•---•---...._.------......................................................
0 Description of Soil-----------•--•-----•-••-----------------------------------•--.....--_..... -----------•--
x - --- -------
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 iITIf 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be ' sued by the board of health.
Signed----._-----.A - ... •----.... `. __�1-�_ _3_.._
D e
ApplicationApproved By............ � `----- ----- --- - -- .................................... ............ ...� ...........
Date
Application Disapproved for the following reasons--------------------------------•-----------------------•------•----------------------•----......-----........._
---------------------------------•----------•------••------------•------•------------.•---
------------------
Date
PermitNo......................................................... Issued_.......................................................
Date
_n!
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...........................................OF.........................................
Appliration for Bi_qpniittl Works Tomuurtion rani#
Application is hereby made for a Permit to Construct ( ) or Repair ( Van Individual Sewage Disposal
System at:
....8Aq-----A'IAI.m... 'T.-I................................................ _..---•---•-........---.......-••••--•----• -•-•------••--•-----...................---
location-Address or Lot No.
CYO_» 4R Nc ..Py------ ------------------------------- --------- ....
Owner , 1 Address
Wl.r�LC�a -------_.......................................... ......yw s._ 11! S�aG�., .................................................
Installer Address
Type of Building Size Lot............................Sq. feet
�-, Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
'4 Other—Type of Building No. of persons............................ Showers
W YP g -------------------•------•• P ( ) — Cafeteria ( )
PaOther fixtures ------------------------------••-•............� •••--••-----•--•---•---------------------------•------------------------ ----------------
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit NO---------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
:Percolation Test Results Performed by.......................................................................... Date........................................
a P P
..� Test Pit No. 1................minutes per inch Depth of Test Pit._......._.__._____. Depth to ground water........................
GT,, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a --------•-------------------------------------------------------------------------•-•--••--_-•----.........................................................
0 Description of Soil........................................................................................................................................................................
x
U --•--••-•-•---•--•-•--•----••••--------------••---------•----•-•-••------•---••------••---....-•--••-••---•-----•-••••-•---•-----•-•--•---------•••-••--•----••-••-••-••---------------•-----•----•---•-
UW .................................................................................................. --•••-•.
Nature of Repairs or Alterations—Answer when applicable....IL�',�±-a_ ..... r- ....Cf�_ ,,.. Z.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITI1, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been-i, sued by the board of health
1 Signed �`. c��-'?*?.ray ,� c.. ` --1-!:. --------
Application .._.
.�`." Da e
A roved B « -- ! _ _�-/'1
PP y----•-••-•-• -
�t Date
Application Disapproved for the following reasons:................................................................................... .......................
----------•---•-•..............................•---------•--•---••--••-•---------.....--•----••-•----•-••--•----•---••-------•--•••-•--•-•-------------•---•••---••----•--• ............................
Date
Permit No..... Issued_.........
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
......................................OF
Trdifirtt#r of Tompliattrm
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
by...................1/ .'. -: .........---........--••--.........----.....--------------------...------......-•-----•---•-••-----------..............-----....--•-•-•-----..........
Installer
at. %! •------------------------------------------------------------•---•--------------------
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------ ................ dated-_..............................................
THE ISSUAN OF THIS CERTIFICATE SHALL NOT BE CONSTR AS A GUARANTEE THAT THE
SYSTEM W F NCTION SATISFACTORY.
DATE_. Z.°� - .......................... • -----------•- Inspector_....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�? OF�...................................................................................
No.. � FEE... ......
Permissionis hereby granted........... -----•-----------------------------•-••----••-........................................................
to Construct ( ) or Repair ( IT"an Individual Sewage Disposal system
at No................b---• 2....---•-•• .o-?Yi r<.. :..........
Street
as shown on the/licat* n for Disposal Works Construction Permit No.__........_.._...... Datd.....•...................................." " _ ......................._.e... ............... _.....•..--•....... I36 d of Health
DATE---�'--� ---------------------------- ,.
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
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ALGER SCHILLING ,
ATTORNEYS AT LAW
886 MAIN STREET
P. O. BOX 449
OSTERVILLE, MASS.' 02655-0063
JOHN R. ALGER TELEPHONE 428-8594
THEODORE A. SCHILLING AREA CODE 617
January 26, 1983
Mr. Ronald Gifford
Board of Health
367 Main Street
Hyannis, Massachusetts 02601
Dear Ron:
In connection with Herb Pheeney's proposed addition .
to his office on Main 'Street, Ostervi.11e, T understand you
were concerned about the cesspool located within the Town
parking lot. I enclose herewith a copy of Certificate of
Title No. 17032 standing .in the name of the Town of Barnstable
and covering that area of the parking lot.
You will note that Daniel Estates , Inc. reserved the right
to maintain the cesspool within the area. At that time Daniel
Estates owned the' land where Pheeney's office is now located
and the cesspool now in question is one of those that can be
rightfully maintained under this reservation.
I trust therefore: that Mr. Pheeney will be able to comply
with regulations.• If. you have any questions whatsoever
please do not hesitate to get in. touch. with. me.
/ey '
truly yours,
JRA/J7
Enc.
cc : Mr. Herbert Ph.e
Robert Smith., Esq. , Town Counsel
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Doc.Tntifratr of 0itlr. 70
From Transfer Certificate No. 4921 , Originally Registered December 30 1938 in
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Registration Book 24 _ Page 131 for the Registry District of Barnstable County.
Qhio to to (Qertifu that The Inhabitants of the Town of Barnstable, a
Municipal Corporatlon located in the County of Barnstable and Commonwealth
of Massachusetts
are the owner s in fee simple,
of that certain parcel of land situate in Barnstable (Osterville)
in the County of Barnstable and Commonwealth of Massachusetts, bounded and described as follows:
Northeasterly by Lot 1, ninety-nine and 69/100 (99.69) fee-6;
f
Southeasterly, 'by Lot 4, fifty-four and 43/100 (54.43) feet d
` Southwesterly by land now or formerly of Edith M. Crosby, -
seventy-eight and 32/100 (78.32) feet;--ancr.
Northwesterly by land now or formerly of Dexter B. Pattis
fifty-two and 28/100 (52.28) feet.
All of said boundaries are determined by tr e Court to be
located as shown on subdivision plan 12546-F. dated April 7, 1954, drawn by
Charles N. Savery, C.E. , and filed in the Land Registration Office at Boston,
a copy of which is filed in Barnstable County Registry of Deeds in Land Regis-
tration Book 124 Page 91 with Certificate of Title No. 17031, and said.land
is shown thereon as LOT 2.
There is reserved to Daniel Bros. , Inc. , the right to
maintain any and all cesspools now existing on said Lot.
Said lot is subject to the rights granted to The First
National Stores, Inc. as set forth in Document No. 7340, Barnstable Registry
District, so far as the same are now in force and applicable.
And it is further certified that said land is under-the operation and provisions of Chapter 185 of-the General
Laws, and Thai the fide of�snz -The"`Inhabitants of the Town of' Barnstable
to said land is registered under said Chapter, subject, however, to any of the encumbrances mentioned in Section
forty-six of said Chapter, which may be subsisting, and subject also Ycx as aforesaid.
WITNESS, JOHN E. FENTON, Esquire, Judge of the Land Court, at Barnstable, in said County of Barnstable,the thirtieth day of September in the year nineteen hundred
and fifty—four at 9 o'clock and 55 fore minutes in the noon.
Attest, with the Seal of said Court,
Assistant Recorder.
Land Court Case No. 12546
l�
MEMORANDUM OF ENCUMBRANCES ON THE LAND DESCRIBED IN THIS CERTIFICATE. 17 osi
DOCUMENT TERMS. DATE OF DATE OF SIGNATURE OF y NUMBER- KIND' RUNNING IN FAVOR OF. DISCHARGE.
INSTRUMENT. REGISTRATION. ASSISTANT RECORDER.
;_�i:.2Gr�.�l/�: �4�^,-'•��-'�- YEAR 6L MONTH D. H.
P.
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� -�GL,.a-�.✓ �2��.. �,o[, :a/:s /"7�i �/C_/G // '/.J.:c_ih�� a'�.
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BARNSTABLE C UNTY `` }
REGISTRY OF DEEDS
A TRUE CoPY, ATT'ES7
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STEPHE WEEKES REGST R #
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SUBD?VISION PLAN OF LAND IN BARNSTABLE ( OSTERVILLE) t—
Charles N. Savery, C. E.
April
7, 1954
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Anthony ✓. CamPana et ux
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Subdivision of Lots �', & G.
Shown on Plan:, 1L546 12546
Filed with Cert. of Title Nos. 2936, & 4078 0 „
Registry District of Barnstable County k
V
Separate certifcates of title may he issued for land
shown hereon asloIs1.fhw_6___________________
By the Court. ,�1 - Copy of parf of p/on
"` /� LAND R£6lSTRATIOU OFFICE
L.o-V S .8 9
dt
t'K%STING BU►LiDItkG 131G. 8 S,�', 'w
PRoD®SE.p P�pvlTlot�� 740;1 .�.F. L
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No.------ ...
Finn $5�t.pp.........
.......... .
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF -HEALTH
.... ._.Town ..................OF......Barnstab.le..................................................
Application is hereby`made for a Permit to Construct or Repair (K an Individual Sewage Disposal
System at:
........QYjSter_,W&Y---E"t....................................;---------- ................................................................................................
Location-Address or Lot No.
......Herb.emt...Pheanv_ . . ...................Qrtterviu . .........Py Harbors
--------*----------------------------"......... -e .....................
Owner Address
.....JOS.eph..P.....Mac-ckmber..&..Son..,...Iac-------- ......................centervIlle.............................................
Installer Address
Type of Building Size Lot......... ------------------Sq. feet
U
Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder
Other—Type of Building ............................ No.—of persons...._...._.........__..._._ Showers Cafeteria
Otherfixtures ..................................................... ------------------------------------------------------------------------ .....................
Design Flow----------------------------------.........gallons per pet-son per day. Total daily flow........................................._gallons.
P4 Septic Tank—Liquid capacity------------gallons Length................ Width..___........_.. Diameter_____...__._-.. Depth.--.__-__._._.
Disposal Trench—No_ --------------------- Width..........__..___-__ Total Length..........._.___._.. Total leaching area-------_-----------sq. f t.
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----------------minutesperinch Depth of Test Pit_.______-___--_-____ Depth to ground water------------------------
(X4 Test Pit No. 2................minutes per inch Depth of Test Pit._______............ Depth to ground water__.______::_____-__----.
(X -------------------------------------------------------------------------------------------------------------------------------------------------------------
0 Description of soil---------$.an_d...&---GraYe-1.................I................... ............. -----------------------------------------------------------------------
----- -- --- -------- -- ----
�4
U ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
I
----------------------------------------------------------------------------------------------------------------- ----------------------------- -------------------------------------------------------
U Nature of Repairs or Alterations—Answer when applicable--.1000...gallon---overf.low------_ -Rit)----------
------------------------------------
-------------------------------------------------------------------------------------------------------------------------------------------------------------------
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 k qe i ued by the boArdjof health.
igned .. .............. ----f------------------------------------------- ---5/1-9/77---------
Date
Applicati6lirApproved By............... .................... ------ -------
Date
Application Disapproved for the following reasons:........................................................... ....................................................
.............................. -------------------------.......................I----------------------------------------------------------------------------------------------------------------------
Date
PermitNo---------------------•----------......------•--•........ issued_: �__o..... ................................
Date
------------------------------------------------ ----- - - --- -----
7? rAll
No.. --------• .............} ...........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Y
.......OF........ ax-n.s.taab-.i_ _...-..
Apli iratinit -for Dhipwial Works C owntrurt ti Prrutil ..
Application is hereby'made for a Permit to Construct ( ) or Repair (X ) an,-Individual Sewage Disposal
System at:
.......... ------::. ...............................................
Location-Address
Y' cr1 I3i�or� .................................
or Lot No.
nn ' 0gxr_rj7jjj ....-------- _? : . __......•.......•. ............•------•-•-........................_...-
_ ---
--------••------•---- . ---p��terHarbors
Owner
W Address
Installer Address
UType of Building. Size Lot----------.-•---------------Sq. feet
Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
1 a Other—Type of Building -.--..-_------------------ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
d Other fixtures
-----------
W Design Flow-...........................................gallons per pet-son per day. Total daily flow----------------------------------..........gallons.
P4 Septic Ta-lik—Liquid capacity-----._.___gallons Length---------------- Width-.---------".-". Diameter-----....-.----- Depth----------------
xDisposal Trench—No. ---------.�......_.. Width-------------------- Total Length-.--------.______--- Total leaching area----------.---------sq. ft.
3 Seepage Pit No________________--- Diameter-------------------- Depth below inlet..._:__y_____.__. Total leaching area.......-----------sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by----------_----------------------------------------------:-_'........... Date-------_----------------------------.-..
Test Pit No. 1----------------minutes per inch Depth of Pest Pit Depth to ground water-.-------.--. ----_...
F+, Test Pit No. 2_______________•minutes per inch Depth of Test Pit-------------------- Depth to ground water.-.--.-----._-._---.---
P4 ----------------------__-----------------------------------------••-- ...................................................................................
Descriptionof Soil ;c-" ------------------------------------------------------------------------------------------------------
U --------------------------------------- ------------------------------------------------------------------------------------------------------------------------ --------------------------------------
W
rZ, ------------------------'...---------•--------------------•---•----------------------------------------- - •^'------�� a rf l n; ( --•--•--------••------
------c-t-•---- ` ; t
U Nature of Repairs or Alterations—Answer when applicable._.1'�.��...�fn I .�•._,� ,•- t
-------------------•----------------------------•--•-------------------.--__- ----.---------------.----------•-•-----------•----------•-----•----------•-------•-••-------------•----------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
7:he provisions of Article XI of the State Sanitary Code— The undersigned further Agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Zigne/d ',eiL 1�- t L /�_�'/?7---......
;. Dat ^�
Application Approved By---.---• -- j�I�.[--------
Date
Application Disapproved for the following reasons:....... ---------•--••--------------•---•------•-----•---------.----_----------•-------------
.............•-------.-•-••--•-------•-•----_------•-••---------•------- .......................................................... •---------------------•----------------------•--------• -------.-----
p
Date
PermitNo......................................................... Issued...................... ------------....................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
-A,ot�rn...........oF....B�r�ist:��.�?
. .................................................
f THIS.IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( X)
t7� ae�?� P. t �nc?.r� r E .ln , Inc .
by...... ................. _............................ _..... ...._..........__.........._._...._................................................................
Installer_
-0s erv�!1e Jester Harbors 7
:. P Keene
-- . -- ••------•-••-- -----••----•--------•---•---•-•-
has been installed in accordance witfi-,the provisions of Ar6�...
I of The State Sanitary Cgcieas described in the
applicationfor Disposal Works ConstructionPermit No._._ ,�__1-__--_-_--- dated.......... 1.^?7.................
THE ISSUANCE OF THIS 10ERTIFICATE�$kIALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE --•----•-----••-••-----•-•••-----•-------•------•--•-•-•---•-•-•-•--•-_... Inspector ....... --
THE COMMONWEALTH OF'MASSACHUSETTS
BOARD OF HEALTH
............... ...........'..OF.......$arn.s.-oat .e?°
No..-------•---ate----`e•- ........................ �.
FEE.`.. =........•....
%spatittl Works i-1-1114Qngtrurtion Vamit
Permission is hereby granted------JoSexmh--P_.....ac�mhp .. ^.- `fin- T11f___.._..._.....____
to Construct O or Repair ( ::) an Individual Sewage Disposal System
at No...... +- �stery Iln-Ovster Harbors Pheeney
�.- -------------- -------------•------....------ ----•-------------------...-------------------------••-•------------•--•----•------•
Street
as shown on the application for Disposal Works Construction Per N .......... . .... . ed---- "� '_
g Board of Health
- .....................
_
DATE-----.. 77..._••s
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS j\