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FORM30 \'I&W HOBBSBWARREN'"' THE COMMONWEALTH OF MASSACHUSETTS
BOARD F LJEALTH
CITY TOWN %11L
W
�j DE AR ENT _ ® /
ADDRESS '`y �j
,0� V l� l Ll
P P"061TEL PHON
BeJ<
Address _ ` Occupant___`_,.'-,,
Floor Apartment No. ___ No. of Occupants
No.of Habitable Rooms S No.Sleeping Rooms___,
No. dwelling or rooming units--- -_ No. or s i
Name and address of owner _ --
Remarks Reg. Vio.
YARD Out Bld s.: Fences: 0 A(®
Garbage and Rubbish
Containers:
Drainage
Infestation Rats or other:
STRUCTURE EXT. Steps,Stairs, Porches:
Dual Egress:and Obst'n.:
❑ B ❑ F ❑ M Doors,Windows.-
Roof
Gutters, Drains:
Walls:
Foundation:
Chimney:
BASEMENT Gen.Sanitation:
Dampness:
Stairs:
Lighting:
STRUCTURE INT. Hall,Stairway: `
Obst'n.:
Hall, Floor,Wall,Ceiling:
Hall Lighting:
Hall Windows:
HEATING Chimneys:
Central ❑ Y ❑ N Equip. Repair
TYPE: Stacks, Flues,Vents:
PLUMBING: Supply Line:
❑ MS ❑ ST ❑ P Waste Line:
H.W.Tanks Safety and Vent(s)
ELECTRICAL Panels, Meters,Cir.:
❑ 110 ❑ 220 Fusing,Grnd.:
AMP: Gen. Cond. Distrib. Box:
Gen. Basement Wiring:
DWELLING UNIT
P� Ventil. L to . Outlets Walls Ceils. Wind Doors Floors Loc s.
Kitchen to.�
Bathroom °
Pantry
Den
Living Room
Bedroom 1 1
Bedroom 2 1
Bedroom 3
Bedroom 4
Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.:
Stacks, Flues,Vents,Safeties:
Kitchen Facilities Sink
Stove
Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.:
Wash Basin, Shower or Tub:
Infestation Rats, Mice, Roaches or Other:
Egress Dual and Obst'n:
General Building Posted
Locks on Doors:
ONE OR MORE OF THE VIOLATIONS C ECKED ABOVE IS A CONDITION WHICH
MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE
OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE
AUTHORIZED INSPECTOR. (See Over) 1
"THIS INSPECTION REPORT SIGNED AND CERTIFIED UNDE THE PAINS AND
PENALTIES OF P JURY."
INSPECTOR TITLE e.�
DATE _ ® TIMEQ:
p �` A.M.
THE NEXT SCHEDULED REINSPECTION !v P.M.
410.750: Conditions Deemed to Endanger or Impair Health or Safety
The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or
impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those
items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the
occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for
human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so
in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that
other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local
health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to
include affect the legal obligation of the person to whom the order is issued to comply with such order.
(A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary
needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer.
(B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of_a space heater or water heater as
prohibited by 105 CMR 410.200(B) and 410.202.
(C) Shutoff and/or failure to restore electricity or gas.
(D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com-
mon area required by 105 CMR 410.254.
(E) Failure to provide a safe supply of water.
(F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR
410.150(A)(1) and 410.300.
(G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object,
including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452.
(H) Failure to comply with the security requirements of 105 CMR 410.480(D).
(1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar-
bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests
or otherwise contribute to accidents or to the creation or spread of disease.
(J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public
Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.)
(K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or
other dangers or impairment to health or safety.
(L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating,
gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352,
so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety.
(M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release
of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105
CMR 410.353.
(N) Failure to provide a smoke detector required by 105 CMR 410.482.
(0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or
knowledge of the owner of said condition or conditions:
(1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven
or any defect that renders either inoperable.
(2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any
defect which renders them inoperable.
(3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of
generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard.
(4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as
required by 105 CMR 410.503(A)and 410.503(B).
(5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550.
(P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con-
dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner
to remedy said condition within the time so ordered by the Board of Health.
. "
F69M36 C1InW > HOBBsBWARREN'M THE COMMON E'A.LTH OF MASSACHUSETTS
BOA�QF, ALTH
i CITY/TOWN C�
W w
2 a ; � •� ���' - DEPARTMENT
ADDRESS ---- �o
,M SJByeW `iiti�
T TELEPHONE---- --
v{ `� t \ !"�/t
Address , QA Occupant
Floor -- Apartment No. No. of Occupants
No. of Habitable Rooms • ' No.Sleeping Rooms J
No.dwelling or rooming units No.Stories
Name and address of o ner- - �L����r � - —
,J• Remarks Reg. Vio.
YARD Out Bld s.: Fences:
Garbage and Rubbish
Containers:
Drainage
Infestation Rats or other:
STRUCTURE EXT. Steps,Stairs, Porches: ':;
Dual Egress: and Obst'n.:
❑ B ❑ F ❑ M Doors,Windows:
Roof
Gutters, Drains:
Walls:
Foundation:
Chimney:
BASEMENT Gen.Sanitation:
Dampness:
Stars:
Lighting:
STRUCTURE INT. Hall,Stairway: - `
Obst'n.:
Hall, Floor,Wall,Ceiling:
Hall Lighting:
Hall Windows:
HEATING Chimneys:
Central ❑ Y ❑ N Equip. Repair
TYPE: Stacks, Flues,Vents:
PLUMBING: Su I Liner
❑ MS ❑ ST ❑ P Waste Line:
H.W.Tanks Safety and Vent(s)
ELECTRICAL Panels, Meters,Cir.:
❑ 110 ❑ 220 Fusing,Grnd.:
AMP: Gen. Cond. Distrib. Box:
Gen. Basement Wiring:
DWELLING UNIT
Ventil. L to . qjsalls Ceils. Wind Doors Floors LockKitchen t�,7+ 'Bathroom
Pantryu
Den
Living Room
,,-Bedroom(1) 1
Bedroom 2 J fSk ,S
Bedroom 3 N`' OVN
Bedroom 4 - -
Hot Water Facil. Sup.Ten., Gas, Oil, Elect.:
Stacks, Flues,Vents,Safeties:
Kitchen Facilities Sink
Stove
Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.:
Wash Basin, Shower or Tub:
Infestation Rats, Mice, Roaches or Other:
Egress Dual and Obst'n:
General Building Posted
Locks on Doors: I
ONE OR MORE OF THE VIOLATIONS C ECKED ABOVE IS A CONDITION WHICH
MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE
OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE
AUTHORIZED INSPECTOR.(See Over)
"THIS INSPECTION REPORT SIGNED AND CERTIFIED UNDEF1 THE PAINS AND
" s PENALTIES OF PQRJURY."
INSPECTOR _ TITLE__ _ -
f C A.M.
DATE O TIME__'
A.M.
THE NEXT SCHED&LED REINSPECTIONJvk— P.M.
410.750: Conditions Deemed to Endanger or Impair Health or Safety
The following conditions, when found to exist in residential premises, shali be deemed conditions which may endanger or
impair the heaith, or safety and well-being of a person or persons occupying the premises. This listing is composed of those
items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the
occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for
human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so
in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that
other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local
health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to
include affect the legal obligation of the person to whom the order is issued to comply with such order.
(A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary
needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer.
(B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as
prohibited by 105 CMR 410.200(B)and 410.202.
(C) Shutoff and/or failure to restore electricity or gas.
(D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com-
mon area required by 105 CMR 410.254.
(E) Failure to provide a safe supply of water.
(F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR
410.150(A)(1)and 410.300.
(G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object,
including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452.
(H) Failure to comply with the security requirements of 105 CMR 410.480(D).
(1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar-
bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests
or otherwise contribute to accidents or to the creation or spread of disease.
(J) The presence of Ieadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public
Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.)
(K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or
other dangers or impairment to health or safety.
(L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating,
gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352,
so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety.
(M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release
of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105
CMR 410.353.
(N) Failure to provide a smoke detector required by 105 CMR 410.482.
(0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or
knowledge of the owner of said condition or conditions:
(1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven
or any defect that renders either inoperable.
(2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any
defect which renders them inoperable.
(3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of
generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard.
(4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as
required by 105 CMR 410.503(A)and 410.503(B).
(5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410,550.
(P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con-
dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner
to remedy said condition within the time so ordered by the Board of Health.
r ,
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Town of Barnstable
Regulatory Services
1k4Jt11WABL4 : Thomas F. Geiler,Director
16,39. A��� Public Health Division
Thomas McKean,Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
December 28, 2006
Attn: Marstons Mills Fire
On December 28, 2006 Health Inspector Timothy B. O'Connell conducted a housing
complaint investigation. The State Department of Public Health has not promulgated
regulations for CO detectors into 105 CMR 410.000 the State Housing Code to date. It is
the policy of the Town of Barnstable Health Division to take similar actions for CO
detector violations Es is currently required for smoke detector violations (under 105 CMR
410.482), which is to notify the Fire Department if there is a violation, or possible
violation observed.
The following property had possible CO detector violations:
9 Black Oak Road ,Assessors Man-Parcel: (101-063):
-No CO detectors present on main floor. One in basement. .
Timothy O'Connell, Health Inspector
QAOrder letters\Housing violations\Rental ordinanceUire Violations\CO TEMPLATE.doc
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LOCATION � SEWAGE PERMIT NO.
VILLAGE
s awls �.
I H S T A LLER'S 6ACHE b ADDRESS
D U I L D E R OR OWP ER
DATE PERMIT ISSUED
f/
DATE C 0 M P L I A N C E ISSUED
1°t 6 �Ji3 M
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16
......................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Town Barnstable
....................O F................................_............-----------•--------.........----•------•----
Appliratiun for Mipauttl Works Tonutrurtiun rantit
Application is hereby made for a Permit to Construct . ) or Repair ( ) an Individual Sewage Disposal
System at:
Lot # 1 - Black Oak Rd. , Vlarstons Mills It MIA
.................................................................................................. ........•••...••••..........••---••••••----•-•••------•-••............•-•..........---:....--.....
Capricorn Re�T`� i dlst 765 Falmouth ROA&j1, Njjyannis
......................-................................... -- .......... ................. ................----••................----•-•••.....••----•••-••-•••••.....--•-•--•-••----•-----••
re tnibft •,xne Address
W
a .............................................. ..._.......... ............................
Installer Addddrere ss
dType of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedroom ..... ............... ..._.___..Expansion Attic ( ) Garbage Grinder ( )
`4 Other—Type of Building•.....C ?
p ................ No. of persons............................ Showers ) — Cafeteria ( )
Q, Othe fixtures -----••------------------••-••••..... _..
W Design Flow......5------...............
000 gallons per per o�I,per day. Totia�fil y� flow.............................................gallons.
811
WSeptic Tank—Liquid capacit,-....._.. gallons Leng ................ Widt ..___....._.._.. Diameter................ Dep4...............
x Disposal Trenc�—No. .................... Wi 4.................... Total Length..._..T.._...._._. Total leaching area... sq. ft.
Seepage Pit N ._--•---------------- Diameter.. ....._.__..... Depth below inlet................... Total leaching area....uu........sq. ft.
Z Other Distribution box ( ) Dosi t nk (�
TlareW Engineering 11-25-81
Percolation Test Re ult Performed by.................. .................... .... ---- ---- Date........................................
a Zou I2' ' one encounte
Test Pit No.-1_fA._--_....__mmutes per inch Depth of Test Pit_.rA Depth to ground wat /ti............... e
Cz. Test Pit No.i/ .._..minutes per inch Depth of Test Pl.................. Depth to ground water........................
tx ..............................................••-•-•-•-•..............••••-•..........................•.......---•...--••••......••....---••-
O Description of Soil_......�.7._ — loam & topsoll
P . ---------- ---•----
x 2 - 1Q 7�iedium••jreTlow-�sand-------•-----------------•-•---------•-----•
W 10 _ �,---•-m6:d.�...wHi e saridJ`traces o r... raveTfrio...wat"era 12 .
---•-••-------- -------------------- ----------- ......--•--•-•---•----
V 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 TITLE 5 of the State nitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Complian a ha n iswu d by he b %rhealth...ed. ....�re;z
ApplicationApproved By --•-• ---•-•-••--•-•-•••-••..............•-•--•-••••-•••••-•-•••-•••....-•••••......••• ... a----------.-----
Date
Application Disapprove or ollowing reasons:...........................•--••----............---•--...--•--•---------....----•-------•--•--................
.........•••---•-•--•--•-•.................•---•-••--•••••-•-.......•-•-••--•-•-.............------....------•-----•---------••-•-•--••--•••-•....•-•--•--••-••-•-•••-•- --•--••--•---•--••..........
Date
PermitNo........................................................ Issued•.......................................................
Date
NOr .....J....... F.4 ...................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Town Barnstable
...................... ....................OF..................................................---.....................................
Apphration fur Biivoiitti Works Tomium#inn Vamit
Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal
System at:
Lot # 1 - Black Oak Rd. , . Marstons Mills I, hIA
..........-.............................................................................. ..................-...............................................................................
n ... o ; N�iCa Capricorn. ea .st 765 Falmouth...Radyannis
- ..............._............ --•--------............ .-• .................
W Steve Lebel Owner Address
,-� •---------•------------------•......--•--•-•-------•----••-------•------...---------••--•--.-_.... ....--•-•-•-----•-------•--•--._......----....................._......._.._.,..._.............----
Ins-alter Address
dType of Building Size Lot............................Sq. feet
V Dwelling—No. of Bedrooms__________________________________________Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building3Za!1Qh............... No. of persons............................ Showers ) — Cafeteria ( )
a' Other fixtures ---------------------------------•-•---••-••-------••..... . .
Design Flow......55.................................gallons per person per day. Total daily flow.......33.Q............................gallons.
WSeptic Tank—Liquid capacitl000___gallons Lengta!6....--..... Widt4_�_10 _.__ Diameter........._ p �$De tl. ...•-••--•---
x Disposal Trench—No. .................... Wid h.................... Total Length.... ___-_-_.--- Total leaching area_..2b_b___.-___.sq. ft.
Seepage Pit N�..:.................. Diameter... ......_._.._.. Depth below inlet.. .... Total leaching area_.._.__.____......sq. ft.
Z Other Distribution box ( ) Dosin�tank ( )
`- Percolation Test Results Performed by......... e : ineerin 11-25-81
Date --...--.............
,aa Test Pit No.,,��12/.�.�........minutes per inch Depth of Test Pit 1j2.�__..._.__.-_ Depth to ground watponje• eneounter—
GT, Test Pit No.11/A..........minutes per inch Depth of Test P tl/...A.............. Depth to ground water. !!-�...._......___. eCC1l
a •-----••-•-•-••••---•••-•••---•-------••-----•-•----••-••-•----------------------------••.........._.........................................................
D Description of Soil.-•---Q� - •2-1 loam..&...topsoil...........................................................................................
x 2' - SO' Tviedium yellow sand_...
...................................... •-------•- -•---....._•••.............
10 - 12' med. white sand traces of ravel no water at 12'
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 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.
Wn'ed.......................................... Pr es s. •... ..........
at
Application Approv r�7 ......._....
Date
Application Disapprove or following reasons:.............................................................................................•---------••-------
-•-•--......••••--••----•----•--•••--•••-••. •-•••-.•----••--...--••--••--•--••--•---••---------------...-------------------------•••••---•--•---•-••-••--------------••---•--..._••-•••--------••----
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH-OF MASSACHUSETTS
BOARD OF HEALTH
..:.......Town...................O F..:..barns t abl e
....................................................
Trrfif irtt#r of Tour littnrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed �C ) or Repaired ( )
St _v . ebel
by.. ---eme el
.....
at Lot. l_..- Black Oak Road, arstons Mills ; MIA =°
-----------•--------------------------------- ----•• ......--•---------. ................
been installed in accordance with the provisions of TITLE 5 of The State Sanitary Codgeas Xs1cribed in the
application for Disposal Works Construction Permit N o._ ........... dated_ .. ._ ....................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE..............................................C1 '/ j t/ Inspector..----.. ......... ......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
....Town..........................OF...Barnstabl e
mot/ . • • .................... ..
Bispnial Workii Tonofrnr#ion "Prrmi#
Permission is hereby granted................Steve Lebel
----•-------------•-----•••••-•-----••---••...-•--...•-•--••..................-•--•....-----....................._..
to Construct or R air Jay individual Sewage Disposal System
T �i� ts�ac c7a t Kct ' Narstons- M lls.-a
at No..•-.+Qt 7 •-- •......
Street
as shown on the application for Disposal Works Construction Permit ................... Dated..........................................
- -- -•••••••--. ............................................................
/ +--- 1
DATE--------------- 1 .................................... Board of Hea lth
FORM 1255 A. M. SULKIN, INC., BOSTON
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No.10951 O
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9,5-U S Z 1 3 -5 k
LEGEND CERTIFIED PLOT PLAN
EXISTING SPOT ELEVATION OxO NO€��s
EXASTING CONTOUR -- 0 ---- ��' c,. Lv; l ;'L"'C/< L?4 L" <'+�
FINISHED SPOT ELEVATION �� �� wostr
FINISHED CONTOUR ® RDRED IN
APPROVED , BOARD OF HEALTH
NO S U16
DAT E AGENT SCALE# / 3 p` DATE
L DREDGE ENGINEERING CO. IN F-9 A 4/C 0
CLIENT. I CERTIFY THAT THE PROPOSED
EGISTERE REGISTERED JOB NO. 83 2-5;6 BUILDING SHOWN ON THIS PLAN
CIVIL LAND CONFORMS TO THE ZONING LAWS
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