HomeMy WebLinkAbout0032 THATCHER HOLWAY ROAD - Health 32 THATCHER+ r10 Z,W a U
A= 148-078QdS6n5 {�`► L,L S
(f U(I
TOWN OF
BARNSTABLE
LOCATION L19 �"� I CclL J i!]f' SEWAGE # 9�1611
VILLAGE Anal nS A41 S ASSESS' 'S MAP&LOTA9.0 7r
INSTALLER'S NAME&PHONE NO �' �os44� iys
SEPTIC TANK CAPACITY A000
LEACHING FACILITY: (type) 'A C ) (size)
-SNO.OF BEDROOMS
BUILDER R OWNER/ fin ry�S
PERMUDATE: 9/9s— 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 leaching facility) Feet
Furnished by
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No !' � F�s... � ......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
ApplirFation for Dbipiti al Ovd.6 Tomitrnr#inn Prrmit
Application is hereby made for a Permit to Construct ( ) or Repair (b< an Individual Sewage Disposal
System at:
..................................................(M. ..1..5----------- - -------
�!) q ) cation-Ad � '/, or lot No. - ^A ' ' ,
....�................—LKC1 hi �/•�--....C:"C/'f/JTJ''.. .... f...��!/�,n[ s�'�I ..✓ ]......----••.
Owner Address
Installer Address
VType of Building Size Lot............................Sq. feet
►.t Dwelling— No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder (`�j" 'a
aOther—Type
of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
d Other fixtures .
WDesign Flow................... ........................gallons per person per day. Total daily flow------------- ----------------gallons.
W Septic Tank—Liquid capacity/!PP-gal
� P_.galIons 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........................................
Test Pit No. 1................mmutes 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........................
P4 •---••••••-- ----------------•-••••••-----••----••-•---------•••-•••----••-••-••-------•-•-•-----•••.........................................................
0 Description of Soil........................................................................................................................................................................
W
u
W
x -•-•---•--------------------•------•-------••---•••------•----------------------•-- -----------------------------------------...........................................................................
U Nature of Repairs or Alterations—Answer when applicable._/AbA......./- ------------ r�
Agreement: S Y-fT �'►'�
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code —The unde signed further agrees not to place the
system in operation until a Certificate of Compliance h �eeissued t board of health. .
Signed ..
7� ---
Application.Approved By . ..... .... -------�------------- ------------------------------
Due _Z
-----------------------------------------......
Application Disapproved for the following reasons- ----------------------------- ------ ------------------------------------------------------------------..-----
-----------------------*----...._.............. ------------------------.._.._.................... ...............Permit No. n `` --
i � ........ Issued /...-----���-- r� -----------
............................ Dare
No-9.... �C� Fes$... �........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Diinpwial Midw Towitrurtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair (ems/ an Individual Sewage Disposal
System at:
..........................`:.A:TGF-1 .--°--.... -u.... r'`f.. /--•---. 5.
Location-Ad s or Lot No.
. --•---.
Address
Installer Address
Q Type of Building Size Lot............................Sq. feet
U Dwelling— No. of Bedrooms--------------------- _---____-__-_--Expansion Attic ( ) Garbage Grinder () �
aOther—Type
of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Q g SS g P P.._..... P y. -----y--- --------.-``...........................••-•-----...--••--•---• s
Design Flow-------------- - - ---- - allons er erson er da Total dail flow.__.
Other,-,fixtures ._._.__...
W --------__?__2A................gallons.
WSeptic Tank—Liquid capacity APu. _.gal Ions Length---------------- Width.....----------- Diameter---------------- Depth_..--____-__----
x Disposal Trench—No_ ____________________ Width-------------------- Total Length............ Total leaching area....................sq. ft.
3 Seepage Pit No----------- ------- Diameter.......(-9---____. Depth below inlet------G.......... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
'~ Percolation Test Results Performed by-------------------------------------------------------------- ----------- Date........................................
W
Test Pit No. 1................minutes per Inch Depth of Test Pit-------------------- Depth to ground water.....................
(1 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water-.._.-_-----___---_.--_.
W ----•---•-------------------------------•-----------------•---------•---•--------------------••-----.........................................................
0 Description of Soil........................................................................................................................................................................
x
U .--•--...-•--•-----------------------------•---•••-••------------••••--•--•------•••--------------•---------------------•--•----•-•......-------•-----------•-----....................................
W
x ............. --------------------------.._....-•--------------------------------------------------- -----------------------------------•--------•••-----•-..........•-----------------.....
U Nature of Repairs or Alterations—Answer�wh_ �when applicable.. Q.�Q......./4 ��-__----.-r_ �_G__��-: _.....�... '.... T
il/ -fd Na.?C..........?--v------------------~ ----•---•-�� U * ..... -------
Agreement: S y T �'✓l
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code —The unde signed further agrees not to place the
system in operation until a Certificate of Compliance has ee issued yM board of health.
Signed ----------------- ---- --------- -------- /
e y�
Application Approved BY ..--- - ------------ ---- ................................................. e�'D�. /..�
Date
Application Disapproved for the following reasons- ---------- --------------------------- -------------------------------------------------------------------- -------------
-
......... ..._.........................._......._..._.. -----
sI .............
D2te
Permit No. .............. Issued _......... .._ _./.
Dare
._._—_ -->--- —a :_,-»...>_,._.,�-.v..-.�,.��a-�..°�_._�z>� .�a�.�.s->�u�re.,-.�.�saes, ._. - ,_- _, _-- -- — — f_----
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
C�Prtifirate of C�vinpliance
THIS IS TO CERTIF It the Individual Sewage Disposal System constructed ( ) or Repaired (o<:�)
by - _. c� G..4:U ,J..... ILLu Lr- a�..1....................................................
Installer
at ------------------ ................ -------T z!¢%.....ram.-die- -------
has been installed in accordance with the provisions of TITI. he,S t�Environmental C d^e as described in
the application for Disposal Works Construction Permit No. F .......�`....-----__7..... dated _ ...=.._.A ."�.J�
L NOT BE CONSTRUED AS A GUARANTEE THAT THE
THE ISSUANCE OF THIS CERTIFICATE SHALL O
SYSTEM WILL FUNCTION SATISFACTORY.
----------- ...-.. `' 7 ---- ---...._---------............. Inspector .... ----------------------------------------------------------
DATE
THE COMMONWEALTH OF MASSACHUSETTS /
BOARD OF HEALTH 7 (}
���' TOWN OF BARNSTABLE .3v
No. .................... FEE----....................
Tvmdr�rrttivtt VrrrAit
Permission is hereby granted________________ _._!1_..........� ' _.__....�®�
to Construct ( ) or Repair (r,- -,' an Individual Sewage Disposal System ,
at No. (E��------i- . ............... = / l_C S
str et
as shown on the application for Disposal Works Construction Perml /�/�
-"r
9-
��J �r /t Board of Health
DATE // --------•-- -7
FORM 36508 HOBBS 6 WARREN,INC.,PUBLISHERS
TOWN OF BARNSTABLE
f
LucATION ��}i/� r2. _SEWAGE # 2:7-6:5 Q
VILLAGE A, ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO. V /` S
SEPTIC TANK CAPACITY IQ?TD_Oa GIA-S
LEACHING FACILITY:(Cype) dc< C-AS�— (size) �Zc�
NO. OF BEDROOMS 3> PRIVATE WELL LIC WAbIRZ/
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
dj
ion/
op
a �
p7t'
��r;:VJ k a-27D-,;,e Awl
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
. v�.M .....--..-.OF�`�.Ae.V-1 -11416 -----------------
Appliration for Disposal Works Tonstrn.rtion 11nmi# ..
Application is hereby made for a Permit to Construct ( ) or Repair ( k4-,w-Individual Sewage Disposal
System at
....... .....................................................
Location-Address or Lot No.
.......... ��'�..__ ar.L. .. - )AL.if........................ .................S_A.'•`�..................................................
Owner Address
..—j-1A.0-A . - •--------------------------------
Installer Address
Type of Building Size Lot............................Sq. feet
U � `
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—Type T e of Building No. of ersons________________________ Showers
a YP g --------•------------------- P ---- ( ) — Cafeteria ( )
da' Other fixtures --------------------------------------------------------------------------------------------•---•--••---•----
•-•--•-----•---•••••--•---•--•••••_--••-
W Design Flow.....:.........:..................gallons per person per day. Total daily flow-._��:f�'s................_......gallons.
WSeptic Tank—Liquid capacity_f JZID.gallons Length....-f....... Width_:�A ........ Diameter 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 ( )
1.4 .......................
-
Percolation Test Results Performed bY---•--• --•--•-------= -•---........•-------•-----------•••:----•---•------ Date---------........................................
Test Pit No. 1................minutes per inch. Depth of Test Pit.................... Depth to ground water........................
(i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
x ------------------------------------------------------------------------------------------------------ -------••-••----••--•-•_:..
•--• •--
Descriptionof Soil.......................................................................................•-------------...._.......-•---....:_.....-------------------•••--•••••••••...._.
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 iITLL 5 of the State Sanitary Code The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issuedl eboard of ealth.
Signed ....
`'
Date
Application Approved By. ....... ................................. ..._...:Z:nz::- a-te
,��•' Date
Application Disapproved for the following reasons----------------------------------•-----------------•---------------------=-----------._...--•---••-••..._.....
-------------------------•-----------......------- •------••••-•--..........------•--.........-----....__....--------•--------------------------•---•---------------•--•------•-----------....._--•••-
Date
Permit.No.......a &� ........................ Issued.........................................................
Date
f .�y�; -`�' � .. •- , -� + • ram. y•4n�r..• ,.. --�; } A. �' N • J� �� - • _ • -_ _ �• -• .- _- -
THE,COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
-.f 1tA�N4�---.•----...OF...-..,__.,Ae.!s r ...i�.Y..'. .......................... ..
Appliration for Disposal Works Tonstrnrtion Permit
Application is hereby made for a Permit to Construct ( ) or Repair ( �.)__an Individual Sewage Disposal
System at:
--____--_--. - Y...................................... .........
e Location_Addd�ress Q.' or Lot No.
/J1 / J n.N,.J. 1`7 t�'........................ ...........•-•-.. `A ......._..._..-..........................................
..............
Owner c i Addre�
....._ �--------------------- ---------- b uc R r C... W f t.C�
M Installer Address
Q7i Type of Building Size Lot............................Sq. feet
aDwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures .--•-•••---------------'•-'---.._...._•--------•-- ...---__...•-•-•-•-••---•-•-•-•-•--•-•-••.._..--•-•---••-•--------'--...._------•-.._...._____....
W Design Flow....."<X".........................gallons per person per day. Total daily flow...�.73.�._..__...._._____._____gallons.
W x
—Liquid capaci.ty.! _ ' Diameter................ Depth................
W . .
6Dis"posal{Trench—No ...:...... idth.....__._.______.___ Total Length.................... Total leaching area....................sq. ft.
Seepage�Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Otherj*Distribution'fbox ( ) Dosing tank ( j
Percolation Test Results Performed,by.......................................................................... Date........................................
Test Pit lNot\l................minutes per inch Depth of Test Pit........_........... Depth to ground water........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
o+ --•-•-•---•----'----'-•-------•-----•-•-•--------------------------------------------------•-------.....--•••-----•-•------•---------._....._....-••---_-----
O Description of
VSoil----••--..__...--•-•-----•-------------!....•--------.-.-.-.•.-.-.-._._._._...._._-••-•-------'--•--'--------•--•------------•--•-•••----...._.....__.._..__..__...--------•-•-_•--•-
w -----•---•---•-------------•--•••--------------•-------_____-. ._...._____----------------- -----------•---•-•--•--------••---_-_----•--•-----•--••----
U~ __.....--•--+-•---•---•-•••-:------•--•-••-----•--•----••--•-•-•••---•-•--•-•-_...-----•-•-••-•-••••--=---•--••---i2 ....-----• ---- . .-----•----•--••k---------•-------
; F
Nature of Repairs or Alterations—Answer when applicable....... ...... ________--_-.
�_r✓1 •--A...................................................... _:--•---•-•-•-•-- .__-o................, I
Agreement: t.
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of T1T.1 � 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 J16lth. -
�- (
4 Si ned _.___- - ............................................
D +
A Application Approved B .........
Date �• -
PPPP y f :.._1_... . ........................•.....------ _ �...:.._
V I Date
Application Disapproved for the following reasons___________________________________________ .....................................................................
.._...-•--•.................'...........-----••----•••-•--....---...---------..._._..._._.__.._..-••---•-----•---------------•-----------•-------------•-•---•••--------••-•-•-•••-••--•-_-----
Date
PermitNo....... ;���i �> ..-•••••-•••••---•--_. Issued_---....--•-----------------•--•-•-•-••---•-•---•--•-•••
/ ..... Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.............. .........OF-�A! s�4 6(•2................................
Tertifirate of Tomplittnre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
by--••-•----•-•-••...... ....... ....-•------------•-...-•----•••...----•----•-•--...------•••.....--•.....................•---........._....._
Installer
at........................... =----^ ...... ---
^_ .:..... 1 \i,
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works with
Permit No.__..____FS4_-....�_���:__- dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION; SATISFACTORY.
�i� --,1
DATE .►i.:
_....-•--•........................................ Inspector....R..--------- ---••---............----
------------— ——————————————————————————— . ———— ——— --------.----
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�i O�..�.........-.0F.. �..ca.+%�.v!- z.v��.-?. ........... ��/
No.......:.. .:.......... FEE......
�••_?........
Disposal Works Tonstrurtion permit
Permission is hereby granted......... -' � '' �'►n!� n 5 *A-----•--•--------••.:...........
to Construct ( ) or Repair ( an Individual Sewage Disposal System fir'
at No....................... �'r-. ''`..: <,n�J 1�1w+� !_--.-----�X----------
�� Street
as shown on the application for Disposal Works Construction Permit No.- Dated..........................................
li Board of Flealth
DATE------------------------------1_.��-�----�..r�.r.._.��__
LOCATION SEWAGE PERMIT NO.
VI�ILACE
r
INSTAL , R'S/ AME i ADDRESS
BUILDER 0 OWNER
Co (76
DATE PERMIT ISSUED �� —7V
DATE COMPLIANCE ISSUED
AS-A�-
l
No..............._..... ` FEs .............
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® .HEPyL H.'
- ...- OZL.............OF............ �. . -..__...
Appliration for Dhivoii al WvrLi Touvtrurtiott ramit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual -ewag0.1e • osal
System at: 1
A-Ar c?..... r � ..o...... .� . ....
ca o n-Ad ess It No.
21 ...-_._...-
.. 9.5®..... :.�Z.r.A.... 7W.
Owner Address
.................
---•........... ........ . ............................................................... -------•--•••.....-•-••..........................................................................
Installer Address
QType of Building Size Lot.............. Z_�...Sq. feet
Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder
Other—T e of Building No. of persons............................ Showers — Cafeteria
a' Other fixtures __________________________________
gg • --••--------- ----------------------------- ----------------------•-----•-----•--------•----•-------
WDesign. Flow...... ........................gallons pef' eay. Total daily flow................... -_-_-_galls.
WSeptic Tank—Liquid capacit/Oci s.gallons Length___...__.. Width...y5- ....... Diameter................ Depth...
x Disposal Trench—No.................... Width............../...... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No----/........... Diameter./o."5-.___ Depth below inlet.... c__o...�Total leaching area.? .<�;.sq. ft.
Z Other Distribution box (.4-< Dosing tank
'-' Percolation Test Results Performed b ._ - L'r.0 �.�..�_���................. Date___rwater
Y -----------
aa Test Pit No. 1."5:_Z___minutes per inch Depth of Test Pit./Y.. .....
Depth to groun �� '._--
r-r y
f=, Test Pit No. 2..!5�Z...minutes per inch Depth of Test Pit.,le.F,"Y...... Depth to ground water.........4...............
t� .......... -- - Q
g
0 Description of Soils- ........... --- --• "A.wr ••---•----- ----- �c9___.te
=/�'f
x •-•••-•-•---•-•••----•-•- ...c - ' '� --- ---- -------------------------------------
t,
VNature of, Repairs or Alterations—Answer when applicable.__-_............................. ............................................................
------------------------------------------------------------------------------------------------------------•-----------------------------------------------------------...••--••--•----............--••
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the rov isions of'TT L
p S of the State Sanitary Code, The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been isseftd, by the boar health. - -.
Slye
Date
Application Approved BY • .----- -••---... . -•-•--......--•--••.... ��� 7?..---.------
� �� � Date
Application Disapproved for the following reasons----------------------------------- == =-
----------------------
-----------
•---------------------------------------------------------------------
--------
•........................................................ .............................
..................... Issued_ `. 1.7�...-----.Date
Permit No.............•-•-------------•----- ..----
-
Date
iy
No .......... .�.^ � Fxs „
_ , .:
THE COMMONWEALTH-OF SSACHUSETTS
BOARD....t
5- O F
Application is hereby made for a Permit,to Construct ( or Repair ( ) an Individual 'ewage D' osal
System at
_•J�ocation-Address or Lot No.
..fsr::-. .._....�....... :.t r:.¢sa..r_... .s...... ...'°.:^e:a.................. ..................................................................................................
' Owner Address
W
Installer Address
Q Type of Building Size Lot.... _ __ !' .Sq. feet
U,_, Dwelling—No. of Bedrooms.__._ Expansion Attic Garbage
Grinder ( )
a Other—T e of Building No. of persons____________________________ Showers — Cafeteria ./
PA Other fixtures -------•••••... ---•---• •-•--•--- --
•-------------------------------------- ----------- --......-
. - r� d 'g � � Ions.
W Design Flow.__.. ,r'`�'.. ..____.... gallons per person der ay Total daily flow__.___. gal
W Septic Tank—Liquid capacity .., ._.gallons Length__..._.... Width____':..F_... Diameter................ Depth...
'__ ...
x Disposal Trench—No..................... Width.._.................... Total Length.................... Total leaching area...._ ........sq. ft.
Seepage Pit No. ........... Diameter f' __ .!Depth below inlet... __._ __.`Total leaching area..K!?.S2.sq. ft.
Z Other Distribution box ( 4,r Dosing tank
Percolation Test Results Performed by._ ______..�-�'ra .............. Date..._��_„��
a Test Pit No. 1__ __--..__--minutes per inch Depth of Test Pit `"'_f_.4_.. Depth to ground
a t
Test Pit �'o. 2___'"' ,..minutes per inch Depth of Test Pit._, 4�..'__ Depth to ground water.____..._......'.:.._.
. 5 s �� -
Description of Soil 2 ____.._._,� - ` >
V _ .......................... --------
x ---. fit"___--�_._.__--_ _- _ .._ _ ' _ ______._. _ _... _ . , �.�"-?.
-
U Nature of Repairs or Alterations—Answer when applicable.--------------------_............. --------------------------------------__________----:-_.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System iri accordance with
T�'1'^
the provisions of f:'l y:� 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.
4
Application Approved B /. � t D
Date
Application Disapproved for the following reasons------- ---------------------------------------•-................................................................
•------------------------------•----•----------------....._...---•---------------•---........---------------•-•---•-..................................................................................
Date
PermitNo..........•-----------------------•---...--•--•--------- Issued_.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH'
' ..OF.
I
:........ .........................................................
/Wr�tf�rtt��
THI IS T CERTIFY, That the Individual Sewage Disposal 'System constructed (" or Repaired ( )
by .......... j)J./♦/.... _..... j .... ....... ............ ..
►41 _•__... __.I ...._ .. _• _ _Y_• .. . ..... .............................°.... !- •_• .
i
at__..__.-- �!J` Installer J t/�-f!l l
has been installed in accordance with the provisionsv, 5 The State Sanitary C e as descri ed in the
application for.Disposal Works Construction Permit No. ...... .._�..?._._.:..... dated------ --------7_______________
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE /2L:n... ` . .Z f Inspec tor-•-•---- ------------------------•----•--•---•-•--•--•----
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALT
......� ........OF........... ............. t �,C .......
No._:.._ _.l..... FEE ........:........
1 � �nin Sri
Permission LI......... ..............................
�by granted ' ..
to Constr or Repair ( ) a idual S e D' s Syst
Street
as shown on the application for Disposal Works Construction Permit o ------ -------
.......... ..... ated...............................7. `.
.................•�°�, Board of Health
DATE--- f''�. . �f `��_..----•-.............................. II��
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS
-- .T0 _...-_- _._.._.- _-
' P N
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