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Home My WebLink About0026 CROCKER ROAD - Health 26 CROCKER W.BARNSTABLE A= o P " U No._-.----•--•.. Fss _ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH oF........ g. s.TA�.� ----- Appiiratwu for Disposal Works Tonstrixrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair (v�an Individual Sewage Disposal system at: -Lo ation. -ddress -or t No. ................______•- ... .. ................................. .. ...............•---•-----•---... --•-----•--•-----..................... • y74 -�NL}Q:C�if�_ t:......_.... -...• -...: .�... ,f� 1� -- w er Address aS.:c: � 1Q � t�,1 .......................... '�7._..T srl?.....B,k��r� ------(Al---- MQ�_4. M Installer Address ^Q3i Type of Building Size Lot.............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a aOther—Type of Building ............................ No. of persons............................. Showers ( ) — Cafeteria ( ) dOther 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. 3 Seepage Pit No--------------------- Diameter..................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank aPercolation Test Results Performed by.......................................................................... Date........................................ ,.� Test,Pit No. l........:.......minutes per inch Depth of Test Pit.............`..... Depth to ground water..................... :-. Li, Test Pit No. 2................minutes per inch• Depth of Test Pit.................... Depth to ground water........................ :x ------------'------------------------------------------------------------------------------•-----.. 0 Description of Soil.........................................................................................................----•--••-----•- - = W --•-•...............:............•---.................-----...........------•----•-•••--•-•--•. ....-----------•-••---........----------••. •-•---•• ------------•------•---- 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 ilTiL 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 h alth.. Q Si ned...--. -------C-X --- -- 1 �.Q.. . �C / Application Approved BY...... '�'f�•--• r`� 6 --......... Date' Application Disapproved for the following reasons:...................-................................. ........................................................... ♦ y i _•_•.•.............................................................•..............._.__..........--•----•......._..........._......_•-_-._...._-_........-----•-----••---•------------------------------- • - , ! ate Permit No._. ...... .......... Issued_....... ! -•---•--•--- ate THE COMMONWEALTH OF MASSACHUSETTS BOARD O EAL.TH L L� 5. ^^S ....oF........... ... ........................... - gertifirFatr of ToutphFanrr 1�• TH TO CERTIFY, That the Individual'Sewage Disposal System constructed ( ) or Repaired bY---•................. �- ,� ......-••••-• - application for Disposal Works Construction Permit•No.... r....._. dated'.... as described in the has been .installed In accordance with the provisions of , I�: 5 of The State Sanitary Coded THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® S A GUARANTEE THAT THE SYSTEM WILL-FUNCTI N ' AT FACTORY. , c, DATE........... :.....:..L-_ . .... ....................................... Inspector----.:... ....d---- ................................................. ... ..� ^•... .43.-�.� =w+-�. a ...r�..J�..-.3.�. ��.�_..-..� L� �...;h';j-. ::'CS. .��1�� -ate `5.;.,�:..k'ri,f..u.�i• ,.e,,.f1�,.,.,a�'3'a.....,.....-�•••- _i...,.,.,y'_/"—••,�...._e 1 �1 C •>f i + 11 Re C4-16. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .r .......+` 1.......................OF........ ,,?. -�� €-�..._...... .........._..........._._..... Ap l ration for Disgiisal,Vorks Tonstrurtiun Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (V/ an Individual Sewage Disposal System at: .................................... Location...ddress...----•-------•......_... -t "v 1�•---^•-•-----------._............_......or...°t.No.---•---•-•--.......___............�.`._. �.c :��.AA�A •_..tA -ld Nll l ........................................�l. fr w� f'n( 1� ...! d_.•. l{l ✓� S• ,/9 I1..... ...... . ... .. ... .. ...._ Owner dress pD —�— Q Address i IQ A .— ��/ 1 ...-•--••-•-- ..-- ..` ! .. l�± _...;C? nlal!.. .....1 t 1 ±9��?_M a J�fa . L........� _........ .. ...._.._. Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—T e of Buildin yp g ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other fixtures -------------------------------•-•-••----------....---•--•--..._..--••------•--••••---• •-•---••••-•.....---------------•--••---•-•-•................ W Design Flow............................................gallons per person per day. Total. daily flow_ ...............__...................._._gallons. WSeptic Tank—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................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date.....-----------......----'........... Test Pit No. I................minutes per inch Depth .of Test Pit..........._........ Depth to ground water........................ Pr, Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground water........................ P4 •------------------------------§--••----....--•-------•--•-••...------•--••-------________-•--•---•--•-•...-•----•._.._....-.._......••----................ ODescription of 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 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>;y the board of health. Signed:_,': �L l:Rh .t s} = i�r --•------•- ` ._._ •�.StQ Date Application Approved By...... ............ ..__.r!'s' ______.... = � Date Application Disapproved for the following reasons:................................................................................................................ I ............................................-•-•-----.......'......-----........._.._......_-....._........._.........................._........�� v-- ....---.-...•.................... •--•-Date Permit No....... --•-- ••-------- Issued.-•-- - Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH :n1 7 �Z �� k � .......OF............................ ^ i . ...................... Trrtifirate of Tomplittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) 1 k�S r( /. r, ---•-•_.. 1 ...by.......... 'J.. , --r -- at................ ....... � rC�c_!�.c' -•-•-= --en ta4erj--�-•--•------------------------------------------------------------------•---------•--- has been installed in accordance with the provisions of T .1 L: 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit v'o._._5---__ �01..... 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 BOARD OF HEALTH 7-&;�j �. ....OF.......' v ��`.' � _�..` �� No.................. FEE........................ Disposal Works Tonstrurtion frrmit Permission is hereby granted....�` '�`� 1 a........h.--i,SS•.. .. �-............................................................... to Construct ( ) or Repair--( ) an Individual Sewage Disposal.System atNo..........----->r^-.............�• f.nr IC.. -. -.............................................` t C ----•-------•------------------------------------------- Street '1:7--� as shown on the application for Disposal Works Construction Permit No .. D'ated_ .. � Y- -•..-•-. - c�<-�-- ll. '................... Board of Health `�••� DATE............... I i ! { e ' Ettlr-i..� I / I ' La,AH �S�t1Ji%C i I I 1536 je l ' • � 6m ti fidF yo ME� S�.a� • I. ` � I I i 60` /s 2 C.UCal1 Ad f I Mid F rze 2�s1'i.�6 /edo GAPS I Q Do 4/-3 o A LOCATION SEWAGE PERMIT NO. VILLAGE -D- 4 c-g 6 c- INSTALLER'S NAME i ADDRESS _ ,Cclrnv�a��Qce t UILDDE-R ON OWNERS DATE PERMIT ISSUED '�� y --r J DATE C0MiPLIANCE ISSUED 9 / 60 fo No................»...... FEE....��........... THE-COMMONWEALTH.OF MASSACHUSETTS BOAR® PF HEALTH /.'...................... `-------------------OF.... � ........................... ----•• Appliration for Disposal Murky Tonstrnrtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at:� �� ..........Z) .._....... ....... -- ....................... .... .... ..... . oca'on- "ddress or W �J Owner - Address .......• .....................•••..._......•••. .................. ..........._............................... I.;a er Address Type of Building _ Size Lot............................Sq. feet Dwelling—No. of Bedrooms.................:.........................Expansion Attic ( ) Garbage Grinder ( ) W`4 Other—T e of Building No. of persons ....................... Showers YP g ---------------•--..._...... P ( ) — Cafeteria ( ) dOther fixtures ------------------=-----------------------------------•-•---------•--•---•----•------•--.....--•-••...................•---•-•............--•--.------ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Septic04 q capacity g g ••--- Diameter................ Depth................ Disposal TrenchLi No ca acit ...._..:_W gallons . Lent Total Lenghidth_.__..._._.. Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date.................................... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (N :Nest Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a --------------------------------------------...... .•••-------------........................................................................................... 0 Des iption of Soil........................................................................................................................................................................ x UW --•-•--•••-•..........-•-------••••••--•---••--•---•---••--•••--••-•----•---•------••••-----...•••--•-•-••••--•-----------•••......--•----•-••-••-- Nature of Repairs or Alterations—Answer when applicable.......... fid....... _<_.._._._.41 f'.............. -------------•-•_._.._...••-•••••...... ............... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has en 'sued b the board of health. C, Sign --• Tc.---� Date Application Approved By............ ................... ....F -- / `_. -_. fff Date Application Disapproved for the following reasons:...................... •......••-----------••-----•-----------•-•----•-....-•--•--•-----•----•---••-•-•.........................••---••---•-•••••-••----••-----••-------••-••-•-•-----•-•••-......•-••••••-----•-••-•-••-----•- Date Permit No......................•--••...._....-• - ...... Issued_._ ... Date No......................... FEs.... .......... THE COMMONWEALTH OF MASSACHUSETTS BOARD 9F HEALTH Appliration for Uiipnsal Works Tnnitrurtion Permut Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .2..--4 C.,` a� ' /l t` :-...... .............................�?C,/ ' (/..•._..... ......... .. ..... ....--•-•-••••••-••- .� ,p /J 5 ✓� g caJ�}o [j!ddress_ d or •�+""/ .................... 1 tiJ.. ................. ..t_....'._�_-__'�-__o..---•---•------••-- -----••----` ._._ 2..�•�x+...I Owner --------------•---.....__......_Address a ................... ..-- ---. ----.....------.......---..............._ ...-------- -...........---------.......... Insta er Address UType of Building _ Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) PLIOther—T e of Building No. of persons............................ Showers — Cafeteria a � Other 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 ( ) aPercolation Test Results Performed bY.......................................................................... Date........................................ Test Pit No. I................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........................ .......................... -......... --------------------------------------------------------- -------- •----------- •..................................... 0 Description of Soil...........................................................•--•----•----------•-------------------------------•-----------------------------------------...----•--•--••- x V ......... .--------------------------------- .._:......--------------------------- •------------------------------------------------------------------ •------------------------------------ -•-------------- -----•--------------------------------------------•----------------------------------......--------------------------------------------------------- ................................ 0 Nature of Repairs or Alterations—Answer when applicable____-----1-�d3 _______ •......... . .... .__. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'I'LE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has en ssued b the board of health. Sign .................................... d Q r Date Application Approved By......... L�! . i!` " 44.y!.:_.". ..--- Date......•----..._ Application Disapproved for the following reasons________________________________ ---------------------•---•-•••••••-•----......_.....••----------•---------....•-••------•...--•--•------•--••-••-••••••---•••----•------••--•---•-••-•••------•----•-•-•-••-•••---------•---•---•--••--- Date PermitNo.- ....................................................... Issued-................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. ..........OF... :C ^±.f ^' ................... Trr#ifiratr of Tam' lianrr � THIrTS TO CER IFY That the Individual Sewage Disposal System constructed ( ) or Repaired (4-- by--------------- - .........._. -------••...............•-•--•--- le at........................... :�E'.`: .6c.!�e. ......��G�...........-I.... ler..... ��.`...Z.....� has been installed for DisposalosalcWorkseCon Construction Term it �f , !• r' r of The State Sanitary C c� 'bed in the provisions with the T E �7' PPP . ------. . dated----------- ------• . . ... ---•-..._••-•-- THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUE® AS A GUARAN EE THAT THE SYSTEM,\W L FUNCTION SATISFACTORY. DATE....... �.1.._�j..`. ............ �%G.. _..__.._. ...-- •-•----------------------- Inspector.. . -----.....-----------�-...----. . .,,-•-••-- r THE COMMONWEALTH OF MASSACHUSETTS BOAR OF HEALTH LCt-t•v"�,r f No........ ... FEE... B 11ispas orkg Tons#rnrtion rrntit Permission is herebyranted..._._ . �-c -•-.---- ---------------------------------------------------•-•--....................•• •- g ... to Construct ( or Repair,,(",' epair �an I v• ual S wa a DIs sal System g ------<....... ..... <y ,,r'street / M ti as shown on the application for Disposal Works Construction/Permit No..................... Dated..�� ...... �.�(-. �......_..... i Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC., PUBLISHERS ;• E i V ... yam.,: -^ •'.l No......c _.: FizE ................. THE COMMONWEALTH OF MASSACHUSETTS J- ` Q BOARD OF HEALT �� ) QO ��L[ ,....... OF......... �.. H l . . .............. Appliratiun -fur Miipoiial Workii Tuwitrurtiun Vrrniit Application is hereby made for a Permit to Construct (,-') or Repair ( ) an Individual Sewage Disposal System at ZCo _d--Q-`....`o.....•....G.Poc I . ... d .. .�NsT►bl.. R�. ,; w..........................................------•--- .... .-.. -------------------�--- A Loca ion-Address o Lot 1�5_�l. ----••-----••••.. . ----•-•- Owner Address VI ---- ---------- ----------------------------------------------------- Installer Address Type of Building Size Lot.. d. ....._Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( Garbage Grinder ( ) Other—Type of Building __alloy .......... No. of persons--------/................ Showers (2.) — Cafeteria ( ) Otherfixtures ---------------------------------------------------------------------------------------.--.-•-..---_-------•----------------------------•----------.. W Design Flow............................................gallons per person per day. Total daily flow--------------------I........................gallons. r4 Septic Tank—Liquid capacity------------gallons Length---------------- Width................ Diameter................ Depth..-.-----..----- W Disposal Trench—No..................... Width---_--------------- Total Length.................... Total leaching area--------------------sq. ft. x Seepage Pit No--------------------- Diameter-------------------- Depth below i let_--- -----_.. _. Total leaching are t...................sq. it. z Other Distribution box ( ) Dosing tank ( ) e OX �C-�— j " /2` 7 aPercolation Test Results Performed by--------- -----------------------------------------------•---------------- Date------------------------------------.... Test Pit No. 1----------------minutes per inch Depth of Test Pit____________________ Depth to ground water..__-_-__._-.-__---- L7, Test Pit No. 2----------------minutes per inch Depth.of Test Pit.................... Depth to ground water.................... ►x ---------------- r-- t--------- ! ------------------------------•--- ---- --- ------------ - - - O Description of §Oil---- - +Z/ J l `7 - - x , , , -- -- -------------- W ..FT4 __ _ __________ _ ______.- U Nature of Repairs or Alterations—Answer when applicable.___-_ _---- D�.' �� -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued bkthe board of health. )Signed--d --- `......`........ . ... ...... ................................ DatApplication Approved By--------- .�....... . ... ........... jiL�!f - Q �'r7�: Date Application Disapproved for the following reasons:_..----••--•---•-••---------------------------------------------•----------•--•................................ ---•--•-•----•-------•-•-----•-•----••-•--•-----••---•----------•--•---•.•-•---------•••-••••-------•--_... Date ;. Permit No.............................---••-•----••-------------- Issued...................... ................................. 1' Date No.- .....°�=--- Fug...../... ..... ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT _.. _ ----OF......... 1 h�..... Aplifiration -fear 'MaV at Vorkfi Tnnitrnrtiun Vrrniit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: // { yy.,�� f— I_o T tQ ct, h OC ! C'S :��1=t1 �t 4 ly) garlFl!L3 •-------------•------...-- ->•-----...... ..._........_ Location-Address or Lot No. t --it .- CI\✓.o'1 G rz�t� 11 ................. .6� r_ i.. t e ?� ..fit;•._.. ( Owner ( Address In GAU Installer Address d Type ofBuilding Size of Bedrooms_____________d Size Lot._ u_`_______Sq. feet U Dwelling _-•----------•---------------Expansion Attic o(I Garbage Grinder ( ) a4 Other—Type of Building .._`�-_ ✓ -___-_--__- No. of persons........./________________ Showers Cafeteria ( ) a Other 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 i let____._________.:_. Total leaching area------------------sq. it. Z Other Distribution box ( ) Dosing tank ( ) C)9. — 3 - /2 - l aPercolation Test Results Performed by-------------------------------------------------------------------------- Date----------------------------------------- Test Pit No. 1................minutes per inch Depth of Test Pit_................. Depth to ground water..------__-----_--..._. f4 Test Pit No. 2................minutes per inch Depth of Test Pit---___-_-..________- Depth to ground water-_.-_.-..--__---__-.._ W . ..../ .............. . ... s f ` O Description of oil- ----; - --. : /-� f�!"" ,�� r, A/--;� � �`Y' U --------------•-----�---------%- ----�` t c� _�. ,K .�. .,� ..-......�............ �'-----��- .�'c..Wi ' `'�' W VNature of Repairs or Alterations—Answer when applicable-----------------------------------------------------------------------------------------------. -----------------•------.....---•-•--------------...--..._..._..._..---....-• ---•----••-•-•----•••--•--.. -------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by �eb rd of health. . c igned..24.. / (f� Date Application Approved By--------- -�= _��___--•--•--•-.-•-- . .... _ -= �. Date Application Disapproved for the following reasons:............................................................................................ ......•••-•----- .........••-•••------•---_--•••-•--••-------•-------•---------•--•-•-------------•--•--•--••--••-••--•---"---------------------------•-•-----• •----------••-----------------------------.------•-------- Date PermitNo........................................................ Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH I,J''''�......OF............... . r G, -,.-c_.... ............................... r Trrtifiratr of hunt littnrr Tull S IS TO CF2TIF hat the Individual Sewage Disposal System constructed ( r Repaired ( ) by �e-r: ... •--- / at ' !'� ' ' �' '�' �'�j `d °; sly In sta 17...... l� ,� _ Z/ has been installed in accordance with the provisions of A icie XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No-�--t7.___.___�_.�,__ _._______. dated......._+r .'..s .`7l.......... THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFAC ORY. 7 DATE. f�---' �---` - - -__------_- Inspector....._ 1 ----------- --------------- ----•------------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARDS)F HEALTH No......................... FEE.../1.1-•••----_.... Bis:pwial MMatrurtion Vamit Permission is hereby granted______________________. ._........._ �'C....._ .................. .............•......_. to Cons��tr//h�ct (� or Repair" ( ).an In idual ewage -''sposaU System � ---- � ----------•----- Street as shown on the application for Disposal Works Construction Perm-i No______ ____ _______ Dated....f :�_r.'.. G�......... DATE................................................................................ Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS .00,�"'� _ ti Q N't ;+ z) 1 •f � w l• n � z. PL 0 7- PL A Al F LAN 26G4j2E A/C E : B�_ClnJG / 07" N CIf ,\ GfORG . yG I NL_26ey CEVrIFY T,4lAT 714,E EX/ST- L /NG FOUNDAT/ON LOCAT/ON /S CVeAE LW _ a .45 3WOWAI AMA_,r'o E s_COAvFoZAy WirN '9,L OIS T E�{per THE 8l�/L D/NG 3E Tl3AG'�PE_�JUi2EME�/T $UR ti OF T.NE TOWN Of _ Il >AIST LE_ _-- --�--- -- A L 0 /.- 30.3 9 WILLOW.57' YA2M007;z/yOQ7,N14. Q5 � E qo X5 1 ��-Ov SiLL E1.E ✓..------fEET46o% Po�D. LOCAT/On/: PL-A/V I A EQReeY c V r/FY T,UA T THE EX1571- Q GEORG ��. 4 /N, G FOUNDA7'/ON 44CL17/ON /,5Cve t W C AS $1-10 ' V AND_2='O ti5_CONFO,eiy W17;q 9 afgYE��4 THE 8U/LD/NG SET0gCk-R6QUiPEMLoV7 $UR74 OF Tf,/E 710WAI FOR _a� G. E,C.C.O / - 303 � A Gt//GGOH/ST. y<'i/1M0 UT1/Pl�.BT,Mq.