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HomeMy WebLinkAbout0032 ASHLEY DRIVE - Health 32 Ashley Drive . Centerville 172-091 UPC 10259 a. No. H�163O_R �,, ` HASTINGS UN YOU WISH TO OPEN A BUSINESS? V For Your Information: Business Certificates cost $30.00 for 4 years. A Business Certificate ONLY REGISTERS THE BUSINESS NAME in town (which you must do by M.G.L.- it does-not give you permission to operate.) You must first obtain the necessary A signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1" FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. m" a s- Fill in please: Date: .:3 .30 D APPLICANT'S NAME: YOUR HOME ADDRESS:ir 3Z �s curl Aa2 BUSINESS TELEPHONE # C�o� HOME TELELPHONE #: .�o Ff'� t{2c� 6 NAME OF CORPORATION: NAME OFNEW BUSINESS wvt A�cs� �r--u.S TYPE OF BUSINESS IS THI ,A.HOME OCCUPATION? �Y NO ADDRIt,SS OF BUSINESS 3Z 14�.►te: MAP/PA RCEL NUMBER (Assessing) When starting a new business there are several things you must do to be in compliance with the rules and regulations of the Town of Barnstable. This form is to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. (corner of Yarmouth Rd. & Mairi Street) to make sure you have the appropriate permits and licenses required to legally operate your usiness in town. 1. BUILDING COMMISSIONER'.S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature" COMMENTS: 2. BOARD 4 HEALTH This individual has been informed o t it requirements that pertain to this4ype of business. Authorized Signature**COMMENTS: HAZARDOUS MATERIALS REGULATION<3 � 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: Date: 3 /3a / TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: ��' E' er wA-r�/2T-�►�ct_f /4,�D TLb6 ,E114T BUSINESS LOCATION: T2- 44f 14A , INVENTORY MAILING ADDRESS: 02.632 TOTAL AMOUNT: TELEPHONE NUMBER: (_f-0F 1 CONTACT PERSON: 34,;0 EMERGENCY CONTACT TELEPHONE NUMBER: -0�r qW-0-�/6 MSDS ON SITE? TYPE OF BUSINESS: Z,+,-b TCAtF_ O INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous.waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor &furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list).- Laundry soil & stain removers (including bleach) Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT!CANARY COPY-BUSINESS - . ..�,,._.,.�..:-.-.......+hL+�,.Ml e.��+vs"+n.�f•;ra.A.•:.y f r.�..�':.ePi "�a ,.:t'"°;, ,,9�R*r'AAa.;.�:;a+. �� 4a `�I. p�t �' ? �' � r _ „ Date: 01 TOWN OF BARNSTABLE TOXIC-AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: BUSINESS LOCATION: I E y Ls- INVENTORY MAILING ADDRESS: 2 C 32 TOTAL AMOUNT: TELEPHONE NUMBER: Z-) C1 CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: ` �GU' os�/E MSDS ON SITE? TYPE OF BUSINESS: ���eC��E C INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111 , Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless.of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) Misc. Corrosive .NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils , Pesticides NEW ft USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel .Aviation gas Photochemicals (Fixers) Diesel Fuel:kerosene, #2 heating oil NEW USED Misc. petroleum prod udts'. grease,_ Photochemicals (Developer) lubricants,_gea��oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt &roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) .- NEW_ USED __» ; ---._.Any other­products with "poison"-Labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor &furniture strippers Other products not-listed which you feel Metal polishes may be toxic or hazardous (please list): y Laundry soil & stain removers €�c� (including bleach) Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash { "I(WHITE COPY-HEALTH DEPARTMENT!CANARY COPY-BUSINESS A_;,. YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $30.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L. - it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1 FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) and 200 Main Street Offices at the Licensing counter. �y x DATE: o Fill in please: APPLICANT'S YOUR NAME: 54A_; ' BUSINESS YOUR HOME ADDRESS: as TELEPHONE # Home Telephone Number: NAME OF NEW BUSINESS �r42�,y & OF BUSINESS L� TYPE _r,_,4P �T ,e IS THIS A HOME OCCUPATION? " YES NO Have you been given approval from the building division? YES NO ADDRESS OF BUSINESS 3 l rsc� 6� , -�0jj_ � , d�3 MAP/PARCEL NUMBER 1, - C� I When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFF E This individual has en info r d of any permit requirements that pertain to this type of business. MUST COMPLY WITH HOME OCCUPATION. Authorized Signatu ** RULES AND REGULATIONS. FAILURE TO COMMENTS: COMPLY MAY RESULT IN FINES. 2. BOARD OF HEALTH This individual een iPignature d o e rmit requirements that pertain to this e of business: type Authorized * Y1AIItHALL COMMENTS: MU A1A TIERrAtS REGULA 3. CONSUMER AFFAIRS (LICENSING AUTHO ) This individuals been " rnred of t ices uirements that pertain to this type of business. lk Authorized Signature COMMENTS: .��Hazardous Materials Inventory Sheet Checklist j�Date �-_Physical Street Address-Check database to ensure it exists Working Phone Number dual Amounts-(te.gas being used to fuel machines,thinner to clean brushes all count as hazardous materials) Storage Information-location of storage,how long is storage for? If none,note that. L_--DIsposai Information-where and who?If none,note that. f/A licant Signature-understand what is listed and noted taff Initial-any questions,know who to ask Vehicle Washinglltinsing? -provide a vehicle washing policy and am it-note that it was given Attach the Business Certificate with your sign off and comments "The inventory form should explain what the business consists of and the procedures they are doing. Notes need to be left to explain what you discussed with them. ., Date: TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: UJAt t2 (-,0 - BUSINESS LOCATION: 32 /fit►+��� �� Cv�w�� M� d�63� _ INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: ' ` EMERGENCY CONTACT TELEPHONE NUMBER-� 2-7 MSDS ON SITE? TYPE OF BUSINESS: L%, c�� M ��� INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous.waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid), Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor &furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers �� (including bleach) Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS TOWN OF BARNSTABLE LOCATION 32 s ��r 12J 'SEWAGE # 206J SSG VILLAGE Ig v �- ASSESSOR'S MAP &LOT ) INSTALLER'S NAME&PHONE NO. rig A— ��p- ��� ��oS�to� J7�+srdvS SEPTIC TANK.CAPACITY 1600 LEACHING FACILITY: (type) Z21V u/��l�S (size) 15 125' NO.OF BEDROOMS3 BUILDER OR OWNER 2 T1zffEp' PERMITDATE: COMPLIANCE DATE: 0 y 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,ka�h ng facility) Feet Edge of Wetland and Leaching,Facility.(If any wetlands exist within 300 feet of leaching facili ) Feet Furnished by _i a ys/ 4� rJ�S�O Fee —166 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for �i5poga16pgtem Congtruction Permit Application for a Permit to Construct(pair( )Upgrade( )Abandon( ) O Complete System 2-R06 idual Components Location Address or Lot No. , O ner's Flame,Address and Tel.No. Assessor's Map/Parcel Q �! Installer's Name,Address,and Tel.No. S/�9 Q-'477.TS Designer's Name,Address and Tel.No. —V 28—-'?36 2 Josy-joh 0, 194"-es 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 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or A�lt�erratiions(Answer luZh- whenapplicabllee),s_ i T `� D—BeA / � 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 Certifi- cate of Compliance has sued by i oar of alth. S gne I Date Application Approved b Date Application Disapproved for the following reasons Permit No. - Date Issued },,� a ' No. L� T .,€l -c .i Fee U y r T i t _�1 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: r - Yes '`\.PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 01ppYication for XDi!6'ogar &p.5tem Cd11 n5tructiou Permit 11 Application for a Permit to Construct(�i�pair( )Upgrade(1 )Abandon( ) El Complete System �vidual Components Location Address or Lot No. —5!2 iY 5' Rd Owner's ame,Address and Tel.No. / Assessor's MapRarcel G,� � 1 172— O Installer's Name,Address and Tel No.5'0,3'S/�2©"� + Designer's Name,Address and Tel.No. S'08 8"�6 2 fry T dam . / G C/tosr l 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 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil i Nature of Repairs or Alterations(Answer when applicable) Z%,11;s� 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 Certifi- cate of Compliance hassbeen; sued by h' -Board of Health. Signed Date Application Approved b�—�— Date /1 ' `�/G 1 Application Disapproved for the following reasons 1 Permit No. cJ<50 5 Date Issued -----------------------------=��--------- THE COMMONWEALTH OF MASSACHUSETTTS BARNSTABLE, MASSACHUSETTS Certificate of Qfompliauce THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( 4�-Repaired( )Upgraded( ) Abandoned( )by �d.S' /1 Z), at S1V/zf=� has been constructed ins acc rdance with the provisions of Title 5 and the for Disposal System Construction Permi No. )00 Sffb dated �. Installer �/r�s c v� II)e- Designer �_`yf The issuance of this ermi+t shall not be construed as a guarantee that the system will function as designed. Date �ULt Inspector � � r y�No. ----------- -- — Fee .�-- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS li5po5al *pgtem (Eot%tructiou Permit Permission is hereby granted to Construct(lij'Repair( )Upgrade( �)Abandon System located at :f 2 oS'�W ; 0; J i and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special condiitti"ons. Provided: Constructi n must be completed within three years of the da'to of h'pe\t. Date:_ l I d Approl Xfo oYw w:. G (11 " D No.7.::-.�W p FEB. ....3 0 . 0 0 THE COMMONWEALTH OF MASSACHUSETTS ' BOAR® OF HEALTH TOWN OF BARNSTABLE Apphratinn fur Diripuuul Hiur1w Tonutrur#inn Frrutit Application is hereby made for a Permit to Construct ( ) or Repair �X� an Individual Sewage Disposal System at: 32 Ashley _Drive Centerville ..................... ...........•----....-•------•...........__...------..._.. ----••••---•-------••---•••••-.........----...--------•---•--------------------------------------- Location-Address or Lot No. SteveLimperopulos ..................•--_...__ .--------------------------•---......-----.....-----------•----•-------------------...---.......-- Owner Address W J .P.Macomher Jr . Installer Address Type of Building Size Lot............................Sq. feet V Dwelling XXNo. of Bedrooms...........'J-.........-----------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—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. 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........................................ a Test Pit No. I................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........................ 19 -----------------------------------------------------------•----....------------••--............----.............................................. ........... 0 Description of Soil................................................................................................ ------....----•--------------------------•--•-•--------••----••-....... W Sand & Gravel U -••-----••-------••-----•••-------•-......---•••-•-----•••-•---•---•-•--•-----•-••----•................•-------•---•-••----•--------------••-------•---••-•••----•--------••--------.......-------•--••. W UNature of Repairs or Alterations—Answer when applicable....A ci i n c{___1.-10 0 0 gallon leach _?i t...to spiti.n ...s. . . .ic...s. . �m............•........................................................................................................................... Agreement: 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 undersigned further agrees not to place the system in operation until a Certificate of Compliance has ben ' sued by the b rd o health. Signed .. ..�.. .... . . ..4. . ........... ............... ...1...../�6/g 3......... `%��� Dare Application Approved By -------- RR,K-.=�........................................................................ ..� .-..�e-.9_....... - Application Disapproved for the following reasons: ........................... ......... ............................... ............................................ ........ .............. . ........... ........................................ Date PermitNo. .....................� �.(�..a-,,........................ Issued .................................................................... Dare ;mow•--•ter �.-----..--�..�-.-^^ .�. -.. ��.......�-----�- -�.-�v-_•_.`^-'-+-•T . No. .-.GG Fas.�....30.00 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE I App iratinn for Ui►ipom' l Work.i Tomitrnrtinn Famit Application is hereby made for a Permit to Construct ( ) or Repair �X�- an Individual Sewage Disposal System at: 32 Ashley Drive Centerville ........................•-------•--•------...----------.....---------------•--..................-- -•-••--••-•-•••••••------•-•--•--------...------.............----•---...--•--••---•--••••----•---- Location-:Address or Lot No. SteveLi.• -----•-•---•-------•-•---•--••-----•-•---------••...-•-----•--••••----......-•................••-- O,ner Address W J .P.Macomber Jr. Installer Address UType of Building Size Lot..-_--------_--_--------Sq. feet Dwelling X-XNo. of Bedrooms..........3---_--------_.. .............Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ----------------------------------------••-•--------------------------- --------------- ---------------------•------------•-----•-------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. tx Septic Tank—Liquid capacity------------gallons Length---------------- Width---............. Diameter................ Depth................ 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 ( ) 0-, Percolation Test Results Performed by---- ----------------'---•--•-••-•-----•-----•-••-•-•-•--•----•-•......--- Date........................................ W Test Pit No. I................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........................ W ------•••-•----------------------•••••--•-•----•---••---••••---••-••--••-•-••....---------•--...--------•-----•----•-•-•--••••-•-•-••-•-...----....------ " ODescription of Soil....................................................................................................................................................................... � - Sand & Gravel V .....--•--•-•----•-------•-••--••--•..::....----••••-•---•-----•-••••••-••-•-•------•••••••••••••--•-•-•-•-•----•-------••......-•--••---••............................................................. W .--••-•-------------------------------------------------------------------------------•-------•--•.---------------------........------------••-----•-•••--•-•...........••-•••-••-•----•--------.....-- U Nature of Repairs or Alterations—Answer when applicable....Ad d i n� _1-10 0 0 g a 11 o n leach pit to .Ax st-ing...septic•..system..•---•-•----•-----•-•...-•--•--•-•---•-•-••-- Agreement-. 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 undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iVsued by the b and o,health. Signed �j'r ...11/26/93 / ........'---Date................ ApplicationApproved.By...............�o --- ...--.................................................................. Application Disapproved for the following rea.Eons: ----------------------------------------------------------------------------- -----.'.....:.---------------------- ............................ ' ........Ir.........:.:....................... ... .... ' ..................................... ....... '........................................ ........................................ f Dare Permit No. ------- ...........:.............. Issued ............................................ Uare —._--.-- o. ——— -- -- --------m.-..s-- ——————————— -.---- ———— --_---- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE 1 (ILTI.e>r#ifirate of Compliance TjHI,S IiS,Icr•0oCAPJIFYjhat the+Individual Sewage Disposal System constructed ( ) or Repaired (XX ) by ... - _..................................._............-.. ......-;................._. -------._.... .. .....-' ' .........- - - - -' " Installer 32 Ashley Drive Centerville,Mass. at ..... ................ ...._............ ....... ..........--...............-._...----..------------..........----------------------------------------------------.-.---------------...--------------------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ...-.. ------ C:_'D.......... dated ......................................... ... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE ! ..'...�/1`- ..,__............. ...._.....-.-.._ Inspector . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH C� TOWN OF BARNSTABLE No.? : 1. FEE,. $_ 30 04 ._, ._ Macomber jrr �trUan �Crrmit Permissionis hereby granted-------------------------------------------------------------------------------------------- ................................................. to Constar t (( ) or Repair (X an Individual Sewage Disposal System at No.... I.� 1�sliley Road enterville,Mass-------------------------------------------------------------------------------------------------- ---------- ---------•----- street gg as shown on the application for Disposal Works Construction Permit NoZ3__66._-.__ Dated.-. ....... ` _ f— Board of Health DATE.......... - --•- 1- ------•------------------------------•---- FORM 36508 HOBBS&WARREN.INC..PUBLISHERS SITE PLAN Desi n Calculations �) Q N SCALE. 1 =20 BENCH MARK TOP of 'P6,g, Number of Bedrooms: 3 FOUNDATION ELEv=100.00' (assuMED) �bh Garbage Grinder: NO, GRINDER NOT ALLOWED WITH THIS DESIGN C T Gk Leaching Capacity Required: 330 Gal./Day enterbr R Leaching Area Required: 330 Gal./(0.74 Gal./Sq.Ft.)=446 Sq.Ft. ;mf sW oak Ln O Proposed Leaching Structure: 1-25'L X 13'W X 2'D Leaching Trench ID Leaching Area Provided: 477 Sq.Ft. � s ova INS Proposed Leaching Capacity. 353 9Pd > 330 9Pd. re 'd. a ac s7aw /st/ of lePJ' � o "CENTERVILLE", GENERAL NOTES 1-25'L X 13'W X 2.0' D 1. ADDRESS: 32 ASHLEY ROAD LOCUS y� leachingtrench usin x tW .r 2. ASSESSORS NUMBER: 172-091 2 H-10 500 gal. chambers with 3. DEVELOPER'S LOT: LOT 100 rye` 4' of stone all around 4. TOPOGRAPHIC INFORMATION WAS COMPILED FROM AN ON THE GROUND INSTRUMENT SURVEY. ti. 5. TOWN WATER IS PROVIDED TO SITE do SURROUNDING PROPERTIES. 6.• '_ REFERENCE WETLANDS ARE LOCATED WITHIN 1E 50FEET OF S S LAN 38871 B . 7. NO 4 8. NO POTABLE WELLS ARE LOCATED WITHIN 150 FEET OF SAS. CONSTRUCTION NOTES DECK 1. Contractor is responsible for Digsafe notification and protection of all underground utilities and pipes. 2. The septic tank op I distribution box shall be set level on 6 of 3/4 -11/2 stone. 3. Bockfill should be clean sand or gravel with no stones over 3" in size. x tuft 4. This system is subject to inspection during installation by Glen E. Harrington. R.S. system Environmental Coda 5. The contractor shall install this stem in accordance with Title V of the Massachusetts and the Regulations of the Town of Barnstable. s. Provide an Acme Precast H-10 5-hole D-Box and 0 2 H-10 500 gal. chambers or equal. 7. No vehicle or heavy machinery shall drive over the septic system unless noted as H-20 septic components. 8. Install qoe baffle or equal on septic tank outlet tee end. �I►� �cb, Lk 9. All existing inverts and site conditions shall be verified by contractor. cp f/� / A 10. Existing leach pit to be pumped and backfilled. Q U.M. ��' �Q' 13cv "v✓ 4o�f� on CS o LOT 100 AREA _ 15,0DDt SO-FT. n• N A/')� SOIL EVALUATION Date of Solt Eval.: OCTOBER 7. 2004 q. Sop Eval. Perforrred By Glen E. Harrington, R.S. Excavated by. JC:'YS`5ptic Service Perk Rate: <2 mpi (ASSUMED IN C1) +-ad'owi �ouso r s Rate: tK.w Test HOW� r f 50 SOLS ELEV. k ALI beiy l".e 1 e• 10110/t • t♦ 9=1 O 124" 34" 1 t�Mh "IC .!'2s.r' O C7 O j PLAN VIEW 2 H-10 500 gal. chambers Isw j a END-SECTION Jj-10 500 GALLON CHAMBER NOT TO SCALE ro r on ot-red USE ACME PRECAST OR EQUAL I �P���t of Mqs PROPOSED SEPTIC SYSTEM UPGRADE o 8N PRAM IN .LEGENQ -E JOEL E. ZEGER Q v H GT EXISTING LEACHING PIT TO BE o.1070 AT 0 PUMPED & BAiCKRUED #32 ASHLEY ROAD o o EXISTING loon GAL. S1 BARN STABLE (CENTERVILLE), MA Exlstlrq Hows 10. TE:min. from--- *Na ALL PIPETS ARE TO BE 4 DIA SCHMAE 40 P.V.C. H-10 SEPTIC TANK house to septk; tank •NME: INSTALL GAS BAFFLE OR EQUAL ON SWI TANK OUTLET TEE. 9�otlo 1a".f a s � �whe woo ow .yet e-= d" away x 1o4OLE .1e DENOTES ousnNc PREPARED BY: wlNl" GLEN E. HARRINGTON, R.S. EX157) aISTHsox e"oe.now-011"A SPOT GRADE een.t'—t/r—t/2' t ohan+3.r eon"mwt e. , --°� EXISTING CONTOUR 9 LEDA ROSE LANE .M°�i" t�""�a+a Ma.+�w�e.toe. wltl,ln a titoh"e woe. - full U" r ` .->ae.4' . APPROX. LOCATIo" ; cellar �' 1�°obRTMa�i , EXISTING WATER LINE MARSTONS MILLS, MA 02648 13 - s3' �H-1TIC o"K . ... . � APPROX. LocAnoN TEL: 508-428-3862 EXISTING WATER UNE FAX. 508-428-3862 LEACH TRENCHft r a a/e•-tt/s•sratc E Roffign of T.H. /I E9w-411.3e' SCALE: 1"=20' DRAWN BY: GEH OCT. 28, 2004 SYSTEM PROFILE e•a a/�•-�t/x•s1oNc DATUM. ASSUMED Net to some FILE: ZEGER SHE 1 OF 5 . I - 1 'I TOWN OF BARNSTABLE kel Lii:A i'IGN 32 �s �� SEWAGE # oyy-S8G ASSESSOR'S/MAP & LOT VILLAGE 6,iq 17�-(7Gll INSTALLER'S NAME&PHONE NO. r,09- 211,9 - SEPTIC TANK CAPACITY 1b00 LEACHING FACILITY: (type) 2- 0/',f WtEll.S (size) NO.OF BEDROOMS 3 BUILDER OR OWNER /r a 114 PERMITDATE: //-S` U�` 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 facili ) - Feet Furnished by ,4e- Y ss v TOWN OF BARNSTABLE r LOCATION -e y J .d SEWAGE # VILLAGE [ e,v7"�R _V/1L� ASSESSOR'S MAP & LOT -� INSTALLER'S NAME & PHONE NO. L OA gel Soy SEPTIC TANK CAPACITY /, d 00 LEACHING FACILITY:(type) ,r. (size) NO. OF BEDROOMS ,? PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER ! DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 'L/ r ' `tN `