HomeMy WebLinkAbout0049 CAPTAIN BELLAMY LANE - Health 49 CAPTAIN BELLAMY LANE
Centerville
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W ESUSA
OETORQAIMATSYEAOM
No...�.5 FEB...Y.va.�....
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
77�.1!V/--------------....OF......BA.9H.�A64Z.E:..........................................
ApplirFatiun for Uhipati al Works Tomitrurtiun ranfit
Application is hereby made for a Permit to Construct (�/) or Repair ( ) an Individual Sewage Disposal
System at:
YlL!-E------------------------------------------•--------------------....------------.
Location-Address or Lot No.
---•---------- 1 __.... ..�t3�X... Z0..... r�Y�_s�. _-<2_-453
Owner Address
a t -s......... ----------------- ---------------------- �...........................................................
Installer Address
Q Type of Building Size Lot... ........Sq. feet
V Dwelling—No. of Bedrooms........!..............................Expansion Attic (Avg Garbage Grinder (A.o)
Pam-, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a Other fixtures .................................
W Design Flow........... ---•-----_.___••-_•--_--gallons per person per day. Total daily flow__.......—a...................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 (V")' Dosing tank ( )
N.'' ._ Date._�__/6/es
Percolation Test Results Performed by._---••___--•-•.--____-•••-••---.•-•-__--•�-••--•-•_•---_-•--•--___ ground
l__ ._.. _
Test Pit No. 1..?. ._.minutes per inch Depth of Test Pit...- .. Depth to water....
Test Pit No. 2................minutes per inch Depth of Test Pit________--_-____-__- Depth to ground water........................
P4 •--•---•-•••---_.._...--•---••••-•.....-•-•••-•-•••----••...........••••...............................•--------•---••...............-•-•••......••••-_••----
ODescription of Soil----•- -- ...... 'K!K.._! N ......................................................................................
-------------------------------------...................................................................................................................................................................
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 TITi IE 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.
M� ate
Application Approved By....... •..°�� --------------•-------•- l/e
Date
Application Disapproved for the following reasons---------------------------------------------------------------------------------------------------------••_..._
-•-•--••••-•------••••--•---••••--•--••••-•...............................••-•...._.................-•-•-.......__....------............--•--•.........••••••••...•••................ ••........•---
Date
�.
PermitNo....................................................... Issued-.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
j BOARD OF HEALTH
riWIV. .....................OF.....jf. `t.d .--------------•.....--•......._.._.......
Appliration for Disposal Works Tonstrnrtinn Permit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at:
....L.+�+�.�l.._�� !...a�/.�.:'�?'.C.(�tl�......�.'...<.i+ly�.�.ttid�3•..�::� �I.G.L.+dems�e.•_•............................................................................
Location-Address or Lot No.
EiA4•"ac� ------�_`� ----------•-------•-- ........ f .-•• Cs�-'fit'- �.$�s;.a,6;,..C.c 'A'. .
Owner Address
W " ......._ T` 't ----------------- --------•-•--•--•--__'--n.P_ l e --•--•--------•---•--------___-•--•----•-•-•-•---•---------
Installer Address
Type of Building Size .........Sq.,feet
Dwelling—No. of Bedrooms........ ................................Expansion Attic ( ,Y) Garbage Grinder
p� Other—Type of Building ____________________________ No. of persons__'......................... Showers ( ) - Cafeteria ( )
Q' Other fixtures -•--••--•--•--••----------------------------------
Desi n Flow............ per person per day. Total daily flow--------- gallons.
W g P P P Y Y --
WSeptic Tank—Liquid capacity..._........gallons Length________________ Width---------------- Diameter________________ Depth__:________:__-.
x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area--------------------sq. ft.
Seepage Pit No_____________________ Diameter.................... Depth below inlet.................... Total leaching area..................sq:ft.
Z Other Distribution box (4 . Dosing tank ( )
Percolation Test Results Performed b ____________________________________________ ..................
Test Pit No. 1__>-__�,,_._minutes per inch Depth of Test Pit---- ' ....... Depth to ground water___ >' i ......
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
R+' -.-.-------•-----------•--------•--•-----------------------•----......._..------•-------------------.........................................................
DDescription of Soil------�-'2-----_- ='�` �" � ��,.�. � }- --------------------------------•--•---------
U _______________� .J. .__'-.5'r�.A! __.,Isl°,a!!;}__-_4.$ ,..t�, rtV:_L..._._______._....______.___.__..__._______..______...__________________.______.____....____
W ------------------------------------------------•------------.._...--•---------.._..-----------...------•-----------------------...------------------------------------------------------------------•--
UNature 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'I'PLE 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..tle board of health.
igned .............................................................. 4?fZ r'° 7
Application Approved BY = ------------•��---•--•--------
Date
Application Disapproved for the following reasons:--••---•••-•-------•-------------------•---•-•----•---•---•-----•----•-------•----------------------...:-------
Date
PermitNo......................................................... Issued.-----•---•-----------------------•----------•--•-•----
Date f
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
._...................OF.....:.. .11le `?s , c>a` .....................................
Antifiratr of Tomph anrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (/) or Repaired ( )
bY----------------------------------1.u!s s..-•----._. ...........•----------....----------------------------------•------...----•--------------------•---------------
Installer
at-----------�1(.7i.- �------ t?:rA N --•—��t�L�=�x�,� �,��"= 4��r��=L!?_�e s��aa-•-----------
has been installed in accordance with the provisions of TITLE ` of Pe ate Sanitary Co describe-d in the
application for Disposal Works Construction Permit No..-_._�_:�:-_`:'_:_� ee �
.__. dated---------- ........................
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONS RISE® AS A GUA NTEE THAT THE
SYSTEM WILL FIJ TON SATISFACTORY.
DATE----------------�j..1_-------- inspgctor
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
......... ...OF.. 1�ar , d�
No......................... FEE.._5. ....... %..
19isposal Works TonStrnrtion an it
Permission is hereby anted... ` = ............................................................................
to Construct (/) or�Repair ( ) an Individual Sewage Disposal System
at No. '% C. f f_L.7C-..•-•••-- ... ............
Street ✓ � - L =�
as shown on the application for Disposal Works Construction Permit Nca-=-___- -:_ Dated_._ `+........................
......••----------------------------•------•---------------------_-____•-------._.._...-••••-•.......
E
DATE • •••--- ---�7 Health
S Board of-----
FORM 1255 A. M. SULKIN, INC., BOSTON - -
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C EXISTING SPOT ELEVATION sO •'. xp NO. i9ss7 1
@XISTIMa :;CONTOUR --- 0 lam �o � CERTIFIED PLAT PLAN
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AWW"EDOE:wrNGINEER/NG`c IN £ �� .
CLIENT. 1, CERTIFY THAT THE PROPOSEQ ' N`.
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LOCATION 044 1T S
�� EW GE P RMIT No.
Qx v� (IV,
VILLAGE
j' l�e
INSTALLER'S NAME i ADDRESS
BUILDER OR OWNER
�. 'G ce eiNLjk:-e�
Ge (Q*,t�
DATE PERMIT ISSUED
DAT E COMPLIANCE ISSUED g ��
� � �o�'��
b�
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3
1,
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YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates (cost$40.00 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.) You must first obtain the necessary signatures on this form at 200 Main St.;-Hyannis.
Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is
required by law. J
DATE: I Fill in please:
APPLICANT'S YOUR NAME/S: LC-QV-
BUSINESS YOUR HOME ADDRESS: QL1Q3 2
' TELEPHONE # Home Telephone Number. .
NAME':OF CORPORATION:
NAME:OF NEW BUSINESS . 2ATYPE OF BUSINESS
IS THIS A HOME,OCCUPATION? Y S O � 2�
ADDRESS OF.BUSINESS L ` MAP%PARCEL NUMBERG f` / [Assessing)
� r(�P 3a-
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 CO MISSI LER'S OF ICEThis indivi ual a #Sr d o a y p m' requirements that pertain to this type of busines�VIUST CC?t�4P, '.� WITH, �� "a , OCCUPATION
BULL ,"i i i<F:ri.'�..^.'�ii.,. FAILURE TO
D,41 Au horiz d Sign ** COMPLY MAY NESuLI i►V MINES.
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/ 2. BOARD O HE TH
This individual has been informed of the kZ!!rb:q�uireSEents that ertain to this e of business.
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Authorized Signature**
COMMENTS:
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature*
COMMENTS:
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TOWN OF BARNSTABLE Date: /gv
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF BUSINESS: C 'RW IU 1 r)6 and 4jM+1"tt10
BUSINESS LOCATION: CIVENTORY
MAILING ADDRESS: TOTAL AMOUNT:
TELEPHONE NUMBER: ro ff/• [ J
CONTACT PERSON:
EMERGENCY CONTAC TELEPHONE NUMBER: ftk6DhLA MSDS ON SITE?
TYPE OF BUSINESS: UCbZn
q/3� � '1045
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 material 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) Miscellaneous 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
Miscellaneous 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 Miscellaneous 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 (including carbon tetrachloride)
❑ NEW ❑ USED Any other products with "poison" labels
(including chloroform, formaldehyde,
Paint&varnish removers, deglossers hydrochloric acid, other acids)
Miscellaneous. Flammables Other products not listed which you feel
Floor&furniture strippers may be toxic or hazardous (please list):
Metal polishes
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 Applicant's Signature Staffs Initials��