HomeMy WebLinkAbout0020 FAIR OAKS ROAD - Health 20 FAIR OAKS RD., CENTERVILLE
A = 168 092 003
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.-.
DATE: s' l- Fill in please:
APPLICANT'S YOUR NAME/S: 1/ 111 i P_✓yl' I $'F>
BUSINESS
YOUR HOME ADDRESS: 21:1 Ec,-r 1-
j: ;;,r,:3yi,,.,.• �•�� ;„,, ;.:.:+?•. ; .,
,.r'li. -7- YJArZ, oz Z
TEL # Home Telephone Number 7 7 `/' 1637- 7 r7 s3
�f•i�tt. :n^s�,n;j•r+;? E-MAIL: / 3 C rn 11 d MZ
NAME OF CORPORATION: C% O m i
NAME OF-NEW BUSINESS f-� �' ' l-1 F� z� sv/ '' ' TYPE OF BUSINESS N.9`
IS THIS A HOME OCCUPATION? . YES NO
ADDRESS OF BUSINESS 20 �vh; D wJS f 7Zd (`. ,-�a,y/- n'p' MAP/PARCEL NUMBER M 003 (Assessing)
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 2nf �ja (5kP�jo , lY�foUpp,T101�Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate ! ta� NS. FAILURE TO
1. BUILDING COMMISSIONE 's F ICE COMPLY.MAY RESULT IN FINES:
This individual has bee inf ed of a it requirements that pertain to this type of business.
Authorized Sig re**
COMMENTS:
2. BOARD OF HEALTH ,
This individual haVbDpene it informed of t requirements that pertain to this type of business.
Aorized 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: .
XUWU Ul DUIUSLUUIU
eTREr�
Regulatory Services
o Richard V.5cali,Director
s
Building Division
RAENSUZM"&. $ Paul Roma,Building Commissioner
°ran +a 200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma us'
Office: 508-962-4038 Fax:. 508-790-6230
Approved:
Fee:
Permit#: -HOME OCCUPATION REGISTRATION
Date: //s l 7
Name: LLt W' J L�YZ n Phone# 7 Z
Address: Z 8 I"4j�T"G' ��/2 S %�oeC Village: C f a!`Vk-A?_
Name of Business: a e l�li �- 6
Type of Business:'—Se•Y f/YL-X Map/Lot
INTENT: It is the intent of this section to allow the residents of the Town of Barn N le to operate a home occupation
within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the
activity shall not be discernible from outside the dwelling•. there shall be no increase in noise or odor,no visual
alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal
residential volumes;and no increase in air or groundwater poIIution.
After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the
following conditions:
• The activity is carried on by the permanent resident of a single family residential dwelling unit,located
within that dwelling unft'
• Such use occupies no more than 400 square feet of space.
• There are no external alterations to the dwelling which are not customary in residential buildings,and there
is no outside evidence of such use.
• No traffic will be generated i m excess of normal residential volumes.
• The use does not involve-the production of offensive noise,vibration,smoke,dust or other particular
matter,odors,electrical disturbance,heat,,glare,humidify or other obj actionable effects.
• There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess
of normal household quantities.
• Any need*far parking generated by such-use shall be met on the same lot containing the Customary Home
Occupation,and not within the required front yard.
• There is no exterior storage or display of materials or equipment
• There are no commercial vehicles related to the Customary Home Occupation,other than one van or one
pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and n6t to
exceed 4 tires,parked on the same lot containing the Customary Home Occupation.
• 'No.sign shall be displayed indicating the Customary Home Occupation.
• If the Customary Home Occupation is listed or advertised as a business,the street address shall not be
included.
• No person be employed in the Customary Home Occupation who is not a permanent resident of the
dwelling unit..:
I,the undersigned,have re and agree above restrictions for my home occupation I am registering.
Applica Date:
l
Homcoc,doc Rev.06/201 .
r i
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.
O 1ao�S
DATE: � 3 Fill in please:
;xn ��`'" f APPLICANT'S YOUR NAME/S: 1 cx c,i v7
znlk
t ft ¢
BUSINESS YOUR HOME ADDRESS: t> 4=
TELEPHONE # Home Telephone Number -1:70 7 O i
NAME OF CORPORATION:
NAME OF NEW BUSINESS TYPE OF BUSINESS
IS THIS A HOME OCCUPATION? YES NO
ADDRESS OF BUSINESS ao F MAP/PARCEL NUMBER /lP� O (Assessing)
baul-70
When starting anew 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 4se
ERIS OF ICE . MUST COMPLY WITH HOME OCCUPATION
This individ al nLSo d f a y mit requirements t at pertain to this type of business. RULES AND REGULATIONS. FAILURE TO
COMPLY MAY RESULT IN FINESr' ed igna eMEN S -
c
Cjr
2. BOARD OF H ALTH
This individual has been informed f permit requirwent5 that pertain to this type of business.
Authorized Sign ure DOUS(rj)t�Si'COMPLY 1NITH"ALL
COMMENTS: HAZAR MATE*LB.REC..�ULATiONS
3. CONSUMER AFFAIRS(LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature*
COMMENTS:
TOWN OF BARNSTABLE Date:) c/
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF BUSINESS: Wrx, K\e-e—r'N J"
BUSINESS LOCATION: are Ce&%+ery tJ 1Z INVENTORY
MAILING ADDRESS: it i f t I TOTALAMOUNT.
TELEPHONE NUMBER:
CONTACT PERSON: — c�
EMERGENCY CONTACT TELEPHONE NUM ER: C��- �� - "7�3 S MSDS ON SITE?
TYPE OF BUSINESS:
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 re uires 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
Wnyi o
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 Appli ant's Signature Staff's Initials
YOU WISH TO OPEN A BUSINESS?
For Your Information: . Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you
must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St, Hyannis.
Take the completed form to the Town Clerk's Office, 1 st Fl., 367 Main St., Hyannis, NIA 02601 (Town Hall) and get the Business Certificate that is
required by law.
DATE: i. IS o Fill in please:
'' APPLICANT'S YOUR NAME/S: u ( F
BUSINESS YOUR HOME ADDRESS: o li m Q <
" * TELEPHONE # Home Telephone Number 5�$ `»
t #
NAME OF-CORPORA t1
ON
NAM.,.E OF NEW BUSINESS c� '771
�' TYPE OF BUSINESS
lS THIS A HOME OCCUPATION?
ADDRESS OF f3USINE$S a o... �r'Oc, MAP/PARCE ..NI. MBER lfog D (Assessing}
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 ISSIO ER'S OFF MUST COMPLY WITH HOME OCCUPATION
This individ al Ins n i for d f y rm' requirements tha ,ertain to this type of businfiULES'AND REGULATIONS. FAILURE TO
_ COMPLY MAY RESULT IN FINES.
Aut oriz i at
COMMENT "
'
/ J d r
`� 2. BOARD OF HEALTH
This individual has been informed If rmit re. ire ents that pertain to this type of business.
Authorized Signat re
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:
d TOWN OF BARNSTABLE Date: 2/ IZ / /3
Gl�+rN, or
TOXIC AND HAZARDOUS MATERIALS ON-SITE OEM MM
NAME OF BUSINESS: S�wr Tech ���; C2—S
BUSINESS LOCATION: 2Q !ram-:r Og.Le.S n 1(p e(_,j-jIe ,NSA 02632 INVENTORY
MAILING ADDRESS: TOTAL AMOUNT:
TELEPHONE NUMBER: -27E
CONTACT PERSON: F ;c�
EMERGENCY CONTACT TELEP NE NUMBER: SOk -71C Q114- MSDS ON SITE?
TYPE OF BUSINESS: Prim+gr + 1 V
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.
9 p 9 �_ o
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
S
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 A p p I i c s natur Staff's Initials
YOU WISH TO OPEN A BUSINESS? €;
For Your Iniornnat,ion: Business certificatle , (cost`i 4C.i.00 for 4 years). A business certific.aTc i JNLY F EG15TI.-R5 YOUR NAME in town (wllicl: ,aj
n'lur t do by tv1( ,t. "it II(JE.S !ILJt glUf YOU F}i'_i'rn ti.I(. 1 t,i2 i;l,]eratE'..� �C2u.n;USt first {.}I}I::illi IL1L (if'i.'Fi"`4ir1' i€,lluT(jrt:•', on this fora-1 dt. fit) ) ,hill tit., I'"-1-vannIS.
i,tka tL.- ��c mok tc rl f��rrrI to [he' Tov,/n C.lork.'y r)If;(el 1 t I F l„ "167''k1z1in St., Hvalmk, VIA 02601 !i t ',it };Al) .end get the Busirwss Certif .,tr il'lai is
r'r't�UIrY°sa i'2}� il',w.
DATE: �12 �3 Fill in please:
APPLICANT'S YOUR NAME/S:_ So`rc. F
BUSINESS YOUR HOME ADDRESS: 70 F,t r go lip I MA 02 632
TELEPHONE # Home Telephone Number 50� 776 165/
NAME OF CORPORATION:
NAME OF NEW BUSINESS 115 11- I er-L cy i-as TYPE OF BUSINESS ,:,4o,+?V Re r 5C<v CeS
IS THIS A HOME.00CUPATION? YES NO
ADDRESS OF BUSINES.S 20 �w, Q e v.l 2 MAP/PARCEL NUMBER I 1 2 OO (Assessing]
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. C Main Street) to make sure you have the appropriate permits and licenses required to legally o-,perate your business in this tovvrl.
1. BUILDING COMMISSIONER'S OFFICE
This individual has been informed of any permit requirements that pertain to this type of business.
Authorized Signature'k'
COMMENTS:
2. BOARD OF HEALTH
This individual hays beerlTja;!fQ�ry�a�I of the permit requirements that pertain to this type of business. MUST ,IMPLY WITH ALL
t� T�tY I M '4AZARdOUS MATERIALS REGUL.ATIr)nt�
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:
e
No.� /W9— �_ Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
2pprication for Mi5po!6ar 6petem Construction Permit
Application for a Permit to Construct( )Repair( v<u'p'grade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. a O �—� �- V��S Owner's Name,Address and Tel.No.
3*eu-. PAS i n
Assessor's Map/Parcel //
Installer's Name,AddreA a&IN'ftNCO Designer's Name,Address and Tel.No.
350 Main Street
W. Yarmouth, MA 02673
Type of Building:
Dwelling No.of Bedrooms I Lot Size sq.ft. Garbage Grinder( )
Other Type of Building TT No.of Persons Showers( ) Cafeteria( )
Other Fixtures /� C/
Design Flow l 77 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 Alterations(Answer when applicable) L/1,514( (
3 , s4evuz, f .t t
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 been issued by this Board of Hea t
Signed Date Q —t"? —00
Application Approved by Date
Application Disapproved for Re following reasons
Permit No. Date Issued
' gab
� � Fee �
No.� _ y
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS
21ppYication for �Dizpaal *pgtem Construction Permit
Application for a Permit to Construct( )Repair(grade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. .)
o F7 S �2 Owner's Name,Address and Tel.No.
Assessor's Map/Parcel // IF0 0 3
Installer's Name,Address,A�dWEVOCANC® Designer's Name,Address and Tel.No.
S50 Main Street f✓l,,q
W. Yarmouth, MA 02673
Type of Building:
/I�//
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building TT No. of Persons Showers( ) Cafeteria( )
Other Fixtures u/Design Flow 77 -,.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
�r
Nature of Repairs or Alterations(Answer when applicable) g- S ° ry A �. I-e a C
0_�4,,v1 s C_j l 3 " s4vK,,L 67,�e ,f,n � SP t,� �iA j
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 been issued by this Board of Hea t
Signed 1 Date 0 - (7 -w
Application Approved by Date �, _ 11 - Do
Application Disapproved forte fol owing reasons
Permit No. Ocari.5, — 10 y Date Issued
---------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of (Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired(graded( )
Abandoned( )by /� 6
at U ; tL; r" CD r- f P r /Lp- has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
Installer Designer
The issuance of this p 1't sha ,of be onstrued as a guarantee that the s will functions designed? i ?S_
Date Inspector MI - 1 1 1 I'ZI � �%I' � 1A )
---------------------------------------
No. O L Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
x1h5pogaf by,5tem Con.5truction Permit
Permission is hereby granted to Construct( )Repair( p rade( )Abandon( ) /
System located at C9U TA r r 6 44 Ix S pi le P(� P'
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 conditions.
Provided:Construction must be completed within three years of the date of this permit.
Date: Dv Approved by
It
1/6/99
NOTICE: This Form Is To Be Used For the Repair Of Failed
Septic Systems Only.
CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS)
I, J64 Av%, ,hereby certify that the application for disposal works
construction permit signed by me dated 1? ' 0 p , concerning the
property located at ;).o S" meets all of the
following criteria:
• This failed system is connected to a residential dwelling only. There are no commercial or business
/ uses associated with the dwelling.
• The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch.
There are no wetlands within 100 feet of the proposed septic system
There are no private wells within 150 feet of the proposed septic system
• There is no increase in flow and/or change in use proposed
/ There are no variances requested or needed.
The bottom of the proposed leaching facility will not be located less than five feet above the maximum
adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when
applicable]
�• If the S.A.S.will be located with 250 feet of any vegetated wetlands,the bottom of the proposed
leaching facility will not be located less than fourteen(14)feet above the maximum adjusted
groundwater table elevation,
Please complete the following:
A) Top of Ground Surface Elevation(using GIS information)
B) G.W.Elevation +the MAX.High G.W.Adjustment. 3-
DIFFERENCE BETWEEN A and B
SIGNED : V I DATE: '` OZ •� ' C�O
[Please Sketch proposed plan of system on back].
NOTICE
Based upon the above information,a repair permit will be issued for bedrooms maximum. No
additional bedrooms are authorized in the future without engineered septic system plans.
q:health folder:cert
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TOWN OF BARNSTABLE
oil
LOCATION AiX �4_e Rt• -SEWAGE #
/ , .
,VILLAGE���`����r �C�' ASSESSOR'S MAP Si LOT/�/H _9
'INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264
_SEPTIC TANK CAPACITY
' LEACHING FACILITY:(type) 16R--If &4gpj&&2 5 (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
"BUILDER OR OWNER -/e V4
DATE PERMIT ISSUED:
�•� VV 4
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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ASSESSOR'S MAP NO. PARCEL 66'
`1`0CATION SEWAGE PER IT NO.
VILLAGE
Ar
`--INSTA LLER'S NAME 6 ADDRESS
;58 U I L D E R OR OWNER
z T
DATE PERMIT ISSUED
DATE C0MPLIAIfCE ISSUED
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- -- --- - -- - --
TOWN OF BARNSTABLE
LOCATION ��` � � + SEWAGE #
Aaxjn�
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.VILLAGEI,:�r�f�'+�. r i�C�. ASSESSOR'S MAP LOT'
I` INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264
SEPTIC TANK CAPACITY Z14 K-
(size)FACILITY
&lAQ1 e-14414A�n_r (size) 7f� _�
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
I DATE PERMIT ISSUED: -
DATE COMPLIANCE ISSUED:
I VARIANCE GRANTED: Yes No
noi
1
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TOWN OF BARNSTABLE
.LOCATION j320 ��'r j,i� (214�'S R L SEWAGE #
VILLAGEge.1 +�v r ASSESSOR'S MAP Cz LOT'
INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) &Aul (size) O
NO. OF BEDROOMS PRIVATE:WELL OR PUBLIC WATER
BUILDER OR OWNER Xc y,,
DATE PERMIT ISSUED: ca - c. .- J t�
DATE COMPLIANCE ISSUED:
VARIANCE_.GRANTED: Yes -No
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No. ....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
1K../W. ..........-.OF.....,1 t 15 4 --- ..........................
Appl ration for Disposal Murky Tons#rudiun 1Jrrmft
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at:
..>t.. ....................l T ..................................
..... oration-Address or I. No
................................... ...................................................... ..........................................
O n- .............. .......... Address
. ..... ...................
Installer Address
Type of Building Size Lot.. -!?_,&A(,C..Sq. feet
U Dwelling—No. of Bedrooms......................................Expansion Attic ( .) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers — Cafeteria
Or Other fixtures
W Design Flow...-________1_1 0.......................gallons per person Fer day. Total daily flow_._........��0.....:...............gallonsi1
WSeptic Tank—Liquid capacity.�OOCI.gallons Length$_...Gn Width4';_.�Q_._ Diameter:............... Depth5_-:_ns.
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit No...QIJ .. Diameter....T.Q.-!_..... Depth below inlet....Cm ........ Total leaching areaZ610"..J..sq. ft.
z
Other Distribution box (� Dosing tank ( )
'" Percolation Test Results Performed by................... ..... Date...................
,aa Test Pit No. 1_-<__Z.....minutes per inch Depth`of Test Pit..'�.� ��... Depth to ground water...KicM 1.�.r..
Lj. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
O Description of Soil. 1- _L ''?'�.'.Z.a ."....LQ a.' ?1(.��._7.. {..........................................
i-1 ii.._C--- ......
A .......1f ............................................. .......... ..•- -----•---..-_...._.......-•----........ .........................
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 LITLZ 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
oper 'on until C 'ficate Compliance has been issued bb e health.
tied... ......... L�C- .... .......................... .. /. .._
ae
PPlication �r By �(��.. .... ............:.............. - L3/ ............
Date
Application Disapproved for the following reasons:........................................
............................................................................................................................................................................._........................._
Date
PermitNo. - ......... Issued..............•-.....................-----.............
Date-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD' OF HEALTH
.......................
-No.........1 ................ . .....j..........OF... FEE
Permission is hereby granted.---•-----... �...... . ...............................................................
to Construct, or Repair ( )-an Individual Sewage Di s _4 sal System\T7,
atNo.................. ..........................................................................................................................................................................
Street
-(7"� 2
as shown on the application for Disposal Works Construction Permit No..................... Dated....._d... .......................
.......... ....... .. . ............
hoard of Health
DATE...... -------------------------
NoF_-& C' o
.. _ :x FE11............2:. ...
THE COMMONWEALTH OF MASSACHUSETTS
'1
- J O
BOARD OF HEALTH-�- EALTH
Il
....( w1.,..............OF........ i 't _.......................
Appliratiou for Dispasal Work.6 Tonstrurtiun jrrutit = r
Application is hereby made for a Permit to Construct ( )a or Repair ( ) an Individual Sewage Disposal
System at
.� xa�� Location Address or Lot No. ................
w S,M. / .1.Z ... 0 .. .1.. . .......... ......Address ..... ................»..............
a ...... - ..................... .....................................................
2• .......f..
....... .yam. ...
Installer Address
Type of Building Size Lot��,..?.o !�Q�r�....Sq. feet
.. Dwelling—No. of Bedrooms...........-2............................Expansion Attic ( ) Garbage Grinder ( )
Other a —T e of Building g .:.......................... No. of persons ...................... Showers ( ) — Cafeteria ( )
Other fixtures .......................................
_ W Design Flow....--.---.. P. .......................gallons per person per day. Total daily flow......... ? ? .......................gallons.
cY Septic Tank—Liquid capacityE n.gallons Length 1'.''.-r-" Width4`,.��a�� Diameter'--........ Depth��
' Disposal Trench—No. .............. Width.................... Total Length.......... .... Total leaching area....................sq. ft.
3' Seepage Pit No.. ✓77*111=.. Diameter.... ...... Depth below inlet..... ..... Total leaching areanly:.Isq. ft.
ZOther Distribution box O Dosing tank ( )
Percolation Test Results Performed by................. ........ Date...........0.....................:.-...
Test Pit No. I.�_.?_..__.minutes per inch Depth of Test Pit..' i.-. Depth to ground water.. .1.. ?bt�..
Lj. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a r" l_<..�.. ._... - ...................... .....-•-.
O0 Descriptionof Soil....--.. � �;-lr�7 t t 1 M 1�..................................................................................................................................................
...................... -••-•--•--•-•..-----•...................••------------............•-----•-•••----•---•----•-•-----•----=----••-------................---•....................._..................
V Nature of Repairs or Alterations—Answer when applicable.......................................................................0.......................
......................................--------.......----............ ..........--..................--•...........................-..........................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITU� 5 of the State Sanitary Code- The undersigned further agrees not to place the system in
oper to until C •ficat Compliance s been issued bylthe,bbbard,of`health.
e r gned.......................................
� .. ..1....
Date
Application A prov By............. ....... /;o ./, _. . ....._.... ..:. ... ...
.. .
f
..,..
Date
Application Disapproved for the following reasons:---•-•--••...........................•----.........................-----•----•-............................_..
........-••.........................•-•..................................................-••••-........-..-•----•-•--•--••--...........-..........................-..........-•-.......................
Permit No. (0 --- Issued.......... - .......... Date
rift.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD rOF HEALTH
.................1.. O F. .........4�2?.. 1..V`".. 1 `�"'.....................................
Tertif irate of Toutpliattfr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( �) or Repaired ( )
by................................................................................1, ...... .... ..............._................... ....................................................' -` Installer / ..r
at............................ ................... :,: . .. ............................................................................
........--•.................... . ..-•••••••--..._.................
ha's.been installed in accordance with the provisions of TITLE_ 5of_The State Sanitary Code as described in the
application for Disposal Works Construction Permit No........ � C���'... dated..... f...... �'(11
.................... Y...........................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. 1 '
DATE............. ..........!................................................... Inspector..... 1. :_.....................................
SECTION - SEWAGE
:4
a:.
10' —SEPTIC TANK — $� — "D"13OX — �1 —LEACH
TOP OF FDN
PD(MSL)• ..2..OF1/8T04a.. LOT
WASHED STONE W�` 2
w
IN• OUT
I��OG IN- OUT•
e28 Q SEPTIC d2
TANK '�J 38,L J \
ELEV. ELEV. ELEV. / Env 6t 6
I {.�f�.Q i'eF.+ I .I TV�►, - �T/..(O/ /'.'"�5 �e /� e ��1"„'1\Y
\\ ELEV. ELEV. (O
kid
CLF_V• ---. OF Ili"-I;&" 1►L '(� \ o- �� \41 p \ \ I
WASHED STONE- �'-p• \ --��\O�� \ \ `� \ \
TEST HOLE LOG s l3a ---- o-f�o(�I of TS E lel.E �, ' �o
T� I7 M p-h c� c.of1
TEST BY t �b�
-_. � WITNESS ✓ •
TEST DATE 2 3 DESIGN 3 BEDROOM HOUSE S 5>✓ ��W ✓
T.H. r 1 T.H. +► 2
s,I� � o .10
_aC ELF-4•4- ELEV. NO.
Ii f' PERC RATE '�2 MINAN. o)sPosER DISPOSER
�4 S 43 I(:• 4 - FLOW RATE 330(GAL./DAY) O .� l 0P.`�'
SEPTIC TANK •37jp. (.l y)s 000 �' ' / 7
REQ.D- EPTI T I E I / l 3
S C TANK II B l
v.
LEACH FACILITY SIDE WA = SS 'f Q71 U G/D +WALL If�irlo ' t2.5) o
(��� 130TTOM (1o�Z = t( •O) S G/D.
TOTAL Sg`I.
III 2�,4 � �- � �� •
0
USE: I LEACHING iT I / --. zO� z
ld
` ) G
WATER ENCOUNTERED � / '�/ �It�Es • ZD' _
NOTES (UNLESS OTHERWISE NOTED) —
�-1.DATUM(MSL)�TAKEN FROM QUADRANGLE MAP , -
2.MUNICIPAL WATER J_O AVAILABLE ,.
3.PIPE PITCH:14"PER FOOT �fx _ ✓
4.DESIGN LOADING FOR ALL PRE CAST UNITS:AASHO• fA
•44 �` �?
S.MIN.GROUND COVER OVER ALL SEWAGE FACILITIES:(1)FT.
6.PIPE JOINTS SHALL BE MADE WATERTIGHT I -
�b �x
7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM:OF MASS: - • - SITE .
.. ..... . 4 \,
STATE ENVIRONMENTAL CODE TITLES -
PLAN
8. Ty�S QL�.`I. t=oL Ti•�?*a` D' LOCKS
30 Of
.
RE:P
�A{;tE_GINEEii 1 O ARN
-• { � � REF:
do n p VOW.
- PREPARED FOR: .� pp�•
liril+`:y n
c e• en n o
CIVIL ENGINEERS
BOARD OF HEALTH �� NSURVEYORSREG.L Nk IStZI III i{�I
g, ,�,,.t LAND ''�� �2
CONTOURS (EXISTING)............. APPROVED LJ►�YAIC�TTc MA �� J �R.. SCALE IZ Ap5
(PROPOSED)-O-O-O-O- DATE / Yam ' 012