HomeMy WebLinkAbout2170 FALMOUTH ROAD/RTE 28 - Health F2170 Falmouth Road
Centerville
A = 169-095
•I® J ® NO. 152 1/3 ORA
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> YOU WISH TO OPEN A BUSINESS?
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
signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st FL., 367 Main Street,
Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law.
x Fill in please: Date: J cj m .� i a..o i l
APPLICANT'S NAME: Li Y�
. YOUR HOME ADDRESS: I O c� l►-v�c�L �-
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7� , , BUSINESS TELEPHONE# HOME TELELPHONE #:
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NAME OF CORPORATION: FID# J 3�5 -74
NAME OF NEW BUSINESS TYPE OF BUSINESS V' �h j i
IS THIS A HOME OCCUPATION? ✓ YES NO
ADDRESS OF BUSINESS a j ja i=c:4 )rv%cz.rth- (;cv,4-t--rY r l 1e Mq 0a1t3,;?-MAP/PARCEL NUMBER L -d9 5 (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 of4
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.
& Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business 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 OF HEALTH
This individual has been 'nformed of the permit requirements that pertain to this type of business.
i-��
Authorized Signature**
COMMENTS:
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual h s been infor ed of the licensing requirements that pertain to this type of business.
Authorized Signature**
COMMENTS: kilno o No
NO. l Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in comp5-1;
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Yes
ZIpprtcatton for �Dtgoml *pztem Congtructton i3ermit
Application for a Permit to Construct(/j>fRepair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. (j 7Y S k—of k/1 mil` n0 Owner's Name,Address and Tel.No. G! r!— 73y
Gr�fi rvi,llr- 2Q/ pohar}r10
Assessor's Map/Parcel
r3 f'yJ,aeS -e
Installer's Name,Address,and Tel.No. 47'1-0 3Y9 Designer's Name,Address and Tel.No. :
Jos�p�i ,l�.e L3,+3rrOS
Type of Building:
Dwelling No.of Bedrooms 3 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 4ls�h�
Nature of Re=Alterations(Answer when applicable) .P G,O/
�rbhi-
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 Pealth.
Signed ,. Date`7—
Application Approved by �- Date
Application Disapproved for the following reasons
Permit No. Date Issued
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n TOWN OF BARNSTABLE
LOCATION -678 SEWAGE # qS- y�2
VILLAGE ('1i� ASSESSOR'S MAP & LOT/C:?-D 9S'
INSTALLER'S NAME&PHONE NO. y7�7- 10V,9
[/�. � ✓O �,r u,.�
SEPTIC TANK CAPACITY iDoo
LEACHING FACILITY: (type) 3^5 0 e)
NO..OF BEDROOMS
BUILDER OR OWNER
PERMTTDATE: 7-o- %$ - COMPLIANCE DATE:_7-, /G- f
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the 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 leachi facility) Feet
Furnished by
y Vb y
No. '
Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
— _ ' Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
Zipplication for Miopozar 6p.5tem Conotruction Permit
Application for a Permit to Construct('Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. G rd S kv�l kr1 rr Owner's Na e,Address and Tet.No.
GI_=�fi.�"►/�/lr 2 /q �//s po ao1 i?o�c1
Assessor's Map/Parcel G O
7
Installer's Name,Address, d Tel.No. �/y�j—O�f�/� Designer's Name,Address and Tel.No.
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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 S'h,, A },
Nature of Repairs or Alterations(Answer when applicable) ;6HS 1 a// 5 S-AD G,O%., ,0.^W Wr
Srb�ie- k;:ry ti 2"/Jrsr ro!%4-
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 ealth.
1 Signed Date
)Application Approved by Date
Application Disapproved for the following reasons 1,
t
Permit No. 9 7"y Date Issued 7
------------------------------=------=—
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( Imo-Repaired( )Upgraded( )
Abandoned( )by
at 11,13, - _ i' has been constructed in dance
with the provisions of Title 5 and the for Disposal System Construction Permit No. L�3 2 dated 7 �
Installer , 4 s:e- Li 0,-- (�iQv�,�s Designer
The issuance of this permit shall not be construed as a guarantee that the systera will function as designed.
Date -� ' !� Inspector
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS
i
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Mi,gpo-gal *p5tem Construction Permit ���--
Per,i ion is hereby granted to Construct(G,-)'Repair( a, )Upgrade( )Abandon( ) r 'Y
/ t
System located at Q 7 9 'kyk1 k A1j_
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`
Date: 7 /ti —Poor
Approved by "'�
i
10/9/97
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
ENGINEERED PLANS)
hereby certify that the application for disposal works
construction permit signed by the dated Z- q- 9S , concerning the
property located at G 7f <7k 4,gkAllFr /a meets all of the
following criteria:
trhere are no wetlands located within 100 feet of the proposed leaching facility
e T ere are no private wells within 150 feet of the proposed septic system
/`There is no increase in flow and/or change in use proposed
4 There are no variances requested or heeded.
f the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the
proposed leaching facility will t>Qt be located less than fourteen(Id) feet above the maximum adjusted
groundwater table elevation.
i
Please complete the following:
A)Top of Ground Elevation(according to the Engineering Division G.I.S.map) J a
i
B)Observed Groundwater Table Elevation(according to Health Division well map) g'o _
4 ~ SIGNED: DATE:
LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER
[Attach a Sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan,
this plan should be submitted).
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ATION
t SEWAGE # o 2
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VILLAGE t'�rH=k//A5 ASSESSOR'S
MAP & LOT/G y-Q 9S'
INSTALLER'S NAME&PHONE NO. :7 44eZ ''a�c.4.
SEPTIC TANK CAPACITY ,2000 /J
LEACHING FACILITY: (type) 3- J 0U Zi l4�iI C*^,,game)
NO. OF BEDROOMS ! '
BUILDER OR OWNER
PERMTr DATE: 7-9-Z COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the 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 leachi facility) Feet
Furnished by
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No................_...1 F>c$..............................
THE COMMONWEALTH OF MASSACHUSETTS
t
BOARD OF HEALTH i
App iration for Disposal Works Tonstrurtion Famit
Application is hereby made for a Permit to Construct (v) or Repair ( ) an Individual Sewage Disposal
System at Route 28
- •e- c.►.. ..a�i - .C.EA1.!EAVzkcCE .......... T .. .....................................................
Location-A4dress _ or Lot No.
Owner Address
W Vetorino Brothers Bvrnstable
Installer Address
9
UType of Building Size Lot.,_ a.4..._..Sq. feet
Dwelling—No. of Bedrooms...........................................Expansion Attic (pVl Garbage Grinder QUO)
p�, Other—Type of Building ......1LllA.......... No. of persons____________________________ Showers ( ) — Cafeteria ( )
04 Other fixtures ------_--------_----------------- - ------------ --------------------- - --------------
Design Flow...../,�0............................gallons per per day. Total daily flow.._......3.3.0.._................._gallons.
P q P Y g gt - 5----• Width}--/42• Diameter---------------- Depth--s•_A
Septic Tank—Liquid uid ca acit .,CP�!�? allons Len -•r . " � " !
W Disposal Trench—No. .................... Width.................... Total Length................!... Total leaching area....................sq. ft.
x
Seepage Pit No......../........... Diameter..../V.......... Depth below inlet....:_.�A."_�--- Total leaching area...f.F4.7....sq. ft.
Z Other Distribution box (1j Dosing tank ( )
Percolation Test Results Performed by.. o/J A.,(_D......A ...Cx--.11-o 2R_A........ Date_.-!=C_;5..-..
a Test Pit No. 1__4 l_____-minutes per inch Depth of Test Pit....Al.......... Depth to ground water----le .............
(14 Test Pit No. 2_4`..__.minutes per inch Depth of Test Pit---IA.'........ Depth to ground water........................
a ---•-•-•--•------------•------------•-•-•.........•------•--••.......-•--•------•---••--•-••-.--•.-•.........................................................
O Description of Soil-• C3" '.��-- /?�
U •-•--•--....-----Z4__4 -p----••------•-------------•---
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 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 by the board of health.
Sied----- ............................................................ ................................
Da
Application Approved By..... f /! =f ---r--------------_------- ...��. ........ p
Date
Application Disapproved for the following reasons:-----•-------•..............•------•------------------------•-•-----•---------------•----------•----...-•-•--•-
...........................................................................................•--------...----•----•----------------•------•----------------------•----•---••----------••--•-•-•--.........
_�2 G Date
PermitNo......................................................... Issued_.....7.....................-.........------._...---
Date
W02
No.................ft?.. � Fxs..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...0
. 1. ..............OF......8 -Rvs.�/_�.n ..................................
Appliriffivu for R.S' Vaspt Works Tonotrurtivit Vantit
Application is hereby. made for.a Permit to Construct K or Repair ( ) an Individual Sewage Disposal
System at
Location-Address or Lot No.
......................_....................................................................----- ............_........---•--•-•---....._.......................•------------••-----........._..
'
W Vetorino Brothers Owner Barnstable Address
Installer Address
� Type of Building .. -�: Size Lot.�,;�?��_6.?------Sq. feet
a Dwelling—No. of Bedrooms............______........___...............Expansion Attic Qyd) Garbage Grinder (VO)
p, Other—Type of Building ...../V/#4.......... No. of persons____________________________ Showers ( ) — Cafeteria ( )
P4 Other fixtures _.
W Design Flow....., /._r�__........................ ;gallons per per,"n per day. Total daily flow____.__:13.A7_______._______._____gallons.
1 Septic Tank—Liquid capacity/0*7 gallons Lengtla�___A`�__ Width,.__~/ __ Diameter________________ Depth_-_f0_`_
x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No_______ __________ Diameter----140----_._._ Depth below inlet.__ Total leaching area...IfO....sq. ft.
Z Other Distribution box (&,I Dosi%tank ( )
Percolation Test Results Performed by..��'t'oN# ......
_i4 ... f!''/D1 ........ Date__, " I_". &249
r
a Test Pit No. 1_ ....minutes per inch Depth...of Test Pit.../A.T......... Depth to ground water....lt"...............
f=, Test Pity No. 2:.'e-0 .P'k:___minutes per inch Depth of Test Pit._.4 i............ Depth to ground water___ ...............
-• -------------••---_-•-- -.....:--•-- -- _-•---k...... ••---
r
O Description of Soil....... '. ..... .--..y �/ 30> x a '" -----, ,f1r'
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 TITY,; 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.
Signed......................................................................................
Date
Application Approved:,BY----- -----------------------
Application Disapproved for the following reason°s`' -------------------------------------------------------•----------------------•-•-...._
4`' ..l
........................................Permit-No.-----t r� ... -•------- ------- � {--�-....• =------------•-...---...--••----Issued_--•------------------------'-=-------nau------ ._....
Date
,,,.THE COMMONWEALTH OF MASSACHUSFTTS
BOARjQ,_•OF HEALTH
Tom O F................Barnstable
.......................................... .......-..............................................................
Ta ifiratr of fauutpliatta
x
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
Vetorino Brothers
by----------------------------------------------------------------------- ------•------------------------------------•-------.
Lot # 2 Route 289 Centerville Installer
at......................................................................--.........=..................•..............t-•----•-•------•-••--•-------------•------•------•----•-----..._.._..-------••--
has been installed in accordance with the provisions of TI 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No. __._ ___ _ ___- dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHAL OEBCt � TRITE® ASiaR/�EN7EQ'FIAT THE
SYSTEM WML FUNCTION SATISF ORY. r:
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DATE....—. .� - -�••- - -•-------------=----- Inspector .....-----•------------ -----= ......................................
THE COMMONWEALTH .OF.MASSACHUSETTS
BOARD OF HEALTH
Ta�vn Barnstably
N ..._�`:. FEE.. ..._.... ..�r,
%110.04 urkj Cnu�tutnu �erutt
storino rat
Permission is.hereby granted______________________�__....w._..._____....__.........__
to Construct or e r `, I Iv e Disposal System
1)ot pro te)2 `, ' � gj P Y
atNo...........................................•:......................
Street
as shown on the applicat�ii for Disposal Works Construction Permit No..................... Dated.._.__ .........
t --•-•• 4 ---------_•-•• ---...
DATE................................................................................
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS-
30 " \ 1
LO 'CATION SEWAGE MIT NO.
VILLAGE
INSTA LLER'S NAME & ADDRESS
.BUILDER OR OWNER
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DATE PERMIT ISSUED `��
DAT E COMPLIANCE ISSUED �7-- �' � ,
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