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Home My WebLink About0121 LIETRIM CIRCLE - Health 121 LIETRIM CIRCLE Centerville A= 169 -039 a YOU WISH TO OPEN A BUSINESS? For Your InlOrmation: E',usiEless certificates(cost$40.00 lar 1. yea;-sj. A.business certificate ONLY REGISTERS YOUR NAME E ICI {'JV9I(i ` Jhllfl VCl1 t'. r'-,ust do by M.G.L. -it does nct give you per n-,iss!on 'D epef-a e] YOU (11LE5t rfi4T Obtain the ne'cess.nlry signatures on thin ioi- l at 00 lvlain St., Hh''!an it ,. fake the completed eted fora-E l:O the {o\•vi-, Clprk'5 Offil:e, l St A., 367 Ma St., H;v iiinis, ,Vila 0 60 i (Tc)'vv n H a11' andIcgpt the BLISiFIf,.SS ;.er ificate �l i E required hly iaw DATEA I rg i n,zola Fill in please: APPLICANT'S YOUR NAME/S: hod►,S� K . S ter: �1 i CIS n(ww S . SILO r"� . .fi . BUSINESS YOUR HOME ADDRESS! 121 L1,2.trr rm ('irc -V TELEPHONE # Home Telephone Number 50 NAME OF CORPORATION: <A n n r- NAME OF NEW BUSINESS TYPE OF BUSINESS S lrooAll S' IS THIS A HOME OCCUPATION? XYES NO ADDRESS OF BUSINESS 72 1 i _✓j'► !i ie�7- r i I MAP/PARCEL NUMBER 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 Nllain St. - (corner of Yarrnou h ROt 4& Main Street) to make sur-e you have the appi-opriate permits and licenses required to legali,r operate your business in this towrl. 1. BUILDING COM 10 R'S OFFI E This individu I h s b i d f ny er requirem nts that pertain to this type of business. MUST COMPLY WITH HOME 0"' IPA ION RULES AND REGULATIONS, FAILURE TO UU uth ri Si nat * I COMPLY MAY RESULT IN FINES MMEN I 2. BOAR OF LT This individual has been informed o th permit requirements that pertain to this type of business. A or zed Signature* COMMENTS: Dw^ a 1% Y r C C'V^t-f-R0- ty,-a1- mu Sl+rdOMs rr- Sa AL 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: TOW N OF BARNS b A BLE LOCATION SEWAGE # VILLAG &4�-.ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITX LEACHING FACILITY:(tyke) , (size) /Ae w 4-u NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER�� BUILDER OR OWNER_ DATE PERMIT ISSUED:3_ O DATE- 'COUP LIANC E ISSUED: i^/ 3 / VARIANCE GRANTED: Yes No �' i No...... .:. Fx$....�p� ........... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH -.---•----------- ---- ---- - .....OF.......................... ..._..... Appliration for Dispaaaal Works Toustrartion unit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ................... ------------------------------ ----------•---------------- ---..._---_..------------ ......------......------......---------••- /y �,,y L cation Address or Lot No. ...... :/1[�i of 5.--- .. ......................................... .......................... ....... af ........ ...............................•...... ow r dress --------. ry 7 < _ ..:.._...Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms____________________ Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of persons............................ Showers — a YP g ---•----------------•------- P ( ) Cafeteria ( ) a' Other fixtures .................................. W Design Flow...... -90..........................gallons per person per day. Total daily flow____-�.30............................gallons. 9 Septic Tank—Liquid capacity'�Pq__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 ( ) '-� Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-.-.____________---____. G Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 •---•---••---•------------------•--•••._.........-----•------•......---------•._.........._.._--•---......................................................... 0 Description of Soil......................................................................•--•----------------------------------------.................................................... x W -•••-----------------------------•-.....•--•...••••---•----•-----------------------............•---•---------•- •----•-•-•---•------- . . -•-- U Nat of Repairso#IeIL /r Alt ra 'on�—A,nsw r when applicable..._ t ____ ..._�°_a�_ ._�............... j =-------------••----------------------------------------------------------------------------------•--•••-• Ag� re�ent: v The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of ': t LE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b n issued by the board of health. Signed.--• . -- ......... 4 Date Application Approved BY............. ------ -�"3.................• _.__........._. _... ------ Date Application Disapproved for the following reasons----------------•-•--•------••-------------------------------------------------------........................... --------------•----.........--•--•----------------•-----•---------------••------•-••---------------•---•-••--•----•-••••------•----...-•••-••-•-•-----•-•----•--•----•-••---•------•----•-----------•- Date PermitNo........ --•------------•----------- Issued----------_--_-------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............ .......... .............OF...............---........---•--........-----.----- .._.. ApplirFatilan for Uispaa al Wlarks Cnnntratrtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 9 , .............................. .................................................................................................. Location-Address or Lot :�o. .......! :.�! ,f f =` <. ✓a---------------•--.........-•----........... ...................... �! y ......------. ...................................... V 1�.__ L._ / �./,F� Owner ./V f? ddress,............ d.!Yi� _ .............. .... ......................3 ------- Installer ddress Type of Building Size Lot--------------:-------------Sq. feet �-, Dwelling—No. of Bedrooms___.. .......•.•........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q Other fixtures W Design Flow.......�.�L?..........................gallons per person per day. Total daily flow...... ............................gallons. WSeptic 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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ 1.4 Test Pit No. 1---•-..---_____-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........................ a -•••-••-----•---••--•--------•-•---•----•--------------------------------------••--•--••-•-••--------••-•----............................................... 0 Description of Soil......................................................................................................................................................................... x rJ W ---------------------------------------------------------------------------•------------------------------------ x , i :--- ------ w. V Natureof Repairs or Altera 'ons—Answer when applicable_.._ -------- ... r_ _�'1 '- !` -•• L------------------------•---•------•-------•••---------•-•-•------------••-•---•------•-----........._------ ;' Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with , the provisions of'T'LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in 4 operation until a Certificate of Compliance hJbIn, issued by the board of health.Signe ''Q-f' _�.� ... -----------•---------►�'(.. ---------••.... Date Application Approved By............{� L �k Date Application Disapproved for the following reasons---------------------•---.....---------------------------------•-----------------•-------•-•---•-----............ ----------------------------•-•-------------•••--•--•-•....-----•-----••-•--•-•-•-••--•--••-••---•-----•----------••••-----•------ Date Permit No......7 2-= d.......................... Issued...................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Tutif iratr of TontliliFanrr THIS IS T0�CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (ye) by---------------�j i �"G�,-.:•, ------------------------------------------------------------------------------...._...._..........----------------•-•--•---•--------------- , � Installer { at.............. d.Y. .............. has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..... y/.................. dated-----------------------------_.................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE ` SYSTEM WILL FUNCTIO SATISFACTORY. D o DATE..... _.. --------- ------------------------------- Inspector. ............................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �I. NO._Lt. ::.;. 7}t. ......... ..................OF............_'......... ..... S .... FEE ✓ DisposFa1 Workiidun ratr#irrn �ernti# Permission is hereby granted------ .. .e , U - - to Construct ( ) or Repair ( ) an Individual Sewage Dispos ystem 1 -'�j....L = _ /e r ( �..r f, z '-------------------••-------------------------------------------- ' Street as shown on the application for Disposal Works Construction Permit No...f_ 61.:__ Dated.......................................... .................................-- - ----------------------------•----•- DATE. r Board of Health FORM 1255 HOBBS & WARREN, INC., PUBLISHERS