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HomeMy WebLinkAbout0062 PHEASANT WAY - Health 62 PHEASANT WAY Centerville Parcel ID SMEAD 61 No.53LOR UPC 12543 smead.com • Made to USA • s TOWN OF BARNSTABLE LOCATION `y -Qa,z;1 t(--l?,4 /e?-rg SEWAGE # 9=5 ` AF VILLAGE CL?A zga,u-k ASSESSOR'S MAP & LOT,76-*, lg-�r INSTALLER'S NAME 6i PHONE NO. , be,L 1 Lamm �iGfT IEPT'C TANK CAPACITYEACHING FACILITYAtype) " T�v cVi� (size) "NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER &-SwceQ cocP_ DATE PERMIT ISSUED: � 4 DATE COMPLIANCE ISSUED: � VARIANCE GRANTED: Yes No V cvaclf 3_ 6- _S'7r /�a r No— THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Application is hereb.Wn ,e�XL��rmit to_Q_Gw&uct or Repair an Individual Sewage Disposal Type of Building Size Lot...12q.x'Z .....Sq. feet I-q Percolation Test Results Performed by......90N&A_U.Qe.A... ............... Date---9].Z[9.3............. '---.-_---'.— ---__----_---_'_--.-'_'_--.-''-__-____— � Agreement: � The undersigned agrees no install the ufozc6eocribc6 Individual Disposal System ivaccordance with the provisions� � of TITLE 5 of the State Environmental e—The undersigned further agrees not to place the f c�1 �A A� ' ZC�U No......................... FEs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r ........ -{.....................OF................... ApplirFafion for Uhip a al Workii TouBtrnrfiun ranfit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: \ •---..... ...---. L!1 --.�...... ..... r-----------------------------•---------- c_x- Lo�cation-Address �:�:No. A� .�► ................... Owner Address W Installer Address Type of Building Size Lot...`..................,yam........Sq. feet v �(Dwelling—No. of Bedrooms..........�� .................._._..._ Expansion Attic �() Garbage Grinder j a Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures --------------- •-------------•----•-•---------•-••-.•-----------•--------------------------•--. �� W Design Flow._..._..._S5.........................gallons per person per day. Total daily flow..... . ._......__.............._._...gallons. R: Septic Tank—Liquid capacity.lt?�,"Q gallons Length..?�:".5..._ Width._c_j_ !4'... Diameter...-' ........ Depth. Ol_.. W - x Disposal Trench—No. .................... Width....»........... Total Length....AO........ Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (Vob Dosing-tank 63 c) ~" Percolation Test Results Performed by..... _V_ELZ-. �.0 ............. Date...9�_�� ............. �l , Test Pit No. 1...---/ 2----------minutes per inch Depth of Test Pit----�.Q......... Depth to ground water--7:.................. f=, Test Pit No. 2.. ......minutes per inch Depth of Test Pit......kJQ......... Depth to ground water_-_—. ............. a' - - ----------------------------------------------•-----------•••------.....---------- ---''--'•-----------•---- -- D Description of Soil....0- '------.W.AA�..(�...`�t?Y3. Q±.L------t'n-� L� �! l - ------.... .............................. x U ----------------------- -.-•---------------• --' ---------------------------- •---------------------- ••----------------- ---------------------------- •--------------- •--------------- •--------------- W VNature 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 Environmental 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 ApplicationApproved By ------ - ---- ------------------------------- ----------------- -------------------------------------------------------------- ------- Dace Application Disapproved for the following reasons: .....................................................------ -- -------------------- --- ----------- ---------------------- -- --- - ------- ------------------ ----------------------- --- -- ------------------------------ ------------------------------------------- ------------------------------------- Dare PermitNo- --------........................................................... Issued ..--...------..--.-- --- --..................------- ------ Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -------- ` . ........... OF ..-... )PS(47.035..1-. ------------------------------- C11er#tft a e of QTarayltttnre }gyp THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( 5� ) or Repaired ( ) b ' ...................................................---------------------..---------Installer...-------- at -----1,.-o.0-----1)----....'f...N;- s�. '� 51-.. ( ... ..........C.C-k)1z_r e_ tw.z-...................................................... has been installed in accordance with the provisions bt TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ................................................ dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL'NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL_f UNCTION SATISFACTORY. DATE...:.. ........ ------------------------------- Inspect -- a THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1..C� .............OF................. ....................... No......................... FEE........................ Disposal Workii Tomitr ion rrmif Permission is hereby granted.............................................................................................................................................. to Construct (Y,,) or Repair ( ) Individual Sewage D� isppsal ys Street as shown on the application for Disposal Works Constructio t No------------- D ............................. X. - - - ---• DATE r�--*---....... Cam' !/ Board of Health "/'C'',�! --- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS / 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. DATE: 1 OK�) Fill in please: ' APPLICANT'S YOUR NAME:` wT. BUSINESS YOUR HOME ADDRESS: TELEPHONE # Home Telephone Number: NAME OF NEW BUSINESS C �J CSC—,\ N) TYPE OF BUSINESS GAk� ��,ZAG IS THIS A HOME OCCUPATION? YES NO T_���J ' -��,) 3N)A Sri Have you been given approval from the building division? YES NO ADDRESS OF BUSINESS _ `� "� U MAP/PARCEL NUMBER 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 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 hpq been ' formed of heA mit re ments that pertain to this type of business. MUST COMPLY WITH ALL Au orized Signature* *COMMENTS: NO t-007i) HAZ4RDOUSMATERULLSREGULATIONS e-� n A N db sA-b c *-A 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: i TOWN OF BARNSTABLE Date: TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS��� BUSINESS LOCATION: i0a INVENTORY MAILING ADDRESS: gQ`mS- cLfb Cab'2v-9__ TOTAL AMOUNT: TELEPHONE NUMBER: "'I'l(Q—" E9 (PQ� CONTACT PERSON: 'TZ?>9--7W CZQEF�_' EMERGENCY CONTACT TELEPHONE NUMBER: `��`�"'��O - ��� MSDS ON SITE? TYPE OF BUSINESS: I bg1 `lbCpc INFORMATION/REC MMENDATIONS: 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 ~ 'e1, `bra`( 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 L Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Date:1 / 1 b / Og TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS'S BUSINESS LOCATION: tOa: �%�� CV � � INVENTORY MAILING ADDRESS: SC-\-`S�Q Q'� ab�y�-- TOTAL AMOUNT: TELEPHONE NUMBER: 0C:%-- CONTACT PERSON: VE-1 2--�- EMERGENCY CONTACT TELEPHONE NUMBER: `��"�-�qd ��r MSDS ON SITE? TYPE OF BUSINESS: 'Pl_> 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) i 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 -�j�0.\( NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, _--�J Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink 9 9 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 ! _i_e!�;r ROLES RSIOS, 9/Z/93 1`�'L4►.a �i^ C�K ZZ9 Rxg3 LOT $brz of � AL'rt-1 S, ullNr.�1►av es MI�P 2.o8 PAO-.f_GL. ht5 Exc ��rr�r�, 1�, t=uLL . ��c�uNt�wl ( Q. 1�►s��tC.T ' 'I f4- 2 Tip- O?�GGQ_VA*0WJ '4JGLL Zit'AC>1t.1&S i�oou>�La i410 t-:L rev 1 I,o F� Na EL F Z�, i 1�Aawt'!� DUgSI">I1. �� tL i S.{ f C. 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