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Home My WebLink About0108 RICHARDSON ROAD - Health 108 RICHARDSON ROAD, CENTERVILLE t A=210-133 �lll Aot ' UPC 12543 a No. . 53..3LOR HASTINGS, MN ,,�TOWNJOpF BARNSTABLE LOCATION &�s Ald' ar ®4 r SEWAGE # �17 217 VILLAGE ��/? r��i ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. �4ID� 1 CD`l5 77,9 Z3y,"fe SEPTIC TANK CAPACITY LEACHING FACILITY: (type) ;!�X,lAti�d C�/� (size). 203 NO.OF BEDROOMS _3 / UII.DE O!� PERMIT DATE: �� 9 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 leaching facility) 1N/ Feet Furnished by gar b ' 37• 5• 3%' Fee�7�� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Application for Migaal *pttem Construction 3permit Application for a Permit to Construct( )Repair( )Upgrade(t/)Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address�''d Tel.Njoall o. Assessor's Map/Parcel 7 cel /+ e? /Lp Ci /PJ9 !s lei' S®eo' Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. i�Q3� Type of Building: 2 Dwelling No.of Bedrooms ✓ Lot Size sq.ft. Garbage Grinder(__2W Other Type of Building �rlG�No.of Persons Showers( Cafeteria( ) Other Fixtures Design Flow 114P gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /�®D OW Type�9 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) /7��a�/ ®X o y��L�/S 33 Z- r22J7 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 issue y h' ar f Health. J Signed Date it-�c31 Application Approved by-- 4— Z Date Application Disapproved for the following reasons Permit No. -7- 1-3 -7 Date Issued No. / / Fee � � { THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: . Yes ` PUBLIC HEALTH DIVISION - TOWN OF,BARNSTABLE.-, MASSACHUSETTS ��„// 2pprication for DiOo5ar 6pgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade(✓)Abandon( ) El Complete System ❑Individual Components Location Address or Lot No./off Owner's Name,Address and Tel.No. Assessor's Map/Parcel. CG'4I7`r { Ile le f Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ,r /' Type of Building: z Dwelling No.of Bedrooms ✓ Lot Size sq.ft. Garbage Grinder(• 1W ? Other Type of Building 1�e6; GNo.of Persons Showers( ) Cafeteria( ) Other Fixtures j i ! Design Flow //40- gallons per day. Calculated daily flow 33d gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /ODD Type of S.A.S. y Description of Soil Nature of Repairs or Alterations(An§wer when applicable) /lil�Xi ryi i'L ��' // •ry.X 3 3 Z ,r 2- v i � a 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 issue W y oar Health.. Signed Date Application Approved Approved by 4e...�.� _�t�.v�+tic.K%�c` Date Application Disapproved for thY following reasons s a Permit No. 7- �-Ja 7 Date Issued THE COMMONWEALTH OF MASSACHUSETTS Z/Gl BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-s' a Sewage Disposal System Constructed( )Repaired ( )Upgraded Abandoned( ) y 4rK at �� oiG are oSDh rizalle, 'r1 '!'!/j e has been constructed in accordance with the prov' ions of Titl 5 d the f Disposal System Construction Permit No. 7 dated. Installer d�7�® / 0�5 Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date i t [ �( Inspector f , No. �`� ——�-------------------- �/0 �J3 Fee -:22 THE COMMONWEALTH OF MASSACHUSETTS fr PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mi!5po!6ar *p5tem ConelXAbandon 1 n ermit Permission is hereby granted to Cons ct( >Repair( )�•pgrade( ( ,) System located at /�g �IGD ✓��XJDY �'ei9�'//!� 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: ate) t^-/ - l 7 Approved by TOWN OF BARNSTABLE LOCATION Al 1,,, i/y,5e /lit SEWAGE # g 7 o2cI7 VILLAGE l'PrI rU�/�t` ASSESSOR'S MAP & LOT a/0 /3) INSTALLER'S NAME&PHONE NO. �� D�s 77/ Y, $EPTIC TANK CAPACITY /DO/D9lr�/ LEACHING FACILITY: (type) �w/�'6l-rc 41 l 42 (size) 7� XJ3 Xa � NO:OF BEDROOMS 3 DE ORC G/env PE1tMTTDATE: S /` 97 COMPLIANCE DATE: 14-1 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet -Pnvate Water Supply Well and Leaching Facility (If any wells exist /L'/ on site or within 200 feet of leaching facility) / Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) r� Feet Furnished by { q,S ,/f S �I qA, .8 B� 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 PERiti1TT (WITHOUT DESIGNED PLAT S� I. hereby certifv that the application for disposal works construction permit signed by me dated 5'/13/1! 7 concerning the oroperty located at meets ail of the foilowinQ criteria: ere are no wetlands within.33 00 eet of the proposed septic m P tic syste Z7.'iere are no private veils within 150 zet of is e-=posed septic system �he observed zoundwatertabte is - etcor reater oelow [he bottom of_ne :eac"L'iv_ac;lir: v/aer� s o increase in' io�v and-or chanae in __ or000sed 7l�erp_ - ,_�_-"_ o ar:a..ces � ..L.,.,t..c or::ee..._a. SIGNED : DATE: 5 113k 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]. q health folder cect Y 4 c r v,. �fl 9'� o 1 i i i i v TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: r i Mail To: BUSINESS LOCATION: k ,�,hcgrd&! Board of Health �— Town of Barnstable MAILING ADDRESS: ,n _ P.O. Box 534 TELEPHONE NUMBER: 77I ZzZ Hyannis, MA 02601 CONTACT PERSON: v o* leav- EMERGENCY CONTACT TELEPHONE NUM ER: 7 7/-2:saj6 Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totallin , any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store: Quantity/Case Quantity/Case Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants ` Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy- Health Department/ Canary Copy-Business .t YC&TIOKI : SEWO C;E PEJRMIT MO.� IMS`TQLLER5 U& E ADDRESS BUILDER 5 1.1 &mF- ADDRESS Dt.\TE PERIsAlT ISSUED D A.TE COMPLI W-ACE ISSUED : � = r_ ,s I f `� 4 l� ` r� �1�� .AUESSOR'S MAP NO. i(D PARCEL 133 z LOCATION SEWAGE PERMIT NO. l® RoL VILLAGE Ce ;-t�co ass , INSTALLER'S NAME i ADDRESS 8 U I L D E R OR NER DAj-E PERMIT i DATE COMPLIANCE ISSUED v ' _ ` 4 nor R G Lu s C ear 1I locatxort. Of-Properly: antlervilic of 1 ' 1g7' 8 P 1 i PR�PosEp 0va -CCU t/NQ lot .1 3a�' 108 h tt 174.Ira' _dyivltull� N6ssson' c at f W4 pR°C T.-250001 0005 C foodu ten,¢;_C �t ;��F :o PAUL' 4N 5 ha4 cer ri y ihcm-M6 tYhCVage wi Wcvs wtyw �tIio' m n �'f QI' QEtOYER_ c*Wlilhg furem does not TaU i&a spedaL . 41ood �;�• ��. ihma&area wi&erm e#ect ve date of s -19-z miA z to tocahom su Z w dwe dacs�--ro�rtv- to tocal.�by- au�s in,¢ ctl at*fine oFc wft uctim with respect:to horizmtrd.dW* Wrwf'o � scaler 1" _ 40 setha k or is eact2 npi-frorm vwtatwn.atfomenwne Date: 4 dct:on .1 law. (�utuL�S C c4*w4oA-.5eet' bm Z File No. Wan PLEASE NOTE! The structures as shown-on this plot plan are approximate only. An actual survey is necessary for a.precise determination of the building location and encroachments, if any exist, either way across property lines. This plan must not be used for recording purposes or for use in preparing deed descriptions and must not be used for variance or building plan purposes. This plan must not be used to locate property lines. Verification of building locations, property line dimensions, fences or lot configuration can only be accomplished by an accurate instrument survey which may reflect different information than what is shown hereon. Please note that this is 'NOT A BOUNDARY SURVEY' and is "FOR MORTGAGE PURKSM ONLY% COLONIAL -LAND SURVEYING COMPANY, INC. "t-i0L �1:i.v• tt°% ,a7 ][ YA4_A !A