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HomeMy WebLinkAbout1188 SHOOTFLYING HILL RD - Health (2) 1188 Shootflying Hill Road Centerville A= 190-098 S M EAe No.a-153LOR UPC 12534 smesd mm * Umb In USA MAN TOWN OF BARNSTABLE , LOCATION SEWAGE # 9-s--- (W4, VIIIAGE ASSESSOR'S MAP & LOTt000 INSTALLER'S NAME & PHONE NO. Z70f�—CU177 CV#,J j %dam SEPTIC TANK CAPACITY /5aG 2±1 7A-,,Jle- LEACHING FACILITY:(type) 1'2/T.5 (size) f NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER ORI WN A44 f4::��— ,D Q�OIJ-4� DATE PERMIT ISSUED: 1� '�/�S'� DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes 3� �3 �u r tv THE COMMONWEAL"MF}'F�RMA`'c��IUSE T O BOARD OF' jHE_ALTH ©?Y TOWN OF BARNSTABLE Appliratinn for Di-ripw3al Mor1w Tomitrnrtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair (b-4) an Individual Sewage Disposal System at: ......................................------------------- ----•---•- ----------------------------------------- ---------------------------•--------------- ocltion %ddr ss r Lot No. we,v� Owne Ada "ss _•-•- .......................................... ..., .f� V Installer Address f____ � Type of Building Size Lot___________________________S q. feet Dwelling—No. of Bedrooms----------------•:�,,.--.--.-----.-.---_--Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons---------------------------- Showers — Cafeteria p' Other fixtures --------------------------............................ w Design Flow----------------'.65................gallons per person per day. Total daily flow--------.--._-_--_-_------------------------gallons. WSeptic Tank—Liquid capacitvl�d_-gallons Length................ Width................ Diameter.....----------- Depth---------------- x Disposal Trench—No. .................... Width-------------------- Total Length-------------------- Total leaching area....................sq. ft. Seepage Pit No--------- ...---.... Diameter..-.-.1.'�------- Depth below inlet.......r`�__......... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) .4 Percolation Test Results Performed by.......................................................................... Date........................................ 1.4 Test Pit No. I----------------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........................ R; ........................................................................................................................................................... 0 Description of Soil........................................................................................................................................................................ x w x V N—at.,urrewof Repairs or Alterations—Answer when applica le.-_144 - .--/4.... --- 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 Complianc �aseenue by e board of health. Signed ---------�------------- ---- --- ----- ----------------- ......3 � Da e Application.Approved -..... % �. ................. ---- ------- `......P� � .......--------------- Dare Application Disapproved for the following reasons: .................................................................. .-----------. ..................... . ........................................................ . ... - . -. ................. ...... . .. ------ -------------------------------- Permit No. f-~� ------- ---.. r...... ...... Issued ...r G SC T Dare No. FEB THE COMMONWEALTH OF MASSACHUSETTS O BOARD OF HEALTH Opp TOWN OF BARNSTABLE Appliratiou for Di_t-,Vv!3M1 Workii Cnomitrurtivit Frrinit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: ....,� E FS c �f eG l rL��r./r� /`fit L l�� ----.....:1 ....•--....-••......-•----••-------................... ................................................................................................. Location•Address �y'gvr Lot No. _I. Q U lIJ Cj i/✓ t, �� c S c j /JtiG f 'i t L /4U C ��/"%cl�l//( L.........__._....-- --.......-• ... •--------•--- -••---•--- ---•------------------................... Owner _...------•............................:...... ` - Address a `'� U-� .. C- &AJ S f_lc�vC.f rCje�f_ _�7�+ 4 `!�! (� .1.!.t:<.._. Installer _ Address Type of Building '. _ ` Size Lot............................Sq. feet ., Dwelling—No. of Bedrooms................. . !------=----------Expansion,Attic ( ) Garbage Grinder ( ) Other—Type of Building -----------------`-------j No.,of persons--------..--.''--..-..--_ Showers ( ) — Cafeteria ( ) Other fixtures --------------------------------1-------------- ---- W Design Flow.................:;r................gallons per person per day. Total daily flow....... L�._... _........_...........gallons. WSeptic Tank—Liquid capacityI��U_gallons Length---------------- Width................ Diameter..._......------ Depth................ x Disposal Trench—No. ............ ....... Width.................... Total Length-------------------- Total leaching area....................sq. ft. Seepage Pit No........./.......... Diameter......,AR�:----- Depth below inlet------y......... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed bY-------------------------------------------------------------------------- Date........................................ Test Pit No. I................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........................ 04 ----------------------------•-----••----•-...............--•--------•-----•----•••--•-------.....----•-------••---•-•......-•---•-----•-- -------------- •--- 0 Description of Soil................................-....................................................................................................................................... x V =------------•----- ................................................. "' -� a E _....,. . ls>,...... �1 4 l '-- --------------- ----------------•-. .-------------------•----•-- U Nature of Repairs or Alterations—Answer when applicable..._.---.. Q.....�.....�•..._.�J)Z 0-. � - Agreement: J ` 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/P.eeenn issued by t b e board of health. Signed ......... r " �1.1 .-... .. ,- 3 `........Dye Application.Approved BK '' ''r' -fir'' ... .�....✓.. ._---------------------------------------- .......' Dace Application Disapproved for the following reasons- ------------------------------- -------------------- ------------------------ -...... ........... ........ ---------------- ------------------- y.--/--.-------- ----------------------------------------------------- .......------------- .------- ...... .. ---------- ...----------------- Permit ......... � .y � Y Date No. ...... .-..... Issued ....� �+!. ....'�-"....tom....... .... Date THE COMMONWEALTH OF MASSACHUSETTS 9` -.lop 11�' BOARD OF HEALTH TOWN OF BARNSTABLE 1��1�ertifirate Of IIOMPliir n e THIS IS TO CERTIFY_TIhat the Individual Sewage Disposal System constructed ( ) or Repaired ( ) � .��- /L� U 1.0 ............. -L tit(�+✓c7'--t G Al Y ... ...... .... . ................................................. 1�.«auet at ........................................................ .. `....-SoQT,c�Zy�n/G.... .:�-:.../�(ia4 � Ti`F/uJicc� -----'................................................................. has been installed in accordance with the provisions of TITLE 5 of_The State Environmental Code as described in the application for Disposal Works Construction Permit No. Yr� _..`:_.. 1 .. dated '�..'. �`�._- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE....... -._ �...'_ F... - .... - Inspector .... ....).- ------ -------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE 30 No. .._.... FEE... .................... Uispniial nrk ��rai r timin rrmit Permission is hereby granted..................<= �� z C_L�7_.....6" l.'1_S' �`U�'� l G°v •. .................. to Construct ( ) or Repair ( 'Jan Individual Sewage Disposal System at No..._..... ••-// --.......•-- .. 5�/G....... /�Y�N�.��i/ � _�A-�.1� c f n77-��t.�/i t L� ------ ------ - - ---....... G// 4 as shown on the application for Disposal Works Construction Permit et N'o 7......... ..../2 Dated- �..........''�..............____.____� ✓Board of Health DATE....... --- ---- ' -----•---•------•-- FORM 36508 HOBBS&WARREN.INC..PUBLISHERS 'fit• / `n-`�1' G ^t Hazardous Materials Inventory Sheet Checklist ✓ Date Physical Street Address-Check database to ensure it exists Working Phone Number Actual Amounts -( ie. gas being used to fuel machines, thinner to clean brushes all count as hazardous materials-no blanks) ✓ Storage Information - location of storage, how long is storage for? If none, note that. Disposal Information -where and who? If none, note that. ----- -Applicant Signature - understand what is listed and noted 7—Staff Initial -any questions, know who to ask Vehicle Washing/Rinsing? -give a vehicle washing policy and explain it Attach the Business Certificate with your sign off and comments "The inventory form should explain what the business consists of and the procedures they are doing. Notes need to be left to explain what you discussed with them. 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'the Town (WHICH YOU MUST DO according to 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" FI., 367 Main St., Hyannis, MA .02601(Town Hall) and get the Business Certificate that is required by law. t ` DATE ' 1,1 I 1 L Fill in please: APPLICANT'S YOUR NAME/CORPORATE NAME GF-t��SP+-{4r2. �•l. p�.ta r gN BUSINESS YOUR HOME ADDRESS: tt � �� '��a"'�--{�tircz �-1 t� P.o o d f L4,.vrEC�c c.t.� A.1 F� c 2 cv� TELEPHONE # Home Telephone Number NAME OF NEW BUSINESS C-le-<e-n L.rnWr� �r��� -ior, TYPEOF BUSINESS IS THIS A HOME OCCUPATION? ✓ YES NO Have you been given approval from the building division? YES NO I ADDRESS OF BUSINESS It MA4MAP/PARCEL NUMBEROq 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 i-n 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 has beeni>f4;�rm will f the permit requirements that pertain to this type of business. Von 1 Authorized Signature" MUSTCOMPLYWITHALL COMMENTS: HAZARDOUS MATERIALS REGULATIONS 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: TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: C1r--e.en BUSINESS LOCATION: t��blb Sr,Gb ��„� kt,\� Knnc-A C-on,4c_r ,d1Q mA INVENTORY MAILING ADDRESS: PO 3cx cecl-�ct-Ji\\.e_ AA A c z_Qs TOTAL AMOUNT: TELEPHONE NUMBER: So y CONTACT PERSON: C.A4e_k%-VZ:, e- /,A- C>n"awl N^J EMERGENCY CONTACT TELEPHONE NUMBER: SEY-) z­?,t MSDS ON SITE? TYPE OF BUSINESS: c c-•� _�� r� ����,on 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. 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) 159�t Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) 95 lubricants, gear oil 01 ❑ NEW ❑ USED 10 Degreasers for engines and metal (25 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 j, Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (2-,5 (dry cleaners) 05 Other cleaning solvents (05 Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials I TOWN OF BARNSTABLE LOCATION /�gll .S��rsf ��/�ti /7ir�I V SEWAGE VILLAGE ✓J/�ryf�!✓ ASSESSOR'S MAP LOTIla— INSTALLER'S NAME & PHONE NO. ti /V 91/ SEPTIC TANK CAPACITY s a e 1 s lav 13 6)`� w�Z-., -e 4eLfick LEACHING FACILITY:(type) 6oO (size) /2`ie l' NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER Say f 4 DATE PERMIT ISSUED: DATE .COMPLIANCE ISSUED: Gf -- 2 R 9 7 VARIANCE GRANTED: Yes No 'I