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Home My WebLink About1000 WEST MAIN STREET - Health (2) 1000 West Main St ; Centerville A=229 - 121 UPC 12534 No..2.95UP wawoar I &4q1 tJ/f1[1Ct IA RIJlgvrh,k Olt 14o'n le -TOWN OF BARNSTABLE LOCATION SEWAGE# v1O VILLAGE ASSESSOR'S MAP&PARCEL ;Z ) INSTALLER'S NAME&PHONE NO. SCv �`^ 1 �z..�.� SEPTIC TANK CAPACITY QX\ S- k®Q0 C rC45-e o C,-.x S- /000. Sort C. �0 19,00 LEACHING FACILITY: (type) , ,, ,� �kb�(s �� . NO.OF BEDROOMS lq 'k, L>C4-U-t.9 U ii_ OWNERS PERMIT DATE: COMPLIANCE DATE:J/cT/'�� 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) h Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) ` Feet FURNISHED BY A era I^SVCc. 3 It 23 S*p GOx 3 r c to 4 s � b kv SIT^spy G � , 72 O ap Town of Barnstable P#_/3/y Department of Regulatory Services BARPWA" ; Public Health Division Date 0 susa. _O� 'D � 200 Main Street,Hyannis MA 02601 Date Scheduled °� Time Vt r_1 Fee Pd. Soil Suitability Assessment f®r Sewage is osal Performed By: SI�(� � A5 ' Witnessed By: ; V SIL j, LOCATION& GENERAL INFORMATION Location Address [ 0 0 0 (_ `- )I Owner's Namec� ' _`. r✓Ill! ,S (V�/ Address t��S lam.c�,t✓`f Assessor's Map/Parcel: a •- a I "` Engineer's Name — C C 1 r NEW CONSTRUCTION REPAIR A_ - Telephone# 3a Land Use Slopes(%) Surface Stones A-AC-) Distances from: Open Water Body= ft Possible Wet Area ft ft Drinking Water Well Drainage Way ft Property Line � 2t ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 7- Parent material(geologic) Zo>' A-S Depth to Bedrock -5 Depth to Groundwater. Standing Water in Hole: 4A- iU f,Ej"- ,� r Weeping from Pit Face Estimated Seasonal High Groundwater _ N//k DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: A-10A E Nj �� Depth Observed standing in obs.hole: in. Depth to soil mottles: Depth to weeping from In,side of obs.hole: in, Groundwater Adjustment t. Index Well# Reading Date: Index Well level Y, Adj,factor Adj,Groundwater Level,, PERCOLATION TES`.11' Date 1J- /3 �,te Observation Hole# Time at 9" r Depth of Pero �� Time at 6" Start Pre-soak Time @ !''"� Time(9"-6") End Pre-soak Rate MinJlnch GL Site Suitability Assessment: Site Passed_41"" Site Failed: Additional Testing Needed(Y/N) N Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTICIPERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# _ Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. o i tenry.%Gravel) . i DEEP OBSERVATION HOLE LOG Hole# Z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsi ncy.% ravel /g 4 &S VA- DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil.Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency, l Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes Within 100 year flood boundary No Yes Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required train' ertise and experience described in 310 CMR 15.017. Signature Date Q:WEPTICIPERCFORM.DOC X-A fUf YOU WISH TO OPEN A BUSINESS? AP 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, 1st FL., 367 Main Street, Hyannis, MA 02601 (Town Hall). .a DATE:o2 j jj,.t e 2 eo6 Fill in please: APPLICANT'S YOUR NAME: G BUSINESS YOUR HOME ADDRESS: Sas-3�o��8G� i�6-0v��s TELEPHONE # Home Telephone Number: _i5o ff- 7 90 %Sy 7 Ix1AMl=:CIF'N: B. S{ .:.,.,U..,.. E ! ;! -.. ..._.._........., .._ _-.. ,..:....._,.,NCB , ,... „ :'. ........... 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 C ONER'S OFFICE This indi 'dual ha ear' o jof�any permit requirements that pertain to this type of business. A on ure** MMENT r 2. BOARD OF HEALTH This individual has be d oft the permit requirements that pertain to this type of business. AA(hor'irzed S gnature** e--- COMMENTS: /�)jdj lZ/» �' �o 3. CONSUMER AFFAIRS (LICENSING AUTH RITY) This individual h een inf oft c n requirements,that pertain to this type of business. Authorized Signature** COMMENTS: 4 Date: /2 / o� TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: /hrnE -Tw 9raue—me'l-4 "�- BUSINESS LOCATION: A2A 1 0-4 5t INVENTORY MAILING ADDRESS: Cc04�ER-cl LJ-``' . rn A TOTAL AMOUNT- TELEPHONE NUMBER: 508P— 360--294ee CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER:_SCS 730 15el7 MSDS ON SITE? TYPEOFBUSINESS: f1,0f"f „Qrd✓EMEN-FS 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) _ Misc. Corrosive /f NEW USED Cesspool cleaners �v 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) 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 I%Li4 SAt, "7o Al 61A:t Q4, (including bleach) Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Twrkiny & Bulldozing 142 Corporation Street Hya-nnnis,,.Mass. 775-0828 n 76 �Q { M ,y; L ,p TOWN OF BARNSTABLE OCA,.TION /O� WaST &,A IAj SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO.y9d/1lU167)97 O-CAXS r Sock;Jlwz 1 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) size) /.;z-� NO. OF BEDROOMS PRIVATE WELL O UBLICWAT -- BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No L-Lcv7( �3W or 5,16 4w P�. �f