HomeMy WebLinkAbout0063 BAXTER ROAD - Health R' Sewer.Acd #2885
63 Baxter oad
-Hyannis
Y. A ;053 - -- -- -- -- - — ---- - - _ _ - -- --- —
1, ~)
No..............
.. ....
THE COMMONWEALTH OF MASSACHUSETTS
�-, BOAR® OF HEALTH
.............::OF..
Application for DiipnsFal Warks Tons rurtiun runfif
Application is hereby made for a Permit to Construct ( ) or Repair ( individual Sewage Disposal
System:� � �� �--
................. .._ .......... ..... �'� --••-•- �'''' --........-...... -----------... -.....--
cation-Address r Lot No.
... =.1.�` .................... .......................................... . -•.......
----••-•------.-.......... --
ow Address ••
---------------�----...�:; _. ..._ --- ............................. ------....------------..:•--.........--•-......-------
y� taller Address
Type of Building Size Lot............................Sq. feet
U Dwelling No. of Bedrooms.............................. ._...Ex Expansion Attic►-+ g— -.---•--• p ( ) � Garbage Grinder ( )
aOther—Type
of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures -----•------------------•--------------------•--------.-----•-••-•-••--••--------•---•----•------------....----•••-------------••--•--............----
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid'capacity........____gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No. .............. Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter. Dept belowinlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed bY------------------------••-•••-•--•--------------------------------------- Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
44 Test Pit No. 2................minutes per inch Dept of Test Pit.................... Depth to ground water............:...........
-•.............................................. .....................................•-------•-.....-----------•------
0 Description of Soil........................................................................................................................................................................
W --------------------------------------•--•----------•-•--------.........-----------••--•-•------......----•-.......,---------------•----•-------•------------•---•-------••-•------- •-------=-==---
---•--------------------•----------•-••---------...••-----------•--•--••------------••--------••-•---•--•---- -
U /Natuof Rgpairs or Alterations werwh ��47.......
Mapplicable___ �f �--r_...10'1�.11.ent:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bpM issued by the'board q healt
Si ne . 2 -_t�1 ......��JJ f? `� � - `� -
Date
Application Approved BY �Ll ............z -------
Date
Application Disapproved for the following reasons:..............
.........................................................:.?:..
---------------------------------------------------------•------••--•--•------••------.......-------••--•-----•-------•--•••-•------- •-----•-•-----•----•---------•=:.....---•-•------•--••---......_.
Date
PermitNo....................................................... �-�•-----------------
Date
No.. ......... 1�.:. FEB........... .........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
/. .........OF.4-1-il� Y'. 7a-4.1..........................
Appliration for Bispoii al Works Tonitrurtion famit -
Application is hereby made for a Permit to Construct ( ) or Repair an Sewage Disposal
System t:. I& .,
000al/
/�cat�ion�-Address or Lot No.
• � ........Cl.. ......... .............
W ow Address
'• staller Address
Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms.........................................Expansion Attic ( ) Garbage Grinder ( )
►-+
Other—T e of Building No. of persons............................ Showers — Cafeteria
QI Other fixtures ................................. .
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
04 W Septic Tank—Liquid'capacity__......____gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
3 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.........................
Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 ..........................................-..................................................................................................................
0 Description of Soil........................................................................................................................................................................
x
W ••-•---------------•-•--....-----------------------••--•---•----------••._......................_.............. ...........----••----
U Natu e gf R airs or Alterations swer w pplicable___ _..__. �!?A.4! :.. ._.------.
�.:::.:.:..::. -
greement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has � issued by the board qi; 1 e.a..l.th-A �f
Signe '' '7/ L� ,�1/ �Da �1
-------- ------
te
ApplicationApproved, By.................................................................................................. .........................................
Date
Application Disapproved for the following reasons:................................................................................................................
..-------•.................•-----------....---•----•-•-•-•-•----.............._..............-•-----------••--•-•----....----------------•---•--•---••--•-----•-•--•----•----•------------•------------
Date
PermitNo......................................................... Issued-. ....................
Date
THE COMMONWEALTH OF MASSACHUSETTS
_ BOARD
OF HEALTH
.......OF.! /- ? -'.�.. ... .... ..............................
C.rrtif iratr of TompliFanre
�� S IS 0 RTIFY hat the ndividual Sewage Disposal System constructed ( ) or Repaired
by__(� w ------C
? /�, ,�r.r,
Installer at...•C /,7 ... :�,/........�---/•_l Id.
has been installed in accordance with the provisi T F 50 T S ate Sanitary Code as described in the
application for Disposal Works Construction Permit No �_...{..�--fl---- S..... dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT AEttt��-�CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE......,. .......................... Inspector---•- ----- - ---------------------------------••--
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
/ OF ��
No.......f.-�!�r- .... FEi�.�................
too I NO rk ion sr
urt' n Trani
Permission is hereby granted ------. ��J -------- -rv-tc
----....-•--------------------------------------..................---....
to ConsPuq ( or R ( ndivid al Sewage isposalm
at No.... )- ;.1.:..,`� .......................
Street
as shown on the application for Disposal Work Construction Permit o. -. .... Dated. "'.............. ..............
d`r- l,�ids1 .................................
`
DATE-------`-.742.4)..-`- ..................:
FORM 1255 HOBBS & WARREN, INC..' PUBLISHERS
Aug 20 2014 3: 59PM HP LRSERJET FAX P. 1
a
CLEAN SURFACE DELEADING INC .
203 Essex St. Ph: (781) 340-0816
Weymouth, MA. 02188 Fax : (781) 337-5346
FACSIMILE COVER SHEET
DATE: Aug. 20, 2014
TO: Director, Asbestos S Lead Program
(617) 626-6965
Director, Childhood Lead Poisoning Prevention Program
(781)774-6700
Hoard of Health, Town of Barnstable
(508)790-6304
FROM: Mark S. Bianco
RE: Notification of Deleading Work
63 Baxter 'Rd , Hyaani9, MA
PAGES: 3
Please call (78_) 340-OB16 if any problems with transmission.
t
Aug 20 2014 3: 59PH HP LRSERJET FAX p. 2
c
ti
COMMONWEALTH OF MASSAC'HUSETTS
Department of Labor& Industries and Department of Public Health
NOTIFICATION OF DELEADING WORK
All sections of this form must be completed in order to comply
with the notification requirements of M.G.L. Ch. 111, § 197,
454 CMR 22.00 and 105 CMR 460.000 as most recently amended
Fite Number: (AGENCY USE)
i
Contractor performing project Mark S. Bianco License t#DC 001055
Lead Paint Inspector Benjamin Misch License##I/R-3984
Date of Inspection 5/29/14
If low-risk deleading work is being performed,complete the following line:
Property Owner: N/A Agent:
Address of Project
Building Name (if any) Floor 1-2
Street Address 63 Baxter Rd. Apt. No.
City_Hyannis Zip 02601
Deleadin Method: We 5rs Scra in �g Heat Gun
Liquid Encapsulant Covering Demolition Replacemebt Other
If"Other" selected,please explain
Check One: . Dwelling is multi-family Single family X
Start date 8/29/14 Completion date 9/10/14
When will work be done: A.M. X P.M. Weekends X
Project Supervisor's name Mark Bianco License* . DC001055
Property Owner Bob Faria
Address • 83 Baxter Rd.
City Hyannis State MA Zip 02601
Telephone (508)775-5060
In case of emergency contact Mark Bianco
Phone: day l,617)340-0816 evening_(781)340-0816
(over)
Rug 20 2014 3: 59PM HP LRSERJET FAX p. 3
Page 2 of 2
In accordance with Massachusetts General Dews C.111§197,454 CMR 22.00 and 105 CMR 460.000,notiec of the date and method(&)of
removal or covering of paint,plaster or other accessible materials containing dangerous levels of lead is to be provided and most be received
by the following agencies,at least 3M(10)days prior to the beginning of deleading.
NOTIFICATIONS MAY BE FAXED.
1. Department of Labor,bead Program,Division of Occupational Safety
19 Staniford Street,I"Floor,Boston,MA 02114 FAX:617-626-6965
2. Director,Childhood Lead Poisoning Prevention Program
Department of Public Health,Donavan Health$gilding,5 Ran.dolph Street,Canton,MA 02021 FAX:781-774-6700
3. Occupants of dwelling unit
4. All other oeeupents of the residential premises,if any
5. Local Board of Heallb/Code Enforcement Agency
6. Massachusetts Historical Commission (if premises are listed on the State Register of Historic
220 Morrissey Blvd. Places,this notification must be made upon receipt of so
Boston,MA 02M Order to Correct Violations or at least 30 days prior to
FAX(617)727-5128 initiating preventive deleading)
NOIMCATIONS SHALL BE COMPLETED IN THEIR ENTIRETY,DATED AND SIGNED-INCOMPLETE NOTIFICATIONS WELL NOT
BE ACCEPTED AND WILL BE RETURNED BY THE DEPARTMENT OF LABOR&WORKFORCE DEVELOPSI ENf'.
PROPERTY OWNER(If owner or unlicensed owner's agent will be performing low-risk deleading work,complete the following):
Properly Owner Agent(s)
Address
Telephone Number (__)-
I certify that I have complied with the training requirements of the Common%=kh of Massachusetts Lead Poisoning Prevention and Control Regulations,105
CMR 460.175,for ownertagent low-risk abatement and containment. I Ibrther c cn*that I or my agent will be performing the following low-risk activities
(I have circled all that apply}
applying liquid encapsulaut capping baseboards removing doors,cabinet doors,shelters
applying exterior vinyl siding covering surfaces
I certify that all the to etdon contained in this notification is true and correct to the best of my kd e6wledge and belief.
Date Signed
Revised 12=7