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HomeMy WebLinkAbout0038 CHASE STREET - Health 38-Chase Street Sewer A_cct # 2678 Hyannis o A = 308 -266 No. Fee 5. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ppfitatiou for bisposal *pstem Coustruttion Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandonw ❑Complete System ❑Individual Components Location Address or Lot No. 3 6 C,�%q 5 G ST'rr_� fi��n+►,? Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No.C4, 9W,_dt 61 n�P) Designer's Name,Address,and Tel.No. J Type of Building: + Dwelling No.of Bedrooms 3 2 Lot Size 'f��P sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) r r— 11rir vkt Z �tss ouo � Date last inspected: Ion 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 Certificate of Compliance has been issued by this Board of Heal n Date 3— 1 1—Za D 7 Application Approved1ky 0 Date Application Disapproved by Date for the following reasons Permit No. 9-0c)q Date Issued �c�- �J`- .,.d.e.+-cV-�.nr.+=rayti•y-^rta'^"^�y.,�.,a.-..'.s..r..:,,'�..h.^a�+-.r. .....---•x+....-�+..._-._ -.. ,� ._ -.� .. ... s... .,.- .. r - ,..- -... � "-. -. ... . No. —� ✓/ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2pplitation for 33isposal 6pstent Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon V ❑Complete System ❑Individual Components Location Address or Lot No. 3 E)<,k R 5 E S"f( � /�j�nn Owner's Name,Address,and Tel.No. C j C u tua_,,., Assessor's Map/Parcel 3 Z!m(o Installer's Name,Address,and Tel.No.0/11 � x ,0,d.4 E,,.i_k,fj;yes Designer's Name,Address,and Tel.No. �} ,). ­ -763 N bq rt n I 1 e m Type of Building: / + Dwelling No.of Bedrooms 3( Z Lot Size t �V sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: 1.00`1 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 Certificate of Compliance has been issued by this Board of Healt . S -ned - zoo-?, Date i 2 Applicati T Approved yam, Date Application Disapproved by Date for the following reasons Permit No. Date Issued �c GA P THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Urtifitate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned(/)by (.44.t,4,tLk Vq il,-f, LC.L, at �38 L ko S..,e �j f +. •I� I� ni S has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No...�r/ dated Installer 0,A Q1A;Ck, LM�( ,.z�� Designer �'I #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system-will-function as designed. Date } �, P �C� Inspector.,..._. ------------------------------------- No. _ 5 ( Fee a-5 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposat *pstrm Construction J)Prmit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) AbandonX) System located at 0-- A -t,;M, S and as described in the above Application for Disposal System Construction Permit. The applicant recognized 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 ✓ / a-�o9 Approved,by �`� YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 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.) 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 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and.get the Business Certificate that is required bylaw. DATE: U[A'4- 1 (-4- . Fill in please: APPLICANT'S YOUR NAME/S: Y-ay V 1 C z V(,t'0' orb BUSINESS YOUR HOME ADDRESS: C(ngse 5f. TELEPHONE # Home Telephone Number 301- 13 NAME OF CORPORATION V1CV[r trvl 1 f)u i CGt+�d s c NAME OF NEW BUSINESS:: TYPE:'O BUSINESS bCa c r IS THIS A HOME QCCUP.ATION? �/' 'YES NO f],DRESSOF BUSINESS: C� S'ti .. n1 S: �(rc7:. MAP/PARCEL NUMBER "" _(Assessing] A 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 then info,�rVd of any permit requirements that pertain to this type of business. Authorized Signature*.* COMMENTS: 2. BOARD OF HEALTH This individual has been inform d o e er requirements that pertain to this type of business. MU8rCCSMP...LY WI ALL' HAZARDOUS MATERIALS REGULATION Authorized Si ature** S COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: f� ti Date: , TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: fy 2 Vow tM r- "rntl/± CIMd lardswuvi q BUSINESS LOCATION: 30 Se_ �A. h!�anvlia MA- INVENTORY MAILING ADDRESS: 3�� ( 5� S�' _��tr�,�y�rii S YYIA- c,�40 1 TOTA UNT: TELEPHONE NUMBER: ( - I�- �'S CONTACT PERSON: Y � Irc_ /MGcrf.�c79vPn f}(as EMERGENCY CONTACT TELEPHONE NUMBER: A-lw MSDS ON SITE? TYPE OF BUSINESS: Land5c. 1n' q 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 W USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) I f 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 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 Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes 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 APgf cant's Sig lure Staff's Initials LOCATION SEWAGE PERMIT NO. VILLA GE.. INSTALLER'S NAME b ADDRESS �) I�VIM[I BUILDER OR OWNER DATE PERMIT ISSUED a� DAT E COMPLIANCE ISSUED _� � � L� 3 J LOCATION 'c� SEWAGE PERMIT D0. VI-� LADE INSTA LLER'S JAM &ADDRESS G BUILDER OR JNER e DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED 15 1 '',1 O J 0..................... .............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......... ..................................................... Appliration -for Dhipoiial Works Tonstrurtion Vanift k�Application is hereby'made for a Permit to Construct or Repair ( 01!�an Individual Sewage Disposal S st JT_ . ...... .... .... ......I.......... .. ................... ......................................................................... L'cation s Add or Lot No. cc,. .... . ........ ..... -- _. .............-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.- .-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-........................ .-.-.-.-.-.-.-.-.-.-.- .-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-. ow Address ---- Insta - Address Type of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder Other—Type of Building ---------------------------- No. of persons..._._.........._..___..____ Showers Cafeteria Otherfixtures ............................. ........................ ---------------------------------------------------------------------------------------------- Design Flow............................................gallons per person per dayy. Total daily flow--------------------------------------------gallons. Septic Tank—Liquid capacity------------gallons Length................ Width.._.........._.. Diameter_____...._.-.__Depth.-.-__--_------ Disposal Trench—No_ --------------------- Width___-___---__-.--_-__ Total Length..._....._.......... Total leaching area.....................sq. f t. Seepage Pit No_____________________ Diameter........_._._..._.._ Depth below inlet_.__.._____..._..... Total leaching area------------------sq. ft. Z Other Distribution box Dosing tank Percolation Test Results Performed by---------------------------------------------- ............................ Date................•....................... Test Pit No. I----------------minutesperinch Depth of Test Pit..._................ Depth to -round water------------------------ Test Pit No. 2................minutes per inch Depth of Test Pit._...........___.__. Depth to ground water-_.-------_----._---.--. 0' ------------------------------------------------------------------------------- ............................................................................ 0 Description of Soil------------------------------------------------------------------------------------------------------------------------------------------------------------------- U ------------------------------------------------------------------------------------------I----------- -------------N----------------------------------------------------------------------------------- -------------------------_--------- ------------------------------------------------------------------------ ------- ------------------- . ...... N re of Repairs or Alteratip"s-,C-Answer when applicable---- -- - 7---- . ... -- ----- ....... . .... ....... .. ---- ----------- --------------------------------------------------- - ----- ------- %L ovAgreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further grees not to place the system in operation until a Certificate of Compliance has be sued by he board of hjealtV/ Sign .. . ............... ....... Date ------ -Application Approved By- ------- .. . ........ . ....... .... 14etlll.............. D -------a--te 7-e-------- 7— Application Disapproved for the following reasons:...................................----------------------------------------------- ----------------------------- ..........................................................................................................................................7-----------------------------------------.................... Date PermitNo......................................................... Issued.--------------------- ................................. Date ----------------------------------------------------------------;-------------------------------------------------------- 9-7i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH / o F: .....(:�'./.l a ..'........................................................ :Apphration -fur 43hiji r ial Eorkii Tomitrtution Permit Application is hereby made for a Permit to Construct ( ) or Repair ( .an Individual Sewage Disposal System t= , �) ,— -� r� Location•Add s or Lot No. t' -.... -- -- ------------- - wne `�. " Address ��- ..-... ................... ---- •.............._._...._..-•-•--•--••••-•------------•----••-•--•--....._.......................... a Insta Address UType of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) 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-------------------- Depth below inlet______-___----_-_- Total leaching area------------------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by------------- ------------------------------------------------------------ Date---------------------------------------- Test Pit No. 1----------------minutes per inch Depth of "lest Pit-------------------- Depth to ground water..-.-_-----.._-..-.--._. f14 Test Pit No. 2----------------minutes per inch Depth of '.test Pit.................... Depth to ground water-_._---.___.___---__.--. 9 ---•----•------------------------------------------------------------------------------------------•---•-•-------------------------------------------------- ODescription of Soil--------- ---------------------------------------------------------•--------------------------_.-----------------.-------------------------------------------------- U --------------------------------------------------------------------------------------------------------------------"------------------------------------------------------------------------------------ W -------------------------- -------------•-------... ----------------------------------------------------------- - © U Na Cfre of Repairs or Alterati .s—Answer when applicable...__ a --- -------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned f/h�ea�ltl; th agrees not to place the system in operation until a Certificate of Compliance has be i sued by -he board f Date Application Approved By. = 1.�� hfll�f ......._..----'•--- //7/---�....7-&......... Date Application Disapproved for the following reasons:... ............................................................................................................. •......................."------•---......---•--....------------•---••---------------•------------------------------------------------------------------------------------•--•---•--•-----•------------- Date PermitNo........................................................ Issued..................... ---------------'•--'-•--........ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OP HEALTH Q... ...... ..........O F.......... ... .. .'...................................:....... Trrtif irate of Tamptianrr THIS I CER' I Y, That the Individual Sewage Disposal System constructed ( ) or Repaired by 4- ------ -------------- -- ----------------- ------ - -- ------- -- -- - I Ile --------•------ has been installed in accordance with the pr tisions of Ar i XI of The State Sa ary Co le as descr' ed in the application for Disposal Works Construction. rmit No.__. ,u `�_�_______________ dated....�/7___Z.'---Z�:_....._...__.._. THE ISSUANCE OF THIS CERTIFECATi SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........�'. '--7�`------•-----••------•-'•-------- Inspector� �---- ----------- THE COMMONWEALTH OF MASSACHUSETTS P: BOARD O HEALTH rr2s- .......� ..........OF......... * ........................................ /� No.......l7-- FEE...././)............ Displa,gal rkq4v urtivat r it Permission is hereby granted.....'=- T- -------- --- �--- to Con ,( Oo pair (�an Individual Se ' isposa- ys- m atNo. ..� f? ---- - ----- --------------------------------- Str /y 7� as shown on the application for Disposal Works Construction Pe No---- ---- --------- /!._---__-------------------------------- ------------ _... - -• ---- ---_-- /`� Board of Health DATE----- ------------------------ -------' FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS (1 O Q f