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HomeMy WebLinkAbout0008 EDGEHILL ROAD - Health 8 Edge Hill Road Hyannis A = 287 - 110 II �I I A#1A r LOCATION SEWAGE # Z- VILLAGE dl/7 �'�� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY az®Ofa LEACHING FACILITY: (type) — l Ze�S NO.OF BEDROOMS BUILDER O]R� G� PERMITDATE: COMPLIANCE DATE: 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) Feet; Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by e ry a� Ze 1 s v No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Application for 33ioozar *patent Conotruction Vermit Application for a Permit to Construct( . )Repair(�/)Upgrade( )Abandon( ) O Complete System ❑Individual Components -Location Address or Lot No. 11����� �� Owner's/Naa�mee,Address and Tel.No. ie 'Assessor's Map/Parcel /j Aen, f Installer's Name,Address,and Tel.No. i Designer's Name,Address and Tel.No. "7 -7 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building R GeNo. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. -5 W ®/I Description of Soil G�Q�®L'/�5 ►/ X yZ'rZ� Nature of Repairs or Alterations(Answer when applicable) 1)`/�' ��J 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 issued by ' Board o ea . Signe Date Application Approved by Date Application Disapproved or the following reason Permit No Date Issued 11 TOWN OF BARNSTABLE f LOCATION ?. /T'�lj/P!!/'J`Q� SEWAGE #Z6VD— Z- VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 0z 0,9 LEACHING FACII.ITY:/ (type) T_ (T E_ �/ J z) NO. OF BEDROOMS lJ BUILDER OR(!C� / GJl� PERMITDATE: COMPLIANCE DATE: /l— /42 — 420 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), Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 440 4V 13 T Q 19Z _ R 13d G 03- No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: L Yess PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Z(pprication for �Diopooal *pgtem Construction Permit Application for a Permit to Construct( )Repair(!/)Upgrade( )Abandon( ) U Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel (/ �,f�`J` �, �-- �i JC- IJ j��.- allt—p Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. kr/-p ©11 '7 7 Type of Building: Dwelling No.of Bedrooms u' Lot Size sq.ft. Garbage Grinder("o Other Type of Building e.Sf &Wc*^eNo.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank azw Type of S.A.S. Description of Soil ' Nature of Repairs or Alterations(Answer wheni.applicable) � f 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 Cer[ifi- cate of Compliance has be 1 en 'sued by is Bo d'.' f e t" -- � Signe r✓/ J Date 13/ D Application Approved by `f U 1 y v i 1 Date (20 Application Disapproved for the following reaso 16) Permit No Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CE ,that he On-sate Sewage Dis osal System Constructed( )Repaired( )Upgraded( ) Abandoned( ) y d/��`O `/ c� 5�". at ee nstructed in accordance with the provisions of Title 5 and the for Disposal System Construe 'on Perm . a it N ted i Installer Designer /`� j The issuance of this pe, s a n t be coats: ed as a guazantee that the sy('em w 11 function/y s� signs Date `� Inspector %(/�- —�— -------------- No. ��? THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migooal *potem,�.Con�truction Permit Permission is hereby ranted,�tp Construct( )Repair(✓)Upgrade( )Abandon( ) System located at P /� `/�'��X-15 t?4& 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. L :Provided:Construction. ust e�cotrl�pleted lwithin three years of the date of this f ' , ': 7/ J Approved b U Date: �Nq, _ PP Y 41 �! A 4 l -•.` ,� ,c. 11�6199 . . NOTICE: This Form Is To Betsed For the Repair Of Failed Septictic Systems. Only. - CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUMON PERMIT(WITHOUT DESIGNED PLANS) ePJOI'I--L'7-0#-OM' herebycertify rtify that the application for disposal works construction permit signed by me dated concerning the property located at q'S1 gl7h12 a� f/ -� /�1/��s�ls.�`/ meets all of the following criteria: F/ �e failed system is connected to a residential dwellingonly. Tfle:e are no cotttme:c:al or business �ises,assocated with the dwelling. `/The soil is classified as CLASS I and the pe:coiation race is less than or_goal :o minutes pet incM VT'ne:e are no wetlands within 100 feet of the proposed septic system - Ine:e are no private wets within.l:0 tee;of the proposed septic s-istem • :here is no increase in flow and/or change in use proposed -e There are no variances.requested or needed. Alle,bottom.of the proposed leachin facility will not be g _ located less than Lye fee,above the maximum adjusted groundwater table elevation. (Adjust the groundwater.table using the Frimptor lethod when alicablej if the S.A.S. will be located with 250 feet of any vegetated wetlands. the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the a:dmum adjusted groundwater table elevati m on, Please.complete the following A) Top of Ground Surface EIevation(using GIS information) B) G.W.Elevadon /0 +the MAX High G.W. Adjustment. /''?-= DUTERENCE BETWEEN A and B 23- 2— SIGNED : DATE: [Slkewh Proposed plan of system on track]. q:haft foldw an f � �•�� . C� �1 i `' .� �� � � �� � � � � �n �, a �� � � � � << � �; � � � (' �' �. j C t �d ��,,pp e "1 �� � `� _ � � --� '� , �'� c� � �� r .r---• _ �� TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: QSt -4 �'L L C Flec�'Vgjc fn��raQ �u c, Mail To: BUSINESS LOCATION: Board of Health Town of Barnstable.. MAILING ADDRESS: V\� P.O. Box 534 TELEPHONE NUMBER: 50 / Hyannis, MA 02601 CONTACT PERSON: a M7 U ;��o cZ / •72� �, Crz a EMERGENCY CONTACT TELEPHONE NUMBER: Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totalling, at any time, more than 50 gallons liquid volume.or 25 pounds dry weight? YES Z 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: sq LQ6_RPh6v3P Ed 4$&NN1S 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 t�p ✓Motor oils/Caste 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 3�L �/Paints, Calrnlses),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, t 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) l wl Va1'F W&I 1 Ran;s-DBme 17 n I _ Other cleaning solvents ��c-T � �"� 35 ��.��lPs7� Con tlna�� C_I�a WiT Bug and tar removers 1051/yo PAR75 _ Household cleansers, oven cleaners i White Copy- Health Department/ Canary Copy-Business TOWN OF BARNSTABLE *unsatisfactory- OMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair nters BOARD OF HEALTH , satisfactory 3.2.Auto Body Shops An 1 o 4.Manufacturers COMPANY (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADORES O .r �� 8SS' 7.Miscellaneous QUANTITIES AND STORAGE (IN=indoors; OUT-outdoors) MAJOR MA Case lots Drums Above Tanks Underground Tanks IN OUT IN OUTI IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerose � waste motor oil (C) new motor oil (C)-- transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: v DISPOSAUREC;LAMATION REAL&R1q: 1. Sanitary Sewage 2. ater Supply Town Sewer ublic On-site rivate 3. Indoor Floor Drains YES NO O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: Q Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product �� YES NO 2. a Person (s) Intervie ed Inspect Wa Y TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair O satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANY 6-o—c 444f°`i— (see"Orders") 5.Retail Stores ado 6.Fuel Suppliers ADDRESS 'Zy A1&s2l� ,,.uL S�>,Class: 7.Miscellaneous U-Y&4 K":0 QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots "DrIlms Above Tanks Undergn-ound Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline Jet Fuel(A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil(C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: ec P -� - S DISPOSAL/RECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply 1-1tC..'q ce 1FJ Town Sewer ublic WW` -3 ) O On-site Q Private 3. Indoor Floor Drains YES NO.�C S �4d � n n , a(,­ �R.bGdG'' O Holding tank:MDC_ �t'' r`�`s e �e�'�'''c ��` f O Catch basin/Dry well 4/0 nL ` O On-site system 4. Outdoor Surface drains:YES N0_X_ ORDERS: Q Holding tank:MDC li./l"l cI O Catch basin/Dry well O On-site system 5.Waste Transporter ProductName of Hauler Destination Waste YES NO 1. 2. Person(s) Interviewed InspectopIr Dat TOWN OF BARNSTABLE COMPLIANCE: CLASS: L-Marine,Gas Stations,Repair 2.Printers BOARD OF HEALTH 0 satisfactory 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY &4_-,, i l& F(.ec doff` f" (see"Orders") 5.Retail Stores 6.Fuel Suppliers 11 ADDRESS Z-4 �il�tG(tiwK 12!: .S7 Class: Y 7.Miscellaneous �Y�^� QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground Tanks IN OUT IN OUT IN_ OUT I#&gallons Age Test a 4 Fuels: Gasoline Jet Fuel(A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil(C) transmission/hydraulic Synthetic Organics: degreasers i Miscellaneous: LU 6-S�,_ 0,- -J 1 e(ecfv� C X 6, exec *­rj S DISPOSAL/RECLAMATION REMARKS 1. Sanitary Sewage 2.Water Supply u < 6 ni '" U r e J Town Sewer 04 Public OV W, 12 'j / clv n dIru I' 0 On-site OPrivate S /A- �G� � W-c /. n cjdw ry . (%l•"l�e4 f7,L loe..lk . 3. Indoor Floor Drains YES N0 �s4 �J .�!w�� 0 Holding tank:MDC �__ c-, 'i iLe Pe l,' u, 0 Catch basin/Dry well. d% i��[ "i�o 44e_ ' ! 4.,4 yr O On-site system 4. Outdoor Surface drains:YES NOX— ORDERS: 0 Holding tank:MDC w�� 1 ��j of t 0 Catch basin/Dry well 0 On-site system r G� 5.Waste Transporter Name of Hauler I)estination Waste Product Licensed?! YES NO 1. 2. i Person(s) Interviewed Inspectoe Date • Rt I\ K cl I -A 71 \� tF- ---------------------t--- 4 -El W 141.14 L Q 4 LL � � Ion � � � � . x 'T 7A t A) ............. ...... tp zn � \ a I \ I � _ I I .I: r � ---- W tvc[1 ✓e riZW A1(1in1lleT NKiN�s=-� .....- .. _-.,•: I _ _ V.. .� - - 1- I R —— z I. +...-....•.. !. �'•+Sroo Wgcc cn/EA� ' 17 I T , r y r J o a, I- --- =3 co = I \ O�_ O�O � P3 =3 -4 GJt 'tn o ^« a W C, CD N -- (M CD CM O� UlI L m r --1=- - j I 1 y: f Ilt 7W I I III 1 rV • --- _— 1 � I s