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Home My WebLink About0240 GOSNOLD STREET - Health 24U GOSNOL ' Y - - --- _ - - - - A = -- - ------ - - --- - �,�306'-114 I • I 0 ° TOWN OF BARNSTABLE SEWER CONNECTION PERMIT OFFICIAL USE ONLY {�ik?2:ii::ii;:i};:;:}$};;2v•: :::C:v., (22yri��i:7::'�i`vi:'-`'2�i?+�2�:Ci iy�O;:L;i2:y}:�:ii,.:..:. .-;•:C':4;..y {2;•}`vt n:�t^$'.-:v::C. .;;h.:....;.:.1. ::{.} .i:%fj:2�:2....n.... yin:n•i:�,.::^•:K:\•?\4:';<:i�lti:'i:Y:i:2:'f.?;:y;:;:;:;:;:i;:tii�:ii:�iiii�:�{<?'�:�'�}:i�i'4i r..'�2ir 4i��i?L`';:v::v:.vvv:r:::::2?n::._::k?:?-•:v:::::v:.v.}.::.v:.v}{:.,:. • :;`4J:�?:•%;nv}??:i•2?$?�n}.'r'f{p:j;•i}:ni???:n2%?^:?.}:4h�:v}:�•y:•i�2vniti}i:ify?::;??:•`.;• Assessors Map No. C3 sS�1`x �3[�l'�` ;�:•:.:.:..::.::::.:•::::.:.:•.:::...::;..>s<>;>: :`:>:::;4�:?~-.w:>> :?:rn^;:»::<::z:>:: Assessors Parcel No OR ..4.. .... .k:i:2:2i '�i y{i:}i ';:�•n rC"i:;2•n.>,n •.v-:n::•:w. Y(� ;•:$.?x -.J..... ,^�..•......:;�z:;? :;n \iicy;t / ; tr2222tf''.h`�n.:`:;.'•iR2:�:-:;.<;{:2 .,;w:,4...,...+,.,�•i:;:;•;:•:;.: Street � Al L� � 2c;:y:.v.,,:y:.�:•.x;`.;};..;:•:?::::.:;•:.ter?.k�;::.;:J:•:._:::.y....: ;MUn� -.: ;vim;`<r:a�2::• ii:C'222222:Si>Yr�+;4�t�i: 'v��'?iti??'- iti i<• ..i\LS\•'COi2Av 2C A� };�fi:2 \\�06�'.?%:iJi'�:J: i •:;• h<• °s.:;:a`.•i at:?:ti;:2;+2, ?o;;aR..;;�,a`\?v�C:`�v: .,,a>x;:�,ay;�4:;?`y.?i �v:4h :•.v^:.v.n?v.• ; ?. } ! S ./Y d/� :>is;•?:;4:;2r{4:4:;.:xi:?-a....... k.• .:4i.:•''•?k<;ti.. .: .? Village: ✓� /(/ ��F�f:#1Vlf.�`�{?.::.;:•>>.,.{:,....;... v.}. F....\v:i>L::2M.C:N i'2; 4-.4:,?i?;<^?};{i::}:{••?}:•�:v?}>kC•}: PROJECT CONTACT S PROPERTY OWNER (Mailing Address SEWER INSTALLER Name: G'fi'd9,�'� S �j Oh'�/y IDvGff1 �5 Y Name: Address: 3��--/ <I �/t✓1 Address: Phone: Phone:gam/ - �7 / 3 License No: OWNER'S AGENVENGINEER Name: Address: Phonw: PROJECT DESCRIPTION REGULATORY REQUIREMENTS :::>�::::::::>:>:><::<:?:�>;:> �:::»::>�>::>::;�A�it�'i:Y:&;L:�A@tCI:£15E�3A;:;!�.�:.:.}:.:.i:.:::.::..;?.i:;.:.;;i:;;4i:;.i:.;:.;:.}:?• • i w the i accorda nce with connections mu n o f all ewer n must'be done installation The and ' s of Artic le XXXV I Town of Barnstable Gener al B -laws n provisions Y RESIDENTIAL regulations issued by the Department of Public Works. Before excavating within a Town Way the sewer installer must also obtain a Road Opening COMMERCIAL permit and comply with the Construction Standards and Specifications outlined therein. At least 48 hours prior to the installation,the applicant must RESTAURANT notify the Department of Public Works,Engineering Division for the purpose ` of inspecting the installation. The Inspector will complete the Compliance INDUSTRIAL Sketch locating the installed lines and connection. By signing the Application, the applicant acknowledges and understands the regulatory requirements and STANDARD INDUSTRIAL CLASSIFICATION NO. understands that failure to comply with them shall be grounds for revocation of the Sewer Connection Permit and the denial of any future application. NO.OF BUILDINGS NO:OF BEDROOMS SIZE OF PARCEL ACRES ESTIMATED DAILY SEWAGE GALLONS -PIPING:LENGTH DIAMETER _ EXPECTED INSTALLATION DATE SIGNATURE INSTALLER/AGEN L$;zt/ 0 � DATE - SIGNATURE(DPW APPROVAL) DATE No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. • Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZippItcation for Mizpozal *potem Con truction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ❑Complete System ❑Individual Components Location Address or Lot No�v 60�:,Kvk tQ—STD Owner's Name,Address and Tel.No. �Assessor's Map/Parcel b— '1y t)o A"i-a5"" Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 16&1 v--Gw Fes epl\C Type of Building: Dwelling No.of Bedrooms_ Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.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. Description of Soil Nature of Repairs or Alterations(Answer when a plicable) �c%riG 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�is � o�� . (� t Sig ed Date `�� `�'�'J Applicatiorr'Approved by Date Application Disapproved for the following reasons Permit No. Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS I�A CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned(ti eE I&MPt0C at C___,o.SNca SZ, has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector --------------------------------------- No. Fee THE COMMONWEALTH OF MASSACHUSETTS _ __ _ Pt�BLIC"rEAl_?ii o►1VIS10iN - BARNSTABLE, MASSACHUSETTS Iigpool *potem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon(W< System located at lsa Sz 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. Provided:Construction must be completed within three years of the date of this permit. Date: Approved by PERMIT NO: TOWN OF BARNSTABLE SEWER CONNECTION PERMIT OFFICIAL USE ONLY ?4:4Y4' .::r.•ai'.::>:r•:;;..:•.r.:.y:ia:•'Jr:$•i{;?'.''frr::';:}:: )::".:?'k":.ci r i7fi4 :'a..%:Y';:.r•{..'•:: :;::::;:tiv,: •:%#<:•• •:•S.:'.�': : h� •$:•:o:::}3: .:KS:•r;:4:•i;r..;4ti a;,•t••n r�r:;SiS:Yr�.•::'':ti:.:7Ft�;, , ;�.• ti ��5� a:a'•..v:x.:•�� ,r';µ?: y.: Q:"'i�:•'c•Q,+�,yy 'tk°}•,y`!?•:' •i'?;drxa}r•:f}:�� ::: `�l{a'.i;':;: lr.::;::•>.:tiar}xa:�:�;::;;%�• ,;.:{f,`r^.•''•. :' ter.•: �l.'�:''' {.',•C�. >•..;y:�.}•:. Assessors Map ;r:}:p „hr•:<fi:a; <:•{•'•;{?�:::,.{ <:;.�:.n�.. Y :L•W;'ii�fii:•;••}:•r•:{{r:.n:•:•...j:�,{•...:. <.: f'' �':{; 2;• :'.••w.ax•••},: :� r,{::: a..: �}:<•?c:•?.r:.,C•:.;:>..,i,�,''+:.io $x•.•�•• \�+'�4' •��},-.`;''o:W.{:{w:n•.�,i Assessors Parcel No "r.. ,:..'.ky.\''' '1�t• '� ";.+:C�Cck..'{KA•%can�:id,�'♦ v \�'': Street: �oSNyt� +SSA•>..:n 1 5 Ei .....:.vx.:.: .v.. j: ;:4:a.{Y.W:r2'2�{{.}h ::4C: ..Z•.v.i.:h\?�:aY.:C{i{i?{.:v :.i.:'{•:.:•:.v:..r..:. } PROJECT CONTACTS PROPERTY OWNER (Mailing Address SEWER INSTALLER Name: .J O R Iyc-' P IV C��/ Name: �1 O( �Q PE S PIC— Address: Address: Phone: Phone: License No: OWNER'S AGENVENGINEER ">f 1� Address: lJ \U J 1 S S Name: 1 rat ct7"-CY�(� Phonw: PROJECT DESCRIPTION REGULATORY REQUIREMENTS ...................................................... :.:.:::.:.............. �c.•wt �,;+ v. rl::r�'n+.•'i�:jti:•,�:::i i':i:}•':yi:•'•::ir:?{a•ti:::'.:.'.:::::v:............:}:it:::�:+{?i}:•:n?i$rr:A:;::::::r?:}:t•.... R:: r``•.:::: ri<:::: ' done in accordance with the ...:....; ....{.:..:.o�:nv .{•n?r<�••}is}<>:}<:}}k.;:::rr: ar•r all sewer connections must be �� ..:..a:::.{.rr>�r:;?{{ik:..,:{.}:,,:.r•::.;:::.,r:> ; •�:.::. {;;:.•: The installation of General B and {.}:•.r:..}:•>:•;r:{::>:•:.;':>:<�::;s::>:.;::;<?::>'>:»>?•>::•>:.::>::>:.::><'::<s>�:;?`:$:::;:<;;>s$� Gen.>:::<>•::{..:<:n:.: Y-laws ::;rr:{:::>::;:{::::;;.r:;.;:.:.};:;{a:{•;:;.;;.;;<:?:K.;i:.r:.:?.:::.;:•r;::{.;;. .:•;:...:.r.:..,....v.:..�::.:.:::..::};.:r:.,.::::::.:.:n.:::::.::.::,.;:::� provisions of Article XXXVI, Town of Barnstable , RESIDENTIAL regulations Issued by the Department of Public Works. Before excavating within a Town Way the sewer installer must also obtain a Road Opening permit and comply with the Construction Standards and Specifications COMMERCIAL outlined therein. At least 48 hours prior to the installation,the applicant must notify the Department of Public Works,Engineering Division for the purpose RESTAURANT of inspecting the installation. The Inspector will complete the Compliance INDUSTRIAL Sketch locating the installed lines and connection. By signing the Application, the applicant acknowledges and understands the regulatory requirements and STANDARD INDUSTRIAL CLASSIFICATION NO. understands that failure to comply with them shall be grounds for revocation of the Sewer Connection Permit and the denial of any future eppllcatlon• NO.OF BUILDINGS NO.OF BEDROOMS SIZE OF PARCEL ACRES ESTIMATED DAILY SEWAGE GALLONS PIPING:LENGTH __ DIAMETER s EXPECTED INSTALLATION DATE SIGNATURE(INSTALLER/AGENT) DATE SIGNATURE(DPW APPROVAL) DATE Check list for unconnected parcels: Name: Mona Gauthier Map/Parcel: 306-114 Prop location: 240 Gosnold Street Mailing address: c/o Joan Duchesney 3324 Pembrook Drive Sarasota, FL. 34239 Visually check property location check for any past pumping records As of 11/7/2000 one record of pumping'since 1985 on 8-22-2000 (pumped with the name'of Reed as resident) check water company for water use 133 ccf per year check with engineering for permits and if they are within the bounds of connecting As of May 17, 2000 no record of any permit taken out. Notify Board of Health to send letter to connect Date BOH notified: Nov 17, 1999 ,Date BOH copy received: ? Date BOH letter sent: Nov. 30, 1999 Date BOH letter expires: May 30, 2000 Sent to Tom McKean 11/7/2000 Connected_to-town-sewer May 1.6-2001 -' CHKLIST.DOC