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Home My WebLink About0029 JOAQUIM ROAD - Health (2) t 215 Old Yarmouth Rd 344-041 Hyannis i 7 1 I I1 1 a �/ TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date (2-0 (7, Time: in Out Owner oa-%S I`()z Tenant �-- Address 7�°�,`) 1`�1 1 C E�I Address2-1,6 OL-D "IAA-M.b'1e - d' 921) Compliance Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities , 4. Water Supply r� 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation f 9. Installation and Maintenance of Facilities 10. Curtailment of Service ,✓ 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17. Temporary Housing N A ' 18. Driveway Width 19. Number of Tenants Observed /�j PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms 3 Number of Vehicles Allowed tj11 Number of Persons Allowed (max) �� Person(s) Interviewed(/a- ((\XL-- Inspector If Public Building such as Store or Hotel/Motel specify here r q TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date _ f I Time: In Out r Owner Tenant Address l0 Address (9 15 Compliance Remarks or Regulation# Yes O Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities Approved: E` — 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal `lj rl ('S 17 1-5 17.Temporary Housing 18. Driveway Width j 19. Number of Tenants Observed !� L— PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms Number of Vehicles Allowed (max) Number of Persons Allowed (max) Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here WN Op rBSTABLE , LOCATION -� � �g�� SEWAGE # VILLAGES J AflS�SE�SSOR'S MAP& LOT3 INSTALLER'S NAME&PHONE NO.QUV40 + l�tl�r d'(S. 411T"XF93S SEPTIC TANK CAPACITY �� LEACHING FACILITY: (type) '5 (size) Z) NO.OF BEDROOMS BUILDER OR OWNER G. . 1� PERMTTDATE: Q —11 "q ',.15' COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility R�� 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 within 300 fee f lea ng facility) _ 1J1,A Feet Furnished by de �" O S e g � e en 3 44 No. / �/ PQ•�.�� .4 6 ' Fee u THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pplicatton for Mt5p0al *pttem Cow5trurtton Vermtt Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at: Ile Location Address or Lot No. a �Vwncr s Name,Address and Tel.No. Installer's Name,Address,and Tel.No.., L f-71 Designer's Name,Address and Tel.No. S� �. c. ` �� SA. 4 1'7-Z93s Type of Building: Dwelling No. of Bedrooms 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 Description of Soil Nature of Re s or Alterations(A swer when applicable) )ogs& 'e--- Date last inspected: « �®�� .r t �� • 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 ' d by is Board of Health. Signed j Date /® "3 t -c?.J~ Application Approved b Application Disapproved for the following reasons Permit No. t-.7� 6 Date Issued '�� .�•(�.r's...+e.... .e'�.7,.-v ..:x.r- -�s.�.r —.'rt' .r... 'L- b`r•� ... �.' ,+-r- ti, 44, A-3-0._DP THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Rppltcatton for Mtopogar *p5tem Congtructton Vermtt Application is hereby'made for a Permit to Construct( )or.Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. Installer's Name,Address,and Tel.No r" 4-77 Designer's Name,\Address and Tel.No. t^��o�-- ^Z�e).:d-.,•,v,LS ag 35' �G+,,•` 1fl V- lr� R,��.r, s� ��. ► S,. .�,. 417-2-8.3s' Type of Building: ? Dwelling No.of Bedrooms 3 Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures i Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets ` Revision Date Title Description of Soil Nature of Red,gairs or Alterations(A swer when applicable) S�` "' 1 �' f'" , d i Ce sg del s^_w5 `\ .- D b u 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 s ed'b ,f is Board of Health.,! p Signed �+ i dl.., Date O -3 I—QJ� Application Approved Application Disapproved for the following reasons. Permit No. c-✓ t 7 Date Issued Y `THEI'COMMONWEALTH OF MASSACHUSETTS iq PUBLIC HEALTH DIVISION BARNSTABLE, MASSACHUSETTS '� C.erttf tcate of Compliance Ta IS I'S TO RTI that the 1Q n-�site ewage Disposal System stalled( or repareplaced( )on by of ` t`��- yn : c.}�•�. for w k% ,k t`b"'Se , as has,been constructed in accordance__.. with the provisions of Title 5 and the for D sposal System Construction Permit No eV7_ ' dated /,o �3r.r!' Use of this system is conditioned on compliance with the provisions setfbrfii below: No. '�.✓ f Fee J 0 ��a1ajSE , THE COMMONWEALTH OF MASSACHUSETTS '34q PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS L x1t9pogal 6pgtem Cone;fraction 3permtt Permission is hereby granted to Y�4 Y`t � to construct( )repair(�n On-site Sewage System located at aO �►C&G e` 1 Q vy w: S YYl G 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. All construction must be completed within two years of the date below, q Date: "915 Approved CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated t) 3 ( ^��5 concerning the property located at t 9c`; meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • -The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. SIGNED : ( X� DATE: 10 LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system. 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