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Home My WebLink About0168 LONGVIEW DRIVE - Health 168 Longview Drive Hyannis A= 251 — 077 i al I ff TOWN OF BARNSTABLE LOCATION 1�� C�elc�'!-�'7.� e SEWAGE# -®P"'T— � VILLAGE ASSESSOR'S MAP&PARCEL --\-Sr` INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY.(type) '(size) NO.OF BEDROOMS --�3 �:)" AAM- (-V OWNER PERMIT DATE: 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 Cif Sv`r/e 0 z d o a � z 1'/(0g , YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates [cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.)-You must'first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is- required by law. DATE: Fill in please: APPLICANT'S YOUR NAME/S: Cb r,Sinphe ( P n e . BUSINESS YOUR HOME-AD 02 S: I ypnaiS y C7�u�a�u-zo) TELEPHONE # Home Telephone Number /,/ ,2 C/,-9a K - ya 7 NAME OF CORPORATION: NAME OF NEW BUSINESS C( Y)IA<3 TYPE OF BUSINESS IS THIS A HOME OCCUPATION? YES NO ADDRESS OF BUSINESS MAP/PARCEL NUMBER (Assessing) When,i starting a new business there are several things you must do'in order to be in compliance with the rules and regulations of the Town`of - Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner ovYarmouth • Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1 'BUILDING CO ISSION 'S OFF -MUST'COMPLY WITH HOME OCCUPATION This individ al h s n ndor_e` !bfjny er t re i me is that pertain to this type of business. RULES AND REGULATIONS. FAILURE TO uth rize na ure* COMPLY MAY RESULT IN FINES. MEN S: At Ll v 2. .BoaRD OF HEA MUST COMPLY WITH ALIT This individual has been i rm�dt�her it requirements that pertain to this type of business. HAZARDOUyS MATERIAL$R �.�C1ATIfNS Authorized Signature* 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: Date: / r TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: eykj Jj,e1W CIWVIIVi(9 BUSINESS LOCATION: 16 f t,nVt��,., INVENTORY MAILING ADDRESS: 169 ( TOTAL-AMOUNT- TELEPHONE NUMBER: 1 9 U gUy40 � CONTACT PERSON: (��(1 f t S'�u►�h c t�1l,t:t®f�-Z.i EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: CV{CM ! INFORMATION / RECOMMENDATIO S: C i�Un�r��, 1f�►�I®rtS 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 ❑ 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) 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 polishesr6n5 901hA lo ror 1 y Laundry soil &stain removers (including bleach) Cleo I(� Tt0( T Spot removers &cleaning fluids t 2 (dry cleaners) Other cleaning solvents Bug and tar removers Windshield washes-' ""---� ' WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials 11 TOWN OF BARNSTABLE LOCATION VLOP SEWAGE # 7• VILLAGE Ni§SESSOR'S MAP & L_OT-�A� O 77 INSTALLER'S NAME&PHONE NO. h SEPTIC TANK CAPACITY �tcsZ- � pC1wJ LEACHING FACILITY: (type) -� ��Y ��- (size) NO.OF BEDROOMS S BUILDER OR OWNER PERMITDATE: �] - �: d-7 COMPLIANCE DATE: :7 -3 c/,7 Separation`Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply"Well and Leaching Facility (If any wells exist t 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 II_ C W � � 9 No. 6 Fee •-THE COMMONWEALTH OF MASSACHUSETTS yEntered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE. MASSACHUSETTS Zipplication for �Dt!5pom.Y *p6tem COTYttruction Permit Application for a Permit to Construct( )Repair(grade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. < 61b L O Nca u l-,_J pf`, Owner's Name,Address and Tel.No. vv �,��t,,T�►'Ut�� 1 Assessor's Map/Parcel 5 077. �-I>✓r I QN'e Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms l' Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 33 d gallons per day. Calculated daily flow 3�ACI gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Zxt n Type of S.A.S. 125 Description of Soil Nature of Repairs or Alterations(Answer when applicable) 'czs STi \ O%� etc}St o ill. X:7=Qvv `�at �,. �4ncaz-� emu•-,a_�L� u�, jLj t 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 A not to place the system in operation until a Certifi- cate of Compliance has bee is Signed Date / Application Approved by ` Date 72 Application Disapproved for the following reasons Permit No. 7— .3_ Date Issued 7- " 7 7 TOWN OF BARNSTABLE D �jN eCJ r SEWAGE # �- .LOCATION VII,LAGE G`�o`' K"` ASSESSOR'S MAP & LOT .INSTALLER`S NAME&PHONE NO. ::SEPTIC TANK CAPACITY �v C IC�C) LEACHING FACILITY: (type) t „ =C�A�� —�'�`-¢►�- (size) NO.OF BEDROOMS :BUII,DER OR OWNER.- �:_ FERMTT D ATE: COMPLIANCE DATE: Separation Distance Between the: Feet :Maximum Adjusted Groundwater.Table and Bottom of Leaching Facility `private Water Supply Well and Leaching Facility (If any wells exist . Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by rE 9 .� s� i � No. : ,_3 Fee . H COMMONWEALTH OF MASSACHUSETTS ,!;Entered in-computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0(ppYication for 3Die;po.5af 6pgtem Construction Vertu Application for a Pernut to Construct( )Repair(v4epgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 166 L O N�.0 l zw V` Owner's Name,Address and Tel.No. Assessor'sMap/Parcel � 5 L �'7 -�erb'��l QN ' Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 33 O gallons per day. Calculated daily flow 3�9 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank ��' 1C i ii CCn Type of S.A.S. f C Ca y '- Lrrc`ty 19S Description of Soil .S Q Nature of Repairs or Alterations(Answer when applicable) _ ?,,,STA`\ 0 P yt_ P_tc151 rrA-E tT H = p:L\ZV✓'ZyGYI5u✓ STG -e_ cYti &13IF-:_S ' 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 d not to place the,system in operation until a Certifi- cate of Compliance-has be -'7 Signed Date �-/-,7 / APPlicatton Approved by, _,.., ate: r,.` - -' Date,' Application Disapproved for thefollowing reasons Permit No. Y 7- .3.34 Date Issued 7 77 4 THE COMMONWEALTH OF MASSACHUSETTS . BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TQ.� at t - 'te S wage isposal System Constructed( )Repaired ( ) Upgraded(� Abandoned( )by e5 at (a 8 L 0 r- v t 0V'.t1'C_ Cr^-`�"�vt has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Pggw*t No. 7-2 36 dated 7- 2 Installer Designer The issuance of this permit sh not be construed as.a guarantee that the system will f ctio as designed. /Date 7 - 3 `� ,Y Z Inspector --------------------------------------- No. C) 7 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH' DIVISION - BARNSTABLE., MASSACHUSETTS Mi0pool *pgtem Con.5truction Vermit Permission is hereby granted to Construct( )Repair( �)u pgrade( )Abandon( ) System located at -&Zy G-v..Tr 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 pqrmit. 117 Date: 7 '~ - 9 Approved by NOTICE: This Form is to be used for the Repair of Failed Septice-Systems Only ..._ . .w.,.. i. xa . r_. .r. a ......w.w..1u......w.m.NrY-',�aw-.......aa.iali.'.i..-w.-. ..w-. � �'. �..�.......,...�...._... ...a. . 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 `d--1-5 , concerning the property located at 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: DATE: C� LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBt'R [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified.plot plan, this plan should be submitted]. i �� o Q S i