HomeMy WebLinkAbout0015 MARSTON AVENUE - Health 15 Marston Avenue
Hyannis
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YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates (cost$H0.00 for 4 years]. A business certificate ONLY REGISTERS YOUR NAME in town (whic
you trust do by M.G.L.-it does not give you permission eras Musiness Certificates are available at the Town Clerk's Office, 1"FL., 367
Main Street, Hyannis, MA 02501 (Town Hall)
DA
DATE: p Fill in please:
i9 :c,a.l '1413i:' fiY ' L'JF'd
APPLICANT'S YOUR NAME/S:
pry f
l'',m; ''sl'y«Git ';:'r
,ra2h BUSINESS YOUR HOME ADDRESS: 15WE
dLL�r o
hn, n D d 1
_R�.�S ` TELEPHONE # Home Telephone Number / —`7
1. 1
NAME OF CORPORATION: r e f J n c o r o'cl }e d
NAME OF NEW BUSINESS Cm uc 1 e t eRenocia f-�a - TYPE OF BUSINESS —r r✓�i/ce fi t'v1,�
IS THIS A HOME OCCUPATION? .. YES NO / (Assessing)
ADDRESS OF BUSINESS S /"<<tr Pd MAP PARCEL NUMBER ✓S r
When starting anew 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 OO Main S orner 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—COM IS 10 ER'S OFFI. "This individu he ee infoFm f ny rmi q irerrients that pertain to this type,of business.MUST COMPLY WITH HOME.000UPATION
-�� RULES AND REGULATIONS: FAILURE TO
/ u or S'gReture � COMPLY MAY RESULT IN FINES.
COMMENT
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2. BOARD OA EALTH _
This individual has e n info e e p requir ments that pertain to this type of business. MUST COMPLY , H ALL
HAZARDOUS MATERIALS REGULATIONS
Authorized nature**
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: /30 /
TOWN OF BARNSTABLE -j
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF BUSINESS: _�,-'Ita121 ei� erI11C,4,
BUSINESS LOCATION: /S 1,((arefvn &-gyp INVENTORY
MAILING ADDRESS: 4/ TOTAL AMOUNT:
TELEPHONE NUMBEY< 3P
CONTACT PERSON: 0 I lvlal)
I EMERGENCY CONTACT TELEPHONE N MBER: E) C MSDS ON SITE?
TYPE OF BUSINESS: �E?,r_,Li)�� reti0 Voi-;e)h-S
INFORMATION / RECOMMENDATIONS: Fire District:
Waste Transportation: &or) G 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 polishes
Laundry soil &stain removers
(including bleach)
Spot removers&cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
Windshield wash f/
WHITE COPY-HEALTH DEPARTMENT I CANARY COPY-BUSINESS Applicant's Signature Staff's Initials Y
Date: I I
TOWN OF BARNSTABLE
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF'BUSINESS: L C u S 10 ffi, oxxw, fi",
BUSINESS LOCATION: 14 S INVENTORY
MAILING ADDRESS: TOTAL AMOUNT:
TELEPHONE NUMBER: S ,n2 3 (o o 33 14
CONTACT PERSON:
EMERGENCY CONTACT TELEPHONE NUMBER: 602 3(n Q MSDS ON SITE?
TYPE OF BUSINESS: v
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 ❑ 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 polishes
Laundry soil &stain removers
(including bleach)
Spot removers&cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
Windshield wash �V
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initial
YOU WISH TO OPEN A, BUSINESS?.
business certificate ONLY REGISTERS YOUR NAME in town which
For Your Information: Business certificates (cost$�10.00 for 4 years). A (
you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Cleric's Office, 1"FL., 367
Main Street, Hyannis, MA 02601 (Town Hall)
:.a[,, N �r•�r„.,,u, DATE: 0 Fill in please:
fi�u ae'G�a.11 T r 44;: L "S
r;TihFl;jr�'r,a�;�;,;i1u , APPLICANT'S YOUR NAME/S: N
0K, I I"T1i. � " °p BUSINESS YOUR HOME ADDRESS:,W z.,E.
m•il�f ili=�'k`11��
TELEPHONE # Home Telephone Number op
NAME OF CORPORATION:
NAME OF NEW BUSINESS TYPE OF BUSINESS
IS THIS A HOME OCCUPATI N? � YES NO MAP PARCEL NUMBER Vgg ��� __---- (Assessing)
ADDRESS OF BUSINESS /
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 G R A-Fain St. — (corner of Yarmouth
Rd. &Main Street) to malce sure you have the appropriate permits and licenses required to legally operate your usiness in this town.
1. BUILDING COM SSIONE 'S OFFIC
bAUST COMPLY UILAHT HOME'IO S ®��RE TO N
This individua a i for rf-iEd f y mi e it ments that per into this type of busines .
� � RULES AND REG
Au e i a`-ure COMPLY MAY RESULT IN.FINES.
MMEN S:
/ - /
2. BOARD OF H LTH
This individual h s ee ..infor orte rmit requirements that pertain to this type of business.
uthorized Signatu
COMMENTS:
3. CONSUMER AFFAIRS (LIC441SING AUTHORITY)
This individual h Infprmed of the licensing requirements that pertain to this type of business.
Authori e Signature*
COMMENTS-
. `.. TOWN OF BARNSTABL wi
SEWAGE # -1,9
ASSESSOR'S MAP & LOT 06 -(33
PP4S iALLER'S NAME&PHONE.NO. /' Z
S&n-- TANK CAPACITY ! S dA4rti dFs2� � lY e/
I x
LEACHING FACIL (type) ; " I try rf (size)
NO.-OF.BEDROOMS
BUILDER OR OWNER
`r'EltMT—T.{DATE: COMPLIANCE DATE: 37 !1 'bi
-.e�aratior Distance Between the:
Tia`x muin'?ldjusted Groundwater Table to the Bottom of Leaching Facility Feet
m
Private Water Supply Well and Leaching Facility,(If any wells exist
oar sate or within 200 feet of leaching facility)
_ A !'G' Feet
Edge of Wetland and Leaching Facihty (If any wetlands exist rn `
"within 300 feet of leaching facility)
Fe;rnaslaed,by��,���"S' i,�(�C�..�.�� ��•_ r
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THE COMMONWEALTH OF MASSACHUSETTS `
BOAR® OF HEALTH
TOWN OF BARNSTABLE
ApVliratilan for Disposal Works Toustrnr#iun Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
Location-Address r No
Z1-----------•-----------------•---•-------•---------------. f�9_ :.Sac 1a4... .............................
Owner p" Address
''`/�� •`:=UN�� ..f s ler �U_.J�JY.1.f..Yl,I�M 1J �'A Address
...............................................
d Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms................ .Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers —
a YP g ---------------------------- P (.-•->------.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 ( )
Percolation Test Results Performed by.....................................................................••••• Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water_-___._-_____-__-_.-__-.
fX4 Test Pit No. 2................minutes per inch Depth of.Test Pit...:................ Depth to ground water........................
W -------••-------------------------------------•---------------......--------....-•-•---•----•--•-•--.........................................................
0 Description of Soil------------------------------------------------------------------•-----------•-----------------------•-------•----------------------------------------......_•..-•----
U ---------------•-----------------------•--••---------------------------------------•----------------••----------------------------------•-------------------------------•------------•....--------------
W
U Nature of Re� J
irs or Alterations—Answer when applicable} �.��_Ac�___�Xt d.t p__.Y?'1� �0�..-pup f--C�1 e c�
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE S of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been issued by the bo/ard of health. h
Signed l'.1. �'� ... ........L.��>.'C,................................. c7i ��...
Application Approved ByGz�.-'�... .......... ..... . ..--........ ..... -- t1'° - 2
Date
Application Disapproved for the following reasons: ........................................... .........................................................---------------------------
... ................................ .. .. .. ................................................... .............................. .................................................................. .... D.................................
l� ate
Permit No. -- --....---- Issued ...... `.. ..... �' `...te......
Date
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• � '' +ivo.����:.� I�� Fps_:..`�.."�.....-C��?
THE COMMONWEALTH OF MASSACHUSETTS f
t BOARD OF HEALTH V/
TOWN OF BARNSTABLE
Appl ration for Disposal Works Tonstnution ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
..... _.. .... - .............................
�/ • Location-Address � ��� �r �•
�//f�) 9 Lot Nod./y��,
.....................•__-_____....__..._.._._.........._ _. /__•� -_--....C_.( a/fC ///_ s..�._�._.._..___.............._.
._��..�.__.... ............ ._....__
Owner Address
U� i�t _ off =•-•-•-•....----•-•-••-.........-•--••••... - g Rm, 7
Installer Address
Type of Building Size Lot............................Sq. feet
I—I Dwelling—No. of Bedrooms............... ----Expansion Attic ( ) _ Garbage Grinder ( )
Other—T e of Building -•-•__ No. of persons............................ Showers
a YP g ='------------------- P ( ) — 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.
3 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 Test Pit.................... Depth to ground water--_-_-_-_____-___••____.
f=t Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................
9 ----------------------------------------------------------------------••••--•-•-•---••••._..._------.....••-•-•••------•••••---..............-•-•••••••-
0 Description of Soil---------------------------------------------------------------------------------------------------------------•------------•---....................................
x
w
U Nature of Repairs or Alterations—Answer when applicable��__P!�lK?cP.P i E„A_ Y11a4n1-• .......iipil C'i1nn
---------------------------------•*-------------------- - , •-----------•----•---
_Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been issued by the board of health.
Signed ............/f?�-_)in�/...--- v
� Date
Application Approved BY - -1t ---------- ......--- �� �� ---
I a Z.
Date
Application Disapproved for the following reasons- ------------------------------------------------------------------------------------ --------------------------------------
- -------- ---------------------------------------- ------------------------------------------------------------------------------------------------------------------ ---------------------------------------
Date
-
Permit No. .r 1� r-- ��-Fr----------- Issued -------�----_.. ..4�..."..- 2.
Dare
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
(f.ez#iftcttte of (game inure
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by....................__------------_-_---i� �AC-------------------------------------------------------------------------------------------------------------------------------
Installer
at -----------------------— --- -----i--el.-----u----c------- --------- -,-q S -----------------------------........
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ." .. -.-, 1 dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. )�4_.D
DATE --------------------------------- ------------�--------------------------------------------------- Inspector ---- ------ ---------...........................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
f TOWN .OF BARNSTABLE
FEE......... ..... ._�.-.
Roplasal Works Tontrur#ion rrmi
Permission is hereby granted......... �h: C_••-- 1?Lc ,l 11,J g__-___-_•_
-- -
/ ----------•----___-•-•---------------------------- ------ __..
to Construct ( ) or Repair ( V)11 an Individual Sewage Disposal System
at No......... <...__.A4ja......... /l n
Street
as shown on the application for Disposal Works Construction Pernut Dated__ �- ' -----__:_-*----------
�) Board'of Health
DATE-------- ------------- �`'---------------------•-
FORM 36508 HOBBS Q WARREN.INC.,PUBLISHERS
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� TOWN OF BARNSTABLE � .
LOCATION / i w.
.��� SEWAGE #
VILLAGE �� „ ASSESSOR'S MAP 6i LOTt� -d� -J
INSTALLER'S NAME 6z PHONE NO.
SEPTIC TANK CAPACITY tooU
LEACHING FACILITY:(type)
(size) s
e
NO. OF BEDROOMS PRIVATE WELL O E�WATER
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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:2, c' ,c: jb I-bud fJPJUt a
__•^' Mb1�--.:`��_z_..�.1...gT...F_,��_•.DWWr+ CApa ENGINEEPING :562 ROU
rna`r street rte 6A } fax $08-�362-988
yormouthpurt. moss 02675
I
down cape engineering. Inc.
civil engineers & land su,,�vyvs
LANC COUIRT , FACS V;t.E IRANSNITTA- FOU
SURVEYS ` Sb8 362 98150
i
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t Arne H. Oja;a P.E., Pl.<
SITE P i-AN WNG j TO: e a v1
f FROM: A�i2,44 V 5 Y
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dlrSfGNS
,NSPECiIONS
PERMITS
CLIENT NAVE
Joe#.
NUMBER OF PAGES (INCLUDING COVIrR PAGE;._ — -.-
IF YOU 00 NOT RECEIVE ALL PACES G~ "HIS T,..RAt:SMIS5I0N, PLEASE.
CAI-L 508-362-4541.
MAR-22-02 12:34 PM DOWN CAPE ENGINEERING 508 362 9880 P.01
939 main street ( rte 6A ) tel. 508-362-4541
yarmouthport, mass 02675 fax 508-362-9880
doyen cape engineering, lnc.
civil engineers & land surveyors
LAND COURT. FACSIMILE TRANSMITTAL FORM
SURVEYS 508 362 9880
Arne H. 0 jola P.E., P.L.S.
DATE: O�
SITE PLANNING TO: jrYl I1A
FROM: C�Va Y4
MESSAGE:SEWAGE
DESIGNS SYSX£M _Me jn 5170teg G f�t_ lr.14) c/ /0
c �
INSPECTIONS
f
PERMITS (r .
CLIENT NAME:
JOB#:
NUMBER OF PAGES (INCLUDING COVER PAGE)
f
IF YOU 00 NOT RECEIVE ALL PAGES OF THIS TRANSMISSION, PLEASE
CALL 508-362-4541.
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m ALARM AND CONTROL PANEL
TO BE INSTALLED INSIDE:
BUILDING. ALARM TO BE ON
SEPARATE CIRCUff FROM PUMP RE PIPE TO D'BOX
1000 GAL. H-19=UAL)
Z ALARM ON 800 GAL.+ SLOPE TODRAIN SACK TO PUMP CHAMBER
FLOAT SWffCHRESERVESETTINGS: PUMP ON
4' WORKING RANGE 8_ STEMATE'
4 LE MODELM282 1/2 HP PUMP
l7 PUMP OFF 4R EQUAL)
Z
W
oa�000-- M. ooc�o
w 6' CRUSHED STONE OR
n. COMPACTION
a — WA TER TI GH T
u PUMP CHAMBER a„_ 2-454,
O (NOT TO SCALE) I fax 506-362-9550
a PUMP CHAMBER DESIGN FOR down cape engineering, inc.
n 15 MARSTONS AVENUE, HYANNIS CIVIL ENGINEERS
MARCH 22, 2002 LAND SURVEYORS
939 main at. yarmouth, ma 02875
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TOWN OFPRNSTAB, .
LATION.,. �a 1 „ ,� SEWAGE # '
VILLAG ASSESSOR'S MAP & LOT
INS.TALLER'S NAME&:PHONE No.
SEPTIC TANK CAPACITY. {
LE,3CHING FACILITY: (type) (size)
NO OF.BEDROOMS
BUILDER OR OWNER
F'ERNiITDATE: COMPLIANCE DATE:
i
S paation Distance Between the
Feet -
?ragcimum'Adjusted Groundwater Table.to the Bottom of.Leaching.Facility ,
Pri}ate 4er Supply Well and Leaching Facility (If any wells exist Feet
or 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) -
Urni'shed;by
C ?
A
r ]
TOWN OF BARNSTABLE
LOCATION SEWAGE # 5
V`i LAGE _.ASSESSOR'S MAP & LOT2"-`-3..5'-
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY 1000 A
. LEACHING FACILITY:(type). a/ (size)
NO. OF BEDROOMS PRIVATE WELL O PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED:.
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
`'o
a ,
No..Z....516 /FEB 30.........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliratinn for DiupniFal Worka Tomitrnr#inn 11rrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
.......... �2�.. Nr1/ .
ocation- ,Vdress or No.
--- 7�9c �rf. ...............
wne Address
Installer Address
dype of Building Size Lot............................Sq. feet
U
Dwelling— No. of Bedrooms._ _________.__._Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
44 Other 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 ( )
a Percolation Test Results Performed by-------- ------- ......................................................... Date...................
--------------
Test Pit No. 1________________minutes per inch Depth of Test Pit_----------------- Depth to ground water____---_--________-__--
Gz, Test Pit No. 2................minutes per inch Depth of Test Pit_:-__--..__.______- Depth to ground water........................
a --------------------------------------------------------•-•---------------•-•-•-•------•------------.........................................................
0 Description of Soil........................................................................................................................................................................
x
U --------------••--------••-------•--•-•----•---•-•--------....------•------------------------------------•-.._..._...----•--------•------------• .......................................................
W •••--------------------------- ................................................................................... --------- - ----- -- ---•- ........ -�
UNature of Repairs or lterati —A swer�wvheya applicable---------- -- -- �... _��..
1�
V..... ---- ................. --
Agreefnent: ��
The undersign d agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Complia has been issued y the board f health.
Signed ..... . - ---- .. ... .. ..............................
Dace
Application,Approved By ------------ - - ------- ---- --- --,r =^- 3. ,.`��...� \/J
Date
Application Disapproved for the ollowing y asons. ...... ............_.....J .... --........... .................................... . .. .. .
........ ........... .................................... ----------------------------------------- --------...... . . .................................... -----------:-------------------------
�r//// Dare
Permit No. ...... - /.b--- ----- -- Issued .
3 - - ---------------
Dace
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate of C antpliance
THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by -------------------------------- ---- 1%.P�ta �.. ...:...CY .. !n-.. .rr
�,�` IA fuller !-
at -----------------L� ..t� / -. ---------- 1--......`..___-----------------------------------------------------------------
has been installed in accordance with the provisions cif TITI.E 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ..... dated .` -'.���..�.�1 ....._.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE... ' =, Inspector . --10� ...t.... -
r_
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
No. •• �!�.'. 1� " ..........
BispusaU nrks g rnotrurtion lirrntit
Permission is hereby granted.. _. �!....... ............
:,-y-' `� .
------------------------•-•---
to Construct ( ) or Repair_ ( )fan ndivi ual SewagDisposal System
� Street qq
as shown on the application for Disposal Works Construction Permit No._ .- Sf Dated.... .� ter` .T ..........
Board of Health
DATE.....Z.............- ----
FORM 36508 HOBBS&WARREN,INC.,PUBLISHERS
No. = •-f/� ///fff FEim 3Z. ..........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Apphration for DioVoottl Workg Tongtrnr#inn tIrratit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: .
........... ...... A�/
ocation-Address ✓ �`l� �f��f [/�J�( �]� or Lot�No.
.......................G ...._, .� ! !�...=--------•---------•--•--- ------ _•Z?,e(itil '_.�v�C!_.�?c !f� _!rf-T �� a!_ lt.L!.
_....
F Owners Address
7/ V Installer Address
Type of Building Size Lot............................Sq. feet
U Dwelling— No. of Bed rooms._:-__-�----------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
QOther`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 ( )
Percolation Test Results Performed by-------- ----------------•--•---•-----••---------•...------...-•------••_. Date........................................
a Test Pit No. I................mmutes per Inch Depth of Test Pit__.__--__.____----__ Depth to ground water........................
114 Test Pit No. 2.................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
04 •-•------•-----•------------•--------•----------•---••-----•--------------------•---------------••-•-----------
-------------------
•--------------------------
0 Description of Soil.............................................................................................................................
x
W ............................................................... ---•----•--•------•---••----•----•-•---•-•-•-----•-.....--•..:--••••-•-----•-••••--•----•---------•-------------------------------------
x --„- n ` ................. -
U Nature of Repairs or Alteratltv�swertiwher} a licable. --- �c �!
,� -
Agreement: i(ir�
The undersigned agrees the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system'in operation until a Certificate of Compliance has been issued by the boardpf health. ,r
Signed _ Ci�Q..a ... .. /f . .......... ........ ... .:.... .:1.`�
Dve
Application.Approved By .............. -------- - ',.^ `w-^ ------ ------------/j----------------............ ...........
�'.—. .A
yDace
Application Disapproved for the following axons: ....... . ........... ....._.................................... . ................ ..
... ...............................:.................................. . . ......... . .. ........ . .................._....................... . . ............ ............_. ..
I Dace
Permit No. ----------- .�.......b...14--------------- Issued ------------------�3----�_:.r.-./:�----------_--
P Dace