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HomeMy WebLinkAbout0694 PITCHER'S WAY - Health } 694 Pitcher's Way ' Hyannis FiR A = 271 175 I z { 1 d d � k Town of Barnstable OF tHE t Regulatory Services Barnstable o Thomas F. Geiler, Director 1imericaiity Public Health Division I I v MASS. g Thomas McKean,Director Zoos �At 1639. A`� 200 Main Street FD MA'S Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 February 25, 2014 Sent Via Certified Mail— 70121010 0000 28511999 Willer S. and Marize S. Pinto 114 Melbourne Rd. . Hyannis, MA 02601 As of October 1, 2006 a new rental registration ordinance was put into affect requiring all property owners of rental units to register.their rental units with the Town of Barnstable Health Division. According to our records, you own the rental property at 694 Pitcher's Way, Hyannis, MA (Map-Parcel: 271-175). Enclosed is an application. Please use a separate application for each rental unit you own. Should you need more applications, they are available online at www.town.barnstable.ma.us. Go to the Health Division page by looking in the Department Menu. There is a link to the Rental Registration information on the Health Division page. You may print out as many as you need, and return them to the Health Division with the appropriate 2013 fee of$90 included. This must be completed within (14) fourteen days of your receipt of this letter. Failure to comply with this ordinance will result in the issuance of a non-criminal ticket citation in the amount of$100. Each day of non-compliance is considered a separate offense. Should you have any questions, please feel free to call 508-862-4644. Thank you in advance for your cooperation. Sarah Donnelly Division Assistant Public Health Division Direct#508-862-4072 I n- ir .. .'" ., Ir r. ' IMMOV r, 1 0 F F ICI cc Postage $ ru Certified Fee O Postmark\<, Return Receipt Fee Here C3 (Endorsement Required) c C3 Fj% C. Restricted Delivery Fee 5 414�` r3 (Endorsement Required) ffff ra r-3 Total Postage&Fees r-q rs ti Sent To.'Wtt'M-_ S + MGLr1•&•e S. Pi•44-D � - - ---------1-------'----------------------------------- -------------- O Street,Apt.No.; D (� �� r- orPOBoxNo. I "I M e t�OOU�(Yl e ►�-(/v City State,ZIP+4 -^ - - 1 � 0 a.coo I - Certified Mail Provides: e A mailing receipt *- , a A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: n Certified Mail may ONLY be combined with First-Class Maile or Priority Mail®. a Certified Mail is not available for any class of international mail. e NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form a811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPSe postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT-Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 OWN ® Complete items 1,2,and 3.Also complete. A. Signature �r� item 4 if Restricted Delivery is desired. X C'Agent m Print your name and address on the reverse ressee so that we can,return the card to you. B. Received by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 1? ❑Yes I 1. Article Addressed to: If YES,enter delivery address below: ❑No Willer S. and Marize S. Pinto 114 Melbourne Rd. ,tAl I Hyannis, MA 02601 ':" s. Service Type if Certified Mail ❑Express Mail ^_T ❑Registered PC Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number ? 7012 1.01--0 1 10000 "88,`5 11 18 (Transfer from service label), PS Form 3811. February 2004 Domestic Return Receipt, 102595-02-.M-1540 UNITED STATES POST!{(ttF CE USt.s I ' Sender: Please print your name, address, and ZiP+4 in this box • I I I Town of Barnstable y Public Health Department 200 Main Street Hyannis, MA 02601 i Tows of Barnstable P as Department of Regulatory Services rwwern»t$ Public Health Division Da te ate A a'6%9. ��P 200 Main Street,Hyannis MA 02601 , Date � `.?'d•. �- � .Scheduled A — Time P Fee d — . Sol Suitability Assessment for Sew zs ®s . q /Performed BY: M Witnessed By: �L 7 LOCATION dui.GENERAL J�ORMA'YION Location Address 6 9'Y �//Ly����e��/ Owner's Name !',A/ Address 16911 oi-16 yeZY U-­4,V Assessor's Map/Parcel oe 7 f — J"I J Engineer's Namc__,�>4l/,O /�I4,SGN NEW CONSTRUCTION REPAIR Telephone# Land Use Slopes(96) i Surface Stones Distances from: Open Water Body ft Possible Wet,rea ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SIff'I'CII:(Street name,dimensions o lot exact locations est holes&Pere.tests,locate wetlands(n proximity to holes) i� Parent material(geologic) Depth to Sedroek Depth to Groundwater. Standing Walerin Hole: Weeping ft'om Pit 1111Ce Estimated Seasonal Haigh Groundwater DEIlH'.1CAIY I A$ION 1L'Old AFL'A,JO AL AJIGHY WATER TABLE -- Method Used: Depth Observed standing in obs.hole; In. Depth to soil trlottles: DcpUi to weeping from side of obs.bole: btt, Oroundwuter Adjustment ft. Index Well Reading Date: 1�gIn7d�exrWelllevellp�p ON TEST _ Adj.C3rtlundwuleY]�Vel�� I. HA R,COLAAkOAV J1EST Date,____,-, 'iIMe Observation I Hole# Tinge at 9" Depth of Pero Time at 6 Start Pre-soak Time @ Time(V-6") End Pre-soak RateMinJinch Site 5uilability Assessment; Site passed Site Pailed: Additional Testing Needed(Y/N) original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***1f percolation test is to be conducted within 100' of wetland,you must lust notify the. Barnstable tC'uservation Division at least one (1) week prior to beginuing. Q:\SEPTll-PERCPORM.DOC DEEP OBSE RVATION ff OLE OG Hole#I Depth from Soil Horizon Soil Texture .Sdil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones;Boulders. 1( onsistencY,g6(3ravell Vik ` a w �� wgf DEEP OBSERVATION H®LV LOG Mole# Depth from Soil Horizon Soil Texture Soil Color Soil, .. Other Surface(in.) (USDA) (Munsell Mottlin g (Structure,Stones,Boulders. onsistengy.% ra el) r ' Al DEEP OBSERVATI®N HOLE LOG Mole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in_) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) DEEP OBSERVATION FILE LOG bole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones.Boulders, Consistency. a 1� f _ Flood Insurance Rate Map: / Above 500 year flood boundary No_ es Witlun 500 year boundary No �' Yes Within 100 year flood boundary No V Yes Depth of Naturally Occurring Pervious Material Does at least.four feet of naturally occurring perviou�- Departmentl exist in all areas observed throughout the area proposed for the soil abso tion system?If not, what is the depth of na rally occurring pervs material?Certification I certify that on (date)I have passed the soil evaluator examination approved by the of Environfriental Protection and that the above analysis was perfo med by me onsistent with . the required training,expert' an ex ri nce described in�10 CIvIIt 15.017. Signature Date Za ZP QAS EPTIC�PERCPORM.DOC f TOWN OF BARNSTABLE / LOCATION, l / G(/ D SEWAGE# ;4!71,V => C>b j . VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME.&PHONE NO.( IIJ�Nd C CD�sI rjD Y— t12v— It i S� SEPTIC TANK CAPACITY /OOU 9 4il" LEACHING FACILITY. (type)*?w9At_ C414M&e5(size) 6f!r,!/,3 NO.OF BEDROOMS,; OWNER /ICE �• v PERMIT DATE: gboli y 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 ��� �������d 0 �� � r � t`' �� 1 1 No. t ' Fee ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 4pl tation for Mispo8ar,,6pStrm Construction Verm t Application for a Permit to Construct 4,� Repair(&<Upgrade( ) Abandon( ) ❑Complete System individual Components Location Address or Lot No.- Fc/ 1,U'1 y Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 4W� _&/ 7$— ` G��/1 dl� v'"`�` 4 191 �U and Tel.No. Installers Name,Address,and Tel.No. /} Designer's Name,Address, /N 1/i O N,�� ?? 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(min.required) �(`7 gpd Design flow provided � gpd Plan Date.- /Z V 1-/ Number of sheets / Revision Date Title Size of Septic Tank 1G2l Type of S.A.S. Description of Soil 'Nature of Repairs or Alterations(Answer when applicable) M ja ;Rfy �e2c�{j�� 7C,^-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 E ironmenta o e and not to place the system in operation until a Certificate of Compliance has been issued by this Boar He th. Si ned Date_351 o / Application Approved by Date 11 Application Disapproved by Date for the following reasons Permit No. ; —Q Date Issued 4 No. I l'�Ll Fee . i THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 1 PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS s 2pprication for Misposai *pstem (Construction 3permit Application for a Permit to Construct(4,�( Repair(lam-Upgrade( ) Abandon( ) ❑Complete System individual Components Location Address or Lot No.6 7v / eR GU y Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No.560rl 0/y® Designer's Name,Address,and Tel.N0�7>4 1/i 0 /A vv Type of Building: Dwelling. No.of Bedrooms , - �-_ ^ Lot Size L� ' '" sq.ft. GarbageGrinder( - Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3C2 gpd Design flow provided gpd Plan Date 7,17 C///L/ Number of sheets / Revision Date " ... Title / Size of Septic Tank Type of S.A.S.C2, Description of Soil P i Nature of Repairs or Alterations(Answer when applicable) 4o, 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 Entironmenta o e and not to place the system in operation until a Certificate of Compliance has been issued by this Board He th. 3 Si tied Date /v Application Approved by Date ,U Application Disapproved by U Date for the following reasons Permit No. 1-) 0-t� - Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constru ed( ) ?,,,4ired(!.-) Upgraded Abandoned by)by 1 /� at � 'y has been constructed in accordance with the provisions of Title 5 and the for /Disposal System Construction Permit No. 6 if Ob dated iv/; Install / /���t / ��'�)/( Q( 4T�% Designer #bedrooms Pj Approved design flow 7v gpd r. The issuance of this permit shall not b co g strued as a guarantee that the s ste '11 nction as desi�ae . Q Date p ,�} hPInsP ecto - ------------ ------------=----- ----------------------------------- -----------------------------------!--//-``----------- No. a �� - o Fee oV THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposar *pstem Construction 3permit Permission is hereby granted to Construct( ) Repair(1-l' Upgrade(�' Abandon( ) System located at V ,4,r&e< AJ.,,/ and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:.Construction 7ust/be completed within three years of the date of this permit. Date 3 l/0f 7 Approved by Town ®f Barnstable oft"E r Regulatory Services Richard V. Scali, Interim Director BARNSTAMASS. * Public Health Division 019. � Alga y°' Thomas McKean, Director 200 Main Street,Hyannis, JTVL A 02601 Office: 508-862-4844 Fay: 508-790-6304 Installer & Design r Certificatiog Form Date: ZI 2oi Sewage Per - - AX sso�-'s 1 Iap�Parcel Designer: `� Van Installer: CILN!t �. Address: �iGhr � �� Address: tiAl �1 L On /o l � - l�l - � ` was issued a permit to install a ( ate) (installer) 1�, septic system at I1 I/based n a design drawn by (address) dated (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in compliance with the terms of th IAA approval letters (if applicable) �����➢ins DAYID sta s Signature �1�t0i j ! o No,1066 a( esi- er's Signature) (Affix Des'b. Here) p PLEASE RETURIN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COINIPLIANCE WILL NOT BE ISSUED UNTIL BOTH TIES FORM AND AS- BUILT yµ�C�A J R D ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. y ` THANK YOU .. Q:\Septic\Designer Certification Form Rev 8-14-13.doc _w p / TOWN OF BARNSTABLE SEWAGE # ®� v� VILLAGE ASSESSOR'S MAP & .OT INSTALLER'S NAME&PHONE NO. �� 1 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) d (size) NO. OF BEDROOMS BUILDER OR OWNER PERMTTDATE: S COMPLIANCE DATE., Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Z 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 h IMP d� `r No. 0'�-'L)�� , Fee 3y� "THE COMMONWEALTH OF MAStSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zippfication for Migogal Opgtem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade�SfAbandon( ) ❑Complete System O Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building .0ee4c" No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow ® gallons per day. Calculated daily flow' gallons. Plan Date 7 - 3_ 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 applicable) 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 place to provisions of Title 5 of the Environmental Code and not 1 th p o p a a system in operation until a Certifi- cate of Compliance has been issued,4 this Board of Health. jZ Signed Date �`� Application Approved by �- Date 2 Application Disapproved for the following reasons Permit No. 7) Date Issued ` .n1M:.- -.. a.-.., �. s..,rr,.r•..,,.,,,.�..-...-rc o..-....,,. .. .. -.v.+r-",.,r'..., -..� ,. . �'TF7 g'w"xq+>.�x..r. ... ,_ �._�.:.x ... . ._ _ w 44 No. Fee THE COMMONWEALTH 6F`I171`A`S�ACHUSETTS Entered in computer: r PUBLIC'H�ALTH�DIVISION - TOWN OF BARNSTABLEs MASSACHUSETTS Yes 0(ppfication for Migool *pztem Conotruction Permit Application for a Permit to Construct( )Repair( )Upgrade�5Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �'0 /� Owner's Name,Address and Tel.No. Assessor'srMap/Pazcel. '00tv. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. <?'/ems dtC".1//o��//� �.�!!//,o '�/�.�J'e•�.. �'.`t'... A- 017 Type of Building: Dwelling No.of Bedrooms `� Lot Size sq.ft. Garbage Grinder( ) Other Type of Building �"c�.J' No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow O gallons per day. Calculated daily flow ©' gallons. Plan Date " 3—cx Number of sheets > Revision Date Title i Size of Septic Tank Type of S.A.S. Description of Soil x .• ���/"�X� ��Y'�� Nature of Repairs or Alterations(Answer when applicable) { Date last inspected: _ { Agreement: z 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 this Boar of Health. Signed f Date Application Approved by , ��_ Date - `2 Application Disapproved for the following reasons t Permit No. C�C�2 Date Issued 25 �V ——— ——————————————————————————————— — " THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded*(*-� Abandoned( )by 0'/^7 at 6'��d D''�Tci4��' llid S/ /5'�y� has been constructed inaccordance with the provisions of Title 5 and the for Disposal System Construction Permit No. C�2-3 2 S dated ?�/ 5 !6� Installer (r/ o" Z edW-Oe4/C Designer ��d/�O .6�.,/��ll✓'ew, �-� The issuance of this permit shalt'not be construed as a guarantee that the ystejmjwill furnctt as designed.Date 12 !C l Inspector . C . 1; �lC�( � , �- - --------------------------------------- No. 2LJAZ) Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS lwiopogal *pgtem Con5truction Permit Permission is hereby granted to Construct( )Repair( )Upgrade Abandon( ) System located at erlp's."' 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. r Date:��2- Approved by ��� `f`.�. - I LO%CAT10N6' _ rs/ SEWAGE PERMIT NO.. VI LlAG.E INSTALLER'S NAME & ADDRESS B :UtLDE R OR OWNER DATE IERMIT ISSUED DATE COMPLIANCE ISSUED Q 1� v � t� to .. ♦'/fit No..............9..r®..... Fad.... .................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Application -fur Ui!ipmal 10orkii Tomitrurtiuu Van it Application is hereby"made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: o A essf ors Lot No. �/ knstaller er ...------ Address Address d Type of Buildit , Size Lot-_------------------------Sq. fe t U Dwelling—No. of Bedrooms..........3...................... ---_.Expansion Attic ( ) Garbage Grinder ( � aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures -------------------------------- w Design Flow........�f�= ______________gallons per person per day. Total daily flow._.._..____...__ ...._._...._......gallons. WSeptic Tank—Liquid capacity./d_- galions Length---------------- Width---------------- Diameter__.._........... Depth..-.--_--_.--_. x Disposal Trench—No. ..................... Width----------------- - ,T/otal Length_-_-__---_---.._-__ Total leaching area--------------------sq. ft. 3 Seepage Pit No..,/�--_-_--__ Diameterj G'._P 1 below inlet ____ ___________ Total leaching area.......-----------sq. ft. z Other Distribution box ( ) Dosing nk ( ) �� °��` ' �7' f-77 ~' Percolation Test Results Performed by.... l�_ ....'-._ .�_ _.emu!✓................. Date_-_ _ .L_ ..`_7 __.___.___.. ,4 Test Pit No. 1----------------minutes per inch Depth of Test lt__----_____----_--. Depth to ground water.._-_-__.-.--_----..___. (14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--.-.----__---_---.-___. 04 ......................................................................................-...................................................................... 0 Description of Soil----------------------------------------------------------•----I---•---------------------------------------------------------------------------------------------------- x w VNature of Repairs or Alterations—Answer when applicable.._________________________-____.._.---_.---_.-.-_--_..-..-_-__-----.--._._-_--.--.-_---- . -----------------------------•..._........----•--•--•--•-------•-----------.._._..----•-_-------•----------------••---- ---------••--------------------------•------------- ---------------------­---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary 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 ......... .l��ll -Gcp----- -------------------- Date Application Approved By-------------------- - ------ -- ------ -------------------- - .7.7._..._ Date Application Disapproved for the following reasons_________________________________________________ t Date -' L/ '� � � Permit No......................................................... Issued.-� --------------------------------------------- Date K FEs...fj................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH k OF...... . .. / / r Appliratiun -for Binpniittl lVorks Tonstrnrtinn Prrinit Application is hereby'made'for a Permit to Construct ( ) or Repair ( } an Individual Sewage. 'Disposal System at Location-Address .................. .............................................--ot No.---•--•----------------------- -•-- � or Lot............................................ i i (owner - ••-Address w ............ ----- ,: � c_ ���, f .?' __Inst511er Address - Type of Buildit ,. Size Lot--.-___---_---•-__.-______Sq. fe t =No. of Bedrooms__________ ________________________________Expansion Attic ( ) Garbage Grinder Dwelling P4 Other—Type of Building __________________________ No. of persons..._____----_-------______ Showers ( ) — Cafeteria ( ) d Other fixtures -----------------:_---------------------------------- W Design Flow-------- !=__;..........................gallons per person per day. Total daily flow.................:-------------------.......gallons. WSeptic Tatik—Liquid capacity-r__:+nu_gallons Length---------------- Width_-----......... Diameter-------....----- Depth_____--__.-.._- xDisposal Trench—No. .................... V idth-------------------- Total Length------------------ Total leaching area::._--.___---..__-_-sq. ft. Seepage Pit. No...Z.-n.__-------- Diameter `fir+A�.__-?'�A Depth belo inle _--yy Total leaching areai____________ ____sq. it. Z Other Distribution box.( ) Dosing)an ( ) / T lf" �" �"r77 Percolation Test Results Performed by. - +..'- (� .G __________________ Date.. _'_-'_j_�'7� a a Test Pit No. 1--_--________-_minutes per inch Depth of Test I it_______________:-. Depth.to ground water........................ 44 Test Pit No. 2-----------_____minutes per inch Depth of Test Pit.-.___.__---_.---_-_ Depth to ground water-----------.------------ +, W ------------------- ---------------------- -•---.•---- •-------------------------- Description of Soil..-"`-------•----••---•--------•----------------•----- -------- •--- ---- ----- - - ---- ---•- - - ------------•- U -------•---------=--------------------------------•--..--------•---------•------•-------------------------•-------- . W UNature offRepairs or Alterations—Answer when applicable..........................:....:......---..._.--_..•-__--.__._._.___----..--_._-..-.._-..__-.. ---------------------------------------------------- -------- Agreement: -The undersigted agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the..>State Sanitary 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. /',acf-fir!i/ r .:i,., Signed ----- -- -------------------------------- Date Apphcattoia .Approved By. Date . � -- --- _`. / Application Disapproved for the following reasons_____________________________________________________________________ r -------------- ---------- Date Permit No. --------=------ Issued �'`" Z. ..-_...._...... Date THE COMMONWEALTH OF,MASSACHUSETTS BOARD 0-17— HEALTH . ..f• /... O F. . ...... ....:....f:..:........._............,..................................... Trrtif irate of 0.1,11mplianrr THIS,IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) �-}} �InstalFer ,r at......................... -- -----------..........................` /c s .c f ,.0 'i• r, -'�*'.�' �r .... 7...................... has been installed in accordance with the provisions of Ta lci e XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit N,.. __�9_ #____ ____________- dated...__9-_i�/__7"'/--„..._.__......_......... T14t ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM"WILL FUNCTION SATISFACTORY. DATE --Z ................................... Inspector------ .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF .HEALTH ............... . OF........ No...............•-•-•---- ` ,. FEE--- . .... �i��n�tt� k�/�>�n�trurtinn �rrntit Permission is hereby granted _..-..----•-----•-------------------------------------------------------------------------.......... to Construct ( ) or Repair (, )-a Individual Sewage Disposal System, at No �., •----•-•-•------------------------------•-------------•--^-------••---•-•---......_........._... Street ------•------------•--•--------•---------•-----•--•--`--------- as shown on the application for Disposal:Works Construction P rt N/____�o;ad ` Dated._Q� /`7 '...................(� t DATE........_/•- .--2- FORM 1255 'i4oees & WARREN, INC.. PUBLISHERS - '_6 t k u yJ G Cut.. C, G'cau v D 1000 G,AI 6 ICUU V D� /yi N fox lU _ ids'S7 >r 4 J` ILLIAM ChG� o� W 4`. m ,P No. 19334 �ClST'c�`i SUR CE�T►F 1�t� p l.bT Pam.!-iU LOC.ATIoV-t 1 CMIZT%r-,-( T"AT T(-AG Pe.,U►• VA11U1L)Su,3,,u►J �t_A►.1 1Z��GIZi=�.1G t-t�Q C zS�J GCaN\PL'-el._ W I TN T1-G 51 DS,Li"E-- A.uC> SCTV-NACK VrQUilZENti="TS oF= T"e G �T -TOvi Q o L C t j 1©ZAA) A300,< 30 2 M/ �7 Z REGIS'[r-_jZr.D LAWC> SUev�YoszS 7N15 DC._Aw IS LIOT SASE't' v"4 A" OSTE�'�/tit t✓ o MASS. t►.lSCeux"'EtJT Suety-,— i -v4c= 1,14cujLl=, APPLI GA► .iT ���� lrUiDE_ �c�L! �c�, t,,bT BG� USC-0 TO De:rc_.v_Mi%jt: t_o-V LiWaS D��IGr.i �tS,TA st�tG�.�. t✓o,nnt��! - 3 8t�tzt�o�vC - d too GAtZn,o&�� Grci,_ E4Z- -% So(55—1 2 0[= r L�•tu,-e = IIC> -4 3 = S-4Cb G•P•t?• S�P`t'tc TA-+�liL = 33oJ iSc % � d-95 6.Rn. USi=- tOc>c) GAL-. ,�15Po<AL PIT - t�SE.. lOoo Gam., AV-EA = t SD BVT-7-oi(A AeELJ%.T Sd Sr--. SD SsF. )c t -C> - ra0 G.PD. To-r'AL -V) d2S G.Qa. L�-f = 330 6.PD. ,� vt✓izG�L�-t'lc. t,l z&7-E : CIO Smiu orc LEss.- 4 Tot' �Na = �oo.o T�sT �• HOLD"' ..ivies••/� � 4. PPE f o�v tLW. :n _z Su83Vi 4'PP� DIST. IW. GAL. q�•7 .••. -Box 91,4 Sertc tom" iuv. f ) -rAP4 S loo0 5 � l,Nv t�ry i /•� .GAL. 9�.() iJ p t3 Pl T ' e' WASHED C EIZTCF'IC,D P LL~T P>L. A.V-1 F oF-t>✓E: taCnTtol-A 4��l�►JtvIS, l�A..SS r U u o Sc CmlzTtF,{ Tt4AT- TPA 5uotic!u - A 1Z i==Pet.IcC ' t-1 ;Punt-1 G��ylnL�<S V tTt-t Tt-t 51De.t_1►- L At.lt� SETt�/�C1G K'C-Q�.11�E��-+-tTS ot= TNt" � Ash F3CX�K �U 2 PAGE Ct Z �'a w t,! or=' tZCGIS'Cr izr-i t-j•, JG ;UC�l� Tt4tr oFc=,T t-�, 7►Icww ��,t�t .t cA.t-J-r` C A A� \!U I DE De-U t.lC�r (5t= ue7>cC) TO TOWN OF BARNSTABLE Date: TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: G oe C- 1q✓ if C%.,4\jl C !J BUSINESS LOCATION: INVENTORY MAILING ADDRESS: TOTAL AMOUNT- TELEPHONE NUMBER: o — G Z — v — CONTACT PERSON: r A EMERGENCY CONTACT TELEPHON NUMBER: -5,06- Co e 7— O -0 MSDS ON SITE? TYPE OF BUSINESS: C/d Al; . 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): 17, Metal polishes I Laundry soil &stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers 'L Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINES �- Applid nt' gnature Staff's Initials C. �::ii.� .a?�.,+_,.� �.?•.: .3a•�in�'�1G'•xw'•�Mlf +." ..' n. �..�. '�, ,1 .. n �.'�k,�S.rs,.<'u•t\f`}''�1 1 ``�'- ' TOWN OF BARNSTABLE BOARD OF HEALTH `"' ARTICLE I1:MINIMUM STANDARDS FOR HUMAN HABITATI N UL),] l iJ Date Owner P'I^ V Tenant Address "����r ����J° �i�1✓I A! i Address Compliance Remarks or Regulation# Yes No Recommendations 2. Kitchen Facilities 3. Bathroom Facilities A. Water Supply ' 5. Hot Water Facilities 6. Heating Facilities Pew iUv 09n• ? � 4-0 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities N Cd rju]p 4,(( 10. Curtailment of Service i 11. Space and Use ! 12. Exits 13. Installation and Maintenance of Structural ` Elements U(,QI IA. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal l-(nr�,q ry S� r! .P a- �Q 16. Disposal Sewa a Dis 9 P Sp�c a 6 u2- 3)S 3 ZoC. 17. Temporary Housing C��� �'`7 L !�r.yP ,/14 i J PART 11 " 37. Placarding of Condemned Dwelling; /G - Removal of Occupants; Demolition / Person(s) Interviewed Inspector T / If Public Building such as Store or Hotel/Motel specify here Wx / TOWN OF BARNSTABLE LOCATION o p��/��� L-t-� SEWAGE # VILLAGE %d�i�° ASSESSOR'S MAP & LOT �/ 9� INSTALLER'S NAME&PHONE NO. L7/1* SEPTIC TANK CAPACITY �G'o � - 4g LEACHING FACILITY: (type) NO. OF BEDROOMS BUILDER OR OWNER 45> "22e, PERMIT DATE: CO*PLIANCE DATE: Separation Distance Between,the: Feet Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility i 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 i5reAVc�: L .p �� ------------- 1 2 ASSESSORS MAP: 1 v� TEST HOLE 'LOGS _ PARCEL: _ FLOOD ZONE: �' SOIL EVALUATOR : WI TNESS vc AvvbvAipvulb REFERENCE: (QQ1 `�. ..w2Z ATE: t - - C7C-i ._ _P. _ ✓ _p_.� :y' PERCOLATION RATE yJ - TH I - k LO �L } lob LOCATION MAP -- - -- - t - r ; I . r s , S I1 a W m z 7z SEPTIC SYSTEM DESIGN U a ICI FLOW ESTIMATE -7 f 2 p ! LBEDROOMS AT �� GAL/DAY/BEDROOM - 'J30 GAL/DAY L - L a : / SEPTIC WANK GAL/DAY x 2 DAYS - GAL USE IC00 GALLON SEPT I C TANK -(f�lt CIL-0 _. SOIL ABSORPTI ON p STEM - ^: .. III �j j "J ��✓".r.�I }� Ya'EOUVJram 6 0064E sc y LA � . SIDE AREA: 29 `� �( x saF�o 1orF . f BOTTOM AREA: �� I . x I *r r 1 t SEPTIC SYSTEM SECTION C1 It,,K1. (� l t b GAL ��✓` D-BOXY 50 ,55 SEPTIC TANK: � �p1L � 166 d5- Dr- I off '` r° Z 110,4 �D 1�6 SITE AND SEWAGE PLAN is5- r __..._.____._.W_ °t►Ii . r �,^ I dvU t�►.a�Li�- _.__ _4. _ LOCAT ION : Cr �$ -___ -__ CAI PREPARED FOR : (dl( ; �,p \`\•. (w.. �``�� SCALE �j r �' DAV I D B . MASON � DATE : Z z o . ° `�� U1 V 0 DESIGNS < � DBC EN IR NMEN AL E IGNS W DATE HEALTH AGENT EAST SANDWICH . MA ( S08 ) 833- 2I77 ASSESSORS MAP : i ' TEST HOLE,L E LOGS G S .___..:._ PARCEL : � �I� _.- . _ SOIL EVALUATOR : i C I � . FLOOD ZONE: t� � D(�C�� C/ WITNESS :TN E 5 5 • � � ���"� �� L�� � t--�_ y „�►� REFERENCE: \ 'G Z� ATE: 1�► �� � / �'�,/ ___ �_ ___._ . . :..- PERCOLATION .RATE. �) _ I� U , ✓ - a r e Iw 1 wo r lb "X_ it�l LOCATION MAP (,r- �� �'� 4r _..._. ._.._........ __. _.._....... . .._._.�..... __. ear. w � �,aOV 121 r ' 2G l�o ��_.�__Tv .- okTW4 SEPT I C SYSTEM DES I G N ._._._ U r_ M Poi- tir s� 'FL01:d ES'a i MA`S E 77) BEDFOOMS AT !(0 GAL/DAY/BEDROOM - GAL/DAY Q' SEPTIC 'TANK • \ �(A �GAI.JDAY x 2 DAYS GAL USE i '0 GALLON SEPTIC TANK1G15"I1 r . _ AF / I SOIL AB ORPT ',N SYSTEM Ip ►x , � ��'L o 0 S/ Co �/ 1 Y DE AREA: -. BOTTOM AREA: � . S, PT I C SYSTEM SECT I ON -� Xw- Noe r A . _ D-BOX , II /tea GAL SEPTIC TANKS _- - UAV to 1�( lb ' i SITE AND SEWAGE PLAN / /� Q'/� , :. _ `h"'rr,re ,.n•+,.•.,: ' ,I T;r.,,,?" , ' 1 iJ� `�I����" ,•V l! �- s! LOCATION . ti PREPARED FOR : MA- 0 � SCALE• � DAV I D B . MA50N DATE: 5 D DBC ENVIRONMENTAL DESIGNS v EAST SANDWICH . MA W DATE HEALTH AGENT ( 508 ) 833- 2177 W