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HomeMy WebLinkAbout1067 PITCHER'S WAY - Health 1067 Pitcher's�Wa' a Hyari :273 198 ni ;f s i � S �� a A.= - ` � ., ''• �,, fir.. ^, a � r u;�+ , .�:. 'ttFt,. . . I A I II y I i �9 III,. II I p�p P k t No......... `�:�... A THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF.............................................................. ------.........Appliratiun -fur Diupuuttl arks Tonutrurtiun M1 Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Individua ewage Disposal S stem at �� Locati Address � ' or Lot No. YRoSi-- -------- D..... --------------------------------------------- ----• ----- !!!f�?! S �Y c>t ......�i �enl.A4_ VV }� AA� ,�Q�Owner ��f� �,y� Add ss /� / a /-..e �J.?-� !" '!^- ........................•. ........_......--"-..�z' :` `�.. .....!!ld Installer Address d Type of Building Size Lot... ------Sq. feet U Dwelling—No. of Bedrooms..____.__._ --- ------- -------------Expansion Attic ( ) Garbage Grinder (//,4) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( — Cafeteria ( ) Otherfixtures -------------- •-•-•---•--•--••---•---•---••-•----------•----------------------------------------------•-----------=---------------•---- W Design Flow.._.___._.._ ._; `,,�.- 111ons per person per day. Total daily flow-------�-�.. .._.-............gallons. WSeptic Tank Liquid capacity//i-TCgailons Length---------------- Width---------------- Diameter----------.----- Depth.______._.-_--. - x Disposal Trench—No- -------------------- Width-------------------- Total Length----___--___._------ Total leaching-area--------------------sq. ft. Seepage Pit No._/0-000 ii 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........ -----------:... fi Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water---------------------- ---------------- ._ O Description of Soil------ n --`--- x --- .4 x Cr � 1 U Nature 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 NI 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 t board of health.S' ed....... - d`�y� "•�-'7l Dates Application Approved B -- ` -------- Date y Application Disapproved for the following reasons----------------•-------•---------------•-----------------------------••------------_---------------------------- --------------------------------••-••-----••-•-------------------•••••--••-•--•--•-•---•-•---------•-•-••....--•-------------••--•-•...---•-----•--------....---------------------------•----------..--•- Date PermitNo......................................................... Issued...............------.......................---------- Date - THE COMMONWEALTH OF MASSACHUSETTS 4 BOARD OF HEALTH Allpfiraation -for :R!ipo_ai. Works Towitrurtioaa Vrrmit Application,.is.hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at:. ocatiQt --!"Address or Lot No. J)eY - 1 ------- -------------------------------- -•-•�.I.....� w-/�_ ,_ n1v_nA.o---- g.ti A l tee...4 S Owner Add ss - Installer Address Type of Building Size Lot_. `.. _ t ------Sq. feet Dwelling—No. of Bedrooms.-..._......,. .............Expansion Attic ( ) Garbage Grinder ( j `1 Other.•—Type of Building .---........................ No. of persons---------------------------- Showers Cafeteria Qy;. Other fixtures --- ---------- ------- -------------------------------------- -•----.. ..---- .---- .... --------------------------- W Design Flow7.r... ;•> - Mons per person per day. Total daily flow------ `,- '~-...........gallons. T. � ",.Sept, Trench tgtNlocaplcity� ( ��llns Length Total Length. �: -_:Total leaching area_ Depth_ ----sq.'ft. x P g g Z ( ' Diameter............:....... Depth below inlet._..---__-_-........ Total leaching area.....;...._.;-_--sq. ft. Seepage.Pit No.__! t` Other Distribution box d Dosing Yank ( ) 3 -s1 Percolation Test Results,, =,Performed by---------------------- ............. Date-----------_-._....._.__----_._--.---. a Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water.._....-..-_-------_- f ;- Test Pit No. 2................minutes per inch Depth of Test Pit.................--- Depth to ground water....-.---------------- . - ---- - -- -- - ----------------•- p=a. Descri tion'"of Soil x ?sp P U r r-Z-- � �' ' .._ X Nature of lx iterations= swer whenaPlicable ._.. -- -------------------_ ...._. ...Y---- ... _. _--- - U --------------------- •------ •----------- ---- -------- .- ---. - -•--- - --- - ------ .4 Y -Agreement , ,The undersigned, agrees- to install the, aforedescribed Individual Sewage Disposal System in accordance with thi $fovisions of.,Article XI of the State Sanitary Code- The undersigned 4urther agrees:'not,:to place the system in operation until a Certificate of Compliance has been issued by th board of"health. .2 r, Si ed ------ ... ' S' --• f Date Application ARproved B ,,.--_-- y � ' �Application Disapproved for -Jae ollowing reasons: s__.---.-- :..- --•----•---------------•------•-----•------------------........................................................................ ----- ----------------- ------ Date Permit No................... = Issued...................... ( r Date ,F THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH OF............' ...... �: ........................................ . ATrrti�tr�tr � i�anrle 4 THIS IS TO CE TIF , That the Individual Se e D' pos System constructed ( ) or Repaired a raj by:.......................... ----- .,, ' " x . Y - Installer - ,r ` � �- . at 3 -------- ------ ---.....-- -----.....-•--•---------•-------•••..•.. ..-- �' -°�- - ----------- has been installed in accorfllince with,fhe provisions of rticl XI of The State Sanitary de as described in the application for Disposal Works Construction Permit o._ .::.: .: . ............ dated-.-� r.---: •- %. ' TH ,r YQ�E ISSUANCE OF THIS CERTIFICATE SHALL R10T BE CO YRUE® AS A SJ WYE YHAT>THE SYSTE ILL FUN CTI O.N SATISFACTORY. DATI .------ --/------ )-- ------------------------- Inspector Y THE COMMONWEALTH OF MASSACHUSETTS ;•r' BOARD OIF HEALTH "7 ._-�.,.�..r ..... . ......OF.......... ... �� � ................ .................. FEE-------... ..`..... `�-- - %s:p g Work, l rtion rm't Permission ' he by granted---- .....-.-• :, k''aP -.•.-. -_-�j�S. •„-•- ---.--- to Constr or Repair ndividu e age Dispos stem �„� - t�0---- � f -1 ---------- Street as shown on the application for Disposal Works Constru tion Per No. - __.. Dated.--- F ........................ Boar o eal}lth sr DATE-• l .--.. ..7' ----- € , FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - �ti 4 ."-a Y '+•l i¢Ei �p4 .`. x i -•T '`ti''.' ?`S f �, I -r.c rM1 �r � T 1 F �{ 4 �,,...2 t 1 t r h"i y v +l 4 d {.� 2�.f t "d e l -.� x� K` —- r a Y� +4 , F d ice. > T fi x r 5 r�+fly 8 #af ab i �"a e 't t.. s F .? x c} t'` <}M +�,5`u ? �- ti ti {Ke'rt s . 3':' r 5 F t R w ,.,y, P: , t S'. T _5.: -a i:Y +'E ti§ F r,xr„Yfi_1:t n+ x ® �® x x M xfi , ass t' I �, A r - f i L -`? - -:P„ _ " A;. : �, 1.y 1't „�{; 't k '4 yti'I%�ht11 �, �!' �' i 1. 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E,�a3is ' {t � }IDS �! ��.., ..,�:.,.'Co J/a'O� W TO Tf B' �O.c.//ti/Gr� 3 t 14 t #�fi �$I ` .1.ssy o, .yE 'rr�wai of_ 3Ak'N57�9�3 ;; �N ��` ° . d I. ���AV ki z �s 4 y ftii«� ty ! - :.- ' �TT15da ° J y� . -.•1. �Y 6. C° z�W.KK�I. e , _., 1//r r'_4'A/61.VE?0,05 t a t t r : {,ab�s t �+ —7 w t e I.��x u+ .r M1y, M >f ya.7 I Qom:`/ ".�.vt .I'.'/].�.+. xTs Nt xtt1� ,y,,k r4' y k g. y rT ll 44I �4rfir/Q�/ I" ; "Y 955 t:'�11Y`' t,4:. - r't{Y Ci,' t;�' l ii��,'F:.F,t yl^ SEPTIC SYSTEM MUST BE s map gnd lot..-nu mber ..t�../., .'^.•...�•.. _ � �. 0 IN 7' IED ITV •G;OiVIPLIAN(� 0."�C;L �J1/1 T H T 1 i•I' STATE . ..:.................. 'jT*QQ,,AND TOWNSewage � .............. . . .... � �F-TME / �6-;o TOWN OF BA A, s- : , MAHH9TADL8• oo'FaMAYa� BUrILDLHG? IHSPECI'0`in pp , APPLICATION FOR PERMIT TOil.�.�►T / �. � ....; .. ................................ I TYPE OF CONSTRUCTION ... .................fir ..............rE! JQ... ..19. '} TO THE INSPECTOR OF BUILDINGS: ? W i The undersigned hereby applies for a permit according to the following information: p � 6 Location .1...� '`Ls�P ..... .! �y/............... ..Rf '' �r ..... . ProposedUse ..... ....Pre.................................................... ..... i .................................................. Zoning District ,,,., !.......................................................Fire District ....t .y.t l!�. 1... %'A Name of Owner . .. .rPP.............Address ........ L. 'lau'T.! ......��?po).... /�Y� ►lC' .g.............. n I Name of Builder �A, . .! .. ?�. .dt � � edress1...�J.1�»!�'. f �'4..� ' . ..... . 4R.M.A14 S ` Name of Architect .��� ©!e��' ...„/ Q4eC ....Address . ..f................. Number of Rooms ... P.�°,P.4.X �7 (fW 0"#� � Foundation ... ......... Exterior a•Q ..� ... R `` Floors ! .1`� V-' ............................................Interior 1, Heating �.477..tv.,q.T'e ,...........................................Plumbing .......... ........................................... I Fireplace ......�le. .G. . ..........................................................Approximate Cost ... Q 0 ....v......................... ......... Definitive Plan Approved by Planning Board _ —___________19________, Area ..........................., .,�-................ Diagram of Lot and Building with Dimensions Fee ....... �.......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH v�b 3a i PS; Oy6 s, A:6►S°,A ,0 .,� I hereby .agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. p ,� 0L ' ' Lk �. G2� 1 YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $30.00 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.) Business Certificates are available at the Town Clerk's Office, 1st FL , 367 Main Street, Hyannis, MA 02601 (Town Hall). DATE: 0,5106106 Fill in please: APPLICANT'S YOUR NAME: FV9 �or»eS J—, U BUSINESS YOUR HOME ADDRESS: 1O 'rL f F, c-1-vu13 TELEPHONE # Hom6 Telephone Number: =�5©S ?z C,,7, 17 �3G NAME OF NEW BUSINESS , T1PE BUSINESS IS THIS A Fft'�ME OC�ClRATIOt�? 1 1 i NO 1 #I������ta��n given�p�rov�l f�ralxt t�t�bb Ong d�rr�srbn� YES _ l�l ;;::... M r. N1A,P�1'AI�CCI�L IdUNIB�R � �.'' 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 GO TO 200 Main St. — (corner 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 C SIONER'S OFFICE This indi idua h been ' or of any permit requi-Mments that pertain to this type of business. Authorized ature** COMMENTS: ) 2. BOARD OF HEALTH This individual ha inforrped of the permit requirements that pertain to this type of business. . r WU D thori a Signal ure COMMENTS: ** f ec ,0 j -Alaae s rec/a 1-e utrV tm,� r fe ALWr � DMev�vrn+-r; /V.AA Z n1c�� ��u��� �ih�►POy w? V. A qn r' P I n D 3. CONSUMER AFFAIRS (LICENSING AU O TY) This individual been i rmed o re ' n requirements that pertain to this type of business. Authorized Signature** £Y COMMENTS: 4 Date: 5_//o /o tc TOWN OF BARNSTABLE TOXIC AND HAZARDOUS ATERIALS ON-SITE INVENTORY NAME OF BUSINESS: II nw- BUSINESS LOCATION: 106? i t� 'S (,U0.�.r I�(�Q n INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: 508 — 2 3 `1 S 913.. �►„� Q„s;,� CONTACT PERSON: Q EMERGENCY CONTACT TELEPHONE NUMBER: SC9� C�6Z2"?3 6 MSDS ON SITE? TYPE OF BUSINESS: G.i �-►� 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 materials 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) Misc. 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 Misc. 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 Misc. 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 (inc, carbon tetrachloride) NEW USED Any other products with "poison" labels v Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor& furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers P �o,,S)' o I L115, �eSS. ,' (including bleach) Spot removers &cleaning fluids klomeowilevr, NO X 1,fwfrl rr d4' (dry cleaners) , ✓= j(��A- Other cleaning solvents r-IVA Bug and tar removers l Windshield wash ` WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS