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Home My WebLink About0388 SEA STREET - Health 388 SEA STREET,H A=306. 182 S-. A ;INN k / i V t 1 I V f 3�I i i w y i 7 v 1 h 03nSsl 13NVI1dw03 3IVO 03ASS1 11MV34 31V0 M NAAO VO V 3 01-I n S 1 SS3VdOV 9 AM rN S4311 V1SN1 ,Z,00000e 3 9 V 111 A •ON 11MV3d 39VM3S. N.011V901 Town of Barnstable Inspectional Services °"RN MAS& Public Health Division 1639. A�0 . Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Fax: 508-790-6304 Office: 508-862-4644 AFFADAVIT FOR A BED AND BREAKFAST PERMIT EXEMPTION FORM Name of Bed and Breakfast: Address: Telephone: Name of Owner: Telephone Number: As Per 2013 Food Code, State Sanitary Code MA Regulations for Minimum Standards for Food Establishment, Chapter X- 105 CMR 590.001 (C)(1) and can be found on website: https://www.mass.gov/regulations/105-CMR-59000-state-sanitary-code- chapter-x-minimum-sanitation-standards-for-food I attest I am qualified for a Bed and Breakfast Permit Exemption because I meet the following criteria: ❑ Owner Occupied ❑ Available guest bedrooms does not exceed 6 ❑ Number of guests does not exceed 18 ❑ Breakfast is the only meal offered ❑ The owner/operator is responsible for ensuring all consumers of this establishment are informed by statements contained in the published advertisements, mailed brochures, and placards posted at the registration area that the food is prepared in a kitchen that is NOT REGULATED/NOR INSPECTED by the FC-regulatory authority. Signature of Applicant: C \Ij �j Date: / / ��v� �' Q f,��,�h Q\Application Forms\Bed and Breakfast Exempt 2019.doc LOCATION � SEWAGE U RMI T O�® VILLAGE I A & B CESSPOOL SERVICE 128 BISHOPS TERRACE, HYANNIS, MA 02601 BUILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED / Q ry pp ro /o `a oV_� � a / QA • l"� s h Tow o��ABL�'��G"�°`� �� TION - 9/SEW VILLAGE ASSESSOR'S M INSTALLER'S NAME PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) a. s' NO. OF BEDROOMS- PRIVATE WELL OR PUBLIC WATER , BUILDER OR OWNER DATE PERMIT ISSUED: '3 z DATE COZIPLIANCE ISSUED: f 2. `6 Y VARIANCE GRANTED: Yes No e"� ��. �""� \�"`� � � ., r4 ,� � ® R9 �� . °'� ��P. ,, THE COMMONWEALTH OF MASSACHUSETTS Fing BOARD OF HEALTH . �.�...............OF...-..... . .. ... ........ ...... ......................................... Appliration for Dhopoiittl Workii Tonstrur#'ton Vernfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Systat_ ..S��.... -- .........4?.. .......yt �= 6............................................................................ Location-Address or Lot No. ............ ....... -----•--------------- --- -•--- -- .................. ..............--- W .ie+�...f.... nY ---'--- -•-"............ Ad.. ....�;.� ....� Y s Address d T of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms---- ..................................Expansion Attic ( ) Garbage Grinder aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria a' 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..................... iameter.................... Depth below inle...... ......... Total leaching area..................sq. ft. z Other Distribution box ( � Dosing tank ( ) ►-' Percolation Test Results Performed by-----------------------------------------------------------------•-•--•-• Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �+ •------------------------------------------------------------------------------------------------------------------------------------------------------------ ODescription of Soil.................................................................----------.....----------------------------------------------------------------------------------.---•- U -••---•••••-•-•--•-•----••••-•--•--•••.......-•-•-•----••--•-•................•---..........:--•••••--•-•---•---•---••••--•-•-•--•--••---•-•--••--••--•••-----•-•••---•••-•-•-'---•--•--•-----•---•..... W ••••••-----------•--------------•-------••----•-•-••---------•••------•-•--•--------•••-------•--•--••-•-------•------•_'0-1-' --------[---------.. .................................. UNature of Repairs or Alterations—Answer when applicable---------- --- -----------------•-•-•• -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------••--••- Agreement: The undersigned agrees to install the aforedescrib Individual Sewage Disposal System in accordance with the provisions of TIT1 4, 5 of the State Sanitary Code The undersigned further a ees not to place the system in operation until a Certificate of Compliance has been issu by t e board health. Signed..........--'.-• •-- ...................... . ............... Date Application Approved By......... � ..... . ..---------------------------------------- .................. ............ Date Application Disapproved for the following reasons-..............................................................................................................- ..............••-••.............-------••--•-••--••--•••-••---...............-••'-•----.............-'---••------•-----••---••--•--._........••....••-•••-•-••--•-•--••••---•••------•-•-•-••-------•--- Date PermitNo.... ------------------------------ Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........................OF.......................................................................................... .Z ppliration for Disposal Works Tonstrartiqu errant Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst t ............. Location-Address or Lot No. ... .. . . .. .. . alter Address 2 T of Building Size Lot............................Sq. feet ,., Dwelling—No. of Bedrooms.....2.................................Expansion Attic ( ) Garbage Grinder `4 Other—Type e of Building No. of persons............................ Showers P. yP g ----•-••---•---------------- P ( ) — Cafetena (ll,*.i a' Other fixtures --------------------------•-•••--•-----•---------- - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid'capacity_1A�t?.gallons Length................ Width................ Diameter................ Dept h................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area...................sq. ft. Seepage Pit No................. iameter.................... Depth below inl ...... Total leaching area.................sq. ft. Z Other Distribution box ( Dosing tank ~" Percolation Test Results Performed by.................................................... .................... Date........................................ Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water,......................... (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 -•---•••---•------------------------------------•--•••-••--•------•-......------•---........._....--......................................................... 0 Description of Soil........................................................................................................................................................................ W ---•------------ ----------------•------------------------------------------------...._---•---.._..._._.....----------- " ..... �.... �.. U Nature of Repairs or Alterations—Answer when applicable............. �- .. ....-----•---•---------------------------•--------...--•----..._...........-----.........._....... Agreement: The undersigned agrees to install the aforedescribe Individual Sewage Disposal System.in accordance with the provisions of TITLE 5 of the State Sanitary Code The undersigned further ees not to place the system in en operation until a Certificate of Compliance has be issu l by t boar health. rs Signed...... ......)L-- --•-----�-..---`- -''-� ............. ..........................-.... -� Date ApplicationApproved By.......... �-- -.?__ 'V .. . .. - s::'.L`.................................. ........................................ � Date Application Disapproved for the following reasons:........................................................................................................... --------------------------------••---...........------------------...............-----........------........-------......._..----••----------------...----------------...--•------••---...----••-_...-- Date PermitNo......................................................... Issued...................................................... ... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH R� s 6�-( ..................F4d.n.:3........OF..........�!.r: ..+x:�:..................................................... Trrtif irate of Toutplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by...................` ,. hk..P �..... �� ....................................................................................................... ._...._ Installer at................. .%!..�.....S x vt.----7 ............ ..--------------------..._...._..._..-----...-------•--------•---•--......--•---.......--------- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No........_Yj__l-, .__. ..... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...............................�e. .�..' .` ......................_ I Inspector.............. _....�...---....---•----...................__.._____.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH l9 .a..........OF........... 1,_tc...;,;....ca.....x...;(' Disposal Works Tonstrudion Prrntit Permission is hereby granted. C�l ...f yeti., � .........................................................................___. to Construct ( ) or Repair (�,a an Individual Sewage Disposal System atNo................. 2.2....... .. ..... ._7^_..._..: 1..�, .�.._� = ............. V street as shown on the application for Disposal Works Construction Permit No.,/ ._ Dated.......................................... ........................•-•--- --:.., ....................................................... Board of Health DATE........................ .r•`•gr•---•----•--•----........ FORM 1255 A. M. SULKIN, INC., BOSTON I I 0 Cz 1 rc, 00 f L O C AT ION SEWAGE PERMIT NO. 0 VILLAGE 3c%— P- INSTALLER'S NAME i ADDRESS R UILDEit Olt OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �� \ L i i a E1 � � I / No...._79r .� Fi$...t5-,_Q9........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......................T.own..-....OF.....-..Barnstable Applira#ion for Uiipnsal Works Tomitrurtiun ami# Application is hereby made for a Permit to Construct ( ) or Repair -( X) an Individual Sewage Disposal System at: 388 Sea St. . ................_...----...--• ... .......................--........... ........._.....--••---•••-------....•---------•--------------......_...................-__•---•--- L tcation-Address William Warbur on 3 88 Sea St 1, H alftS, G 02601 a A & B_ Cesspool Service 128 Bishops Teiae, Hyannis, 02601 ............................... Installer Address 00 e, . Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms..........................Q._...............Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons.............2............ Showers — Cafeteria Q, Other fixtures -------------------------------- - W Design Flow............................................gallons per person per day. Total daily flow......................._.................... gallons. WSeptic Tank—Liquids capacity............gallons Length_............. Width................ Diameter................ Depth.... 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........................................ aTest Pit No. 1................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........................ R+' •------------------------------••--------•-------•----•----._.......--------........--•-----.....---......................................................... 0 Description of Soil......................Sand....................................................................................................................................... W ----•---------------------------------------------------------•----•----•-------------•-------•---------•------•--•----------------------------------------•-------....__....-----•--------------:----- U Nature of Repairs or Alterations—Answer when applicable__._Installaz .l0--- Of ... 1-x000 ,311011 _- .st.one- packed...le_ach.pig----�.ve.rflaw.)..------------------------ -------- -------- --------------------- -------- ---------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITL v 5 of the State Sanitary Code—The undersi ned further agrees not to place the system in operation until a Certificate of Compliance has been issued the iealth. Sig .....5�14�7-2- Application Approved By..._--.... ___ ..r 5.�#e�79 Date Application Disapproved for the following reasons:.............................................................................................................. _ ----:...-•----•----------------------•--•---•---------------•---------------------------•---•-=-----•------••-•---------•--•----•-•---------------•---•--•------------•-----•-•----------------..._...._ Date Permit No.....79'....................... 5/14/-9 Issued •-----• --- - ,. Date f } t No....'j.�[: ...!ifif r� >„�Fps .._$5.00............... {u;••.-._,:, THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town OF AsrnsUble ........ ....... .......---......... .......................................---------- ................................... ApplirFa#inn for Disposal Works Tonstrnrtinn Prrmit Appl>cation„,i, hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage. Disposal System'at 388 Sty 8t% �...HX.......................................................nit......... .. --.......--•----•-•- •••--•._ .. _. 1l � Ul {_ rc�caotnn-Address 388 Sea St. � dMi s 0260 ........................... ........ .............................................. ........ w A & B CesePool Sg?ViGe : 128 Bishops Te ��5_e_ . �,Hya4njs, 0�2601 Installer Address Type of Building Size Lot............................Sq. feet 1 a Dwelling—N;o, of Bedrooms___________---------------4----------------Expansion Attic ( ) Garbage Grinder ( j p-I Other—Typefof Building ____________________________ No. of persons..............2_........... Showers ( ) Cafeteria Otherfixtures -----------------••----••-•-•--•------••------ W Design Flow........... :..............................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—j 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 ( ) '-q Percolation TestrResults Performed by........................................................................._ Date........................................ 4 Test Pit 1A. I________________minutes per inch Depth of Test Pit.................... Depth to ground 'water........................ a . Test; it No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 1 - _--------------------------•-••---...__ __-------------- _-__------------------ _._.............. ........................................ O Description of Soil-•----------------..a�....................................................................................................................................... V ...---•---------------- -- -----------•-•••--------------•-------•------------ •. - UW •- .....-.-... ----------•-- Nature of Repairs or Alterations Answer when applicable-_-; PtSllatiG!1---Of--a.. --------..................................................... V �l Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TiT?_.��' 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued the o iealth. @a 4 ¢ .v'/14/C / Sig _. '' '�" Application Approved By---- --- --- - --- ! -/ �e/�9---------------------------- Date9 Application Disapproved for the following reasons:---...---•-• ........................................................... --•--••...................................••-----T..---------------------...---•-------•--•-•---•------------------ .........................................................•........................ Date 5/14/79 ' PermitNo.....?9' ___---------------------------------------- IssuecL...................................................... Date THE,COMMONNVEALTH OF MASSACHUSETTS BOARD OF HEALTH .. �ilE ........�OF..................BarntttablE3............................................................ • � �rr#ifirtt#le of f�nnt�rli�anre H S S TO CERTIFY That the In a e 2 e Dis e co Repaired 3 Cesspool Service, ` ps ', t' iA*j b ............................................................. ......... ......... .••---... ........- ---•----•• -••• •----- .._.__... ....-•---- •---•-- '•-_.. .._...... 388 Sea St e g r gyannis, 02601 ---i ll is W-arbnrton,, at..............................................--- ---------•---__----- --•-••-•- - -------- --•----- --------- ....................................................... has been installed in accordance with the provisions of TI" S of T}e State:Sanitary C.deb s. bed in the application for Disposal Works Construction Permit No ......... /--___.______� dated------ --- 4 ___________________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® 4,S A giUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 79 5/ DATE—.- ...._ -�.-•---4/ .................................. Inspector THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH °19-9Z�f Town........OF.............BW"table ....•---•............... No. 95,CC ........... .................- FEE ... ......... Disposal Works TUnns1r ion 'FarAit Permission is hereby granted &-__B__.Cesspool S�erv'ice. I2Bishopo lei'. . . Hyannis •---•- ------• -.. ....... .. to ConsNt or ,air div wa am.Disp � t ' at No . S a, , , 1jWarbu on -- � ................................................ ........•-•...._._..._...------.. -- ••--•-•••••---•--- -------- Street as shown on the application for Disposal Works Construction mit 79"c______ Dated..-5/ ___________________ �. ........................ ar o�lt DATE /l �?9 FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS 7 .