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Financial Services
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805 W. Main St. 6/15/2010
BARNSTABLE PUBLIC SCHOOLS
ELAINE GRACE /FACILITIES COORDINATOR
P.O. BOX 955,HYANNIS,MA 02601
508 790-6374,FAX 508 790-6431
FACILITIES USE APPLICATION
Please check the desired schools below: Please check the facilities desired below:
A,' Barnstable High School ❑ Performance Center
- ❑ Barnstable Middle School Hyannis ❑ Auditorium
❑ Barnstable Middle School MM W Gymnasium
❑ BWB Elementary ®' Field House ' Rath o►
❑ Centerville Elementary ❑ Library
❑ Cotuit Elementary ❑ Lobby
❑ Grade 5 School ❑ Computer Lab
❑ Hyannis East Elementary ❑ Cafeteria
❑ Hyannis West Elementary ❑ Classroom#
❑ Marston Mills Elementary ❑ Parking Lot
❑ Marstons Mills East Elementary ❑ Bathrooms
❑ Osterville Elementary ❑ Showers
❑ Osterville Bay Elementary ❑ Band/Music Room
❑ Other Other I_jZAC,k ♦ ConteSS(Orl S-Oa+nc�
Intended Use of Facility:S AeC�j Uty&jj7jCS ;1 nuo_j 0kC '♦ VA)
Date(s)of Use: S4T. MA I Ya-, 20O8
(Write Season for regular usage,then day of week)
Time: From %aM To: (Please include set-up/and clean-up time in request.)
"Number in group or expected attendance: .500
(� !Vnn MFIC.s
Group or Affiliate: c��1C Cl Oa�
Address: 'SOS WeST 14cLin 5+ , NoLww!;, MAr
Contact Person: Y 71A t Telephone: 11 b 32
Fax:
Alternate Contact: Telephone: 5o8'737-
*Please include a non-profit certificate if you would like your group to be recognized as a non-
profit user. A certificate of insurance liability may also be requ'
Will donations,admission,or a fee be charged?(circle): YES .if,yes, $
Have you or your groups used school facili is
the past? (circle): YES NO
Applicant Signature: Date: ZV 104F
2
P
Town of Barnstable
�DFtHE Tp�
ti Regulatory Services
t sazuvsrnsM ; Thomas F. Geiler, Director
039. ,�� Public Health Division
TFD A1A'1 A .
• Thomas McKean, Director
200 Main Street, Hyannis, MA 02.601 .
Office: 508-862-4644 Fax: 508-790-6304
MAIL TO:TOWN OF BARNSTABLE
PUBLIC HEALTH DIVISION
200 MAIN STREET
HYANNIS,MA 02601
FAX 508 790-6304
Please include copies food sanitation training certificate(e.g.
ServSafe)of the personnel serving meals at the event and,if the base
of operations is in a city or town other than Barnstable,you must
include a copy of a Valid Food Establishment Permit from that City.
CATERER
NOTIFICATION OF EVENT
DATE ' C�
CHECK THOSE THAT APPLY: Single Meal 0 Birthday Party ❑ Wedding ❑
Family Event ❑ Holiday Event ❑ Other CAS Explain �.",t L Com q i1'o r-N,
NAME OF PERSON(S)REQUESTING PERMIT
LICENSED NAME OF LICENSED COMMISSARY Gt7U✓,GT �yy .11L .
TELEPHONE# C -7-7 q - 02 3� `(�1 I S
HOMEADDRESS S I SP.l�,v�� C,&z-ke. VILLAGE Cen1f-Y,J�I C'
NAME OF ORGANIZ'A.T1ION c• cs TELEPHONE .5�K - �l (O � Z'L
ADDRESS S10 S W e,�4 Ivlrzt n S-�. III A h h►S V A A- GZ(o 0 i
FOOD TO BE SERVED(LIST EXACT FOODS)
NAMES OF TRAINED FOOD HANDLERS
-(ATTACH COPIES OF CERTIFICATES)
ADDRESS WHERE TO BE SERVED -7'4`{ We-S i I chi
DATE TO BE SERVED �j l p RAIN DATE I ��
HOW WILL FOOD BE KEPT BELOW 41 DEGREES F 5 I yL 61 C,U 0 UffS �l Le i �`'r l C G
HOW WILL FOOD BE KEPT ABOVE 160 DEGREES F_ U S Vk G► CG 4Vldt..y yyL&J yjavWLQL�'
HOW IS FOOD COVERED_--
HOW IS FOOD SERVED 1
TYPE OF HAND-WASHING FACILITY ��h I.cs a Co) c tss i 0�7
(SIGNATURE OF APPLICANT)
APPROVAL MUST BE RECEIVED FROM THE FOLLOWING DEPARTMENTS
WITH THE APPLICATION FOR USE OF FACILITIES
Chief of Police
Approval Date
Board of Health
Approval Date
Licensing Authority
Approval *Entertainment License Date
Fire Department of Village
Approval Date
Building Dept(Zoning) D��
Ap roval Date
The followiniz are Policies adopted by the Barnstable School Committee that aaaly
to the use of all Barnstable Public School Facilities:
A. The use of all facilities will be at the discretion of the School Committee. The
appropriateness of the activity should adhere to the proper use of a school building or
grounds.
B. The activity should provide the community with an artistic,cultural,recreational or
educational benefit.
C. When scheduling conflicts occur preference will be given to organizations associated with
the Barnstable Public Schools.
D. No tobacco products or alcoholic beverages are allowed in or on any school property. If
alcohol or tobacco is found on or around any part of the(13)Barnstable Schools, it will be
grounds for pulling your permit.
E. A certificate of insurance liability prior to use of the facility with a minimum amount of$
1,000,000 coverage combined single limit for bodily injury and property is required.{The
Town of Barnstable must be named as an additional insured)
F. The School Department reserves the right to refuse the use of school property to,any and all
groups.
G. The School Department reserves the right to enter into special contracts and arrangements
with any and all groups.
H. The School Department reserves.the right to request payment in advance or to require a
deposit.In the event of any damage to:or theft of property the user group will be charged,
for the cost to replace or repair the damage or theft.
3
r
BARNSTABLE PUBLIC SCHOOLS
ELAINE GRACE /FACILITIES COORDINATOR
P.O.BOX 955,HYANNIS,MA 02601
508 790-6374,FAX 508 790-6431
FACILITIES USE APPLICATION
Please check the desired schools below: Please check the facilities desired below:
Barnstable High School ❑ Performance Center
❑ Barnstable Middle School Hyannis ❑ Auditorium
❑ Barnstable Middle School MM 0Y Gymnasium a0.t n
❑ BWB Elementary &- Field House — Rain
❑ Centerville Elementary ❑ Library
❑ Cotuit Elementary ❑ Lobby
❑ Grade 5 School ❑ Computer Lab
❑ Hyannis East Elementary dam Cafeteria — Ra'tr1
❑ Hyannis West Elementary ❑ Classroom#
❑ Marstons Mills Elementary ❑ Parking Lot
❑ .Marstons Mills East Elementary ❑ Bathrooms
❑ Osterville Elementary ❑ Showers
❑ Osterville Bay Elementary ❑ Band/Music Room nn
❑ Other Other T UC 't' (&. 4 Ko 0 eA s
Intended Use of Facility: Seehona I Games Sioecla.l MP las
Date(s)of Use: Iyt.OW 5, 2W
(Write Season for regular usage,then day of week)
Time: From 1Af&_To: (Please include set-up/and clean-up time in request.)
**Number in group or expected attendance: 1300
. r I
Group or Affiliate: �peL�a 1 G 6urnp
Address: Q� Yy�.ST 1`�1Ulbin St. AY11'1 LS MR p2(p�
Contact Person: hn rP,&Za /i• Telephone: 508.�23 2—F901
Fax:
Alternate Contact: Telephone:
*Please include a non-profit certificate if you would like your group to be recognized as a non-
profit user. A certificate of insurance liability may also be required—,
Will donations,admission,or a fee be charged?(circle): YES NO s, $
Have you or your groups used school facilities ' the past? (circ e): YES NO
Applicant Signature: Date: 5 7
107
APPROVAL MUST BE RECEIVED FROM THE FOLLOWING DEPARTMENTS
WITH THE APPLICATION FOR USE OF FACILITIES
C,
Chief of Police _
31z1 ���
Approval Date
t P.o Board of Health d
Approval Dat
Licensing Authority �/7 4jU bGQlvsle—
Approval *Entertainment License ate tLt-LcUd-ff E
Fire Department of Village
Approval Date
Building Dept(Zoning) ¢!/102eT„L l3 0 (1� /�CeeAIS2n T
Approval Date h�—� --
The following are Policies adoated by the Barnstable School Committee that apply
to the use of all Barnstable Public School Facilities:
A. The use of all facilities will be at the discretion of the School Committee.The
appropriateness of the activity should adhere to the proper use of a school building or
grounds.
B. The activity should provide the community with an artistic,cultural,recreational or
educational benefit.
C. When scheduling conflicts occur preference will be given to organizations associated with
the Barnstable Public Schools.
D. No tobacco products or alcoholic beverages are allowed in or on any school property. If
alcohol or tobacco is found on or around any part of the(13)Barnstable Schools, it will be
grounds for pulling your permit.
E. A certificate of insurance liability prior to use of the facility with a minimum amount of$
1,000,000 coverage combined single limit for bodily injury and property is required. (The
Town of Barnstable must be named as an additional insured)
F. The School Department reserves the right to refuse the use of school property to any and all
groups.
G. The School Department reserves the right to enter into special contracts and arrangements
with any and all groups.
H. The School Department reserves the right to request payment in advance or to require a .
deposit. In the event of any damage to or theft of property the user group will be charged
for the cost to replace or repair the damage or theft.
3
i
Paco L-n
3-24" DIAM. ACCESS MANHOLES
10' min. from
NEW Foundation house to septic tank *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.'v C ± 10' -e" er y
T.O.F. sent. 102.00 grade Septic tank covers must be +, ,, y ,_ W
within 6 in. of finished
9 Crode over Septic Tank - 100.00 -Grade over D-Bo. - 10000 atle over SAS - 100.00 SECTION A -A-- /J\ ',,� ��' - ~'t1'•'ee' w�+cb
% PROFILE VIEW OF LEACHING SYSTEM
s = 0.02 +�
3 HOLE � THEFT
10' 5=0.01 iH-20i JiST. BOX 3' Maximum Cover /-TOP OF SAS - G775
A _ ., INLET
PIPE o NEW 1,500 GAL 3/4" to 1 1/2 Washed Crushed Stone J THE ACCESS COVERS FOR THE SEPTIC TANK, '"" �.,d►'r
FROM FOUNDATION tD r` 5• S= C.C10' er loot 3• of + • _" •"'�• 4R'
SEPTIC TANK r sjyy"w"p�,, j8" - t/2' Washed Peasto�e C- � DISTRIBUTION BOX AND LEACHING COMPONENT
H-10 n CN 20" �- r SHALL BE RAISED TO WITHIN 6" OF
�► �9. 4
N o o \ •.•.(�..'..`",-;,.,a'4:,^r,;?T„-r,,..++. ^:...I, FINISHED GRADE.
CONCRETE FULL FOUNDATI > 11 n 1 ^ \ \
_u rn m A STEEL REINFORCED PRECAST CONCRETE INSTALL TUF-TITS GAS BAFFLES OR EQUALS
u _u N I 3.6 -J.S' \ PLAN VIEW
ON ALL OUTLET TEE ENDS �.a�' CIO,
u >i II y oob n ,R
SYSTEM PROFILE v a i 8
cl -u I u fY' a O O O C7 O 3-24• REMOVABLE COVERS o ttooe ree ee erve en raor w vyee e n 'ee+v,a ever s L2?.3Zi}_ i
Not to Scale d 1B Effective Width C3 C3 t= O O O O
> > O O O O 1
i
c 2 Or)is Q 85' w/2' Separation 19' I
.�.. . GENERAL NOTES
6 'in-of 3/4"-1 1/2" ~-�9' �•I 1 J min. clearance I
compacted stone $ �3�- -3' �NLEi e_mie_T_12•_min. Inlet to outlet e• ouT�T �,r PUT - 1. Contractor is responsible for Digsofe notification
�-7
BottoBottom of Test Hole t Elev.s90.00 .25' N� = +o�ml" 1 I u°�' �. and protection of all underground utilities and pipes.
m
---- Test
Ho--- Elev- - EFFective Length 5' -T --- +
s -7' 2. The septic tank /4 distribution box shall be set
s --- level on 6" of 3/4 -1 1/2" stone.
SOIL ABSORPTION SYSTEM (SAS) $ 0.Gem iLq�id depth 3. Backfill should be clean sand or gravel with no
500 - C (H-20) LEACHING UNITS / WIGGINS PRECAST �. stones over 3" in size.
4. This system is subject to inspection during installation
\ Not to Scale "',�' s••. ", ! by Carmen E. Shay - Environmental Services, Inc.
NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE 10'-0" s' -6' 5. The contractor shall install this system in accordance
CROSS SECTION END-SECTION with Title V of the Massachusetts state code, the approved plan
and Local Regulations.
6. If, during installation the contractor encounters any
\\ l'PICAL 1 500 GALLON S-PTIC TANK soil conditions or site conditions that are different
from those shown on the soil log or in our design
NOT TO SCALE installation must halt & immediate notification De
10 LOADING) made to Carmen E. Shay - Environmertol Services, Inc.
FOUNDATION 10' SEPTIC TANK N D-BOX .. 2p' - •LEACHING FACILITY 7. No vehicle or heavy machinery shall drive over the
septic system unless noted as H-20 septic components.
- I 8. Install Tuf-Tite gas baffles or equals on oil outlet tee ends.
9. Ail Distribution Lines shall be 4" diameter Sch. 40 NSF PVC pipes.
10. All solid piping, tees & fittings shall be 4" diameter
P E_R C 0 LATI 0 N TEST Schedule 40 NSF PVC pipes with water tight joints.
11. SITE and Surrounding Properties are Connected
Date of Percolation Test: 1996
Test Performed By: Carolyn Doyle- P.E., C.S.E. to Municipal Water.
Results Witnessed By. Barnstable Board of Health
Excavator: Unknown
Percolation Rate: Less Than 2 min./inch 0 32" BELOW GRADE.
N 63d 43' 33" E _fit_ 100.00' --
___ NOTE:
-�- I Test Hole ( THE PROPERTY LINES ARE APPROXIMATE AND
No. 1 COMPILED FROM THE SURVEY PLAN GENERATED BY
i \ ii ALL CAPE ENGINEERING OF HYANNIS, MA, DATED 1 1/6/96
it- DEPTH_ SOILS Ell ENTITLED " PLAN OF LAND W CENTERVILLE, MA OF LARS E. STONE"
\ 0 100 AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN
\ Loamy Sand IT SHOULD BE USED FOR NO PURPOSE OTHER THAN
10YR 3/2 THE SEPTIC SYSTEM INSTALLATION.
A 99.67
! Sandy oarn
i
tOYR 5/0
e'- 32" B„ 97.25i WETLANDS LOCATED WITHIN A 200' RADIUS ARE SHOWN ON PLAN.
99. ' 0
/ \ I MedSan rse X I
25 v 7/4
32"-96" C, 92.00 ASSESSORS MAP - 149.0 PARCEL 130 LOT 3
% Fine - Mod.
Sand ZONING - RESIDENTIAL
LOT #3 2.5 Y 7/4 FLOOD ZONE C
-- - - - 49,925 Square Feet +/- \ 96"-120" C2 90.00
1,146 ACMES +/- - WETLANDS LOCATED WITHIN A 200' RADIUS ARE SHOWN ON PLAN.
i
LOT 2 Perc1
/ Depth at Perc: in. n 58" r- � ��
# -
Pere Rate=<2 min./inch `EG F' V D
Groundwater Not Observed
99.98 / BOTTOM OF TEST HOLE Elev. 120" i
_X _
�pRFA Jj ADJUSTED H2O Elev.v. = No
Acjustment Rec, -ed. DENOTES PR OPOSED
30. SPOT
ALL OUTLET PwES FROM n� GRADE
R 31
DISTRIBUTION BOX SHALL SE
�",= •+ _,� i SET EA! FOR AT LEAST 2 FT. '2. '-' -CONCRETE COVED DENOTES EXISTING
(``: FACHING 99.
�
!" _21,
SPOT GRADE
KNOCI(OLTSy '2' ' - PLD-BOX PROPERTY `INE
1500 al.
96 Septic 97 PROPOSED CON TOUR
X
x O
•" - SCH. 40 T• 7.75-
4, 99.98 ! 97- - - - - -97 EXISTING CONTOUR
50• z , 4' PLAN SECTION CROSS-SECTION
100 j 3 HOLE DISTRIBUTION BOX - H-' 0 LOADING DEEP TEST HOLE &
I�j NOT TO SCALE PERCOLATION TEST LOCATION
FENCE
PROPOSED 3
o Design Calculations
I BEDROOM HOUSE x
Number of Bedrooms: 3 Equivalent to 330 Gal./Day (330 Gal./Day Min. per Title V) PRIVATE DRINKING WATER WELL
Ge Garbage Grinder: No \ / c
99.48 �u��t� 9SYNT FL b6 a 94.0 Leaching Capacity Proposed: 330 Gal./Day Minimum (Min. Per Title V) E V I J I 0 N C J
/ ed TOF - 102.0 99.86 Septic Tank : - 2 x 330 Gal./Day = 660 JSE 1,500 GAL. Septic Tank.
9 •96 FNSE FLR 3'LV 103.0 X SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch
/ TEST HOLE #1 x `� Bottom Area: 0.74 gal/sq. ft. x 300sq. ft. = 222.00 gallons I NO. DATE: DEFINITION
ELEV.= 99.75 Sidewall Area: 0.74 gal./sq. ft. x 148 sq. ft. = 109.50 gallons
99.32
Providing: = 331.50 gallons
X \'✓ _ �\ o `� Use: (2) PRECAST 500-C UNITS, HAVING A 2' EFFECTIVE DEPTH, ,
TO BE USED WITH 3.5' OF WASHED STONE ON THE SIDES AND
\ 99.98 3' OF WASHED STONE ON THE ENDS AND 2 FEET IN BETWEEN 2 UNITS.
`DSO �Q<�ne PROPOSED
S x
�- c' ' o� GARAGE
Dr-eb 491/ x SLAB ELEV. = 101.50
99.7
996 (� 7I R 0 P 0 S E L�
PROJECT BENCH MARK 't It 99 x6 A RE-
D 0 R ,
PK NAIL SET ' � `, `, _
g9.70 o SUBSURFACE SEWAGE DISPOSAL S1 STEM
ELEV. = 100.00 (Assumed) ,
X 1 OF
99.92 ; ; AIRS E . STONE
o x � L LOT # 3 GOLDEN ROD LANE EXT.
_ 52.67'
TtIDR� / 300'36' # 805 WEST MAIN STREET CENTERVILLE , MA
99.48 pF l PROPOSEDASP�L
X
N 9So HYANNIS MA PREPARED BY;
OO I 'p^ l Y 7
56d 21' 26 _ t : EVVIRONML'NTAL SERVICE'S, INC.
( 508 ) - 7 ''8 - 685
1
0 �tNOf 34 THATCHERS LANE
OILU ERT /
Tel/Cable Pos LOT #4 T. m
EAST FALMOUTH, MA 02536
1 TEL/FAX : 508-548-0796
c100.44 '� SCALE: 1 "=20' DRAWN BY: CES DATE: OCTOBER 16, 2003
o x PROJECT#SD-483 FILENAME: SD483PP.DWG SHEET 1 OF 1