HomeMy WebLinkAbout0031 CROCKERS NECK ROAD - Health 31 Crockers Neck Road, Cotuit 1
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LOCATION SEWAGE PERMIT NO.
VILL. AGr31 .�_
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iNSTAILLER'S NAME A ADDRESS
D U I.I. D E R ON OWNER
DATE PERMIT ISSUED
DAT E COMPLIANCE ISSUED
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'TOWN OF BARNS ABLE '
SEWAGE # �tJ
VILLAGE 0 _7_V r ASSESSOR'S MAP & LOT G& ®�f
INSTALLER'S NAME&PHONE NO. AVA 6
SEPTIC TANK CAPACITY'!`����
LEACHING FACILITY: (type) 60 '' r ze 14 (��jlt�sf�;�-ram
NO.OF BEDROOMS
BUILDER OR OWNERL°
PERMITDATE: ,S� S COMPLIANCE DATE:
Separation Distance Between the: t
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Welland 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 ,
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No...--f�.1"��� � � C(�4CK�S �eC�C (�d.� �o��t�� FEs�........:...................
THE COMMONWEALTH OF MASSACHUSETTS 1
BOAR® OF HEALTH
TOWN OF BARNSTABLE
Allp iration for Diipoial lVarlai Tomitrttrtio Vrrntit
Application is
hereby made fora Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
Syst at: CC9 fu I'f- -4
.....C..RQC
........ ...
n Locati t�- ress r or Lot No.
wncr \! Address
W - ----•--•--�--------------••----•------•-•----_._....-----.._..............----
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms------------------------------------------._Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons-_-_--.--.--_--__--__----_ Showers ( ) — Cafeteria ( )
Q' 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 ( )
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........................
04 -----------------------------------•-------.._.._..-----•------•-----•--•------•---------•---••••••.........................................................
0 Description of Soil.................................................................................................................. .--�.................................................
V _...__--•- f
W �w
U Nature of Repairs or Alterations—Answer when applicable.--
___________________________________________________________________________________________________________________ ___ _______ ---_-________--_____-_____........_.......bg
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 be s the rd of healt .
( ¢�
Signed ---.. . -- --------- ---- ---- ------------------- ----------- . ./ /...
- ---- ---------
• Application.Approved B r_e
Dare
Application Disapproved for the following reasons- ----------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------
Permit No. ---------?..6._---------)— ---------- Issued /y�
...................:.. "..��...�_.f �� Date ....
—Uare
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No....-r. .:. 5� 1 >�{^,�' ��c k.jc J.".....................
-THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Diti-poml Worlai Towitrurtion- rrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
System at
f-1)o C) 161 C 01 �tz,�" I A
Locatio� \d}nss c or Lot No
� ��- .
' . ..
�' Owner Address
L. Installer Address
UType of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms------------------------------'._-_---------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building -------------------- No. of persons------------------------.... Showers ( ) — 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.............._.........
fX Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
-----------------------------------------------------------------------------•-----•--------.................-------------------------•--------....-------•--
ODescription of Soil------------------------------ -------------------------------------------•----------------------------^� ------------------------....-----•------•---------•---
-------------------------:----------------••--------------------------------------•-------....-----------------------------------------------------------------........................................
W ------��- /--•---------•----I--•-•-
x - r
U Nature of Repairs or Alterations—Answer when applicable... .. .:!a ..` .. ................
............................................•--..._...................._.............................---... ._.....-.f.......- ". ................... ...........................................
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 .. : ,O 1,9
-- N ---
Application Approved By ........... .��. ..r �..... ............ . ....... ..................._...............` ��.."..C/...'..l `2�.._..
Dare
Application Disapproved for the following reasons- --------------------------------------------------------------------------------------------------------------------------
--------------------------- ---------------------I------------------------------------ --------------------------------- ---
L?are
Permit No. ----------T5—----------- --------- Issued .-------.......... .. ..,r -.."5�{...............
`'Dace
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Gertifiratr of Tomplinure
THIS IS TO CERTIFY, Tha6the Individual Sewage Disposal System constructed ( ) or Repaired
by r'_ `: ---
--- ---- ----- ------- ._ ..._...... ---- _---
47
has beewinstalled in accordance with the provisions of TI I.E 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. .... .. '., ""_----- dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE----------------- --------{ --------------- ---------- Inspector ------ ------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE --�n
�t��rns�1 "r��
Permission is hereby granted_.._ --.. _ _: ` "°.°^...... .......................................................
to Construct ( ) or Repair (�)�n Individual Sewage Disposal System. .
•.... �s ------ ---••- -
y � 9 °.c/4/ IF �/fStr,et
as shown on the application for Disposal Works Construction Permit Dated---- -- .............
Board of Health
DATE------ z-:- - - ( `�
o._..--•-•••--•----•-•..............•-•--
L
FORM 36508 HOBBS 6 WARREN.INC.,PUBLISHERS
TOWN OF BARNSWLE _ t
L ATION / ('il`/'�' /� �(�,�� 1 t 0� SEWAGE # 9
VIL E n 6z i ASSESSOR'S MAP & LOT G O O 7
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) 641 -Gv- Sze) LFA['l9 �Liuls t7—,
NO:'OF BEDROOMSoe
BUILDER OR OWNER
PER14ITDATE;, �=,COMPLIANCE DATE:
Separation.Distance Between the:
Mikiir►tiar Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
`oq site or within 200 feet of leaching facility) Feet
Edgeof Wetland and Leaching Facility(If any wetlands exist
within:300 feet of leaching facility) Feet
Furnished by
.............
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INE r°k� Town of Barnstable Office:508-862-4644
Public Health Division Fax:508-790-6304
• BARN SABLE. • 200 Main Street• Hyannis, MA 02601
�OrFDMn+"�0� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT
` Business Name: Oep4v, 44, L Date:
Location/Mailing Address: "; CLOG zx-Le- Co 41 h 190 ,,X'
Contact Name/Phone: Pa, 106,--
164t,I IP. vI1.711
Inventory Total Amount: a� S"`��,5� O�SS7DS: QVk,IaIOl� bvL�,1�— License#: _
Tier II : cod Labelina: (�K- ce' &� 1 " Spill Plan: 0
Oil/WaterSeparator: Floor Drains: Emergency Numbers: OK
Storage Areas/Tanks: -5j> Igo
Emer enc /Containme ui ment:
Waste Generator ID: Waste Product:
Date&Amount of Last Sh pment/Frequency:
Licensed Waste Hauler&Destination:
Other Waste Disposal Methods: Q.V1���QAsVe- �44
LIST OF TOXIC AND HAZARDOUS MATERIALS
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 requires a license from the Public Health Division.
Antifreeze Dry cleaning fluids
Automatic transmission fluid Other cleaning solvents&spot removers
Engine and radiator flushes Bug and tar removers
Hydraulic fluid (including brake fluid) Windshield wash
Motor oils Miscellaneous Corrosives
Gasoline,jet fuel, aviation gas Cesspool cleaners
Diesel fuel, kerosene, #2 heating oil Disinfectants
Miscellaneous petroleum products: Road salts
grease, lubricants, gear oil Refrigerants
Degreasers for engines&garages Pesticides:
Caulk/Grout insecticides, herbicides, rodenticides
Battery acid (electrolyte)/batteries Photochemicals(Fixers)
Rustproofers Photochemicals(Developer)
Car wash detergents Printing ink
Car waxes and polishes Wood preservatives(creosote)
Asphalt&roofing tar Swimming pool chlorine
Paints, varnishes, stains, dyes Lye or caustic soda
Lacquer thinners Miscellaneous Combustible
Paint&varnish removers, deglossers Leather dyes
J Miscellaneous Flammables Fertilizers S6?
Floor&furniture strippers PCB's
Metal polishes Other chlorinated hydrocarbons
Laundry soil&stain removers (including carbon tetrachloride)
(including bleach) Any other products with "poison labels"
(including chloroform, formaldehyde,
hydrochloric acid, other acids)
VIOLATIONS:
ORDERS:
INFORMATION/RECOMMENDATIONS: c, < v,5 -cam
JL J
Inspector!r, Lwj-&-e—
Facility Representative: Pa
WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS