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HomeMy WebLinkAbout4130 FALMOUTH ROAD/RTE 28 - Health 4130 Falmouth D ) ccr6o j A=040-116 I i _ _ __ __ _ _ �_ __ g __ _ ._ _ .... �,�_� i a� � � ��� �:�� 3 �� � � �� ,�� s ,, .; � i i I i THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) I M 7-'N- 'L� DATA OLY'�- 73 1 y 01 l'-e a 7� �7 Tv" / a-4crl/ pp�� ii� pp TOWN OF BARNSTABLE LOCATION 6/34 IhIOv-r6 /?'OkI SEWAGE# VILLAGE ASSESSOR'S MAP&P/ARCEL/ D`/® //!o INSTALLER'S NAME&PHONE NO.S69-V20-`77,l �/oS oy ��L3�3r'Hos SEPTIC TANK CAPACITY /®08 LEACHING FACILITY:(type) ' Sid 0 �19�3�'1i�HYS (size) NO.OF BEDROOMS 3 ,/ OWNERO PERMIT DATE: ",S / 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 •C G z 7 3, pr<r< 37, o 0 e o No. /7�1 —7 Fee ®v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for -Misposal 6pefem Construction j3ermit Application for a Permit to Construct( ) Repair�Jpgrade(Al"Abandon( ) ❑Complete System ❑Individual Components Location Addres s or Lot No.'//30 f,1100afti Jf*#9d 0 Owner's Name,Address,and Tel.No. .�wr• '" � N'�oH����o .PygFr4y� Assessor's Map/Parcel 0y,0 l Installer' ame,Address,and Tel.No, Designer's Namp,Address,and Tel.No.1O8-3L0-3 3141 � __ I - meyEr F.Sa�'s zlVc Type of Building: Dwelling No.of Bedrooms ,?j. Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures v� Design Flow(min.required) J ® gpd Design flow provided z- gpd Plan Date 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) pP/wol i 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 Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Q Application Approved by Date 9 �" Application Disapproved by Date for the following reasons Permit No. �o-0 �-� Date Issued ' L No. a0z L ' Y Fee THE COMMONWEALTH OF,MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -Tom OF°BARNSTABLE, MASSACHUSETTS Yes ftphLation for Disposal 6PA , C'�OttBtCUcttOIY erYlilt Application for a Permit to Construct( ) Repair Upgrade(v Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.y/362 � % �c•l r9 /:vW�� Owner's Name,Address,and Tel.No. ' Assessor's Map/Parcel j Installer's Name, Address,and Tel.No. Designer's Name,Address,and Tel.No.S,� S 7 VC � Type of Building: Dwelling No.of Bedrooms " Lot,Size sq.ft. Garbage Grinder f Other Type of Building ./ No.of Persons Showers( ) Cafeteria( ) Other Fixtures l , Design Flow(min.required) o gpd Design flow provided ry gpd, Plan Date ;Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil i Nature of Repairs or Alterations(Answer when applicable) �� T,,%� ! r,/ rr�i-r.r T: 4 Date last inspected: 7 Agreement: , ` The undersigned agrees to`ensure the construction and maintenance of the afore described on-site sewage disposal system in .J accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed i - Date Application Approved by Date I Application Disapproved bye Date for the following reasons { Permit No. G I I--) �9 ( Date Issued L ? ------------------------------------------7 - - - - - - ------------ -- -------=------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Dispo al system Constructed( ) Repaired( }- Upgraded - Abandoned( )by �D-5_e,IJ/- s at 4// 7-1, :f" � 1. t'�>c :!.> fZ//f, has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No' G I L/—�.h dated Installer ,)1C!-f'lZ_ Designer #bedrooms �n Approved desi`2n flow (� gpd The issuance of this permit s all no a co strued as a guarantee that the system I fu��tion as des* ed. ®G Date Inspector ------------------------------------ --------------------- - ------_--------- - -- - . - ----------- -------- No. Y�d �' _ Fee . THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS -- Bisposar 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair Upgrade( )- Abandon( ) System located at ell g/: 'S7W11 S L11i��S 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 must bf compl ted within three years of the date of this 'ermit. Date �� 5 Approved b Town of Barnstable Regulatory Services o� + Richard V. Scali,Interim Director + BARNSTABLE, 9� MASS. Public Health Division Arse +a Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form A Date: I �� Sewage Permit# . ©/�{- 2G Assessor's Map\Parcel Designer:`!/ d��S l�L. Installer: JD�{1 S -� OT1G .SF_�'ViGI Address: P� gC77C q VI Address: On 5 was issued a permit to install a (date) (installer) septic system at A Fpmnvy­-7-�i based on a design drawn by (address) ' l A14-- 619ce -- f /ML. dated �/!? )Y Yew. (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 the RA approval letters (if applicable) OF .t A N M. y� ( staller's Signature) . No: 1140 AFC/STEM (Designer's Signature) NIJA0 PLEASE RETURN TO BARNSTABLE PUBLIC HE ALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc P# Town of BA astable Department of Regirlatory,Services i • Public Health Division Bate • '° �,►tw�tom; ' - � 1639• ems$ 200 Main Stree Hy#nnis MA 02601 . 1 Date Scheduled i Time E Fee Pd. , oil' Shitability'Assessra ent fog- ►dew Performed By: Y ��i� t "t�-� Witnessed By: LOCATION & GENERAL INFORMATION Location Address l 3 e� 1 V Owner's Name'� OH k MA-E� S HAIP 10v e 1 i ZZ r V (OTy 17 kivk- ., Address �S N�e � dy el Assessor's Map/P#cel: v40�1 Engineer's Name lms /9 1911c ",04tw NEW CONSIRUtON REPAIR X Telephone# 5-0% 360�'-3-311 Land Use 1 �� �� Slopes(95) Surface Stones /"A Distances from: (3pen Water Body �dd• f[~'Possible Wet Area?alo' ft Y Drinking Water Well :VV ft Drainage Way° y ft. Properne r d ft Other ft ty Li SKETCH:($treet name,dimensions%f lot,exact locations of tesfholes-&pere tests,locate wetlands in proximity to holes) of rd �la �l w � y i CI 2 ,... .e-.,.� ... - ♦..31......—..tea.-�—t.._ a.-.+t*,a r ,v al }.. r 999'2 is _ 0i00 i �A Parent material(ge(logic) �. - "�t � ets�1 � Depth t4 Bedrock Depth to Groundwatdr. Standing.Water in Hole:' h ; Weeping from Pit FACe -� Estimated Seasonal;0gh Groundwater - DtT NtTION FOR SEASONAL HIGH WATE R T"L. E Method Used: ! I w _in. Depth to salt mottles: In. Depth CfbServed standing an obs.hole: i in. Groundwater Adf ustutent Lt Depth toiweeping from side of obs.hole: 777�' , _ A Wtor...,._.v.- Adj.froundwater Level— Index Well# _ Reading Date Index Well levd] PERCOLATION TEST Date1 � Observation Time at 0" ----- Hole# Time at 6 Depth of Pere '• . . , �. 'Time(9l'-6") Start Pre-soak Time.@ -- ; 0— i End Pre-soak 1 Rate MinJlnch _ Site Failed: Additional Testing Needed(Y/N) Site Suitability Assessment: Site Passed Original:.Public Heal Division Observation Hole Data To Be Completed on Back— ***If percolag6n test is to be conducted within 100' of wetland,y ou must first notify the Barnstable C6 servation Division at least one (1)we6k prior to beginning. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil•Texture Soil Color Soil Other: .Surface(in.) (USDA) (Munsell). Mottling (Structure,Stones,Boulders. Consistenc %Gravel 9 '° yf a P317, Z''132' � �• �� • DEEP OBSERVATION HOLKLOG Hole#_ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling .(Structure,Stones,Boulders. Consistency.%Gra el DEEP OBSERVATION HOLE LOG Hole.# � Depth from Soil Horizon Soil Texture Soil Color . Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil ter Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. ra Flood Insurance Rate May: Above 500 year flood boundary. No_ Yes _. Within 500 year bounda ry No Yes Within 100 year flood boundary No/ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious terial exist.in all areas observed throughout the area proposed for the soil absorption"system? If not,what is the depth of naturally occurring pe vious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Envir nmental Protection and that the above analysis was performed by me consistent with the required t "g,expertise and experience described in 3;10 CNM 15.017. Signature Date Q:\SEPTIC\PERCFORM.DOC YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates(cost$40.00 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.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office,.lst FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: 0 Fill in please: t APPLICANT'S YOUR NAME/S: A G" A i-1h.F9 F~ BUSINESS Y UR HOME ADDRESS: il I //Il' t T TELEPHONE # Hame Telephone Number r NAME OF CORPORATION„ NAME OF NEW BUSINESS 'F` E t c I�tG+ OF BUSINESS IS THLS A HOME OCCUPATION? �X YES; N0 � ) AGDtlf� `_ rifcc T B MAP/PARCEL NUMBER•; . 0 (AS slug] ... ."ADDRES5 OF BUSINESS= 40 ses 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 COM SSIO ER'S OFF1 -� This individu I he b infor d �f any arm" r quireme is that pertain to this type of business. MUST COMPLY WITH HOME OCCUPATION RULES AND REGULATIONS. FAILURE TO uth riz- Si-natu GQMPLY MAY RESULT IN FINES. •O ME . .l 2. BOARD OF HEA-11TH This individual he be for ad of the permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: t 09-25-20�7 a 1 2 = 34P To be 'used as a Guideline NOTICE: The Town of Barnstable recornrngods th2t thw applicant seek legal advice to prepare a property worded deed restriction document DEED RESTRICTION � IYIOq� iYl/rl�lJ S� `/ WHEREAS, � �� Q � of (owner's name) Try ep hl&Cf�ZEL NIA (address) is the owner of �j 30 �L/iha JT �'1� located (address) at , MA (hereinafter referred to as 41/30 A05V )w and being shown on a plan entitled "Subdivision of Land in (*7-o u T MA, Property of &6 /ice .IN ho -s/���iQVIIC et al, duly recorded in Barnstable County Registry of `.r) Deeds in Plan Book o2 , Page ;;2 7 ; 0 Or on Land Court Plan Number WHEREAS, -OAA/Q y/- as the owner of said lot has (owner's name) agreed with the Town of Barnstable Board of Health to a restriction as to the number.of bedrooms which can be included in any home built on said lot as a pre-condition to obtaining a disposal works construction permit in compliance with 310 CMR 15.000 State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage; WHEREAS, the Town of Barnstable Board of Health, as a pre-condition-to granting a disposal works construction permit for a septic system in compliance with 310 CMR 15.200, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, and authorizing the issuance of a building permit for the construction of a•single family home on this property, is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on the lot be put on record with the Barnstable County Registry of Deeds by recording this document, - dxdr f NOW,THEREFORE,L11 Df,�,¢/yj�,Qp / f,�,Q thereby place the (owners name) following restriction on his above-referenced land in accordance with his agr- m -nt with the.T.owmof whieh restFietion-sha$ run with the land and be binding upon all.successors in title: 1. y/30 0° may have constructed (address) upon the lot a house containing no more than�/ed,Z.(3)bedrooms. agrees that this shall be permanent deed (owners n ) restriction affecting located on CO TU, T MA,and . being shown on the plan recorded in Plan Book- 1 ,Paged .2? Or on Land Court Plan For title of y/30 fAlArgAy!e see the following deed: Book ` ,Page Or Land Court Certificate of Title Number Executed as a sealed instrument A5;`' day off �10� Owner's signature Owner's signature Owner's signature COMMONWEALTH OF MASSACHUSETTS 20 0) Then personally appeared the above-named known to me to be the person who executed the foregoing Instrument and acknowledged the same to be free act and deed,before me, ,�t 'y ( Notary Public 0�" MY commission okpire P•Laao (d w' 18.2M* a ea"rt tassa % char �- s �• � '^,• %i MUMBLE REGISTRY OF DEEDS B.k 22195 F9317 -D 4r2477 07-18-2007 a 02=03c Town of Barnstable VE Regulatory Services BAMSTABL6• = Thomas F.Geiler,Director �bPA 3 9. Building Division 1°fen r�na+a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 AGREEMENT FOR FAMILY APARTMENT I(We), the undersigned, being the owner(s) of property situated at 4130 FALMOUTH ROAD in COTUIT,MA, holding title under a deed recorded with the Barnstable County Re istry of Deeds or Barnstable County District Registry of the Land Court in Book gkk - , Page �� ' , or as Document No. , being shown on Assessors' Map 040 as Parcel 116, hereby agree, certify, warrant and represent to the Town of Barnstable that the accessory attached apartment,which contains living quarters,is intended for use as a family apartment,for year-round occupancy. The intended and authorized use is for SHAID HAMID, NEPHEW OF OWNER, SHAFIQUE MOHAMMAD,associated with the residential use on the same premises. This unit shall be used for a"Family. Apartment"(as defined in Zoning Ordinances)which would require compliance with the Family Apartment Rules. and Regulations. This unit shall not be rented as an apartment or as a single room,or in any fashion,which rental would be a violation of the Town of Barnstable's rules,regulations,and zoning ordinances. Prior to occupancy of this unit,affidavits reciting the names of occupants are to be recorded with the building department. This agreement shall be updated whenever a change occurs or every calendar year. This Agreement shall be duly recorded or filed at the Barnstable County Registry of Deeds/Land. Court for the purpose of alerting future owners of the property of this binding Agreement concerning the use of the property as herein stated. The consideration for this Agreement is the issuance of a building permit and/or certificate of occupancy by the Town of Barnstable Building Department. WITNESS our hands and seals this 15 day of 200_VL. TOWN OF BARNSTABLE OWNER(S) By: c ) ,___L , CC wilding Commissioner THE COMMONWEALTH OF MASS CHUSETT BARNSTABLE COUNTY,SS Date n Ig Zpb1_ Then personally appeared the above-named (owner), Y�Oha mmc�alab� made oath as to the truth of the foregoing instrument,before me. otary Public My Commission xpires: +. �•' lQmbedy Ann Lartfmore Notary Public i u My Commmisslon Expires April 2l,20t i fe Commonwealth of Massachusetts g'•, FalmouthRM 130 BARNSTABLE REGISTRY OF DEEDS i I VIV Ltp .qId NIT m:. :.,, e,m. - !axe V. •�- A Tf iVSa 'A1l_i �� i.- 1; i.•J' _1./ 1 -r_ • f♦ Ir. I.J r,. - f. -•i M. - - 1 lE lijr . � � P :rr. �s.� - a.w; '+:•:1 ibm. t ....e.4— .. I'i- Liw. 'i,::e,.r• rlt ccu - ,.-: ,. =a.>��..e. Pap2afl) - d ®1MCLA- ,3MPi1,nOPfPMd—NOT FOR VL3LUMARY A SZWAGZ DERMAL SYSTM MMFORK PART A CZRCA Proprtymdnm. i1130, �' a� O'C... Owaimr. e - Dab of : m& : cam& AACD W 3 IMSM eoqpbb na ofSmdm D 1 =y. i- which 00 myoftbe iOme mitain descrUnd in 310 Cat ISM or in 310 CMR 15.304 mdsL Any fiffimaterm am evahmand are•mfficaed below. OW ar msme 2YWM affil finaft a dualiedis t '"scud=need to be or nPsm,e&'W:YNOM VOR COMPled=oftbe fVkmmsM Or a d by*e Boaed of Fka*will paw. Awww yam,no or m damkW(YAM)in tbs for irm 6mmiser plow —Mm t=k is mdd cmd ova 20 ymtoiP or*t sapdo tok(mbedtantsw ar at)b sautmany eA'bits mbduathl fidilkifim or oxfflusdan Dank he=is hmniam sysum WM pm hmpowmiftlu: cdsftg tm&is mplaed w tk a coax Wb*nos%MR=L oved by dke Boyd ofHed& °A m dd a M*WM 1m if it is so=,nat leaklog t2d ffa Cadficm ofConpUme gdatiptokishmdm20ye=old is uvdkWL ID mph: Obmvtdun 0 smpb=kup or aot or hi*stk WaW hmd into o boat due to bakm or avd of Doard of t): b (s)tr 1Ie sysam AW4WW pain mme 9=4 dmis a year due tot r c h im or obmucted pips($) iu sysuaa Wm Pm• if(WM*NOW ofte Bond offluft P9V3 FORVOLUNTAR SUDSMACE s AGIC bISPOML ENS FORM PAW A IIOx c /33 2p C Dab Ofbowim C- by**Baud dwawft CmMm ads wbich mqvim ftmew evahmGm by*a Dowd of Heaft in ardw m ddOugut if*0 SYSOm is fajmsm pav&M public b=M.s r of do �• Syftm va Pon=I=HOM4 aptRod&dsftrcjMin aw9rdma vft no CMR I, i)(b)that the sys"Obwtalryll III abs va paftd poWe bamM cftyasel tba campot orpaivy is SO fed afn=Am waM caswed WIMY is with 3O aia �a syatm Isfgcc&mftis€a=saw tt wd _ no*vm has a sop&wk and sad ap*=sue► )and ft SAS is widain 100 ilet do s�sa watmr eaPPtY artribs�►�a s wad lY The rysam)w a tmA and SAS and to SAS is wider a?me 1 da public wam supply. ju$ystem ho;a s wd SAS and do SAS is 50 fut afa Tha has a tm�csd SASa 3AS im thaa 1t1O fse4 b�iO faam a ' t��plywafd�°. s to evrgds gym=pma if she vMHwadadysik pwfi=W at a DEP OwNed IdWIMY.fOr • and voictft argank conqxmm& titft wan m1 Am=ad=fivm V= mdt md e rboamn is equd ft a7boom S low *mRv 3. I laa 4 of 11 OMC3AI,. 10"--NMMRVOLUMARY SU Ate.MWAGZ SYSTM IN MON IMORM P A Addrom ® t ZU . . Dee� V "Mgt: ice lie of bmacom a sIdim ciftwk epputabb to cm$yo of ism ar sym m +da to avid ac SAS of oo pOol SAS ar l Ind la ft Mogmdm iw dxm ogst kwat&aW ta 6vubi&d cff cMMd_ SAS c �.. m fslm C ►mar t iolM*=Vsfyfps _.._ .� mama d=4dombndw im yew dnto IpWs).bbmber ). Ofthm . Avypmtm*f*tSASxmpxlwVivyb ►hl&Mumd wet dneum Any pmlbm ofcosspd or pivyb wd&100 ft of a cc UtMUZY W a MWO van .y 'Any p,m sm n®fa compd ewpivyb mob a Zow 1 ofa Any partim of a cxsspaol or privy is t So Axe ofn piveft am ugly vieL Awj porn of a compd at ptivy b►1=gm 100 3bat but gm=dm 30 ft ftm a Pdvm Wm thmto vmu b the dmt fndffq sndtb promm of mdtiftdoiall d4 ea o (Ye t T� i titr#ass a oftl w*t m in 310 CUR 15-M3,tmahadwaygm hft MmrjMmo=x dwWcontmdm Homd of H Id to wM be wry►to ooamect do l IL .r a CM fimooft sob saaa ggft to a symm iwommm aft egbmh adxm} yu no �. the System is kcmd in anibvW seaskiw am Onuft'f oMmd Ratudm Area—MPA)or a an 11®fS Me NY"l to my qms*m in ftefin Eft sysonfa amdands tlt�,At in Ddmm to ho rimahmMiTim omw woputicrafaW tlnft ftdi=EvzMWuWwS=dmDdmR gypu emsydmkmmdmmwM3l4CMR 15.3".mo sbwald cooftattbs ragimW d5a oftm DopcOmakt