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HomeMy WebLinkAbout0053 BRIDLE PATH - Health 53 Bridle Path Marstons Mills A= 149-149 ' 1 _ •., TOWN OF BARNSTABLE SEWAGE # VILI- GE__ �[� �/l, I�n ASSESSOR'S MAP& LOT i 1 21STALLER'S NAME&PHONE NO. � -� Y• SEPTIC TANK CAPACITY e S o oo LEACHING FACILITY: (type) / Q -n., (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: y`zCOMPLIANCE DATE: U Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 20n feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by_ r a 3s y, No. / r �� Fee �V / THE-dbMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pprication for Mizpozar *r5tem Construction Permit Application for a Permit to Construct( )Repair(t/11u,"pgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. � , ` ` �� rn Owner's Name,Address and Tell..No. Assessor's Map/Parcel i y Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �� ��e —\-- Jb e✓� 0a 64eT,-� � Type of Building: � `/ Dwelling No.of Bedrooms� Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow s­ gallons per day. Calculated daily flow wo gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank f71 a s i Y= 1000 S e l t C i, Type of S.A.S. sw F�: L:V r&=1 Description of Soil A�ti� Nature of Repairs or Alterations(Answer when applicable) / . C-2— k obc) A-(I C_ry"-i 1`O 17 S j�LTC� ` S'I UV—� �y[�c /LO t &ir, �v— riJ Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in r acco dance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b this Bo of Health. DD Signed Date " Application Approved by Date Application Disapproved for the following reasons Permit No. (� Date Issued 2 No. ` '`^I _ - r - Fee I ..Tm bMMON.WEAL`TH-OF MASSACHUSETTS °`ti~�"Entered in computer: .�--...- � Yes PUBLIC_HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS .x. 2pprication for Oigpogar *proem Congtruction Permit Application for a Permit to Construct( )Repair( Xgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No! Zo 9L`TAN Owner's Name,Address and Tel.No. Assessor's Map1parcel �, t , / / 9G 1�V— �tiri-�� vU 0 y t•P Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. rZ as- D Oct Type of Building: Dwelling No.of Bedrooms i Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow" /07-•- D-z cu-L, gallons per day. Calculated daily flow �/�/� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank C-K)S=I q � t t C 7A-r Type of S.A.S. =JA_.F. LT ed,`t d/Z S Description of Soil wk--es rr O Nature of Repairs or Alterations(Answer when applicable) C--g- 11 o vt_, 7 LT✓C`r o Date last inspected: : " Agreement• S 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 Certifi- cate of Compliance has been issued by this Bo cf Health. Signed '` Date s2-0-5 "7 Application Approved by Date ;?- J 5-- 2 Application Disapproved for the following reasons z / , rfY• f! S fr Permit No. 957 /�./[� Date Issued 2 # 92 �, -- t----- -- -- — —------ --- --- --- THE COMMONWEALTH OF'`MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded(V-1 r Abandoned( )by ' �a��._ _T.�>_ �-� S at -Z r �—'7►GT"L IM, yyw�� has been constructed in accordance ' with the provisions of Title 5 and the for Disposal System Construction Permit No. 9-a-,//D dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will fu ction as designed. Date �"� l 1 ! / Inspector Q I ------------- No. 9 2— 7v Fee 5�0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 1=igpogal *pgtem Congtruction Permit Permission is hereby granted to Construct( )Repair(yak}Upgrade( )Abandon( ) System located at '1Z "TA yt 0 C r k� 1 and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. r Date: 9 2 Approved by ,,r �� TOWN OF BARNSTABLE LOCATION .) ��, SEWAGE #1742/1) VILLAGE =ILij L ASSESSOR'S MAP& LOT Q INSTALLER'S NAME&PHONE NO. ` r i SEPTIC TANK CAPACITY LEACHING FACII.TTY: (type) !.j;2(j " 4 (size) NO.OF BEDROOMS _ BUILDER OR OWNER C.��l.., PERMIT DATE: 7 COMPLIANCE DATE: Ll — / 2-7 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 2100 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 30LI feet of leaching facility) Feet Furnished by_ 7 T 7:j t� Sc Rcr..r Nmiff: This Form is to be used for the Repair of Failed Septic Systems Only CER'TIFI A'TION OF SKI;I'CII AND APPLICATION FOR A DISPOSAL NVORKS CONSTRUCTION PERMIT (WTTIIOU'T DESIGNED PLAN 1 hereby certify that the application for disposal works construction permit signed by me dated `'�; 1'y L - , concerning the property located at j 3 ,<- - `��� � meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • T'ftere are no variances requested or needed. SIGNED : DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER (Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submittedj. j:cert LO•C:)( DIN SEWAGE PERMIT NO. t VILLAGE 'INSTA LLER'S NAME & ADDRESS BUILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED S'-_1�.,-7 4` I \N f• i5� TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: <A9vte2-4�_ Board of Health MAILING ADDRESS: e Town of Barnstable TELEPHONE NUMBER: c , i110 e� P.O. Box 534 CONTACT PERSON: ad�i � �U Hyannis, MA 02601 Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous characteristics and must be registered when stored in quantities totalling more than 50 gallons liquid volume or 25 pounds dry weight. Please put a check beside each product that you store: Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants Motor oils/waste oils ✓ Road Salt (Halite) Gasoline, Jet fuel / Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business d .3t+= .Y+.'��.:R„'w-'Y":-,,-,.:r.y;.s:+w.!""�:""`I«,,.: "�'���....- ".,,.'�'v�'3'r,�'"`_�'^�.=,�.•+••.,�"r, �s.��'•=�=�Y•G'.�4"�"`�r.;��="h�;�,.��1..•.--'"�•-. TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair Q� satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops , � O unsatisfactory- 4.Manufacturers COMPANY f ctc•�7" �� t�,�' % ss - - (see"Orders") 5.Retail Stores VAsA hy 6.Fuel Suppliers ADDRESS AW . 6 �7 `'f°v;r � � //,,Class � 7.Miscellaneous QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) S Diesel, Kerosene, #2(B) Heavy Oils: Waste motor oil (C) new motor oil(C) transmission/hydraulic Synthetic Organics: degreasers Gf Miscellaneous: �O ,�r tom` al41-IC AV DISPOSAURECLAMATION REMARKS: p- 1. Sanitary Sewage 2.Water Supply O Town Sewer OPublic 0 On-site OPrivate 3. Indoor Floor Drains YES NO 0 Holding tank:MDC ,(b Catch basin/Dry well 0 On-site system 4. Outdoor Surface drains:YES NO ORDERS: 0 Holding tank: MDC O Catch basin/Dry well 0 On-site system 5. Waste Transporter Name of Hauler Destination Waste Product EEO 2. � '4�1 .,,• •�.. V Person (s) Interviewed Inspector Date , o : U 00,01 IF , .' -0. eGe) ve, -.G�4�pogr�5 . o_mcr7 __ h,� l� �o m ` S►Gr�.S �.+�' re�Lr _ CedG S S _ . ` c( �G�l y.6 Ar,d2 r.5oV7S D l�'IgG I . • 4 } r , , r r i t , I Ake RaoT -- -- --- i 1 , , . y, t-00 It . 00 r _ Jca�� yy - l.'p,, _ rnn f lot �I .tom .. /Vew. Fier-n'1 e� �orG h C4cross f��, 'e r-7 C"xi5 t �� 32 �C(o 2X9 'p7" deck �'rA�'7� mghoyG� d_eGkg� �. V On W — L/Xy PT � ri ht o,5-6s y _ 2 - 2X /o w/ P� wood �Aeu r de y �X . Geil, r) J 01 SAS 2,X 'rQ ft-e r5 /(-" o0 C e tf-r' S�✓►�se, zx8 P7 1499*-J to 6 0"5*. tvel-y I!o" 571ac�yc,re,d d ou blc Z-x 8 pT olits,c4. boa( lo,gge� -�o yXy (41oright �an�e,rs on evtry jo%SL i2 tz /4f f�e poi CGI,o/) ceolcr-goo Fri , Jae h e w roof w' t h old roof, 2-x x/oo,- 8, L"/ A (p p;f�h rotOerS SnS�q�� ZXIzXI�lc o�b�ed L,p hego(,e ZXGx G� Ge;�,'n JDiS t !6" on ce,,) t��., w;�h t�rc.�. �oS �ow� 7D tXrS�i/1 �2 CDX, PI ywoo oo roo i be d rooro wet I1, l Slb Frill PGper grld root^,'r�. si n.9/t fo rrna ic.h ex,'5t•? house, i J2 ILI 1 x.131611 NE I - - C, N o fG tin 5 ZX�-IX-Se 5 � ds � Via. � ex%5. 5 will , — � t — 2XgX -X8 — V2-. CDX ply-woad o�► goo ' wa l�� zxux I c�sl6 . Lel 1 pgp er And root J Sh,'�y��S �o rrmafG�) y 10 bee 15 11sn �Ov5e, EX 16 door joist arc, Gl�� thet C aid otre, 2X 10 Q ' I� Y ��oo m 7 U uji�n 3/i/ �J/yw00d. 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