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Home My WebLink About0151 CAMMETT WAY - Health ' 151 CAMMETT WAY MARST4?-n! r j A=099.043 J 'j �,a 1 No. Fee _ : THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: _es Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for M gpogal *pgtem Congtruction Permit Application for a Permit to Construct(pair( )Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. j 'l �'l46�l /.G� Owner's Name,Address and Tel.No. Assessor's Map/Parcel ®qQ ov3 Gc//4 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ,los t !J�l3aj4'.03' , t%®s�IC'y 9-e d oh-ry.5 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 gallons per day. Calculated daily flow gallons. 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) f i Zj jLW,1 if00 x 2 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 Certifi- cate of Compliance has been iss ed by this Board of Health. Signed Date Application Approved by Date- fr-Q�1 Application Disapproved for e fo owing reasons Permit No. Date Issued W.• •K 47=•. t i!lu. .. ` 3 No. S.� v._ a-lam Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS application for mitpozaf 6potemi Con,5truCtion j3ermit Application for a Permit to Construct(pair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name1'r At ,Address and Tel. Assessor's Map/Parcel ��rS1Ge/13 J�'"/MS / JFg1.5 f lf;, H Cl-- 5 Installer's Name,Address,and Tel.No. �,�� 4!�7' Designer's Name,Address and Tel.No. Jo5'e,04 a l3i ~s, Jos�p� Oa /3.v�ra►.g 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 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil—:5 _Z �sy Nature of Repairs or Alterations(Answer when applicable) - �r 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 Certifi- cate of Compliance has been issued by this Board of Health. Signed Date ! -i/- 9'2_ Application Approved by Date Application Disapproved fo e-fo wing reasons Permit No. Date Issued —————————— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed(4_,LRepaired ( )Upgraded( ) Abandoned( )by / v, A�4400.6, 5 at00VZOV. has been constructed in accordance with the provisions of Title 5 and the for Disposal System onstruction Permit No. _ dated Installer Designer The issuance of this permit shall no cey construed as a guarantee that the system will function as designed. Date ��3 " ! Inspector No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Xi5pofW *pgtem Construction 3permit Permission is hereby granted to Construct( 4.)4�epair( )Upgrade( )Abandon( ) System located at i r� — 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. Date: _��_g'C/ Approved by 10/9197 NOTICE: 'T'his Form Is To Be Used For the Repair Of Failed Septic Systems Only'- CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSA►.L WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) Ji hereby certify that the application for disposal works construction pern'dt signed by me dated 1— // 49 , concerning the property located at 1511 *No,"-e—/7 Gr/ra y I�YI, l�Yl,llS meets all of the following criteria:: at�There are no wetlands located within too feet of the proposed leaching facility 6l--There are no private wells within ISO feet of the proposed septic system There is no increase in Flow and/or change in use proposed There are no variiances requested or needed. • If the proposed Leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will nol be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S.map) B)Observed Groundwater Table Elevation(according to Health Division well map) 30 SIGNED:- DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER �?zl (Attach a sketch plat of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted). q:health folder:cent s i O O - 0 W I 1 I YOU WISH TO OPEN A BUSINESS? 1=or Your Information: Business certificates [cost$3❑ for 4. ears). A business certificate ONLY REGISTERS you must do by M:G.L.-it does not give you permission to operate.] business Certificates are available at the Town C Main Street, Hyannis, MA.02GO1 [Town Nall) YOUR NAME in town [which Jerk's Office, 1°` FL-, 31j7 Fill in pleaso: oo,E• 1 APPLICANT'S YOUR NAME: �z`s Se DUCINECe YOUR HOME ADDRESS: TELEPHONE # Home Telephone Number dj h NAME flF IV.W BUF3INESS•• --- IS-THI-S A"HOME O=J_PATlbtV TYPE OF BUSINESS: f3/�/ ,� YE5_-_TNo ADDRESS OF BUSINESS - / :MAP/PARCEL NUMBER. r r� When starting a new business there are several things you must do in order.to be in cgmpliance with the rules and regulations f the Towni Barnstable. This form is intended to assist you-in obtaining the information you Inay need: You MUST GO TO 2QQ Main St Rd. & Main Street) to make sure you have the appropriate permits and licenses-required to legally operate yo __-b- usiness (cornern of Yarmouth his town. 1. BUILDING'COMMISSIONER'S OFFICE This individual has been informed.of any permit requirements that pertain to,this type,of business. Authprized Signature** - OMMENTS: 2. BOARD OF HEALTH . �. This individual has be �ized �M�dtf the it re irements that pertain to this type of business. - �(ut ore** --� y= MUALL STCOYWTH COMMENTS: . HAZARDOUS MATERIALS REGULATIONIs 3: CONSUMER AFFAIRS ICENSI G AUTHORITY) This individual has.be forrQ'ed th lice i equi ents that pertain to this a of type business. Authorized Signatur COMMENTS: �.� Date: ,3/�� / a,P" � TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: BUSINESS LOCATION: " INVENTORY MAILING ADDRESS: B � TOTAL AMOUNT: TELEPHONE NUMBER: s��' �� o CONTACT PERSON: ZYC-N,h L-C EMERGENCY CONTACT TELEPHONE NUMBER: ��' ��'��- MSDS ON SITE? TYPE OF BUSINESS: INFORMA ON RECOMMENDATIONS: &I Fire District: 1275 oS — Gl ace t110 00 oao,& Waste Transportation: Last shipment of hazardous.waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, 'orage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) _ Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides. NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible I Ao Car wash detergents Leather dyes `A V Car waxes and polishes Fertilizers 4`2 h9y Ugh/ Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor &furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents 6&Z Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS .:�+ i .., TOWN OF BARNSTABLE LOCATION 1�� H'/-L� Goa k' SEWAGE # t . VILLAGE /yl sr-r9r&`I S ASSESSOR'S MAP.& LOT 0 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 4:yo LEACHING FACILITY: (type) 'fr (size) 0 X 41 �2 NO.OF BEDROOMS ' BUILDER OR OWNER -G.S R&1y7.GFS PERMITDATE: 1-11—q9 COMPLIANCE DATE: !— 12 ^9 9 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 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching faci 'ty) Feet Furnished by t4�. ' Dock y . R wl-wr f