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HomeMy WebLinkAbout0144 LOVELL'S LANE - Health �c�rs 7"dnS 1'Y1�� t -' 144 L:OVELL L_., A = 078 036 f r TOWN OF BARNSTABLE C `,LOCATION SEWAGE #off VILLAGE AP ' + 1 l ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. i SEPTIC TANK CAPACITY A0 ;e LEACHING FACIUN: (type) ft�#GGsx,i (si '� F NO.OF BEDROOMS eAY s BUILDER OR OWNER A rs J a rs PERMTTDATE: 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 1 t O 9-0(js 01 r t � YOU WISH TO OPEN A BUSINESS?- For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR.NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. _ DATE: �-I-1�-A Fill in please: APPLICANT'S YOUR NAME/S: �'.. ��V�-ZGt�� �k BUSINESS YOUR HOME ADD ESS: " TELEPHONE # Home Telephone Numbef U NAME OF C�ARP@I rF1 PJ: 4 :VAC NAME OF NEW BUSINESS TYPE OF BUSINESS ISTHIS A HOME'OCCUPATION? YES NO ,, 2 ADDRESS OF BUSINESS ='�� .aW/PARCEL NUMBER V ��03 h (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 2.00 Main St. - (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that perta6't'o this type of business. Authorized Signature* COMMENTS: 2. BOARD OF HEALTH This individual ha be for d of the permit requirements that pertain to this type of business. MUST COMPLY WITH ALL . I'✓�f�l KVAROM MATERIALS REGULAYION$ 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: (is 9 �/ / TOWN OF BARNSTABLE Date: � TOXIC AND HAZARDOUS MATERIALS Q� NAME OF BUSINESS: w BUSINESS LOCATION: M 6-\j-SknM INVENTORY MAILING ADDRESS: PtO •6 oy OTAL AMOUNT- TELEPHONE NUMBER. CONTACT PERSON: \ ✓ EMERGENCY CONTACT TELEPHONE NUMBER:,e—'6S �— 7 ?� MSDS ON SITE? TYPE OF BUSINESS: INFORMATION/RECOMMENDATIONS: Fire District: 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 material use, storage 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) Miscellaneous 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) �,asoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous 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 Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT I CANARY COPY-BUSINESS Applicant's Si ure Staff's Initials No.�(� � ©�g' Fee .J—L�— THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zippricatiou for Tigpogal 6pgtem Con.5truction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) El Complete System ❑Individual Components r� • Location Add s o Lot No. / ,I �OaP404�'S�O�v Owner's Name,Address and Tel.No. ••• h041 r i Assessor's Map/Parcel G r / e [( [ t -Yo if Installer's Name,Address,an Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures L S Design Flow S S 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) 1 j t I N e ce p PSv c✓ r Too,J( ( r Date last inspected: Agreement: The undersigned agrees to ensure the construction and maint na of the afore described on-site sewage disposal system in accordance with the prov o it e n iro ent Code and not to place the system in operation until a70,0 ifi- cate of Compliance has een issued is e Si ned Date Application Approved by Date — f Ca d Application Disapproved for the ollowt g reasons Permit No. 21d0 -- ��' Date Issued TOWN OF BARNSTABLE LOCATION / 'C® SEWAGE # VII LAGS //'/' !° � T_ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: � (si type d NO.OF BEDROOMS n BUILDER OR OWNER PERMITDATE: 600 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 i a t. elm I 9'9' ,�: - No. , /)60 t Fee y THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: -- es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 2pplication for Migpooal *pgtem Congtruction Permit f Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) O Complete System 0 Individual Components Location Add reds oyLot No. } oti,e' ��a rse�a� S Owner's Name,Address and Tel.No. Assessor's Map/Parcel Q I lS k �� 1 "�14 r Installer's Name,Address,an Tel.No.�( Designer's Name,Address and Tel.No. ---I if (0/U GaJ Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures L - Design Flow 5 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title " r- 4 Size of Septic Tank Type of S.A.S. ti Description of Soil F Nature of Repairg orAlterations(Answer when applicable) TX sl-A rl iu e w gin,[ Ud' rA P . Ur R elyl ro Y• !.0 t Date last inspected_1 „ Agreement: i ... f The undersigned agrees to ensure the consruct.l ion and m aint nance of the afore described on-site sewage disposal system in accordance with t e provi ' o a e n iron nt ode aifd not to place the system in operation until a Ce if- cate of Compliancehas en issued b is f e t Si•ned Date /� 0 - / Application Approved by _ Date j..— /(,- !� r ' Application Disapproved for the Mlowi.14 reason Permit No. 2000 — �,_ Date Issued -- . --THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS 'Certificate of Compliance THIS IS TO CERTIFY, that the On-site S wage Disposal System Constructed( )Repaired())Upgraded( ) Abandon t )by _ glo— at �`` `w ` '/ has been constructed in accordance with the r + ' io Lof Title 5 and the for Disposal System Construction Permit No. f5?�f' dated Installer e f C.. Designer. The issuance of this perm�i shall nort construed as a guarantee that the system vvill�fyunct�i�n�as des;.gned. Date Inspector �1 No. 3-0,PO' �01// Fee�� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Mi!6paar *pgtem Congtruction Permit Permission is hereby granted to Construct( )Re/air Upgrade( )Abandon( ) r r l� System located at �.�o ,a. � <w C t S 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:Constructio must be completed within three years of the date of this permit. Date: 0 Approved by !) %57 4a`\ •{ .' _> x°z� � " "� ,4't yajw+ t x•K!' F3•+ "?n" - ell S \ i �• c° !s a,+'4 t7 �'„rj'g'ki°� (n _s ���y 'a r.a r 4 5' r� yam.."�,Y•'� _ '�'` Pxt .t 4�'f'"' 1 f t48 °"�'.°4 r•t`4 1 tr '�+ :.wr raa".• a1�.r' . 116199 ... v�•s'tf !' .a...?A ,r a� i i j� r .cZ �<, _ .f .e ! -.tz l NOTIC : This F6r To Be Used For he Repair Of Failed } fbehc`Systems Only , �t - }�� - ;ip ♦ $`✓ �r i` ray t r'' ��s .. �'� 1 > z ! L. .. �,/.a a,..x��.z •i::�{, n`j'` �^.yt S .}'�'•,• Y'e s, - s ': IC'ATIOiy OF'`SKETwr�.AND AwPPLICATI(7N FOR A DISPOSAL r CFR ,. WORK CONSTRUCT:, P'+RMIT ,�' DL;-I'THOUT IGNED PLANS) = y YS��� �,��� �A �€�1`�rs��.fi 1�J sl�'A� •^,y a'�"t Si s ,r ! �! d. a ., � •. �y� .r� . .� � e +� .'>s -. S .hereb rerl that th a .. ,;a Y �Y. ,p tio�1 for disposal works 4x` construction perriit signed by me dated concerning the : pic,pertylocatec' at 1C iv meets al e .x 1441 kx, m 1 of th following cntena t '.' t >• ZVr' X ." _T� ,,,� ('+i x••.. ,: E The f r! ;`system is.connected toea rF t idenUal d•Nelling only,. C eri, re'no`commercial or business uses,ssociated•.with the dwelhng •r 1'h,XQ's% is classified as CLAD°A a the percol;,i,(n rate is less ha z por equ�,Vto 5 minutes per`inch. I, 1 ! ...E There ail r o wetlandstwithinz100,f ,t of the pr,,i.)sed septic sy a:m - W. There are no privat wells within o feet of th:proposed'eptu: ,y t ni, Jy,.F3 i •' There i< no inc�.eas; m flow and/or cliange in u;:proposes l ' There are nova ianc`es requested dV't-.eeded' - r • The bottom of the proposed leaclunglacility Will%ot'be located 1:ss tl,xn five feet above the rnaximurn adjusted groundwater table elevation. (A-djust the ground hater table using the Frimptor method:when a-iplicable]r,;; • If the S.A:S will b,:locaied with 250'feet of any:izgetated wetly,ds, the bottcin.of uie piuposed Leacltin.'T`icility will not be located le:,s than fouiteen(14)feet a1,OVI-the ma imum adjusted l�rour .vratE:r,table elevation, T°' r .. ' ,y. . 'leU&. .onrplete tt a following.' ' 'ry A)_ < of Ground,�� lace EIe' ation(using; ,IS informatics B).G.W.-Elevation ++11te MAX.;l.gh G.W. Adju.7 n(� 2 ✓�?. z S' '! ' DIFFERENCE BETWEEN A'anyPzi� XA `>IG U ra�-a DATE: Q C�• ' b 1. K, i LSketch proposed'plan of systerh oihback], y q:ltea.ith folder .kTi a r