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Home My WebLink About1676 FALMOUTH ROAD/RTE 28 - Health (2) ✓� 7(e .�a.lrru�u� �aao� C##Fllw� J�jj For office use only TOWN OF BARNSTABLE Received by OFFICE OF pate BOARD OF HEALTH �00 i639' 367 MAIN STREET Ito MAY k' HYANNIS,MASS.02601, / VARIANCE REQUEST FORM All variance requests must be submitted fifteen (15) days p rior to the scheduled Board of Health Meeting. / TEL. l -o (/Bo NAME OF. APPLICANT !f® _ ,,,� ADDRESS OF APPLI CANT 0 61 NAME OF. OWNER OF PROPERTY SUBDIVISION NAME cP„r�'�E'r✓' �^� a GATE APPROVED ASSESSORS-MAP & PARCEL NUMBER. LOT: SIZE. LOCATION OF .REQUEST VARIANCE FROM REGULATION (List Regulation) f REASON FOR VARIANCE (May attach letter if more space is needed) PLANPOUR COPIES OF PLAN MUST BE SUBMITTED CLEARLY OUTLINING VARIANCE REQUEST, VARIANCE APPROVED NOT APPROVED REASON FOR DISAPROVAL Ann Jane Eshbaugh, Chairman Susan G. Ras Joseph C. Snow, M.D. BOARD OF HEALTH TOrN' OF BARNSTABLE No........... ... ...... Fizsl...1 .00.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH I Town of................Barnstable.... , ppliratiun for Disposal Works Tonstriirtiun Prrmit Application is hereby made for a Permit to Construct ( ) or Repair (x) an Individual Sewage Disposal System at: 1694 Falmouth Rd. , Centerville, MA 02632 - The Candy Store -------------•-------------- -..........--•------.-----•---•-•----•-•-•---•-------..__..._.._.... .--.-•-----------------•-------•---------------•--------.-------------------••-------- ..... Loca re Julie M. Poyant, SpeclalAdd-ssRene L. Poyant Barnstable,Road, ffyannis, MA 02601 ......................-.......................................................................... --•-...--•........-•------------•---........_......•-•----•-••••-•---.....-•------............... Add W ss A & B Cesspool Service°wner 128 Bishops Terrace, yannis, MA 026®1 Installer Address UType of Building Size Lot___________________________S q. feet �-, Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers a —Type g --------•----•-•------------ P ( ) — Cafeteria ( ) Otherfixtures --------------------------------------------------•-----------•-•--------------------------------•-----•----------_----- 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 ( ) aPercolation Test Results Performed by.......-•------------------------------------•-••-••---------•-----.-•--- Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P+ -•----••----------------------•-------------------••---•...--------.......------•--••-......•---•---......................................................... ODescription of Soil--.S ....................................••-----•------•----•--......------••----•-------•----------••-•------...-••------------------- U ---••----••••-----•----•----•-•-•---------•----••--••.................•-•-----------••.........-----•...------------------....•-------------------------•••-------------------..........---••----••----- W ------------------------------------------•--------------------------------------------••---------------------------------------------•------------------------------------•--•------------------------ U Nature of Repairs or Alterations—Answer when applicable...installation of_a._1,000__.gallons.ire-cast, stone__packed_.leach--pit---�Oyerflow�. - --- ---------------•----------•--------------------------------•-----....------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T I T U 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board o It ne84 • ................... .. 3121 of �, ApplicationApproved By. ,------------•-------------------------------------•----- ........ 3/2 ` _----- ----------------- Date Application Disapprove r ollowing reasons--------------------------------•----•-----------------------•---------------------------- ------•-----.......-. ................................... ...................................•-------.........------....----....---.._......----------•-------.-------•.••.......................... .............. Date Permit No...&:................................................ Issued..........--------3 27-8---...---------•-•-- Date — --- -------------- - No.........L-nl/.-.. Fs$4....15..00....._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......T own............_OF................�arr_s`.a'hle ---------------------------------------------------------------•-•- Application for Uhipaii al Works Ton,itrnrtioat Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (x. ) an Individual Sewage Disposal System at: 1694 Falmouth Rd., Centerville, MA 0263? - 'The :,a.ndy "tore ................__ ................--....................................................... .................... ----•-------••-••-••------------•-•----•---••------•--------...........----- Julie 5. Loca'on Add res Lot o. Poyant, S.rac$al r SRene L. Poyant Parnsta'hle,Road, ffsrR�lltsf �',A 02601 ......................-----....._..........._.. ....-----........---•.........----•-•---------- .......----••------......-•••---•--•----....-•--•-----.........---------------------...---•---•--- W A & B Cesspool Service caner M-, Bishops Tarrace, "Ib.nnis, YA 0260 Installer Address Q Type of Building Size Lot............................S . feet U q .—I Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria QOther 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....................................... W a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �r.l Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 •-••------•-----------------•-•-•----------•-••-.......••----------•.......---•----•-----------.._...-•-..._._..----••--....--------•••----••--••-----.•--_.. DDescription of Soil a ...........-•--•------------••-•--•-•---------•..._......--••------•---•-----------•--•---•----•------•-•---------------.................................... W U ............................................................-----------•-•--•-•---•---•-----------••-•-•--•--------------------•-•----•-----------•---------•--- W -------------------------------------------------------------------------------------------------•-------------------------------------------------- --------------------------•---------------------- U --Nature of Repairs or Alterations—Answer when applicable..._�_ratalla:`_3_oy of a 1,000 gallon, prv-mast, stone wc?;ed_leach ni.t Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLi: 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by theeoard o e l rl ne�� L -------- �-------------- .......................... - ApplicationApproved By. .__. I. = " --•------------------------------------------------------- - -- ........................................Fl y Date Application Disapprove r ollowing reasons-------------------------------------------------------••------•----------------•----------------------------.... ------------------------------------------_------------------------------...--------------------......---------...---......--•--•-------•--•------ ,,------../..�/rc Permit No......................................................... Issued_...... ---- - -y-----_Date------ Date THE COMMONWEALTH OF MASSACHUSETTS ZD BOARD OF HEALTH Town OF................L amsta.`le le ................................................................. Tntifiratr of Tontplianrr e,. THj I TO CERTIFY That Itl,`Lw'dual S wa e Dis 1 S em C nstr ( ) or Repaired ( X) A & ' escpool Se vice, 17� r is o�,s 'e. ce P Ian i�s, �' �1 by---------------------------------------------•----- ---------- ------------_-----------•-• ...---------•-------•---........_._.............---------......_...-•--•----•-••-•---. 1694 Falmouth Rd. , Centrvi.11e, !'A 02, ?11= 5'heCandy Stare - Rene L. Poyant, Inc. at........---------•--•------•-----------•----•------------••-...----••--••----•---•--------------------•-•-------- has been installed in accordance with the.Eprovisions of TIT �jjo/ he State Sanitary Cor e� s� e ribed in the application for Disposal Works Construction Permit No___________----_O1/_ .___......... dated---.._.___.--_._-__---.---_--____----•----_•_--. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU D AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 3/2?/ DATE... ----•-.......... Inspector THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town earnstarle 84- ..........................................OF $ 15.00 FEE........................ RouosFal Works Tontrnrtion rranit A ct D Cesspool Service . Permission is hereby granted.................----------L---------•---------�-------------------------------------------•-----------......---------...-----•---........_._.. to Constru�t6? F ao mot it l d en'd"rgAe;�`r D6M) q Sy� ,e Cand.y Store - Rene L. Poyant, Inc. atNo. -----------••--•--------•--•---------------------------------------- Street „ as shown on the application for Disposal Works Construction Permi .. ............... Dated.......................................... 7/pp'''' ---.. ------ 3/ z tF / Board of Health DATE.................................................................. > FORM 12-55 A. M. SULKIN, INC.. BOSTON t 1 utr t 3°eMw, e1`P a � `' #.r�',P �'-ir'�.�,"�t• '�, ., e'°�.,��'�,i' �'�ti �..' ` -Y'�'i7' � 46' S •tR +ot � � �� d.- �, �c. �� '-� � ��.^g- � '^ s,-.s'E,: s"��" +� ; e •a � � phi� �� 'v h P b0 F 6 rrf� 2-a ra,. 'v '� ',� ii � M 7,°' `• ,e^'^ ^ e 'P r','y"P.„ •`a � h -,e .tr : ' '. Q s n x s w '� 2 Y # f+ v'_ .� 4Y✓�� E� �z�d+C�:�� yr�F P ,�t c +1 �:x '�a.;:: .y, +'� � °"E� --'s LOC--ATION _ SEWAGE PERMIT NO. u �_ ' � f VILLAGE a s L - A & B CESSPOOL SERVICE -�x 128 BISHOPS TERRACE, HYANNIS, MA 02601 g � ' ;. BUILDER OR OWNER TUL ��- DATE PERMIT ISSUED DATE COMPLIANCE ISSUED t 14 s y - u _ .. _ m L� 1t t # �g - +' �� n�,y � a M w<.�s: � :_c,,F , _.... ��.. � p a. •�� "5'- r.:: - _ _ J 2 0 � e �„ �'a ,��d3e. fir•, 7 a 400 -N. MINIM [OWEN A & B CESSPOOL SERVICE 011279 128 Bishops Terrace HYANNIS, MASSACHUSETTS 02601 A 775-6264 ' CuS10./ERSJRDER N- PI-TONE MECHANIC HELPEfu 51 ART ING DATE 9 / 12/8 BILL TO ORDER TAKEN BY Rene' L. Poyant, Inc. ADDRESS 7J I P.O. Box K DAY WORK li., E] CONTRACT Hyannis, MA 02601 EXTRA JOB NAME AND LOCATION Creative Images Julie M. Poyant, Spec ial Centerville Sho pin Center I JOB PH Route 28 - Centerville MA 02632 DESCRIPTION OF WORK Installation of a heavy duty 1, 000 gallon, pre-cast leach pit (overflow) with a heavy duty steel cover. Patched paved the worked area and replaced the Blue- stone in the gravel area. All work done in accordance with the provisions of TITLE 5 of the _State Sanitary Code and inspected by the Town of Barnstahl e Board of Health 'Department._ All material and labor included $ 112 0 Deposit of 9,1091/83 r0 J Balance Due 625 r0 - - i TOTAL MATERIALS TOTAL LAMM TAX DATE COMPIETED WORK ORDERED By TOTALAMOUP(T = F-11 No one home ❑ Total amount due Total billing to for above work:or be mailed after Signature completion I hereby acknowledge the satisfactory completion 1Ih%interest after 30 days. of the above described work. 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