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Home My WebLink About0304 WOODSIDE ROAD - Health 30�1 �(uu�.5�r� �� o � e No. WOV] Fee BOARD OF HEALTH TOWN OF BARNSTABLE ZippYication _for Yell Construction Permit Application is hereby made for a permit to Construct( ), Alter ), or Repair( ) an individual well at: Lo ation- ddress Assessors Map and P cel 0 ner ddress Installer-Driller Address Type of Building Dwelling Other-Type of/Building No. of Persons Type of Well CQ. Capacity Purpose of Well Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Certificate C liance has been issued by the Board of Health. Signed /-),/,,�A Application Approved By ��!yU\� j D Application Disapproved for the following reasons: Date Permit No. Issued Issued le�l? Date ----------- --------------- — -------------------------I BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate of (Compliance THIS IS TO ERTIFY,that the individual well Constructed tl/, Altered( ), or Repaired( ) by l Installer at ��/ �ilJ �'�-du&A has been installed in accordance with the provisions of the Town of Barnstabl V f He Private We P to n Regulation as described in the application for Well Construction Permit Ni . ted THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date �'� �� Inspector No. V v O Fee BOARD OF HEALTH TOWN OF BARNSTABLE 2ppricatiou _for Vett Cougtructiou Permit Application is hereby made for a permit to Construct( ), Alte ), or Repair( ) an individual well at: W q �)(gj?;- yl)-e 72 —L cationl1/Address l // � I Assessors Map and P cel Owner ddress �— Installer-Driller Address Type of Building Dwelling r/ Other-Type of Building No. of Persons Type of Well�� . Capacity Purpose of Well Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Certificate of Cnce has been issued by the Board of Health. l Signed Da a �I Application Approved By Dae � Application Disapproved for the following reasons: r Date Permit No. L`(/ v Issued Date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of (Compliance THIS IS TO CERTIFY,that the individual well Constructed Altered( ), or Repaired( ) by &( W (Z,t�L Installer at has been installed in accordance with provisions of the Town of Barnst bla oar of Heil Privatere 1 P ote I Regulation as described in the application for Well Construction Permit No Dated - x THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. , Date J�� Inspector BOARD OF HEALTH TOWN OF BARNSTABLE ,Well Cou6tructiou Permit No. ( O Fee Permission is hereby granted to Al/(�r( Installer to Construct Alter( ), or Repai//r O an ind'vid al well at: 42 No. 3o Street / as shown on the application for a Well Construction Permit No. O! —0 ated l Date /�� f(p Approved By ASSESSOR'S MAP NO. L O CATION —--- PARCEL ylllAGE S EWA G E PERMIT NQ. Am INS TA LLER�S NA IRE b ADDRESS ; Q UILDER J OR i � oWtelER DATE PERMIT ISSUED DAT E COMPL I IANCE ISSUED 0.41 4k 600 q `p �J N Fps ......... ` THE COMMONWEALTH OF MASSACHUSETTS BOAR F HEALTH .............. 0F... .. ..cj.<" �.fcl.._ ..1.1" Applirtttiun for %qpuual Workg Tonstrartiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( 1�2)—'d'f4'Individual Sewage Disposal System at• 0 0........................j..... _1.. !... J. Location-Address or Lot No. o - s ------- ..........--............._.. .....-- ..._..... Owne �-` . ( 4. i(J �/ A es ------- ..................- -- Installer Address U, Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.......... .......................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — 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_______-_______________- w� GZ, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......................... P4 ..••••••--••-•--------••••••-•-•--•--••-••-•••._...-••••--......-••••.....--•••••...............•---......................................................... 0 Description of Soil....................................................................................................................................................... U -••••••••••••••••-•----•-•-••••••--••••-••-•••••--..................................................................-----•--------•-••-••--••-••-•-•••-.._...--••-•-•-•---•----••••----••••-----••--••- W ••--••---------------•-•----••---••••-•--•-••-•••••••-••••-•-••••-•••----••••-•••••-•-••--••--••••••--------- �s - U Natur of Repairs or Alterations—Answer when pplicabl __ Zlif ________________�._.-_._ �. Agreement: �/ The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iealth. tSigned- _ - -- - •-•-• -•• • -- ---•---•••-•_- Application Approved By...••-•-•••--•-•• ••••. �� 1��0- --------•- Date Application Disapproved for the following reasons:...............................................................•=................................................ •-•-------------•---•-----....--------•---------•----------•---------•--......---•-----.......------•----•••••••-•--•-•-••••--••••-------•-•--•-••-------••-•-••••----•-••-•-----•••-•-•••••---•••:---- Date Permit No.... ---•-•-•- ------ ------------•---- Issued.................................................. --- Date FE THE COMMONWEALTH OF MASSACHUSETTS , - BOAR OF HEALTH OF.. ")q..r .. ...�_. ..-r----......................... �. I Appliration for Dispoiial Works Tonitrurtion rrutit Application is hereby made for a Permit to Construct ( ) or Repair ( 'fin Individual Sewage Disposal System at: ) , yyam�'',� Location Address .......................................1... .. *" o Lot No ......r _._ .... =• �`L .,-�`...I....... ..........• ------._......... ow v ddres a 41. ............................... Installer Address UType of Building Size __-- _-Lot-__•---------------- q._- S feet 1-1 Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers a YP 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. I................minutes per inch Depth of Test Pit................. Depth to ground water........................ fX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 --------••••------••--••-•-------------•---•--------••-----........----..........-----•••--••.------......................................................... Descriptionof Soil.....................................................................................--------------•-----------•------•----.......-•---•-----------------------------•- x W --------•----------------------•-•-•--------•••-•-•-•-•------------•------••• r Z.. _____ Applicable'. r U Nature of Repairs or Alterations—Answer when a ` ��-a _ '.. a �. '✓ 'f .... .. _. ------------------- Agreement: 7 The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL i:, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been�itsued`by the board af'health. Application Approved BY �: 1fna._L !'= ... : ------...---•-.•---- ! -� �' Date Application Disapproved for the following reasons:-------•-------•---------------------------------------•------•-------------------------------------...-----4`' --.....----•----------•---•----------•---••--------•---------------•--------------•---••-------------- Date PermitNo.----='=.-. ..... ---------------- Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD,.-OF HEALTH r...................................OF... .. .x:. .... rrr. .�..:.. ,w.................... 01rdifiratr of Tontpliattrr THIS IS TO CO3TIFY, Tha the—Individual Sewage Disposal System constructed ( ) or Repaired ( r' bye f'[� `''" `� - �'4.1 a � _..a°"'" sal- .. € --- at has been installed in accordance with the provisions of TI I ice'. 5 of The State Sanitary Code as ribed in the application for Disposal Works Construction Permit No�:.' _.:c�-7�.......... dated..........'_.. .................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL 1 CtT3 N SATISFACTORY. DATE.............. .................................... Inspector--------- -----------------------------------------...-•-------•---•-•----- THE COMMONWEALTH OF MASSACHUSETTS /l BOARD OF HEALTH No......................... FEE......................... iu ruu ku Tonot an rrrmit `� .• Permission as herebyranted---------=--� �- :....- --�--- �-•-�--------•----•---------•-•-----•----•------...-•---•............. g , . .. to Construct ( ) or Repair O an Individu :1 Sewage, isposal System at No Street as shown on the application for Disposal Works Construction Permit No.=�`~_ u__ Dated_ s'� ��,��C2.............. r I •................... .................................. . ......Board of Health DATE..- ................ FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS y\; Date: TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: • a�9�HS7 Ft/3L C �E�'1a[�E'L�w�i BUSINESS LOCATION: 30 �/ MAILINGADDRESS: 0&6_11K Mail To: Board of Health TELEPHONE NUMBER: So - 3 Town of Barnstable CONTACT PERSON: 00 12 P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: 78-o - 7? 7 Hyannis, MA 02601 TYPE OF BUSINESS: Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own use? 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 character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antifreeze(forgasoline orcoolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Paint brush cleaners Any other products with "poison" labels (including chloroform, formaldehyde, Floor& furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxi or hazardous (please list): Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS ASSESSOR'S MAP NO. PARCEL LOCATION SEWAGE PERMIT NO. VILLAGE Am IS2 OZZ ")p apla 'y/,"d , 11 1 I I N S T A LLER'S NAME ADDRESS _� ��y'✓- Ile- 8 U I L D E R OR OWNER DATE PERMIT ISSUED .2 ? 6 DATE COMPLIANCE ISSUED ,q_ ,(7� oj V6 fqA P,�r _ L' a --- ................Fug.. THE COMMONWEALTH OF MASSACHUSETTS ��L�Otiv BOARD JPF HEA TTH --------------oF........ .. -------....._--- ApplirFatiun for Ramat Works Tons#rurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual ewage Disposal Syst at L� �Q u Z- .......................... Loca ion.A__d. ess caner �� _ Ad ress -- - - W .... .� l{/Ii1V a M Insta11ei,. �. Address f Q Type of Build in /� Size Lot__��®.f�l_Sq. feet U Dwellin �No. of Bedrooms_________________,-_:___i......_.....__..._.Ex Expansion Attic Showers Garbage Grinder g P ( ) g ( ) aOther—Type of Building No. of persons............................ ( ) ( ) Wa Other fix � --- :__ Design Flow. ..... gallons per person per day. Total daily flow...............��__ -----------gallons. tx Septic Tank-I Liquid capacity _gallons Length................ Width_-_--.----_-_-- Diameter................ Depth---------------- l� Disposal Trench No. .................... Width.................... Total Length-------- ........ Total leaching area....................sq. ft. 3 Seepage Pit No_ ________________ Diameter.!l_t ___ Depth below inlet....... ............ Total leaching area.....J.' q. 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....................---. fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_--_--__________-_-----. -••----- ----°------------------- ...... O Description of o --------- ----- ?--- ---* C` `--�- - ---�--- ----- ------- ------------------------------------ x W . - , - 9--------------------------------------------------------------------------- '" ' ------ UNature of Repairs or Alterations—Answer when applicable--------------------------------------------------------------------------__---_------•-__---. ----------------------------------•--••••-•-•--•-•---•••-•----------------------•---••-••-•----------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article YI 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 of health. Signed. • --- -----------------••---•-•-•---•----------------•--•-•--•--•-----•-•••... ................................ � D e Q/ Application Approved BY / 112- Application Disapproved for the following reasons:...........7 Date .... ----------------------------•-------•-------------------------------------------.....--------•-•-........------------•••--•------•--------...---••-••------•••----------•--......--•-------------------- Date PermitNo......................................................... Issued........................................................ Date l THE COMMONWEALTH OF MASSACHUSETTS BARD F !-I EA :7 H .•c OF.-.. .. ............-. , pplirativit for Digpos tf Works Tonstrur#ivit Vrraaait Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual ,Sewage Disposal S st a W 'y" }� fr i f f a '' g/�t/r6 °�tidpy'✓_`I � r - �°70 k 4f J Location•Address :' t s f e; 1 47 wner Add _._ ress Installer Address d rL0 d Type of Buildin �dt,. S t'3'-,3 Sq feet Dwelling No. of Bedrooms_____________ --`_a _________________Expansion Attic ( ) Garbage Grinder ( ) p� Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ......................... Design Flow_______________________��`'':f Mons per person per day. Total daily flow.____._____._.-�____ ___ ._.___gallons. W g �, - g P P P Y Y W °Septic Tank -Liquid capacity;`_=' : gallons Length................ Width----------.----- Diameter................ Depth................ x Disposal Trench-, No. .........----------- Width.................... Total Length........ _______.-. Total leaching area--------------------sq. ft. Seepage Pit No.!................. Diameter../lI ___ Depth below inlet...... Total leaching area----�'.A� 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_._.____..___...___...-. (X, Test Pit No. 2................minutes per inch .Depth of Test Pit...................... Depth to ground water------------------------ O Description of o ------- ------- � ------ � r -4• _--`_ -------------------------------------- ---------------------------•----------------•---------------------=------------------------------------------------------------------------------------ U Nature of Repairs or Alterations Answer when applicable................................_______________________________________________________________. -----------------------------------------------------------------------------------------------•--••-•--•------------------------------•----•-•--------•-----•-•---------------------------••--•------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI 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 of health. Sr ned r ----••.......- t�/ ) D e Application Approved By!-' � , , -'--t L-, -_A / - �/° Date Application Disapproved for the following reasons:-_______-.-/--------------------------------------------------------------------------------- .............................................................--------------•-----------•-----------......---•---------------------•----------•.----------•-------------------------•------------------- Date Permit No........................................................... Issued Date THE COMMONWEALTH OF MASSACHUSETTS I BOARD F HEALTH rw r ,�.: r......................oF...............--'1 �2 :.:_..............-----............ Trdifiratr of Tourphaaairr TH45 I TO CERTIFY, ghat the Individual Se ag -D osal tem constructed ) or Repaired ( ) � . by-- - - •- - --+_--= -- - - - =-- --- 1 .° (Installer sP ---• -----------------Z�,. � { -y '� +!•• �"'`s�'` has been installed in accordance with t e provisions of Article XI of The State Sanitary Code s descr.ibed in the application for Disposal Works Construction Permit No..................i. 7__.::_, ----- dated....._ /_-�.-- - '-_-.••_-- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WIL N ION SATISFACTORY.,", ,,, DAT-E. .� �.¢. .•- - Ins ector THE COMMONWEALTH OF MASSACHUSETTS t i , ..d , BOARD PF HEAL7 No......•-----. ...•••-- _ FEE... . i, #u13 irk is $raar iaa� rr Permission i .hereby gra -7- ------ - - ... .. ....(loe nted---- to Constr 'i t or Repair ( )an In i dual Sewage Disposal System / ,I at' No.- c ° �.'= tea.�- �� %:T- rsG,e! f �'�'' l ---- ----- -� Street Q / as shown on the application for Disposal Works Construction Rqmit .o. 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