Loading...
HomeMy WebLinkAbout4083 MAIN ST./RTE 6A(BARN.) - Health y LA I Rt. 6AMain Street, Cummaq' id 336-053 i 8 0 0 TOWN OF BARNSTABLE L ATION L �J dPT Gl/ 1��%D �5�`SEWAGE # $ /VII LAGE ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE N0. �/� � ��/1,��;" 7� ✓�9 SEPTIC TANK CAPACITY iS t� -4 A L— ` LEACHING FACILITY: (type) size) l Q 2— �C- 4i NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: Z COMPLIANCE DATE: .=�, 3 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 facility) Feet Furnished by i � 0 i -s 7 f 3 � 0 TOWN OF BARNSTABLE ` M�lN St� LOCATION LffJ? oPT '�gSEWAGE # $� VILLAGE ASSESSOR'S MAP &LOT 3a� v 3 INSTALLER'S NAME&PHONE NO. &if7nGa ���� 7 7/""3 Y SEPTIC TANK CAPACITY k te'a -6 i LEACHING FAC]LTTY: (tYPe) --� 4- C� �oc�iZsize) IQ r C � v. J'C. 14 NO,OF BEDROOMS BUILDER OR OWNER a I PERMITDATE: Z� 9g COMPLIANCE DATE: 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 facility) . Feet Furnished by APPROVEU MAY 2 8 2008 Town of Barnstable / Old Committeeway ir vi{ d L �� �� �0� �� ®��' Pa�o� O �P� ����������` '�o�0�`G�Q` �oc''� i a No. �7� di 7J Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for ]h5pont *p0tem Con0truction Permit Application for a Permit to Construct( )Repair(' )Upgrade(V)Abandon( ) L/Complete System ❑Individual Components Location Address or Lot No.1/�Ir� fflo Owner's Name,Address and Tel.No. Assessor's Map/Parcel 6 �iP'� ���� ` wlkl)) Installer's Name,Address,and 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 Design Flow /,14 gallons per day. Calculated daily flow er gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 1;5'0a4g1l Type of S.A.S. y - 5_©a9®/o,-11 Description of Soil Nature of Repairs or Alterations(Answer when applicable) �- 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 y this B and Heal h. Signed Date Application Approved by Date 9 Application Disapproved for theYollowFd reasons Permit No. T Date Issued No. dl Fee ��• / ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: �• PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZippYication for Migpogof *pgtem Construction f � Permit Application for a Permit to Construct( )Repair(• )Upgrade(✓)Abandon( ) M Complete.System ❑Individual Components Location Address or Lot No./JO Owner's Name,Address and Tel.No. Assessor's Map/Parcel ul��lT �� 6/iW/ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. . o Type'of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(/ e-7 Other Type of Building `yp g GL�_ No. of Persons f-x f) ,Sl"iower's-( ) Cafeteria( ) Other Fixtures _ 1 7 Design Flow //-42 `gallons per day. Calculated daily flow gallons. Plan Date {Nurnber o-4,f eep ��� i Revision Date Title - Size of Septic Tank Type of S.A.S. 'y ' S4G'9�1��'! �•ZO e Description of Soil Nature of Repairs or Alterations(Answer when applicable) / � Date last inspected: - �.- Agreement: The undersigned agrees to ensure the constructi'n 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 Application Approved by fi Date - C Application Disapproved for the ollowi reasons Permit No. ore, Date Issued ————————————————————————————----------- THE COMMONWEALTH OF MASSACHUSETTS 33 5 3 BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded(vr O Abandoned( )by e/_/�Ze/// 7` at Y4��X r �" 446t&"&Ll has been constructed in accordance -with the provisions of Title 5 and the for Disposal System Construction Permit No. ' - a dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date "1 W Inspector ---- ----------------------------------- JfJ Fee No. r THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION_-BARNSTABLE, MASSACHUSETTS lwiopozal 6p.5tem Construction Vermit Permission is hereby granted to Construct( )Repair( )Upgrade( dAbandon( ) System located at !A/Lti oeT 1,4- ll�/ 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: Approved by a r f_ S LIJ N <„J :. r yak-- A,_,:E Ce 4 D Y`Lmw iFF+, 0 0 p�tA1�o s 3 Sip - ;l�ybpY' �k ,. UL__T Jws xwT- j,. � ,x;i` s2 '. ,* �+ 8'rijrl �-; R s 3 '` .1' � �^u}4 m �r �' �",� # t � - x +-s r�+"i' -rr.+ *r sa - fi do #�� �`• - � . '��+",���x��`�w,�,'�� �s-src�` ff z�£ .,�,�� �. "f �t�`�'.:'t�."k'��� �.( t�'�.., has .-4�.�F�° -ors` �_.j- prt.�`�'r a. ter. � �., •,.z ..��-�-� � �,y.� •f a}*-°�. :�wY �'�cs;X�'�::�Cs"�''�'�."�� -s a-.-e'�+�'!'`��«�.�� ..� r� n.,`•�"...Ji nr�:�;:`�t x �*`y a�`���5. ���..:,�1'aF�3' � �:'��:`as� �.a �1��'°•,�;.��-�ar _"`'`� �x..wt.- �s`�,...� ,+r�d�:,,,r,R�z'`�' t3 �..t--:�-;�,'"r s�,., x _S�..r�� >s � �,,�.,�.{� �C.,.•�.a,��} � r�Fa,.i l.,cL4 r�`� �,jr.t`�.n.�'"" -" '@ +K���k^����_ �� ,� .. 1o/9/97 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) A404k , hereby certify that the application for disposal works construction permit signed by, 'm e dated concerning the property located at � J'/��`-������°�` �U� �u meets all of the following criteria: /Tihere are no wetlands located within I Oo feet of the proposed leaching facility There are no private wells within 150 feet of the proposed septic system ere is no increase in flow and/or change.in use proposed lif re are no variances requested or needed: he proposed leaching facility will be located within 50 feet of any wetlands, the bottom of the proposed leaching facility will be located less than fourteen (lu) feet above the maximum adiusted 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) C SIGNED : DATE: z"Al Z LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER Attach a sketch Ian of the proposed system.Also if the licensed installer posesses a certified plot plan, I P P P this plan should be submitted]. . q:health folder.art Date: °����" 70 TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: j6jee7 eat oes+ - BUSINESS LOCATION: YOU f GU'n dl— (d ina i MA- ©)W MAILING ADDRESS: Fo OQX Z Mail To: TELEPHONE NUMBER: d 5-- Board of Health IX, CONTACT PERSON: e' - ( ween e+ Town of Barnstable _ P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: SeJ�' '77 -- G/ / Hyannis, MA 02601 TYPEOFBUSINESS: AA—Sue Dion 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 Antif reeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes 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 Any other products with "poison" labels Paint brush cleaners (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 toxic or hazardous (please list): Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS TOWN OF BARNSTABLE .:;`LOCATION GL/ lli /4y'4 5--"'SEWAGE # f Yr :VII:LAGE � �lyllPQ�j� ASSESSOR'S MAP&LOTv 3 :INSTALLER'S NAME&PHONE NO. ...' SEPTIC TANK CAPACITY tta .,,.,..,:.LEACHING FACILITY: (type) ,44..Jia-�size) NQ.OF BEDROOMS :BUILDER OR OWNERd Al r l?ERMTTDATE: 2'"/O-9g COMPLIANCE DATE: ''Separation Distance Between the: ..Maximum Adjusted Groundwater Table and Bottom of beaching Facility Feet ]?iiyate Water Supply Well and LeachingFacility ty (If any wells exist n site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) 'Fuiiiished by Feet 's � Q f 0 N v4tW �t t YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$30.00 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.) Business Certificates are available at the Town Clerk's Office, 1"FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) ' DATE: _ Fill in please: APPLICANT'S YOUR NAME/S: ��e 1 j)a eta-�I pTig�f3 sC�x t `, � wm BUSINESS YOUR HOME DRESS: t TELEPHONE # Home Telephone Number Z cx j NAME OF CORPORATION: w Ct' ✓`f O NAME OF NEW BUSINESS TYPE OF BUSINESS IS THIS A HOME OCCUPATION? YES N ADDRESS OF BUSINESS b�; ff MAP/PARCEL NUMBER 3J� ��✓ (Assessing) rn 1C., 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 200 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 pertain to this type of business. Authorized Signature** COMMENTS: 2. BOARD OF HEALTH This individual ha be med�e^pe ��quirements that pertain to this type of business. Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS ICEN ING AUTHORITY) This individual has en i f rm d of the licensing requirements that pertain to this type of business. A thorized Signature COMMENTS: ** S �� _ /, �� L �`''�- r,