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HomeMy WebLinkAbout0434 MARSTONS LANE - Health 434 MARSTON LANE,BARNSTABLE A= : , a; •i+ I! S. 1. r. :... . ,r.� .: _ �_• ,. L' • . 4 p. T • r d • Q6yPi 14 r - a n , , • A r , ' • t (� TOWN OF BARNSTABLE LOCATION /41:2g lam► A a sn is- LA jr SEWAGE # 5 V—9 9 VILLAGE G v cu -gig _ ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. ut-,',gJ ,gLw,' a 179 F-o 41'141 SEPTIC TANK CAPACITY /.5'00 GS7- N zo LEACHING FACILITY: (type) -5" WtA X Lw i 2 (size) es,x 493 X 2' NO.OF BEDROOMS BUILDER OR OWNER CLAuoe ca,2R�.�craJ PERMITDATE: /3-- 9 E 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 A ra f3 Ta IVY- --To . o e. � I i NO. ?C/ THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT dY 3/Application for a Permit to Construct Repair ( ) Upgrade ( ) Abandon ( ) - ❑Complete System ❑Individual Components Location Owncrs Name ap/Parcel# rAddress Lot Telephone H Install,r's Na ne Designers Namc n G . s5 L1 al ��s..� �-1 A`� T i�� u J d ress ^ 3&-2 s Yrel Iress / G Telephone 0 / J�if �.y yy elephone# Type of Building: Lot Size 5; 6 Sq.feet Dwelling—No.of Bedrooms Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures - Design Flow(m- .re uired) 3 gpd Calculated design flow �® gpd Design flop provided�I y gpd Plan: Date � /'>< O Number of sheets Revision Date �1 Title e3jTZf -4V' F S Description of Soil(s) see Soil Evaluator Form No.JL11A Name of Soil Evaluator J 0 D 14-*- Date of Evaluation e-7-7�e DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE S and further agrees not to place the system i,operation until a Certificate of Compliance has been issued by the Board of Health. Signed 77/ Date Inspections FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 TOWN OF BARNSTABLE -3 :LOCATION Iv►,A R sT JS- LASE SEWAGE # ViLLAGE ASSESSOR'S MAP& LOT ;INSTALLER'S NAME&PHONE NO._ k"gJ Vi c<I, jr— ►79 -o yyy .SEPiTC TANK CAPACITY /So 0 6 S T N tLEACHING FACILITY: (type) 5 MA x i r4;Z r,P (size) Yo.Zr)( K P3 x 2— NQi.QF BEDROOMS 3 B JIL'DER OR OWNER CLAu,oc PERMITDATE: 9 F COMPLIANCE DATE: Separation Distance Between the: Maiuii um Adjusted Groundwater Table and Bottom of Leaching Facility Feet N#ite.;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 FuinisTied by �.1• , j h' ,:' �,. �— Ar �STo ^j z- 24 � 3 Al—,3 Al A/ — Z�f 0 S • � n r wY�� ` t�"�.,_��:1t�:. y°'�....r•-...� `'"�'��'7;4„'. �-�"•r�tiair-}t'I,,,+"`rrb,.-.^^+14.�:.7 �r ... n ^r �•- � .� r �r ...�;; �"n.a+m-m,. No. ��- 9� THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH 7!ra"4 I — OF A APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT ' Application for a Permit to Construct Repair ( ) Upgrade ( ) Abandon ( ) - ❑Complete System ❑;Individual Components "r �1 k-4 4,' 1)N1- -�R 4 d- [_ 4 A rat 60&4 WOE A c.( Location O'wner's Name ap/Parcel# Address Lot 9 yh� Telephone N Installyr�Name Designer's•Namc C. Ad ress Address ,eve l� ,O + Telephone 8 /2// _© t/,9 TteleI5hrme N Type of Building: r/ �,! ��� GC- Lot Size Sq.feet f Dwelling—No.of Bedrooms Garbage Grinder ( ) Other—Type of Building No.of persons• Showers ( ), Cafeteria ( ) Other fixtures Design Flow(i .re uired) 1 3 a gpd Calculated design flow ��� gpd Design fl o provided gpd Plan: Date Number of sheets �_ Revision Date �y Title S!� r ,��✓rr �. �n� a� ltD 41 / W5 4 Description of Soil(s) / ,-.7li Soil Evaluator°Form No. Name of Soil Evaluator O Q Date of Evaluation X-7-r' DESCRIP.TION OF,REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees not to place the system Lioperation until atertificate of Compliance has been issued by the Board of Health.' Signed ' " Date Inspections FORM J - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 " , M1. No. l if - THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH CERTIFICATE OF COMPLIANCE ' Description of Work: ❑ Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System;Constructed(}o,Repaired( ),Upgraded( ),'Abandoned( ) rby: has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. dated tj .R Approved Design Flow (gpd) / Installer 7 Designer: / - Inspector Date The issuance of this cer ificate shall not be construed as a guarante that the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 No. THE THE COMMONWEALTH OF MASSACHUSETTS FEET P3. c BOARD OF HEALTH 'S DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to Construct (7) Repair ( ) Upgrade ( ) Abandon-,( ) an individual sewage disposal system at QQ as described in the application for Disposal System Construction Permit No. dated Provided: Construction shall be completed within three years of the date of this permit:-All local conditions must be met. Date Board of Health FORM 2 - DSCP DEP APPROVED FORM 5/96 FORM 1255 (REV 5/96) H&W HOBBSB WARREN TM PUBLISHERS- BOSTON - T' "A- 1 Date: TOXIC jkND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: BUSINESS LOCATION: MAILINGADDRESS: I-Ol�e4e 1 yDu� �4Dt Mail To: TELEPHONE NUMBER: S d —� Board of Health Town of Barnstable CONTACTPERSON: 0 ua6I P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: Hyannis, MA 02601 TYPEOFBUSINESS: Gt Does your firm store any of the to c 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(for gasoline or coolant 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 (creo)sote) 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 G&,Oa t cep (dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS TO ALL NEW BUSINESS OWNERS lease Fill in: APPLICANT'S NAME: C' �. 6 &/-� /'HOME ADDRESS: TELEPHONE UMBER: 0a- ,7 6 'Y Y (Please give us a number-where you can be reached) ., ,. 7 >+J'• rt""V s# .`� `'§r •z.�s.. y .rag,4< ;� r� x+�r,vas. 'R}y .r„�d- ` .•+... �>:�:q� z� � .. �..�, .� P IAM� F,IEW B, St�l>ES5 zTP: O B,l,)S( � 5 , a n x fir. s 7 �x = :5 >ry 3 Y, .i' �e xb..^�iL+'� S'TIS�A ,NOI�AE"OC :t��►. I ►D LESS,O Si ESS :, , F ,.. ., - 'r�r.�x• �Viz.' "i- .? "' ! 'e &•°.� "'E`A-L ik�e rw,. .r,.s'�:`. �'a .;sit,:,. ,.>�a,a.E.a`� iu:. 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. Once you have obtained the required signatures, listed below, you may apply for a business certificate at the Town Clerk's Office (Ist floor-Town Hall). 1. GO TO BUILD G INSPECtOR'"FFICE (4TH FLOOR TOWN HALL) This individual h been V. rmed-of p 7� requirements that pertain to this type of business. Aut a Signature COMMENTS: f /r 2. GO TO BOA OF HEALTH (3RD FLOOR TOWN HALL) This individual/�a een ind of the permit requirements that pertain to"this type of business. `� Zl�'11f.�/ � /3�S �• Authorized Signature COMMENTS: 3. GO TO CONSUMER AFFAIRS (LICENSING AUTHORITY) -(3RD FLOOR SCHOOL ADMINISTRATION BUILDING) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature COMMENTS: After obtaining the required signatures you must return to the Town Clerk's Office to obtain your business certificate (cost $20.00 for 4 years). A business certificate.ONLY registers your name in the town of Barnstable - it does not give you permission to operate -you must get that through completion of the processes from.the various departments involved. 7 fH . ... +A, . . .... .. .., . f. . .i..r-' +R`Mtn'• ..sue.. -+.,.st...ra..ra .Y.,.... nC.ir+:r-E. ._ ,, ,;,> kr'�fi`. Date: TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: BUSINESS LOCATION: �!` �F MAILING ADD RESS: A91?0-� Mail To: TELEPHONE NUMBER: g -- 36 q Board Health Town off Barnstable CONTACT PERSON: C 11u y' 0�J a to r' o P.O. Box 534 z EMERGENCY CONTACT TELEPHONE NUMBER: Hyannis, MA 02601 TYPE OF BUSINESS: G 4 Does your firm store any of the to is 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 O R POUNDS. Quantity 7 Quantity Antifreeze(for gasoline or coolant 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,42 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 �. Woodfpreser..vatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye ortcaustic soda Car wash detergents ;` f ;Jeweiry 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, s 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 oP a ft na�. ) Io }pg. :sr -- N �' le-aCA? Lj C.va'a e d ` 7 /0775 ,r'?O ID/-.7� � C3o7/Oh7 /match 94 A,,O 7-E O /l� EXT&AJD f�LL f� �'P:-lGf� BLE . . COVERS TO 4AJ17-HI/V /2` OF r- lN/SHED G ,2,9L>E scNED. 4© P V C. o,e E O U,9 L 7-0 SEPTIC (rr m r n r rn c.�rr) 1 Pe r -,Ca o-f-� 2 of �B - �2 wash e d 5-/-0 rn e � • • e A O D_/;57- BOX °. • (o dra ° 6" sump ° o o OCJ Gr9L ,> S�P7 C Tf�ti✓/C 0 314 - //2• ' °°o �� o• • waSf-ied S- 'one �o a o>< 0 1061- ,f �', .� / wel 10 -- -- LE- LOG 000 �pR \^ `� / _ E-D2OOM '-1OUSE DF� 7E-5T BY': COZ-'J FI �1ELC... i %��/C Q ! B - -----r ,0(t,•; '. ,` _. �' e:K-> 0�:i ��%%�h d i SPoS�I', -7 Q ` A2 C- 7C g - OLrn /r �0 n` F LOi..J 42ATC- _ 33o GALS �DHY '/7 • r i` . �� � D A TC/M P ' �� s� PT;c 7rvrv �c _.._ / s = 9 TEs7 Ho� E #/ TEs-r Ho� E- z _ .. .�o x �q5 10�•r� � k.� 1��' R;. r�IJ' U.SE /S� G/9L TA�II� �I fir'. /O 7 1 ` 20m:-. l) LE•i9CH P/ 7- f-or ,Soi \ }°g 88 E G',c. D �q _/O. / /oa.rr� \0�( �j "eatf P DEPT _ _ / }011 �_ S/DEw�C L = . (z.25) 44�.3 ,a D.. I �0.3 Ilo:o 4� G S G S.f p 8 07-•ro/� S F = G.= S c (U.9, ) = wi fh 7-07-i9[ G r j P I Q x 4.1 ` N % -�/!?ev 9� w, � \Ql boc.�/de r /70 l.�afer er7courrfered (`\ / CE,2T/F Y T/-I,qT 7 NE P�2o�oSED OA./ THE- G�E'oUnlD FJS — / -" v`J 1 / S H O Uv A_l O ti/ -T f-/i S �/_ F-?N F O,E' : l T .A ,' Boo !� :' ;�� j %y GO/l/FOi2M TO "TNE BU/L j,/,�/G sET- /'✓f�j /E? S T o/V S C.. �/�✓�' r2 E Q v i A2 E-M E Aj TS o f T-,.- E ro4AJ/v o� -I'- Jl ;r' f^, U/C.� /✓'I/4 S S. e � P,9e � r(De . GOCJ )(—=:;' Tor j%k OF �JGPf/EL- Q / / / / ERE , ,9S SNCwN n T� /�J EVERE 1 tVINCKL H. o H� � ! HINCKLEY HINCKLEY o..1787 k. No 1323(',(� Ar I' rF.r' 5-N#L C.._ Q !/lJ E G/V (_ L E7 j �u•� `SrON�I. ��= 0 00 = ex �St/ nc� e /e �at,on BLD �. S�TE3F�c,� ' © DO r-)r-op oSed eiCVCif-rOn CJ7TH �IHSS. - -- - - - ex /,St/ "I con tcaur-s P oPos�d c c�n tour'S S r de B.�, et15T7F L - -