HomeMy WebLinkAbout0281 OLD JAIL LANE - Health 281 Old Jail,Lane
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041THE COMMONWEALTH OF MASSACHUSETTS
. D BOARD OF HEALTH
�1 -1 -•----..../o w�..............OF.....
Appliration for Disposal Works Tonotrurtion Prrutit
Application is hereby made for a Permit to Construct (g,�. or Repair ( ) an Individual Sewage Disposal
System at: 4
GD Tr9 GL �/�:..:/.�r r��.I STi L-`�s ��T 1 .........
................. •--......
Location-Address or Lot No.
9�.( v✓�zcH- --- --.-- .... r9T ��'".....................................•----•--.....--------
Owner Address
WG a e?�..-•••••..� .s-.......-•••-•......•--•-•................... ..........................................................dG�
Installer Address
Type of Building Size Lot.... ...o-•.....Sq. feet
�-, Dwelling—No. of Bedrooms................-.3.........._............Expansion Attic ( ) Garbage Grinder ( )
a44 Other—T e of Building No. of persons......................: Showers
Other—Type g ---------------------------- P ----- ( ) — Cafeteria ( )
dOther fixtures -------•---•------------------------------------------.•-••--•••••••••••••---•••••--------------------•--•--.....---••••-••-••--•••......•............
W Design Flow________________S............... allons per person per day. Total daily flow-__-----•- 3e?-----_................gallons.
WSeptic Tank—Liquid capacity.!O,�!d..gallons Length.. 6'.... Width.4_.K" __ Diameter................ Depth..:;F�
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No........!_.......... Diameter...._.%_-`...... Depth below inlet.....6-......... Total leaching area..Z6.7......sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by....drPW4 __. ._ -L .----------........ Date'Tvv� U /j�s'
14 Test Pit No. 1....L-_-'..minutes per inch Depth of Test Pit..__/���... Depth to ground water......................
ri, Test Pit No. 2..._L.'..minutesper inch Depth of Test Pit.... Depth to ground water-_-_--__--•-••----_-___.
9 ------------------------------------------------•--•----....--------...........•---••---•--•-•-•-----•-•---•-••---._...•--...----..... .......•....
O Description of Soil.... `�__ `_'_.da000s __ Se�B-so rL ----- ¢?_.._ �yl�s�f=ini 5 ..�_..
b•.....
U l06 rr— 7Z`.._ G`7�lSG' ..............................
"!D ._..... •/'lle � IRS 6r
U ....---•-----•-•--••----••-••-
W
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 TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
o ration u til a Certificate of Comph ce has been issued by the boar fd/fof hea'lth./
Si ned-••-- 5
Date
Application Approved By.......... •-•-••••••.. ..` . ......... ... ---
Date
Application Disapproved for the f ollowi g reasons---------------•----------------------------------------•------------------------------------------......••......
............................................•..---------...-•----•---•--•-••-----•---------.....--....---•••••-••-•--•--•-••-•--•-•---••---••-•--•---•---••-•-•••••-•---•----••-----•-......----•...._.
Date
PermitNo.......................................................... Issued_..............................................:........
Date
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No......................... Fiat..........................._.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
ALTF H
-•----.._.T. O�r...............OF..... ?A ani7/..,/%GG-........_.....
ppliratiou for 11wpoaal Workii Tonstrurtion rrmi#
Application is hereby made for a Permit to Construct (v'r or Repair ( ) an Individual Sewage Disposal
System at:
:.... 2y... - l-oT
Location-Address or Lot No.
.T�: / Qc��/ V V,V,oc INLZ G /_......... 8 1V5Tf 'G ,--•---•-------•----•-•-----•--------------------- •- ..
T.- ._......
/ Owner Address
to
-----------------
� Installer Address
Type of Building Size Lot........,.______7_______
....Sq. feet
.-° Dwelling—No. of Bedrooms________________3_________________-____-Expansion Attic ( ) Garbage. Grinder ( )
a` 4 Other—Type of Building No. of.persons Showers —
YP g -•------------------•------- P -• ( )------.Cafeteria ( --).
dOther fixtures -----------•---------------------------•--------------.•..------------------------------•••-•-•-••-----•------------
W Design Flow................
............................gallons per person per day. Total daily flow............................................gallons.
1:4W Septic Tank—Liquid capacitywoe___gallons Length__�'_�_....... Width.:!-.!�__'__. Diameter______________•_ Depth...........
....
x Disposal Trench—No_____________________ Width.................... Total Length.,................... Total_leaching area....................sq. ft.
Seepage Pit. No........ ___________ Diameter____._/a_.__.___ Depth below inlet...... ............. Total leaching area._A6Z_=...sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
'-' Percolation Test Results Performed b ��w�?�___. G"cz« ...................... Date`T""!� z1 1:`&S.
--
Test Pit No. I____L____Z__minutes per inch Depth of Test Pit._._(' ___ Depth to ground water............._..........
44 Test Pit No. 2.....4:__7--__minutes per inch Depth of Test Pit....!i;�........ Depth to ground water........................
C4 ................................-•-----.....-•----------._......---•--......_...-------•-----.........-------------••----•--•-----------
O Description of Soil....0-- - 'bf ��� "`? SuB-Sn<< -02a':__ `i�iG ...Sb
U .... ..........?�"--. G x!S� ..........? .C/_D -:5,10 7Z'� /�¢ ML��G► -•-•--••------•--•-_.. ._
W
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 TITIE 5 of the State Sanitary Code—The undersigned further agrees not to place the s ste "in�
operation until a Certificate of Compl- ce has been issued by the board p e ltl '1' 4"/'�•'
tt
Signed... ............. --... ................................................. ..........................
Date
Application Approved BY .... -------•-----------•Date----•-•------
. #c •v��? ........
Application Disapproved for the f of ing reasons---------------••-----------...__...---------------------------------------------=-----------------....._........_
............................................................. -••----------
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
T 1"/A v� sTf-3 G ---
......... .... . ..............oF....................................... ....................................
T rfifiratr of Tomplianre
THIS IS TO CERTIFY,.That the Individual Sewage Disposal System constructed (t_'or Repaired ( )
bY------------------------------------------- +�1
p,r. �l_.:c7.. ----------------------------------
Installer
at.. ---------•-•. -
.... f ---- L ��,� ••-
has been installed in accordance witl�ithe provis > oTI 5 of The�tee finitary Code as described in the
pplicati iI for Disposal Works Construction Permit N ______________
11 ° . �
TmE ISSBJANCE OF THIS CERTIFICATE SHL'[��9E COIdSTRIBE® AS A GUARANTEE THAT THE
SYSTEM WI F NCTION SATISFACTORY.
. ' DATE.......... . .��... �' --•-_. Inspector. °k"� . .c ��-'=� ---------------------
err THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
R�
OF.... -�`................ 00
f�
Permission is hereby granted........- _
to Construct (�•�or Repa ( ) an I divi u 1 �S�e ge J -System'
atNo..................... -----=a -•-----6,41t-IA.1-4t?..............................................
Street
as shown on the application for Disposal Works Construction Permit N !_S- ) ______ Dated..........................................
.............................. ...............................................-- - -----------
[� oar f Health
DATE_..... •-••--- �.................................................... w
r FORM 1255 A. M. SULKIN• INC., BOSTON -
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LOCATION f3 ^!.sT�BG J M'9ss,
SCALE . /"=/ao.�. . . DATE
PLAN REFERENCE
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L LA �� I CERTIFY THAT THE
SHOWN ON THIS PLAN IS LOCATED ON THE AROUND
AS SHOWN HEREON AND THAT IT CONFORMS TO THE
SETBACK REQUIREMENTS OF THE TOWN OF
WHEN CONSTRUCTED.
DATE . . . . . . . . . .. .
—/�4 7 REGISTERED LAND SURVEYOR
v� •
L. .87��.. ... .
TOP OF FOUNDATION
e CONCRETE COVER
CONCRETE COVERS
Z,Sn' , e 4��CAST IRO �.
II 12"MAX. '
OR SCHEDULE 40 4"SCHEDULE 40 PV.C.(ONLY)
I , P.V.C. PIPE PIPE- MIN. LEACH
1J° ' PITCH 1/4"PER.FT. PITCH 1/4"PER.FT. PIT
„e IF
ST
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LEACHING
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INVERT ' N
` e EL.Bg .:: INV R INVERT :SEPTIC °TANK ,�p3 DIST. ,3 wV.INVERT BOX , -8 Zo .. GAL'. INV T H- 0. •,
EL... ...... $� INVERT ;' w w 0• I V2EL...:.... �� \ D8 '' tz--7 vo
' . .Zz--►}4—W DIA. —fA,vnDIA
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PROR LE OF GROUND WATER TABLE
SEWAGE DISPOSAL SYSTEM
NO SCALE
SOIL LOG WITNESSED BY :
DATE T""/E ?�!9. TIME. /o:oo Arj �/�,Ar�t'3 CoNLo!� BOARD OF HEALTH
TEST HOLE I TEST HOLE 2 ENGINEER
ELEV. . .4v,80 . ELEV. .p ,.47q
WooDLeArf WoovLo.AyN .
DESIGN DATA :
,q,Zu �•7�3o t2.88•00 ' 3
NUMBER OF BEDROOMS
Go� HE'D/y.vG' . . . .• : . . . . .
/`ICD, TOTAL ESTIMATED FLOW . 33o GALLONS/DAY
74 8 0 '
D4NS6r ?ACAZD BOTTOM LEACHING AREA ��''. �?. SO.FT. /PIT/C,P,L.
ss�rr A
7t �• 7.S8o S,gT/D. SIDE LEACHING AREA . . /8�'So. . . SO.FT./ PIT/¢7/C.AD.
GARBAGE DISPOSAL /v dF. .(50% AREA INCREASE)
N�1��mSb�
3a TOTAL LEACHING AREA SQ.FT
A?- -0,80 13Z'� AZ,790o
PERCOLATION RATE LESS �� FNq MIN/INCH
LEACHING AREA PER PERCOLATION RATE .15�O.. SQ.FT/C'PI>
N4. .WATER ENCOUNTERED
NUMBER OF LEACHING PITS .4?M4
APPROVED . BOARD OF HEALTH c�/ti/ • . • • • , Dc�S
DATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
AGENT OR INSPECTOR
orOF a
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GO T / F L'LEY -a C7 R.HA
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PETITIONER
Hpizar,dous Materials Inventory Sheet Checklist
O)ate
ysical Street Address-Check database to ensure it exists
—/,,,��orking Phone Number
_Actual Amounts—(i.e.gas being used to fuel machines,thinner to
clean brushes all count as hazardous materials)
yStorage Information—location of storage,how long is storage for?
If none,note that.
isposal Information—where and who? It none,note that.
pplicant Signature—understand what is listed and noted.
Staff Initial—any questions,know who to ask.
LIAVehicle Washing/Rinsing?—provide a vehicle washing policy and
ain it—note that it was given.
Attach the Business Certificate with your sign-off and comments.
"The Inventory form should explain what the business consists of and the-procedures
they are doing. Notes need to be left to explain what you discussed with them.
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 the 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, 151 FI., 367 Main St., Hyannis, MA 02601(Town Hall) and get
the Business Certificate that is required by law.
i�nix 'ems
DATE: (o L � ' f:>2
ng
Fill in please: I
a APPLICANT'S YOUR NAME: W 1�tt V�Q. h�� Cl�l.L�.✓Yr 5)
R BUSINESS YOUR HOME ADDRESS: J62. old -ja_i r L�vv� Bawl r h(e yvl,a U a!y 3 v
3kz
— r,I, �?Ll k?& 0n9.1
TELEPHONE # Home Telephone Number: 1`t H iC 3 ij i
NAME OF NEW.BUSINESS C0LA►''r►no�t J���re_(r� OX TYPE OF BUSINESS
IS THIS A HOME OCCUPATION? YES N -.
Have you been given approval from the building division? YES NO
ADDRESS OF:BUSINESS E5Itea�J _ v . cA, _ _12 MAP/PARCEL NUMBER
When starting a view 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.
i. BUILDING COM ER'S OFFI E N MUST COMPLY WITH HOME OCCUPATION
al h s infer f a rmit requirements that p b d in to this type of business.
This individ RULES AND REGULATIONS. FAILURE TO
p � A orized Signat OMPLY MAY RESULT IN FINES.
COMMENTS: �U
2. BOARD OF HEALTH .
This individual ha n inform f eZperiregpireme is that pertain to this type of business.
COMMENTS:
Authorized Si ature** +s+r.7 KWCOWYWMAIL
F�
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature**
,r.
.COMMENTS:
iM
�. . . Date: 6 /d3 /09
TOWN OF BARNSTABLE
TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY
NAME OF BUSINESS: Cuu `s LU-C( Y 60
BUSINESS LOCATION: r?51 old. a-r i (_c��e harns tzLb Le MA 0-a&3L.)NVENTORY
MAILING ADDRESS: 60x Rq 6 6awns,-a bi.e. MA 0-aCp 30 TOTAL AMOUNT:
TELEPHONE NUMBER: 7P`I' 93ta •OSc °1 _
CONTACT PERSON: y-
EMERGENCY CONTACT TELEPHO NUMBER: q 8-3(v O5q,9 MSDS ON SITE?
TYPE OF BUSINESS: RWO VS4= De_2 1 q V\ 4s arc S
INFORMATION/RECOMMENDATIONS: Fire District:
-f-Ol.� fiU 'C u r nri ►'I✓e
Waste Transportation: ��n►ti+ s - ' Last shipment of hazardous waste:
Name of Hauler: a i"� Destination:
Waste Product: CIQ A^i� Licensed? Yes No
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials 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) _ Misc. Corrosive
NEW USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road Salts (Halite)
I
Hydraulic fluid (including brake fluid) Refrigerants
Motor Oils Pesticides
NEW USED (insecticides, herbicides, rodenticides)
Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) j
Diesel Fuel, kerosene, #2 heating oil NEW USED
Misc. petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil NEW USED
Degreasers for engines and metal Printing ink
i
Degreasers for driveways &garages Wood preservatives (creosote)
Caulk/Grout Swimming pool chlorine
Battery acid (electrolyte)/Batteries Lye or caustic soda
Rustproofers Misc. 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 (inc. carbon tetrachloride)
NEW USED Any other products with "poison" labels
Paint &varnish removers, deglossers (including chloroform, formaldehyde,
Misc. Flammables hydrochloric acid, other acids)
Floor&furniture strippers Other products not listed which you feel
Metal polishes may be toxic or hazardous (please list):
Laundry soil & stain removers �{-` -ftx ¢.A Sh,012 CAAA c
(including bleach)
Spot removers &cleaning fluids
/ (dry cleaners)
V Other cleaning solvents
Bug and tar removers
Windshield wash
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS