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Home My WebLink About0017 BERNARD CIRCLE - Health 17 Bernard Circle Centerville A= No. 42101/3 ORA 100 o ® m o Date: & /Z > TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: BUSINESS LOCATION: tO L MAILINGADDRESS: S � �I i�6wC /i°VBdX .� ,89— 4 Mail To: Board of Health TELEPHONE NUMBER:^Sorg Town of Barnstable CONTACT PERSON: z'I, P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: Sffi'h�,�.� , w� Hyannis, MA 02601 TYPEOFBUSINESS:�'2AJ' G' f Does your firm store a 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 otherthan 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 (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 ft ✓— Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS LOC1ATION S E W A E PE MIT NO• VILLAGE oe? ola 1 c- cy;q I N S T A LLER'S NAME i ADDRESS "s ole' ona-, q�ifl o o-r BUILDER ' OR/ OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED e� i - 1 e " p _ , 71 THE COMMONWEALTH.OF MASSACHUSETTS 4492�__ BOAR® OF HEALTH /_-O.Y�I A./..-.....OF........R�....�. .2...f✓s�Tf�f��............. Apop iration for Diipusa1 Works Toustrnrtion throb# Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: -' Z ........ ./.��?...��. . 1��..�G i..---•--........ -••-- %...------------`-...------------------------------------------------------------ Location-Address 4 NO Owner 4V. L./4+� d Address ....-•-•••-•-------------------------•-•••............................ ............. = Installer Address Type of Building Size Lot../,,.�®q.Sq. feet U Dwelling—No. of Bedrooms..............-ate--.........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons......................... Showers ( ) — Cafeteria ( ) P Other fixtures -----------••--•--•----------- 1 .��,0�®®ire•------- <�--•------•------------ W Design Flow....../ ./2............................gallons 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........4......... Diameter..i�............ Depth below inlet....,............ Total leaching area..... _sq. ft. Z Other Distribution box Dosing tank '-' Percolation.Test Results Performed by.... ..G.`��F` :.... _._`4.0...................... Date../-Gll/ .............. a Test Pit No. 1....!!5� ._.minutes per inch Depth of Test Pit..../_- fg�f.• Depth to ground water........................ 4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ....................................................................................................... 0 Description of Soil...C...-.��D......—MR- 'GBI---___ / .-.-----�ci-A...i--•----- w -------mrP....----V---- � r--------..�r n------------------------------------------------------------------------------------------------------------------- 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'I'll-, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance h issued by the boar of ealth. ne .. As t ----•----------------------• •---- Date Application Approved By--- ---- . .... / !�'�-- ----------- ------------------------------------------------------ Date Application Disapproved for the following reasons-............................ ............................ ............................................•------••-•-------•...-------••--•-----.....-----•-•-----•••----------••----------•--••---------•----------•-----•----------------•-------------------..... Date Permit No......................................................... Issued----i)------� -�----------------•--- Date N6........ Ex.. ,.................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........; �!Si/V..........OF.....� >......................... Appliratilan for Dispas al Works Towi rnrfinn ramit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: a ....... .. Location-Address or Lot No. ......................___...................................................................... ••---.....---------...----••--••---•--•--------•-.............•--•----------------............-•-- Owner Address W Installer Address Type of Building Size Lot.J ..................Sq. feet �-, Dwelling—No. of Bedrooms.............- ..........................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons____________________________ Showers — Cafeteria Other fixtures .--•-•-•---•----------------------�i>itoow� W Design Flow.......l�G............................gallons p r:*sen per day. Total daily flow____._..._._._ .._0.._.________.._gallons. WSeptic Tank—Liquid capacity.&Mgallons Lengthsg-_�.____ Width.15�._ Diameter________________ Depth_ _.�__-0._ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........../-------- Diameter..../Q_........ Depth below inlet......._��__......... Total leaching area....�2_sq. ft. Z Other Distribution box (e Dosing tank ( ) '-' Percolation Test Results Performed by.... �__ �4_.a/_. `1� ��_ !�!C.......... Date._/G�/�.__`' Test Pit No. 1_ .Z __-____minutes per inch Depth of Test Pit____ �� Depth to ground water_._____ _"__._.__.. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -• ----------------------------------------- --- O Description of rJ ?`1T .. --------4i` =r........-5-. m,Z?.---•-•--------------------------------------------------------------------•--------------•----.....-------------- W UNature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ ...-----•---------------------•----------------------------..._._...----------------................----.....••---•--•---•--•--•--•------•-----------......--•-•......_........----.....--••--••-•••--•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with "le provisions of TITI.% 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 of health. S'g ed_. .-- ...--------•-•-•-----...._.... �ry] Date Application Approved By.._••••.................. ..}r'� `.. —------------- -•-- ./A Date Application Disapproved for the following reasons_........................._____ ____............................................................................ --•------••----------•---------------•---••-----•--•--------••---------•-------------...---•--------------•••-••.....---•••-----.._..----•----------------•-----•------------•------••------------------ Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH ...................OF.... ..... .G ........_......_..............._........... Y TurrfifirMtr of Tompliana T TO N Y, That the Individual Sewage Disposal System constructed ( or Repaired ( ) by.... .. .._`__..._•.... .� nstaller has been installed in accordance with the provisions of T F' 5 of The State Sanitary Code as described,in the application for Disposal Works Construction Permit No_ _______ _____�*d.l._____ dated....... o.......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRlqED AS A GUARANTEE THAT THE SYSTEM WILX FUNCTION SATISFACTORY. 4 DATE......... .........................•-...-----••-_. Inspector. �� . THE COMMONWEALTH OF MASSACHUSETTS �d BOARD O HEALT .... .. FEE.. ........... t tit k pan #rnrtion �rlYttf Permission is hereby granted------ -- .... '--•---------------••---..._...-•-----•-------•-•---._.......-•-•- •-•-•--- , to Constru,,t//( /h Repair ) an I ivid 1 Sewage Di osal System at No.... ----• 2 treet as shown on the application for Disposal Works Construction Pep 14 N0. o /_.. ated..... .- 2 // Boar f ealt DATE..,......-7---��- --° -�v-•-----•••------•••-------- -------- FORM 1255 HOBBS & WARREN, INC., PUBLISHERS 94`"1+��ti„y,,q}a .-, „- ..:. . s••` :.. ,..n�.r.. ... _ ... �• f "s/•CaF' ,_ - q Y -�' �"w'..`'�i-�C:>r/�//its//',y' r,:.;'�c�.,�1 � � /!•�1 C�.!?7 �,/�.�' �G° }��^:��-_ /69 f 77 r �.4 F t o e �L,.-ter :%f� L1 n ' t I,k, LOOT S 3 �9 re, .i' f �� rC,.�•; .�I'7 .'�.:_ ./-,,:raw i - f "� ut /�f 7IA/0` ' am" /. I / T✓r � ` 1'` K OF F RI-HARD yG /f.4 �liCl1ARD ny DAMES M 1RAkES v O'HEARN y w �`tfF?4RfR No.694 Q t1e 27871 —r 9�,GrsTt �,y01gTfF44'�o. LEGEND SANITARIF� Q SURv� EXISTING, SPOT ELEVATIONS . 0,0 EXISTING CONTOUR = — 0 FI:NISHED:, .SPOT ELEVATIONS FO-0 FIN I`SHED` .0 ONTO UR 0 PROPOSED PLOT :PLAN APPROVED: BOARD OF HEALTH ; MASS. r DATE AGENTTS� CERTIFY THAT THE PROPOSER R. J. 0 HEARN, INC, RL S,: RS E3UIlDING SHOWN ` ON THLS, PLAN 1348 ROUTE: 134 , :CQNFO:RMS_; TO T-HE. '"LONING 'LAWS EAST DENNIS , MASS.. OF A2& 1/s7.0,_,,, = MASS. DATE: _77 2,.' O SCALE 3 JOB. NO. ��G, /S CLIENT AT ~:R GfSTE`' EDI�'L ND SURVEYOR' DR. BY 2--(2:;' SHEET F' 2 �., •.-^.+^„n^",�o..*^' ,�`P"t.^'.-^. ,•*r•�r r4:s�+: -•r.....-*+.rat+ •-+s+rt..+s* +�,•�n.mmr�<e+s,m'.^nmm.+��,�rncm-?...n�a..}-.....r�1,, m�.rA�nn ,ap+.crv-.s +..s�.�.-' ,4,nw ; 'S"'m""t--•� SOIL TEST. INVERT ELEVATIONS ;NOT ES F SOIL TEST' ' r 'u INVERT AT 6UILQING:. ✓ 3.0 F . ALL. WORKMANSHIP .AND M.ATERIA�>=S, DATE 0 -,- I 2..2 SHALL CONFORM TO D.E:Q.E, .TITLE 5 ;. - •.: T T. SSED BY � ', - ?'' INLET-.• SEPTIC TANK:. - FT . _ W I N E A1'C r R i .� 'SEPTIC TANK �2: FT S PERCOLATION RATE MIN./IN:CH OUTLET - SO FOR SUBSURFACE E 'AND THE . TOWN - INLET: .DISTRIBUTION BOX '. ./ NAND REGULATION OBSERVATFON HOLE ( . OBSERVATION. MDL.E Z FT.; :DIS.POSAL', OF-;� SANITARY SEWAGE =j ELEVATION —ELEVATION-. OUTLET DISTRIBUTION BOX 9I: 3 FT �. IN.LET' LEACHING PIT,: 91•0 FT. - BOTTOM LEACHING PIT 3�� ": o FT . j, DESIGN CALCULATIONS NUMBER OF BEDROOMS .. . ' GARBAGE DISPOSAL UNIT:: . ^r R _-- TOTAL ESTIh1ATED FLOW ( //� GAL./BR /DAY x BR.) 0 GAL/DAY REQUIRED SEPTIC. TANK 'CAPACITY:. . . . ;. GAL. ACTUAL SIZE OF SEPTIC TANK TO' BE INSTALLED:.. : 10� GAL. G LEACHING AREA . REQUIREMENTS WALL AREAL GAL./S.F. BOTTOM AREA � GAL./S.F LEACHING CAPACITY ( BOTTOM f $IOEWALL ).. .. S_' ``' GAL. r RESERVE LEACHING CAPACITY.. . . . ... . . . . . . . 7 GAL. TOP OF j FOUND. 11 ELEV.=,<%�1. `li - ��„ r CONCRETE 4 SCH. 40 CLEAN SAND COVERS �. PVC PITCHCONCRETE /8N� PER. FT. COVER /µ C ,\ _ 2 /a MIN. PITCH j- .t.. 11 1 12 MAX. �`, tP��a OF Mesa /. W unnR11 1DiAW2 LAYER OF 1/8- 1/2 a JAMts In p is NE 1 CYHEARN O E64NWASHED STONE s �,.z�en 9411CAST IRON O z 9 - a 3/4- i 1/211 ,C��QIS7EP�40� �C/ST�� WASHED STONE O [TAR- PI PEMIN. PITCH ° >s ,� 1/4 PER FT. DIST. k. t— PRECAST LEACHING . . n U o w BASIN OR .EQUIV. - //o d D CJ ELL v - GAL r.,i T; J m A S S SEPTIC TANK. R. J. 0 HEA►RIV,INC., RLS, RS - 134.8' ROUTE 134 3 EAST DENNIS, MASS.. PROFILE OF.. . Y GROUND WATER . TABLE JOB :NO. 8/S CLIENT. i SEWAGE DISPOSAL SYSTEM ` NOT TO `SCALE DATE /Ci2.0�8G SHEET OF