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HomeMy WebLinkAbout0195 KNOTTY PINE LANE - Health 195 Knotty Pine Lane f I 191-088 Centerville J `- Date: MAP., TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: BUSINESS LOCATION: i' K.p�c-,Trot F=s�r_ LU- N)T: L&A.C>a6 MAILING ADDRESS: 195 4hanrTN vty. c�e tT . , . npt, Mail o: TELEPHONE NUMBER:(Is Board of Healthog\) -7q0 ��,�� Town of Barnstable CONTACT PERSON: 16��.r u`. tE� P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: 7761C)- l&SC— Hyannis, MA 02601 TYPEOFBUSINESS: /&DZr_� Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own use? YES be_ 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 (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 toxic or hazardous (please list): 1 Z Spot removers & cleaning fluids T (dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS - r TOWN OF BARNSTABLE J �' LOCATION/� gg_, �Ls SEWAGE # VILLAGE C'� � V/f�-P. ASSESSOR'S MAP & LOT �D .INSTALLER'S NAME&PHONE NO. G SEPTIC TANK CAPACITY G•� �a't.s / '�"� LEACHING FACILITY: (type)'457-t <-'41 C�AM PiS (size) Ve *4?k2r j NO. OF BEDROOMS { BUILDER OR OWNE i PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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 r • - 1 4 No. ` r I Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Application for Migaal *pgtem Congtruction Permit Application for a Permit to Construct( )Repair(,Upgrade( )Abandon( ) ❑Complete System ❑Individual Components � i Location Address or Lot No. (�S 1(40#Y 1''A4 14,L . Owner's Name,Address and Tel.No. Assessor's Map/Parcel G Q A et-0w c ft g 0 /- oOFF 2?k- 96sa Installer's Name,Addh*VeCVAe0 Designer's Name,Address and Tel.No. 350 Main Street W. Yarmouth, MA 02673 Type of Building: Dwelling No.of Bedrooms .3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /doa EX;ass i4, Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) -Tn i f f L • e�C '�o 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 by this Boaz Her Signed Date 7-do -QQ Application Approved by Date Application Disapproved for the following reason Permit No. ZY —zlZ 7 Date Issued — Z Z No. ( �� r 9 _ � Fee U THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for Mi5po5al *pgtem Congtruction Permit Application for a Permit to Construct( )Repair(w-fupgrade( )Abandon( ) ❑Complete System ❑Individual Components Y Location Address or Lot No. /9 j j(170 uy P17,1 e �R w- O Hers Name,Address and Tel.-No. Assessor's Map/Parcel /9 D fJ '~ Installer's Name,Addre ')cu Designer's Name,Address and Tel.No. o 350 Main Street W. Yarmouth, MA 02673 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) i Other Fixtures }Design Flow 330 gallons per day. Calculated daily flow gallons. , ' Plan Date Number of sheets Revision Date ,Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) =ri j 4,4 L) • to ox roo !j,91. �e"Qc C�+r9s3�()Ci 5 k/� f/tos 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 by this Boar 6 H th. Signed t t Date E Application Approved b - Date; :.ZZ2 f 9: Application Disapproved for the following reasons , Permit No. 7 Date Issued 2 Z s THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS ' Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired("I Upgraded Abandoned( )by U at has been constructed in accord ce with the provisions of Title 5 and the for Disposal System Construction Permit No. 9 7 dated Installer P Designer ,f A 0 The issuance of this hall noldbp construed as a guarantee that the s ,sle l . 'll�funclio as esigned Date �� 1 Inspector N. Fee. sU THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS 1=i.5p0!5 *pgtem Congtruction Permit Permission is hereby granted to Construct( ) epair(✓)Upgrade( )Abandon System located at 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. a 4 Provided: Construction must be completed within three years of the date of this permit. ` t e7' Date: 2 Z— ,Q 9� Approved by 1/6/99 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 DESIGNED PLANS) h J 1 ) h eLey-A hereby certify that the application folr disposal works construction permit signed by me dated J 7—d concerning the i property located at /Q S" kil i hf-YI J AZ) AA— meets all of the t_- following criteria: ./ • The failed system is connected to a residential dwelling only.,There are no commercial or business uses associated with the dwelling. 17 The soil is classified as CLASS I and the percolation rate Is less than or equal to 5 minutes per inch. ✓ • There are no wetlands within 100 feet of the proposed septic system ✓• There are no private wells within 150 feet of the proposed septic system; ✓ There is no increase in flow and/or change in use proposed C • f'd-__— .____ _ ./ • There are no variances requested or needed. t • The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table+elevation. [Adjustlthe groundwater table using the Fnmptor method when applicable] •� If the S.A.S.will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) T S+ .S B) G.W. Elevation _+the MAX.High G.W. Adjustment.3.� != P T._J DUFERENCE BETWEEN A and B /6 r SIGNED : JI) DATE: [Sketch proposed plan of system on back]. q:health folder:cert w fi T ' o } TOWN OF BARNSTABLE LOCA110' r SEWAGE # � a/ILLAGE ASSESSOR'S MAP & LOT ::INSTALLER'S NAME&PHONE NO. fT _L -.-:SEPTIC-_TANK CAPACITY LEACHING FACILITY: (type) ' C cat l i5 (size) 2.4? ',NO. OF BEDROOMS 4. 'BUILDER OR OWNE :' PERMI'1'DATE: COMPLIANCE'DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Watei Supply Well and Leaching Facility (If any wells exist Feet' . on.site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feei.of leaching facility) Feet Furnished by =`A .��-�- 4 s. { rt f / 'f � I �� s .. - .. .� v i � �_ � _ _ 3�� _ �f` � ` � � ` lr� ` �� p �,' S.,- w G ` Fxs... .... N /. ..`t-l`...... i THE COMMONWEALTH OF MASSACHUSETTS j OA R® F C l G Appliration for 11ispasal Works" orks nnitrn.rtiun rrmi# Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System at Locay' Addr s � or o ` AIM- ZIY - caner .. . .._.^ !Y ....ki.. y���-.................. Installer Address Type of Building ize Lot... .In.�,�_ n.-Sq. feet Dwelling—No. of Bedrooms...........................................Expansio Attic ( Gar e rinder ( p pa, Other—Type of Building ............................ No. of persons............._..__.___. Showers ( — Cafeteria ( ) Q' Other fixtures ................................ -•--•....................---•-•--•--••••••...---•-•---.._..--.•--•- W Design Flow.................. . .................gallons per person per day. Total daily flow---- ��', ................gallons. WSeptic Tank—Liquid capacity./0-1P.P.gallons Length................ Width_.............. Diameter................ Depth................. x Disposal Trench—No......................Width.................... Total Length.................... Total leaching area..._...._...r�`_.._.sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area.? .....sq. ft. Z Other Distribution box , Dosing to ) Percolation Test Results Performed by........ ..... .............. ..... ........ .. .............. Date._ ,4 Test Pit No. 1................minutes per inch Depth of Te Pit .. ...._.__ Depth to ground wat r;. - 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water................_....... 9 --� --------------- -- ...........--•-- .: .. 0 Description of Soil--- - -- n^ - �---- -•--------••---......- •-•------------------•----•-•-•------•--------- x -d---- 1 . , -- ------.. ---------- - - •• . --- VNature 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 TLILTN E 5 of the State Sanitary Code— The undersigned further agrees not o place the system in operation until a Certificate of Compliance has been issued by t board of teal Signed ?t--• •-- �..... .. -- ......... - ...... te Application Approved By. ... ,., 1..... .. --- - - Date Application Disapproved for the following reasons--------------------------------------------------------------------------------•----------------......---•---•-- ..............••-•--•-------••••._._...-------•----......••------•••-•.....--••- ------------------------------------ Date PermitNo......................................... Issued....................................................... Date L,O-C A`T IONJ9� SEWAGE PERMIT NO• KrYo 77Y `VILLAGE TC'/k vle- INSTA LLER'S NAME i ADDRESS �1uelr7Y BUILDER OR DATE PERMIT- ISSUED RZ� DATE COMPLIANCE IS-SUED �?EAR NoFEE..... ..................... THE COMMONWEALTH OF MASSACHUSETTS BOARD,,,,QF HEALTH 1-71: OF....... ......................................... Applirativit for Dhiposal Workri Towitrurfillit Vrrmit Application is hereby made for a Permit to Construct � or Repair an Individual Sewage Disposal System at: a ..- .......... .........................../.? --------- ................. or -I-No. .......... ------- Ad rje , .�! � .. 'k ........... ... .......... ...... ............................ .... .....Z�..... wn er ............ ... .................. Installer Address 'ot.... Type of Building q. eq UBedrooms________________4 ( P�Ae L ..S f t Dwelling—No. of %3 r..........................Expansion Attic Gar e Grinder (IV)67 PL4 Other—Type of Building ............................ No. of persons_____.6----------------- Showers'( Cafeteria Other fixtures . -................................................ ------------------------------ ­------------- _________.___._gallons.---------*---------Design Flow....................5.. ---._._____gallons per person per day."Total daily flow.-._._.__ 1:4 Septic Tank—Liquid capacity./40.VViallons Length________________ Width___.__...__._.._ Diameter________-_____- Depth__.__________._. Disposal Trench—No_.................... Width_._._.-.__..._..____ Total Length.......:7........... Total leaching area...... sq f t. Seepage Pit No._..*................ Diameter......._._....._..__ Depth below inlet.___._....__.._-_._. Total leaching area._Zi� sq:ft. z Other Distribution box Dosing tank , '_4 tr­�_�. .................. Date...Percolation Test Results Performed by.........E- -------------­......... Test Pit No. L!5�.. ..minutes per inch Depth of T�Spit/??.�q. .... Depth to ground Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.__.___......___.._.___. ... . . ..... ................ .............................................................................. 0 Description of Soil_.._ ............ ..................*,e7.............................................. ....................................... .......... U WAxe-F................................................ W ........... Z-3........... Z-1.1 /J z -------------------------------------------------------------------------- ............................ ... 5C 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 T I T 1L E 5 of the State Sanitary Code— The undersigned further agrees not o place the system in operation until a Certificate of Compliance has been issued by�thn�bdl of licalt bo�ir Signed. .............. ---------- .. .. ....... .......i�� ..... ate r, Application Approved ...I........... .... ....---•-------•-•------------------- Da ........te Application Disapproved for the following reasons:............................................................................................................... . ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD C�f HE H F A............OF..... ......................... Trrtffiratr of Toutpliattv THI S TO CERTIFY, That the dlndividual Sewage Disposal System constructed or Repaired by....... ...... .. .......... e.........R..L-&.................................................................................................... tallg at............ ........./�........ ...... X--------- -------------------------------------------------- has been installed in accordance with the prow' ions of TITU4'. -5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No ------------ dated------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE.CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTIONS IS ACTORY. DATE........................................ ............. Inspector.................... IF Z.Ae..................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD,,Of HEALTH ...........OF ........................... No.. ....... ............. Permission-is hereby granted............. ------- ...... .................................................... to Constru-1, or Re 'r a ndiyidu��Sewage Disaosal System atNo........ 77 .. ...... ----------- ....................................................... Street as shown on the application for Disposal Works Construction Permit No_____________________ Dated.......................................... /Z ......................................... �. �ea h ...... ..... ..... DATE-- ....... ................................ FORM 1255 HoBBs a�W�. �INCIUBLISHERS a C - 1 FP fie vz C71 N �"ucc N V N 0 i 1c; w r t�� ovKf - � b, os 013ERV SURF' `, F f S LEGEND. - EXIST N 8POT ELEVATION` B£RT Qx0,: " � �9v� CERTIFIED PLOT PLAN +' AL � EXIS I CONTOUR•-� — 0 �.. ._ ' ,2r .� .. -y ( = FINI D SPOT ELEVATION FINISHED-CONTOUR ' 0 IN APPROVED, BOARD OF DATE AGENT SCALE= I —.gD DATES LD RED GE ENGINEERING Ca INY . I CERTIFY 'THAT THE PROP08EQ EGISTERE REGISTERED �; ; J10111, NO, ��,��, BUILDING SHOWN ON THIS PLAN CIVIL LANQ-�- CONFORMS TO THE, ZONING ,LAWS G OR. Y - Q ' :B:A.R N.S T L E 1 M A SS. 712 MAIN ST. CH, 8Y - ' HYANNI9�' MARS. - SHEET;, Of. ::.'-.DATE REG. LAND SURVEYOR t !VOTE /F E/7-HeR T"tlE S-E-7P7/C TANK OR 20 FT. M/N. ��fFCNIIvG PIT ARE MORE THAN /2"BELOIV /D FT. MIN• aRAOE� 24"O/AA4 ET.ER CaNCRFT� C-OIYER SJ,rALL B.F 9ROUGNT TO GJ;AOE.�i'iN .-x7'R.A CONCRC rle 4"PVC PIPE H--,4VY CA ST !/PON COV,=R ,$H144L I3E VS�1� MIN. P/TCR !F/N 271?/VEyt/A Y a 3.S CO/iERS - f8"QFR FT M/N. COJVCRL�TE CO ✓ER CLEAAl .SA/VAC' eAC.-le 4 L L/(PUID LEVEL 2"LAYER 4"CAS T . v o e AF /fie'--��8" r IRON P/PE i / cog o • •� o'b MIN.PITGN GAL. e • • • • • • • • o ,e WASHED S7ONE DIST, %4" at Pe J�•T. SEPT/C TANK D 4 • • • • • • • • e a r a, rEFFECTI✓C •• • • • • Dz or • •a • o • WASNED ST401OVE •. _ � e o • • • • • ••♦ � Leo • • ..D • •o• • • • • • • • • o p o REc's;ST SE.CPAGE tT%-S x2.5= 4'7fvPD • • • . • • • r• • � , .v P /NVERT' ELEYATr'oNs -74.5 x 1.O = 6PD a y w• • • • • 4 • • • • `o G/7 DR EQl!/✓- . • a E.= C72.0 P,-t c�pgciT'r Saq 6PD 6 FT D/AM. /NYERT AT ®UILD!/VCr- Io,�J,k!w FT. - //VLET SEPTIC T,4yK�.>: !o a'� �T, t� FT. O/f1J►'J. G(SEE 7�aBUL.4TJON> OUTLET SEPTIC TisB/VK� /='� 1W,fT OISTRIB!lT/DN B1�X OF GROu/VD J ITER TABLE �urLErD�srRIBUTIaJv� Bx� �: SEy6/AGE L�lSPDSA L SYSTEM /KLET cE.acNJNG .4011T ._ 98,0 FT. TA I-ATID/V LF�#G'H/NG p/T 3 FT. f .� . D/ME/VS/OA/ A S LE : / CA DES/G/Y CRJTER/�l 4 DI��Jvs/oJv B--z-FT. . Aulmm-R OF BEDROOMS _ D/ME/VS/ON G_ -FT. "`J GARBAGEA/SPOSALUJV/T U SO//- LOG "/L TEST TOTAL eE FTIMAT'ED FLOW 3 3 0 G.+44.1DAY SO/L TEST A/ SOIL TES7-02 �A(UMBER OF 40ACNIIV6 P/rS I /"ELE✓, 7 -ELe•Y. DATE OF SOIL TEST S/DE Ld`ACHJNG PER P/T _ 'Sq. FT. 2 ' RESULTS OYJTNESSED dY aB04TOM LCy9CN/NG PER P/T_ SQ. PT. L af{ �?� PERCOLAT/©N /IAT� / '�OTAZ LEACH/NG AREA S4. FT. avB�o«- PIERCOL�4T/ON RATE 2 p RESE�►�EGE,4CNJN6 AREA SQ. FT. cv .rz_s E O A#-y S!� G=�il i/a�'L. �•U T /9 A kh'UTTY .�/�� Z.'•.t'e..��'`4. `�F�A �p �N ssq,j\ '-= /s$ ' C�`j�/7Ic'i//G L-E BERT NH • .2 s EL DREDGE ENG/VEER/NG CO,/NC 1O8E1?� ,� f.s. SE �b ''t �.�S 1`� No.16951 4C?� �. ,, F �O ;\rs .<,• • NOG OUNv i-Yi4TER E/VCOIJNTEREP NYANN13, MASS. ''` G/STEM p� •al..;SSIOt1Al� " -"`a R f .. ��� SUR�E'� GMO UND PVATER AT ,E'LE(/ - JOB /1/0. �/O /�/ SHE.ET?-'OF.2-