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HomeMy WebLinkAbout0062 PINE TREE DRIVE - Health 52 Pine Tree Drive A= 188- 1o9 Centerville S ME A D No.2-153LOR UPC 12534 smead.com • Made in USA Q'A OcYc4 c0 v Date: 1 m aq TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: 14 fc W TAW IDES t"S BUSINESS LOCATION: 6 a 190K"r(E!�_ Dml y E 6w;fSev''11_ �.k3�- MAILING ADDRESS: (O a pcM(. ��> prtit C�iY►- y� 1�4i Mail To: TELEPHONE NUMBER: m 7,)$��/oS1 Board of Health 2('�1r,(� R, Town of Barnstable CONTACT PERSON: ���'�-� P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: Hyannis, MA 02601 TYPE OF BUSINESS: wam (0 paTM Su.r-F.(_Ce_s Does your firm stor 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 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 f Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) o Paint & varnish removers, deglossers Any other products with "poison" labels Paint brush cleaners (including chloroform, formaldehyde, daA Floor & furniture strippers � Metal polishes hydrochloric acid, other acids) Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids o& OV (dry cleaners) d Other cleaning solvents Bug and tar removers C� 'WHITE COPY-HEALTH DEPARTMENT/fANARY�GOBUSINESS TOWN OF BARNSTABLE LOCATION n�' ,Q� r� SEWAGE ✓° VILLAGE e,17 U'I l� ASSESSOR'S MAP 6 LOT INSTALLER'S NAME & PHONE NO. r 1up (,�- ' SEPTIC TANK CAPACITY LEACHING FACILITY:(type) A /n4j17-,e ®?( (sue) " e X jq � NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUI DER OR OWNER TO 14 n l DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: '4 '^ VARIANCE GRANTED: Yes No �� yeas° /L 6 ",6 10F/ C-J 7 �v �1 TOWN OF BARNSTABLE LOCATION PiNE--rCer4�5- bat SEWAGE# —IS-Crr VILLAGE e4e%9 2 F-k-C11 C ASSESSOR'S MAP&PARCEL IS-8- INSTALLERS NAME&PHONE NO. /ty"{COLll�q� SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) 3e � NO.OF BEDROOMS l q,A q4 e Agr OWNER R> &LA PERMIT DATE: /I 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 eaching facility Feet FURNISHED LIP o6 Q5f 14teet eg .......1...... Fss.. ......_..'............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratinn for Ropaiial Works Tnntrnrtiun frrnfit Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System at: -- we Z f�i n� %?� ....�1':... i 1�2 jfl�Lh� ------------------------ Location-Address or Lot No. -----------�!�✓ !#._ n�:!&JW4<!!l!.......................•--------- ...........- ••--..-••_----•.-•----•-••_-- --- ----•.--.... ----------------- Owner ress W !!7.Goa' .,. ------------ .'------------------------- Installer Address -•=R d Type of Building Size Lot.._ _ _S�-¢eef U Dwelling—No. of Bedrooms.................. _--_..______--..__-___Expansion Attic ( ) Garbage Grinder ( ) `PL,L, Other—T e of Building No. of persons............................ Showers — Cafeteria A4 Other fixtures --------------- --------------- . W Design Flow......................... .........gallons per person per day. Total daily flow.._...._4-40.........................gallons. WSeptic Tank—Liquid capacity!542..gallons Length.14_4;_.. Width.4 -__- Diameter............... Depth. x Disposal Trench—No. .................... Width./9............. Total Length___-:f_X....... Total leaching area...A ......sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (✓) Dosing tank ( ) Percolation Test Results Performed �'Z�...................... Date....3.'.z :�l ........ Test Pit No. 14s _z_..minutes per inch Depth of Test Pit______-.......... Depth to ground water..... __S-_-_--__--. 44 Test Pit No. 2................minutes per inch Depth of Test Pit-__------_______-_-- Depth to ground water........................ a ----------------------------------------------------- ----•---....-------------------•••-•-•.-----•........................................................ 0 Description of Soil---------- s e 4..!-�'` ........4'0.VeA�Vm.. r'Q.c/d x W ----------------------------------------------------------------------------------------------------------------------------------------------------------•-----............-•----------------•------- V 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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia has been 'ss ed he board of health. Signed . . .. .. . . -- ......... .............................................. ----------- ------------------------- Dare Application Approved By --­- .... ...---- Date Application Disapproved for the following reasons: ---_-------------- -- ------------------------------------------------------------------- --------------- -------------- ---------- ------------------------------- -------------- ------------- ------------------------------------------------------------- -- --- ------- -------- --------- -- -------------- ........................................ Date Permit No. ...... ........... Issued ------------- `� ------��--- �_' ..ram;,• ������� ` THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - TOWN OF BARNSTABLE Appliration for Disposal Works }Touotrnrtiun 11amit Application is hereby made for a Permit to Construct ( ) or`Repair ( ) an Individual Sewage Disposal System at# Location-Address or Lot No. ' ...........L, ... • . --------------------•------------- .....---- ............................................ - --------- ,��/j�,��e fi Owner ram" A dress �--� Installer Address UType of Building Size Lot.... Scfeet .-� Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) `04 4 Other—T e of Building No. of persons............................ Showers — Cafeteria dOther fixtures ----------------------------------------------------------•-••--•-----------•--------•--------•-•------ ............................................ W Design Flow..•...........................s.......•.__gallons per person per day. Total daily flow......... ...............:........gallons. WSeptic Tank' Liquid capacityZ5�_.gallons Length_��'.�_._ Width. �'J'.--_ Diameter..-------------- Depth-"> x Disposal Trench—No..................... Width.ZQ. .._._._.. Total Length___.-�fX'...... Total leaching area___ ......sq.-ft. Seepage Pit No..................... Diameter-__..-__-___-___--_- Depth below inlet..................... Total leaching area..................sq. ft. Z Other Distribution box (✓) , Dosing tank ( ) '-' Percolation Test Results Performed by..�L_t�- �?!'.�..... ..................... Date..... ......1.4 Depth-of Test Depth to ground water--___..__.5........... t=, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_--________--_..-_.-_--. 04 -----•-••--•--••--------------•-•-•---••-•-•----••-•---•--........................••----•--•-.---••-......................................................... O Description of Soil ` ' ...... ? !J //ia: A•c/ x - 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 Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been .ssued bKthe board of health. Signed .. ....'..:- ..... ----.. ........................................ Dat Application Approved By .... .... 1.�r� ... 1�F . /,� -ter y i Date J Application Disapproved for the following reasons- ------------------------------------- ----------------------------------- ------------------------------------•....---------- r Date Permit No. ------ 1 '' Issued...... - � =p . Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Tertifirate of Tomplia cce THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( �) by -- ----------------------------------------------------------- ------------ ------------------ = ^ - ................, ' Installer at ... ..� o.-- r� '' �7- ' ,1/......... �. ..--.�-6�d�� ,e��� � ... ............ has been installed in accordance with the provisions of ITLE of The State Environmental Code as described in application for Disposal Works Construction Permit No. . -_ ,:-...�l. �`" '.... dated ...1�...r!---_------------- the11'.... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUAkANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........ Inspectot,:..-�� --------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No..l �j > !� TOWN OF BARNSTABLE �"�/.�Y' �i' Disposal Works Tunstrwtuan Vprrmit Permissionis hereby granted.............................................................................................................................................. to Construct ) or epair ( /-)man Individual Sewage Disposal System p at No..--- .,...'Q>...... --t J;l,�v-4s.."' ��....CZ �- -z .- —..---•--.---.--- ser as shown on the application for Disposal Works Construction Ple it No l.l� l:.. ated....* - .., - ...�.....`..... ` �� - --o.... ._... .. Board of Health � ,.ol DATE------...C-- ..•---••----.....-------------- .................... FORM 36508 HOBBS&WARREN.INC..PUBLISHERS l ,`.J 1 I I tt 1p f . �a.90 i I s�Q i i r G� 27 . p'copoaed u t!3-CZ a Q..� 6 scow a _— --- - og 3 i .Lot 36 � unitA Y 20 ja f 66 { sl p f �1 klAj lu t JOwYG'.( �0 r{(7�uti Vp 10,7 — '---- --�-^ -- --- _� 9.8 151LL I �cG.lz qp ------------- . . fC � �38 3,38 � Noi,i4/ Coy_ apac+.r�ty 9,90, qp i I• �7ppp } . H D , Jk-CtCA P1 lJi�2�, t ' .��t.�2C�a _ Filw' C.71124122,.-��- �cy_ u,4, :IV 0260( �Levc�,tiovv� c�ce bc.�P.l on wu�;eic ouvul ors to and arl�:u ited, , '..I 1 1 $ ' Y. �a to A A ge.�rt� roa2d o� _' I r i�• I feat ;pert I 98 ; W4 ed . } _ j�Pii1 2 sort. I" + 7.7 e. p it OE s.'t+ 1 77,zO.Q UAL ' AA' G wA, { sSfd �� pyGi T� L TOWN OF BARNSTABLE LOCATION - . SEWAGE # , f 70 VILLAGE ASSESSOR'S MAP & LOT 0,9 INSTALLER'S NAME & PHONE NO.J " G 1 7 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) P�� (size) 601 NO. OF BEDROOMS—a—PRIVATE WELL OR PUBLIC WATER v i BUILDER OR OWNER DATE PERMIT ISSUED: �� -+J 92 DATE .COUPLIANCE ISSUED: / VARIANCE GRANTED: Yes No L/ I ..r �. 9 �� aq � \� � �. ., o � � � � � � � ��� - � �- - . ©. btu' ., _ �. ASSESSORS MAP NO: PARCEL NO: Finc THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ....--...T-OWn......................OF.............Barnat able Appliration for Biiipusal Workii Towitrurtion rrmit Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: . 62 P_.inetxeeA__Drive-,CentQxy. 1Y........ --------------------------------------------- �� ...... Location-Address or LotNo. 01D1?� ioner------......•--••----..._--- wJ,P.Macombe r w -------•--------------•----------------•- -•-•-•----------•---------------. Address..-----•--•------------•-•----•-------•---- Installer Address Type of Building Size Lot............................Sq. feet ►� Dwellings-No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther —Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) A4 Other fixtures -------•------------------------------••-•-•---------_.. W Design Flow............................................gallons per 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..................... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-------.-___--______-_-. fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-----_.--__--_.......... W ------------------------------------------ ---------------------------- -•-------------------- _------ -------------- •--------- •------ ••--------- --------------- 0 Description of Soil...........apt_and...&...('arw..al....................................................................................................................... W U ---•--•---•-••-•••---------•-••---------•----•-----••----••-=---•------•--...-------••---•------•-------...••-•...............•---...-•••---------•-----•---........................................... W U Nature of Repairs or Alterations—Answer when applicable_I""6.QD...gad l.0D._l ac-l1_.P_7.t.a__.�.3G�3. ....................................................��.---.. 9Ae Agreement: The undersigned agrees to install the afor edescribed Individual Sewage Disposal System in accordance with . the provisions of ilTl; ;of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issuedZbbthe hoard pf health. Signe --- --- . ........ --•• -•--- -•. ---.__----- Date Application Approved By--...-- .�r�................................... ........................................ Date Application Disapproved for the following reasons:................................................................................................................ -----------------•---•-----•-----•--•-------.._..-•----•---...----------•-••---.._...-••--------------••-----------------•--------••-----------•-----•-•----------------------•------------•--•--_...-- Date PermitNo.------ ..................... Issued....................................................... Date No...;J_. ... 7U Fps. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......................OF............:T.' :.l.V>. "'.:.t:...-br ............... ................. - ,2 pp irFa#ion for Disposal Works Tonstrnrtion 1hrmit Application is hereby made for a Permit to Construct ( ) or Repair (rµ ) an Individual Sewage Disposal System at: p ................_......_. .....:.----- Location-Address or Lot .................... :..__.....:.__.=..._..... ........._..._...._..............._...._._.... ............._.. 9 No. .37`3 ,"4 'Owner Address a ........ .....•----------..........-------•--••-•----......------.................._..__....... --••----•-••--•-•-......................_.._.......-•---•----------•-............-•---....-•-•---- Installer Address Type of Building Size Lot............................Sq. feet U Dwelling;.;—No. of Bedrooms.............................. .. .Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures -------------------------------- . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No. .. ................. Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water---_--_-___.-_---_---. rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --------------------------------------------------------------------•---..................-•----•--.....----......-----....: ............................. Description of Soil..............-ntQei - K='u E. -------•------••--------------------- V ..............................................--------------------------------------------••-•----•-•---------•----------------------•-----•••.._......--•-------------••----•----•----•---------------. W ----------------------------------------------------------------- --------------------------------------------- ------------ U Nature of Repairs or Alterations—Answer when applicable=.!t(':.��_._y_ �t-�-_1*t__1.�F__?_l ..r'-1,-�a----2__ �,rA:"' .._k eF.E+/��WS", rl• C t:�' 0./:5,� �.`°`9 � .............................`.........................................'..............................................._..................................................................__.._..__...... Agreement: The undersigned agrees ,to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i i L p 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 b the board of health. Signed J�F r,*,, �. � :d.----- r ----•- Date Application Approved By------ ..a..rfdR ---------------------•-------------•--- Date Application Disapproved for the following reasons:---------•--.........-•-------••--------------------•----------------•----------------------------.........----- -------•------------------------------••---------------•----•--•--•--------••------•---••--------------------•-------•••-•-•-•-••-••---•--......... Date PermitNo.......$.7..:.. _ ..................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ,,,,,,1 ,.. ., . ;. Trrtif irFatr of ToutpliFanre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (4, } ............................................................-............................................................................ t = Installer has been installed in accordance with the provisions of i i i E 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 YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE .. ........................... Inspector. cry- �� �-t--"""- ----------------••--- �Ci U THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH l au n No..._-1.:.37� FEE........ �..... Disposal Works 02Wonstraion rrmit Permission is hereby granted ''.. �`_..... ---------------------.................................................................................... to Construct ( ) or Repair '(' ) an Individual Sewage Disposal System at No c.:L -L rcE .r iv t �:;tr r1 11!e Street y as shown on the application for Disposal Works Construction Permit No>1�Z 32Z?-•- Dated.......................................... ................ --------------------------------------- DATE Board of Healt FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS I " A5StSSOR'S MAP NO. PARCEL LOCATION SEWAGE PERMIT NO. VILLAGE Can4-er-li t INSTALLER'S NAME A ADDRESS S U I L D E R OR OW NE (-30A(eLA D A I D A T CO _ D r w� �P too � i. i I , t a - Collu i ct��'-%'( H��� � I � t'_. L zr•{o`��th1'. `\.:�-+ram -'�:-.�` !' (-, i , . - -�-` ��lr� u�-thus ; I TO la f. - 1 I ram Ihirlt�lc� I P v�'o�r i`2 _ r t r rH - 1LfT ED Oil t �A ® LI-/irJyl - pLL `J i — —: I-too ell oil loll "--- `- - �, oaZ� n�r'OI I --- �x-1� -'U(J 1'(; r'lc rag•�.2>3-C�(2'b • � emu;r�..�U,ti, MF-