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Home My WebLink About0018 BODFISH PLACE - Health 18 Bo Place Sewer Acct# 3278 Hyannis _ . r _ A = 306—099 oqc) V TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: L0 L3) C t PW 0, Mail To: BUSINESS LOCATION: 1 �� f s°i'� P, t Board of Health Town of Barnstable MAILING ADDRESS: P-0, 130_�x Z�j"% /1yxg10i i ru /171, 9 e 2el,6.� P.O. Box 534 TELEPHONE NUMBER: 721-6 5�;E3 771-lre-? Hyannis, MA 02601 CONTACT PERSON: 'D ,6`z Z e 6 r,464e. EMERGENCY CONTACT TELEPHONE NUMBER: Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? 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: Quantity/Case Quantity/Case Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business :f9•Rl'1A.")a�$At1;��)fi'W'.rtY'` -.. - r.i , • - ' , ; r TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM j NAME OF BUSINESS: C® C- 5 C0 N_,`f`Q(_ Mail To: BUSINESS LOCATION: S (306k /;/ ,rH PC/ Board of Health Town of Barnstable MAILING ADDRESS: Ae.). r3Dx ZSS/ /qy191vA-zs, �A er z66/ Barnstable P.O.p Box 534 TELEPHONE NUMBER: -7-2/-69of3 w t/ ?7/-A '6 r Hyannis, MA02601 CONTACT PERSON: p rd w 6r,4 EMERGENCY CONTACT TELEPHONE NUMBER: 771-ss'aVr i Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totalling, at any time, more than 50 gallons liquid volume or 25 poYhds dry weight? 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: Quantity/Case Quantity/Case Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid)" Disinfectants Motor oils/waste oils a Road Salt (Halite) Gasoline, Jet fuel , Refrigerants Diesel fuel, kerosene, #2 heatinga,oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) - Degreasers for engines and metal ' Photochemicals (fixers and developers) Degreasers for driveways & garages . Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other produwith "Poison" labels Metal polishes (including'chloroform, formaldehyde, Laundry soil & stain removers ,..hydrochloric acid, other acids) (including bleach) , Other products not listed which you feel may Spotremovers & cleaning fluids b4,io c or hazardous (please list): (dry cleaners) Other cleaning solvents =' Bug and tar,removers Household cleansers,'-oven cleaners j White Copy- Health Department/ Canary Copy-Business c s s.I 30 N 3 N � 1 C7 O N I ® � M 3 R, 40 W Is a � . 1 !�' j � � - ////� � � ��%� tom' �iQ � o � � c� ��j,�� \� z (� r �°ter �� _ � \ �� T /`�� - — as - 6 No..00: .. A` r .�F�sQ:f u...... THE COMMONWEALTH OF MASSACHUSETTS _-----BOAR® OF HEA TH -•--•-. .......CyWn.......OF... a///� .... ............................... Appliratiun for Mipoii al Workii Tonatrurtiun Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( 4Yan Individual Sewage Disposal System at: .-•-...... ,�� h.. 1 .................. ......... -•---...._.....-------- -----. Location-A r ssM or Lot No- ---------------------- L..�lJfel!6+ w -r ___•_ __•_• le. /E.••/_J.ml- „/ dress........................... � Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No, of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures ----------------------------•••. - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic 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 ( ) . . aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water______________.______-_. L=, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_______________________. V . --••••-•----••---•••••••••. O Description of Soil - � -•........................................................ - x W --------------------------------------•------------------- •---•---•'••••---•--•---•--••••••------••---------- -•- --•• --- 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 TITS 5 of the State Sanitary Code— The undersigned further agre s not to place the system in operation until a Certificate of Compliance has be issued by theWoaof health. Signed- � ......... Date Application Approved By. - --•---------------------------•••-- *3 d�j Date Application Disapproved for the following reasons:--------•----•-----------------•------•---------------------------------------------------•••-•--•-••'-"-'_..._ ...............•--•-----------------------•-----------------•----•------------------------•--------------•-•-----•••--•-•-'--•-••-•----•-•-----...••-•-••---•-•-•-••••--•----•-•----•••-•-•••••-•-•_'-- Date PermitNo......................................................... Issued....................................................... Date FEB THE COMMONWEALTH OF MASSACHUSETTS -----BOARD_ OF HEALTH �.................. .......,F .,,.......OF...... '1' .........../; / /�. --- . ..._.... -------•............................. ApplirFation for Miposal Iforkii Tomilrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: - �, �- ,i dam, .. l�. F Location-Address or Lot No. ...................�'..__ /f_..._.... ..../_.�.��. (::i.._.�:... _ ......_.... __... �___•• /..-:.. .�.....� --••...._......_........................ ..... ... ._.. ..... _ _• 1 _•_-- �' Owner 1 ,� • Address 1 t I nstaller f Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building ............... No. of ersons............................ Showers — Cafeteria P� YP g ------------- P ( ) ( ) a Other fixtures ------------------------•-•••••. - W Design Flow............................................gallons per per,5on per day. Total daily flow............................................gallons. W • Septic Tank—Liquid capacity............gallons Length................ Width---------------- Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No----_--------------- Diameter.................... Depth below inlet.....•.............. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY.......................................................................... Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water-____._______-____---__-- (i, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water____-_---.-_--_._--_____ -•------------••------- ------------•---....----....--•-•-......._..----••-----••-•---•..._.._............................................................... O Description of Soil........................../' = r=�--' /'/ `-- ---------------------------------------------------------••--- x x -----•-•-•------------------•----••••••-•----•••-•-•-----•------------------•••••-••--------It--------------------------------;--------------------------------------------------------------------•---- V Nature of Repairs or Alterations—Answer when applicable.......... .......t___ -------.------- .. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT11 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. Signed /f ° :7 :% : l.... '_... = r f O Date Application Approved ------.: �� ✓----•................................. :.� Date Application Disapproved for the following reasons:--------•-----••------•---------------------•---------....------------------...-----.......................... •-------------------------------------..........................................................................................--------------------------------------------------------------------•-- Date PermitNo.......................................................- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD—OF HEALTH .............:....::!.......................OF.....(....f..;/.................CZZZ.'............................... Trr#ifirate of f ompliFana THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (:_) bi ...`. .�` ' ...i / {- . .............i ..................................................................._................... � Installer at -.._..f.•:'.----I.............................. ff r". .. '1// /.a/ `-------------------------------------•-------•----....----�--.............................../f a ler has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.--19?".sa.............. dated_...__-___._.____-____._.__..__-__---_-_-------. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SAT SF CTORY. DATE....................... f� :. Inspector.... ..... .................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTHf r / , No...........s..'J........ FEE..... .......... Rapos al park ��a� #r Uan eraati _ Permission is hereby granted - . l'/.... !--�f'-•.................�!-- .....---�-: ...C------------........._.......------.. to Construct ( ) or Repair an Individual Sewage Disposal System , at No... = i '---_--... . ./! / .. .. .. i/ r l.'. ; • ... ................ Street as shown on the application for Disposal Works Construction Permit No.-_---_--_•---__e___ Dated.......................................... /� j •---------------.�4-v `✓��;y ----------------•--•-•------------••-•---•------- DATE --•---......--•-- •-••-••• - •o`' ....................•__....._._. Board of Health FORM 1255 HOBBS & WARREN. INC., PUBLISHERS n a THE COMMONWEALTH'OF MASSACHUSETTS �.. BOARD 9F HEALTH ------- �..-------.O F....... ------ -pliratiun for Bispviial Works Tutuitrurtiun Vrrmft Application is hereby made for a Permit to Construct (?-�) or Repair ( ) an Individual Sewage Disposal Syst t 27� --- Location- --------- --- ---� -: .-4--..- -- . .-_........................... --- ...� _.-� Owner Address Installer Address Type of Buildin� _ Size Lot jjj. Sq. feet Dwelling' No. of Bedrooms.._...._.__=1-- ---------------------Expansion Attic ( ) Garbage Grinder ( ) aOther Z' Type of Building P-4 r/ _.__ No. of persons........... .._._.. Showers ( ) — Cafeteria ( ) Other fixtures�js— --�--------------------------------------------------------------- . W Design Flow....................... ns per person per day. Total daily flow___..__....____________ _____.__..__gallons. W Septic Tank id capa ns Length................ Width...._......--.-- Diameter..... Depths_/� 1 `` x Disposal Tr c $Fe:-.................... Width_.___......_.._.._._ Total Length_...__.__...__...... Total leaching area_1p.��........sq. ft. Seepage Pit No Diameter Diameter...._........._._._. Depth below inlet.................... Total leaching area_____________-_---sq. ft. Z Other Distribution box ({7 ) Dosing tank ( ) aPercolation Test Results Performed by............ -------------------------------------••----•--••-•-----•-•-- Date---------------------------------------- a Test Pit No. 1----------------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...............___._--.-- 9 -•---•------------- ------------ -- - - ---- 0 Description of Soil-.>________________________� _ - --------------------------------------------------------------------------------- . ----•-----------------••-------.. ------- _--------------------- - x .fir W ------•----•-- ------------------------------...................................................................................................................r ----------------------. 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 Article XI 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 bo rd of health. Sie --•-• -------•• • •--••••... ............................... )k to Application Approved BY7' Y Date Application Disapproved for the following reasons:...--��-a.4W -•---•---•--------------•-------•----- .... -------------------- Y Date Permit No-------------------: y Issued. l -- ate 1 `� �' t `� ,�` v � � � � � 7c � M � � � � � � � � , �'` a ;,�, No.-I, FEE... : ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD , F HEALTH ..........OF....... .......--'---------------- Xppliratilan for 43itipwial Works Towitrurti�att run it .Application is hereby made for a Permit to Construct '(4o) or-Repair ( ) an Individual Sewage Disposal ��',y/'gg�// p Location-y!y*es p""q or t No£' 1 f --------- • f '/s'�.��,�,..- -- ------ -------------- °� 4--.� ._.��. �---....t.�r._._ . t! ! Owner Address W •^!w. �..i� Installer Address _- U Type of Buildin Size Lot.. i _: ________ Sq. feet 41 Dwelling No. of Bedrooms.___ ...........................Expansion ttic ( ) Garage Grinder ( ) Other k-Type'of Building a ypet ..... No. of persons........... ..':_____-_-_-_- Showers ( ) Cafeteria ( ) Otherfixtures ------ ...................................................................................................... ----- --- -------------------- g .... gallons per person per day. Total daily flow...................... ..........gallons. W Design Flow---------_-•--- �. ,� 9 Septic Tank , . uid capacity IS_ gallons Length---------------- Width---------------- Diameter................ Depths;-_--- W 1 x Disposal Tr c 3`3or.................... Width------------------ Total Length-------------------- Total leaching areaAea%..........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.-.-_-•-__----.-----.--- f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-----------------_------ ODescription of Soil--=---------------------- -----. . _ - -----------------_.......------------------...----"------------------------------- U ------------------- --------------------------------------------=---------------------- -------------------- W -------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------------ ------------------------------------------------------------------ •----•----••----------------------------------•-•--•---------•--------------------.-•---••------•------------------------------------ Agreement: The undersigned agrees to install the aforedeseribed Individual Sewage Disposal System in accordance with the provisions of Article XI 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 lheaI h. �---- ......... Si / i ? yf ®Date it Application Approved BY ------------------------- ° ��" Date Application Disapproved for the following reasons---------------------I----------------------------------------------------------------------------------------- --------------------------------------•-----------•-----•-----------------•---------------•--------------- r---••------- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS' BOARD OF HEALTH F ..........OF.......� .. �.�!�?. ... 6dif iratr of T111aptittnrr THIS I TO fCERTIFr, That the Individual Sewage Disposal System constructed ( r Repaired ( ) by.t`..--•-- A �°` 3 fr f r Installer fr .w... has been installed in accordance with the provisions of Article XI of The S ate Sanitary Code s descr'bed 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 FUNCTION SATISFACTORY. DATE-------------•--•-------------==------------------------••-•---•-•••--•••--••... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD YF HE TH ......... a......... .OF..... - r /, s ................................... No. FEE ------ inpolia1 arkii Tomitrurti"n ranfit Permission is,hereby granted.............. ...... ------- -7 --=-------------------•••----------•-• to Constr ct or Re sir an I divl 1 'sewage Disposal stein at No. .. St ee/j V as shown•on the application•for'Disposal Works Construction er it N '. _ _ _"Dated-_ _ 7. ........ p • ----r-•--- .............- Board of Heafihh} zr w ff FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS