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Home My WebLink About0061 SAINT JOSEPH STREET - Health 61 Saint Joseph's St 291 -213 Hyannis i I i i Date.�Z/ TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF'BUSINESS: Ag8 BUSINESS LOCATION: INVENTORY MAILING ADDRESS: 61 S%. To-)E!'G� S% TOTAL AMOUNT- TELEPHONE NUMBER: D E/ S "7 CONTACT PERSON: pIq/V 11n U EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: L_A-w(z�Sc AtPE INFORMATION / RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product- Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month re uires 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) Miscellaneous Corrosive "EW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants P7 Motor Oils l Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) / (,A Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) iesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED - Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible l Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers / 6,4 • Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials _ _ ..'Y .-.�,1 ♦ .�` r, _ ... .. ♦ .. �.Y `"..wV1.F4-�v�l ,�BjS'.'r emu:_.' ;,A 7tT.J�T Date: 9 /a 3/ O � TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: L Aju. S( R P�(-' BUSINESS LOCATION: ST- �_Ph S/ ' INVENTORY MAILING ADDRESS: y A N N I e s.5 6'? CC ► TOTAL AMO NT- TELEPHONE NUMBER- �� 1 77S —0S39 5 P, br\l CONTACT PERSON: ��• YY)L) it/ // EMERGENCY CONTACT TELEPHONE NUMBER: ( '�D0 3 Co ` 070 y MSDS ON SITE? TYPE OF BUSINESS: ('A-i\,1 SCaP�_ INFORMATION/RECOMMENDATIONS: Fire District: r r°s Pv s s d Z>\ ��z o- 5�� 64 Waste Transportation: Last shipment of hazardous_waste: Name of Hauler: Destination: Waste Product: Licensed? Yes (' 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 f 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) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) ✓Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) 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 Degreasers for driveways & garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible V 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_ 1 r) ChA5.(<J iA (including bleach) Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents / Bug and tar removers V Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS ♦ �Z No....,� THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliratioaa for Diopoofal Workii Tamitrurtion ramit Application is hereby made for a Permit to Construct ( ^) or Repair (--�an Individual Sewage Disposal K US System at: L 0-4/1- -------- ------------- ...........................-...................................................................... � Locatidf1-address ` .,.Lot No- !/Ll 'rA ---•------------------------------------- �ef--_c................................................................. ,, owner .. Ad e� tess ...... ...... ------ y -----i--------------------------------------------------- --- S _/ / `l 'c Installer Address UType of Building Size Lot____________________ q. feet .-� Dwelling— No. of Bedrooms-____ ______________________________Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ____________________________ No. of ersons-_-__-_________________-_-_- Showers — a g P - ( ) Cafeteria ( ) d Other fixtures W Design Flow............................................gallons per person per day. Total daily flow.....................................,......gallons. WSeptic Tank—Liquid capacity/QL*galIons 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 ( ) Percolation Test Results Performed by..................................... ------------------------------------ Date-------------------------------------- Test Pit No. I________________minutes per inch Depth of Test Pit-------------------- Depth to ground water_-.._-_-__-______-_____. fT4 Test Pit No. 2................minutes per inch Depth of Test Pit_................. Depth to ground water---------------------- 9 -------------------------------------------------------------------------------------------------------..................................................... 0 Description of'Soil--------------------------------------------------------------------------------=-------------------------------------------------------------------------------------- x UW ----------------------------------------------------------------- -------------------------------------------- --------- ------------- Nature of Repairs or Alterations—Answer when applicable.__-_ 04 ------------------------------------------------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmen ode—The undersigned further agrees not to place the system in operation until a Certificate of Compliance as b en i sued the oard of health. Y �/ �a Signed - 'yam 7.2 6"/S ---- - ---------------- ........ -...........I...... Dare Q Application.Approved BY --------- - -. . - - --- .^ <t�i Date .Application,Disapproved for the ollowing rearon.r: -----------------------------------------------..---------------------_--.-.- -------------------.--------- --- - ................. ............................... .. - � Ua�e... . ........ ......--- ._.----- Dace Permit No. �J -.3.�...._...._-..--------- Issued 7.....: .� 1 pp � a� - THE COMMONWEALTH OF MASSACHUSETTS . BOARD OF HEALTH TOWN OF BARNSTABLE Appliratilan for Diti-.pniiul Marks Towitrnrtion Vrfmit Application is hereby made for a Permit to Construct ( j or Repair (C�- 'an Individual Sewage Disposal System at ............... St T _ s , ...................................................... Locatio i-Address or Lot No. //d11/ ._..._.. ........................ ��' -!' ------------------------------------------------------------------ �— o Ow er �.• ` Address W (D ........` --------------------------------------------- J /7 e, ` Installer Address UType of Building Size Lot............................Sq. feet -, Dwelling—No. of Bedrooms.--_-_ --------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of perk's._-__--_-__.----._-_-_.-._- Showers ( ) — Cafeteria ( ) d Other fixtures ------------------------------------------------------ WDesign Flow....................:.......................gallons per person per day. Total daily flow..------------------------------------,------gallons. WSeptic Tank—Liquid capacity/&_XX al Ions 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 ( ) Percolation Test Results: Performed bY--------- ----------- .................................................... Date....................................... ' ..a Test Pit'No. '1:....:..........minutes per inch Depth of Test Pit..-.________....___ Depth to,' 'and water_. f� Test Pit No. 2.�`_y-_--___-minutes per inch Depth of Test Pit---------------r .. Dep h to ground water..`.................... 1............................................................................................................................................................ Descrjptionrof= oil------------------------------------------------------------------------------------------------------------------------------------------------------------------------ x ------------------------------------------------------------------------------------------------------ -- 1, w V Nature of Repairs or Alterations—Answer when applicable. = ,-� 3�5--------------•--------•-----�'/�� I t .... .................•-----•--••••-----•-------•--•------•------•----•----•----------------•---------•-•----------------------------------------------------------....----------------.....-------•-•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmen ode—The undersigned further agrees not to place the system i operation until a Certificate of Compliance asen i.sued b the trd of health. - .......... - �' . .0 --------------------------------- A . . . Da,e.15= Signed .... ...... n APProved BY ... ..... pplcation Disapproved forthA e ollowing reasons- ---------------------------------..........-------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -.-......_.-..---...._ ...y^`� - Dare Permit No. - (- Issued_---------------7. �e� g,,�-- t1 Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _ TOWN OF BARNSTABLE (Zer#if ratjE of Tompliance THIS IS-ZO C RT Y, nThatrt Individual Sewage Disposal System constructed ( ) or Repaired �--\. ------------------- --------- --- .... --------------.......... .. by ..........- ......................... .........---_.......------..------------------------ ----... . Installer at ----------6-1--------- � -T S ....- has been installed in accordance with the provisions of TITI_Ezof T e State Environmental Code as described in the application for Disposal Works Construction Permit No. ... S".-._1 G- - dated -... .. ..-.�....--_.g°s'" THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. a DATE...... 4...-..._....--- --------- - Inspect r ` .. , f THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE FEE....ap.:.' . �i��las�tl nrk� C�.nn,I�t►ruan rrmit Permission is hereby granted------- -------------------------------------------------------•-- -----........... to Construct ( ) or Rep tr (� dividual Sewage Dis osal System f at No........4.11------ 4 S 1��?- t � ----------------------------------------------------- ................-------------- treet as shown on the application for Disposal Works Construction Permit N15:: a�m1`'-a�. Dated.------7n_a_,�._.-72-s-.-. -----••••---......--•------•-.-••-- Z)------------------------------------------------ DATE. Board of Health FORM 36508 HOBBS&WARREN.INC..PUBLISHERS CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL ; WORKS CONSTRUCTION PERMIT(WITHOUT-DESIGNED PLANS) hereby certify that the application for disposal works i f I construction permit signed by me dated ��y. 2,3; concerning the property located at G ! S ^S-<) 4 s 3� meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system -� There are no private wells within 150 feet of the proposed septic system t • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. r SIGNED: DATE: 9S—� LICENSED S C SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. ' 4j, r1 _ a t, J - � N l eA ri � In k r r • G a , � �i