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HomeMy WebLinkAbout0129 STRAIGHTWAY - Health 129 STRAIGHTWAY, HYANNIS A= HP Melo Bros Landscaping i r TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: a �� Board of Health MAILING ADDRESS:10 .!2in,44-tacitz /� ,;,�nfs ��1.9 oydal Town of Barnstable TELEPHONE NUMBER: �� 3�/GS — 2f � �35y� P.O. Box 534 � A Hyannis, MA 02601 CONTACT PERSON: {Tn�P ]1 :�' � 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 gallonsliquid volume or 25 pounds dry weight? YES — NO This form must be returned to the Board of Health regardless of ayes 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: a 1 {' l,'�t7r ��S��S - .�I,`I/r, 6f� TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous characteristics and must be regli5tpred pid Please put a check beside each product that you store: d10 Antifreeze (for gasoline or coolant systems) t/O Drain cleaners &— Automatic transmission fluid le s Toilet cleaners .iI/a Engine and radiator flushes ,r/p Cesspool cleaners `& ' Hydraulic fluid (including brake fluid) of Disinfectants ` e 5 Motor oils/waste oils 410 Road Salt (Halite) Ves Gasoline, Jet fuel . f1d Refrigerants /r5 Diesel fuel, kerosene, #2 heating oil Yef Pesticides (insecticides, herbicides, Yes` Other petroleum products: grease, lubricants rodenticides) _/p Degreasers for engines and metal wO Photochemicals (fixers and developers) WO Degreasers for driveways & garages PS Printing ink ,,f/G Battery acid (electrolyte) Wood preservatives (creosote) �/_ Rustproofers , o Swimming pool chlorine I Car wash detergents -6/0 - Lye or caustic soda "ji4 Car waxes and polishes 4,zL? - Jewelry cleaners 41D _ Asphalt & roofing tar Leather dyes ,4,10 Paints, varnishes, stains, dyes yp Fertilizers (if stored outdoors) -X,1D _ Paint & lacquer thinners .{/0 PCB's �lL�L Paint & varnish removers, deglossers ✓t V Other chlorinated hydrocarbons, .riU Paint brush cleaners (inc. carbon tetrachloride) V0 Floor & furniture strippers L6' Any other products with "Poison" labels D_ Metal polishes (including chloroform, formaldehyde, /_ Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may VD Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) Wft-en l,&G 5 cietmer Other cleaning solvents �iPSP� /-�P/ 5Q gG(1CanI �t/O Bug and tar removers (61C AOVIP a./1 n l-S ar y eS Household cleansers, oven cleaners ,� rMr`�S r �vP� St6f�gP White Copy-Health Department/ Canary Copy-Business v LOCATION SEWAGE PERMIT NO. - ...,� is i7�� cy,h �.✓c- i ��� '- �o VIViAGE I III ST LLER'S NAME i ADDRESS Cad L4mim f�. h) B U I L D E R OR OWNER o- DATE PERMIT ISSUED �: �a � 3 DAT E COMPLIANCE ISSUED 0 �J� ^. �, o � � � � � c,� `S � �; ti �@ g f ' a � � �" _. ';�. , , .w • � No , Fss.. ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................O F......................I................I....... .......................... .... Appiiration for Diipoiitt1 Works Tonstrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal' System ............ ... .........................................•-•••-•....----•-•....---•---•••-•--.••................... ocation.Add', or Lot No. .. .... ........ . •......................... .............._ ... •---••........._.. .. .... .... . ...... ... ...... Owner @ddress W .................................... Inst er Address dType of Building Size Lot............................Sq. feet v Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building --------------_------_---- No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures .................................................. d --•-------------------------------------------------- ........ ............ •-.----------------------- 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. I................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........................ pl ................•------.._........-•----••-----•.....•---....-•--•--•-••••---•...............__.......•••••••-••-•........--••••----•---..............--•••-. ODescription of Soil........................................................................................................................................................................ W ---•----...--•---•---------------------•---•-._...------...._............------.---•••--•--•-•-•--•--------•---•------------•-•----••--•---•--•-----•------•-•---••••--•----------------------------•-- U Nature f Repairs Arteraltio s Answer whe lica le.......................... ._.____ __ __..._..______ .a.. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate Wnceh.ae ued by the board of Health. ..............•-••--••-----•-••...---•--•._......--------........--------------- Application Approved By •----••-•...........................•--...........--.•---- •... Date Application Disapproved rs:----•..................................................................................•--:..----........------ -------•-•---•-----•...................•------•-----------••--••••--••--••.........-----.........._........ Date PermitNo......................................................... Issued....................................................... Date ..........................................._................................................................................ THE COMMONWEALTH OF MASSACHUSETTS 7 3/��3 BOARD OF HEALTH IvDr• ............OF.................. ............ ........ Ta of iratr of Tout Iiattre T IS TO , ERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ................. .•----............----..................----------•-------•---•------..........----......--------..................•--...... Installer at - has been installed in actor ce ith the r isions of T F 5 State Sanitary Co as bed in the application for Disposal rks onstr cti Permit No.os j.......M....._... dated_ ....... .............................. THE ISSUANCE OF THIS CER FICATE SHALL NOT BE CONSTRUED AS A UARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE......................•--•----•-•-------..........................•--••......... Inspector.................................................................................... i7 -- Fxa............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........... ....................OF.......................................... Allphration for 3�i ipaiial Vorkg Tonotrtirtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at t .....------ --•-•-••-•--••----•---- ocation-Addres or Lot No. ................................ ............... Owner �" dress Inst. er Address Type of Building ' t Size Lot............................Sq. feet Dwelling—No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building •----•._ No. of persons.......................... Showers � YP g ------------------- P -- ( ) — Cafeteria ( ) QOther fixtures ------------------------------------------••----------.••••-•••••••-••••f-••-••--•-•-•---••......-•••••......••. 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 (� ) Percolation Test Resultsr Performed by ................................... Date........................................ Test Pit No. I.................minutes per inch Depth of Test Pit.................... Depth to ground water........................ G14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ------------------------------------------------------------------------•-..........•--........•---•................................................ 0 Description of Soil........................................................................................................................................................................ W .......................... U Nature f Repairs r A teratio Answer whe lica e................. e.__ Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compli nce has^bee k4ed by the board of health. gned Application Approved BY -- -- ..... .. --------- ----------•--•----._..............----•-•---•-- �,__,e _ �- .... Date Application Disapproved r t following reasons---------------••----•----------------------------------•------•••-•--•--••-••••••-•••---•• ••................ - t ........................... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OFF HEALTH ..........................................OF.................................... ................................... C9rdif irttte of Toutpliatta THI- IS TOCCERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired. by-- ,�.,_.. = ........... ._._ .. ............................................... ...................................................... Installer has been installed in accor�arrc ith the prdvisions Of T F 5 0 �T State Sanitary,�Cos bed in the application for Disposal �' rks onstr trio Permit No. ......�! �::__..._.. dated_ .. _ ___ ____________________ i THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...-•--•---•---...--•------•-----••.....................•-•------....--•-_------ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS f BOARD OF HEALTH w � ...........................................OF.......................... /V No. ........... ........ FEE.........._............. Diopoott or o Zonotriirtton rruti# Permissin is hereby granted =`== ....----•-••--------------•----•---------------...----------•---............•-----------..............---.... to Construct (� 3 •ar--R a' r : an IndiviF al Sewage Disposal System atNo..... ---•-------------------------•------•._.._.._.....-------•-----------------------•-•••......•••< T Street � �T as shown on theme plicatio or Di osal ��or Construction Permit No.................. -------------•---••••••-•---•......... ••-- -•-•-• .................................................. oar Health DATE.............. ... ................................... FORM 1255 A. M. SULKIN, INC., BOSTON LOCATION r 3EWA /vGE PERMIT C30. VILLPAGE INSTALLER'S NAME i ADDRESS S U-I L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �I ! � �� � �-- �� �; �- J J n 00 No.........$.7� FEZ.... ............... THE COMMONWEALTH OF.-'MASSACHUSETTS �» BOARD OF HEALTH . ...............OF......819R.L�J. .T>4-I, G:' Appliration for Dispaiial '30orks Tonstrnrtiun rtrutit ;, . Application is hereby made for a Permit to Construct or Repair ( } an Individual Sewage Disposal ystem at: 1.YY.1Q l�l� ............... ..•--, T.. - lt7lcj Locatio ddress r Lot N....................................................... Owner Address w L, -> ,o e� Installer Address U Dwellin Type of BuildingSize Lot._`f�_7_,-_-_Sq. feet ' No. of Bedrooms............... ._.._Expansion Attic QV� Garbage Grinder (90) aOther—T ,e of Building ____________________________ No. of persons.............. Showers ( ) — Cafeteria ( ) a' Other fixtures ---------------------------------•- d pe� TDesign Flow.... ________gallons per day. al daily flow___.___.. ----__--- -gal gallons. _ ____________________ WSeptic Tank—Liquid capacity/RV5L.gallons Length Width_X_`?d_`:'_ Diameter________________ Depth_a_ram"-. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No...../----------- Diameter.__ Depth below,inlet:•:_4a...._____.._ Total leaching area. Z Other Distribution box'(° Dosing tank ( ) aPercolation Test Results Performed by.)ZO-ts)A-D...A-_...6r__LA-Aiz&P.___2: ......... Date...Atla :.._�Ga1� a Test Pit No. L_/_. ._minutes per inch Depth of Test Pit....1Z-__ ....._ Depth to ground water__/1, -0A/e ,__. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Q+' ----•----•-••••-•-••-•--•-•:...............•--•--...._...---••----•-......••-•--••--•.............--......................................................... 0 Description of Soil......... :/; :��. d�.liE---1�151: ....''lAdtf ---- ---=-1, __�`. �$l��.► _.. �,�� V /Pru fr ;1 _..._..._. y'e�'Y'`� �� •-Ce2'.v*_S•'e.......... •...............•--.....------•-----_.-•-..---- W 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 L I'iE 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,......... ... Date Application Approved By.......... ✓-" �(Jt _7 :. -••-•----------•------••-------•---••----•-------------------•_ Date Application Disapproved for the following reasons__________________________ .___.......__ ..............•-•---........---------------•-•-•••-••---•••-•......_.........-••------........••••-•-------••-•-••-•--•-••-•-•-•••-•--•-•--•-•-•---•--•--------•---•-•--•••---•-•---•----_..----------•- Date PermitNo.............•--•---------.............................. Issued....................................................... Date No.......... .1 CP.. Fis....rd............. THE COMMONWEALTH OF MASSACHUSETTS ' i�• BOARD OF HEALTH liration. for Disp.aiiai Works Tonstrnrtiun ramit Application is hereby made for a Permit to Construct (+` ) or Repair, ( ) an Individual Sewage Disposal System at: A. /JL5.............. -•----4. .r............. .............................==-........................... / Location-Address or Lot No. e j. � Ca.:.'f..L '1•..��,...._. �` _ .c�.:..........: J .: �.....)......:.:........... .......Z. ..._.... Owner ... .� i .'/' 4Addres's %✓ ; .f ./7% �� ,i ', ....................................... �.,::._... �tl f� "�.,�.s........•.........•................ - Installer �'��� � ddress--- Type of Building ,.. Size Lot_.. ...Sq..,feet Dwelling-No.4 of Bedrooms.............. .........................Expansion Attic Garbage Grinder (NQ) a`4 Other—T e of Building ...._...._ No. of persons........................... Showers YP g --------••--------- ----• ---- ( ) — Cafeteria ( ) dOther fixtures �n -•-•••••....4 ....`..I it f:id•��1nC+v W Design Flow__. f�-�.....:.....................gallons pererson-per°day. Total daily flow_-_..... .,a,��._.._.._.........:gallons. WSeptic Tank—Liquid capacity/ _.gallons Length&r4..--.. Width.?."'O" Diameter................ Depth.S.,(.r-' 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 ( ) aPercolation Test Results Performed by.K0.NA.(..P...A n...+r i?•,6,AX>....P.-...f..... Test Pit No. I.../.. ..minutestiper inch Depth of Test Pit.__ ----- Depth to ground water.ZLIP.,/Al.... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-----................... a ----- •.. , --.......-•..............•----.---•- D Description of Soil.........Onr _,e2•vzv 4.�s ..... � _ry1 ._. r' 2 "-G �: ,a"......FAI U ��-`--------�s'"t�. v _.......p��'' - C ` �� ^'� .�" -------- -----------------------------------------------• W UNature of Repairs or Alterations—Answer when applicable............................................................................................... .... ---------------------------------------------------------------------------------------............................... ; , Agreement: t The undersigned agrees to install 'the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State'Sanitary Code—The,�4indersigned further agrees not`to place the system in operation until a Certificate.Aof4Compliance has been issued b7C board of health. i Signed Date A lications A roved B { PP PP Y ........................ Date Application Disapproved for the following reasons:..........................................................•--•••-------•-- ---•,•.............••-•••--•-•-••---••-•-•--•••••---•--•••--••--.........-•---•--•••-•----•-••-•-.........-----•........................................................=-.--------••-•--•---•-•---•---•- Date Permit No........... :. .. Issued--------------------------------1--•-------------------- a 1 Date THE COMMONWEALTH OF MASSACHUSETTS 4a. 4y BOARD OF HEALTH ..' .. ?.lhl...............oF...... ,!211�+: s!.-4;............................. �� �rr�ifirtt� ,af �nut�rlianrr _ THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) by........................... . . .....-•--• == -T n:C.. = �_ j>.................. .` rC...^.....a_.1..!-' !�:....-•-- ` -.--.... . .. :... ..... --- Installer at..........�'•�-----•Via.............. ,.......... ','`fir! ---•-------------------•---•--... . .....•-----------. has been installed in accordance with the provisions of The State Sanitary (� "bed in the application for Disposal Works Construction Permit No.............................:.......... dated............................:t_.__......._.._... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. A' DATE ��%� '� .......... Inspectors V _a4s1'W /i 7, A tea THE COMMONWEALTH OF MASSACHUSETTS a ;b BOARD OF HEALTH .............OF....... � M� a��lA�. �-•ra( �"�. r,....................... No......................... FEE........................ Disposal Norks Tonstrurtion Vprrufit Permission is hereby granted........... ............/--.L.-----`-- <..!.':.C_..L-_ to Construct (,.�,`'or Repair ( ) an Individual Sewage Disposal System at No.. -4�•• '�----------•••- ,," '/ .: ln3 �' A."�S`' ' ��-----------•---- -7 Str A ��'����-:`/jam' • as shown on the application for Disposal Works Construction NO. d•__ ---_-------------•----•-- ................................................................ ..-----------------.............---._ Board of Health DATE..... 0!! = FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS `°' r'w�. ya'_ �. l.._ E _'i< Er ,r,.� .r,. a ^t..• w. d' v.�t m�P.. tir=•s^?• .r, ;q.4 s '.• 4 Y z Y ! g: ..rt r. d° +•_'t , ...-. .1 a 4•s ,. -a +P... f• tst'. ,.e•? •rt+r i•. y< ,�„•< i;c2 '" +i. "" - !� � :4 }S :t � r R}a.,t �''�-:C a'y. s •tP'* �. .,;. k�..a�.#,u w�+ F��+a *+ �.. .a t ! .i, ,s/` q 'f sR f±.s` ' r ',.rt•: .ti- ;n 'a'" .,sF y ,x b +; '�;1 '•s s P, t fi� ' - �''�i'a"-rt „i '„{. 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