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Home My WebLink About0546 MARINER CIRCLE - Health 546 Mariner Circle, Cotuit a= 0 Z'q— o g-7 Rainbow Text eart Kits Company { �zDate: .7-/ TOXIC AND HAZARDOUS MATERIALS RE ISTRATION FORM NAMEOFBUSINESS: R4)vi ee ` r_X-hk _ 1 (!0M1 BUSINESS LOCATION: -SZ 6 PAP o)rk 0 R<L6 0s- MAILINGADDRESS: PC' 949 j CO-71J)7 Ad Mail To: TELEPHONE NUMBER: L/L ' ��-/? Board of Health Town of Barnstable CONTACTPERSON: P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: Hyannis, MA 02601 TYPE OF BUSINESS: m Q L) 411 r Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own use? YES NO P" 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): Spot removers & cleaning fluid s ds 9 (dry cleaners) Other cleaning solvents I Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS LOCATION SEWAGE PERMIT NO. ,,C D T ? 9-' .3w, s- S VILLAGE INSTA LLER'S NAME D ADDRESS fv� �y GUILDER OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED Ig-/lZ/�� w V No........_uU lf_l FIMs..s Yll THE COMMONWEALTH..OF MASSACHUSETTS j BOAR® OF HE LT _ ................OF...... � ,.5.....C�� _..........__..:1......._....._. Appliration for Uhipuual Works Tunutrurton Prrmit Application is hereby made for a Permit to Construct (Y,") or Repair ( ) an Individual Sewage Disposal System at ..................•--------•--...._....... ........... . a----u! a ....�� ..... Loc on-Add .. or Lot No. ...................... ....-••-- .. ...._...._. .......... ....... ... ......................... Ow r Adi, ess Installer Address l Type of Building Size Lot.e;j-.3Y .....Sq. feet U Dwelling—No. of Bedrooms------------ -----------------------------Expansion Attic ( ) Garbage Grinder ( ) per, Other—Type of Building ....__ _ ._.__ No. of persons...........(............. Showers ( ) — Cafeteria ( ) P4 Other fixtures ------•----•-----------•------•• . WDesign Flow........... ........... .......gallons per person per day. Total daily flow....... .........................gallons. WSeptic Tank—Liquid capacity./G�.gallons Length./P h�r 6`Width.S- . Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.....................Total leaching I r area___.._...... _ sq ft Seepage Pit No � .. Diameter___... Depth below inlet.....��___. Total leachingarea _ Z Other Distribution box ( ) ) Dosing to k ( ) Percolation Test Results Performed ........ .... .......................... Date........................___...._.__.... aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.... _ __ __ �KL Gt, Test Pit No. 2.........:......minutes per inch Depth of Test Pit.................... Depth to ground water---.........___.... a ........ -•-------------------------------------------------•-------..------------------------------------------------------------ O Description of Soil....0=4rt.... x --- L 3®----------------------- (� 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 TITI.j 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been 'sued by the rd of lth. �gned. . ...... . . -------- .-Y-........................ ze Application Approved By.............. -• -• .=..... - _z44--• ••,•----------- ...••. .... ...- �- 1 Date Application Disapproved for the following reasons:............................................................................................................... --•--•-------------•-••-•._........._...-•••-••-•---•--•--••--•--••-•-----.....-•-•-••-••-••---••••----••..-•--••-••--•---------•-•••---••-••----••---•-----------------•••------------------•--•••-•--- Date PermitNo...................................................--.... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOA RD . OF• HEALTH ---.Xa.G!.��)---------------OF.....e%. ' 5 !? Appliration for Disposal Works Tomitrnrtion ramit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at // /� / 6 C .... Cr U/ G _... ..............••.......... ...._.. .........J 1�^ ...-------•--•-........................................ Loca on-Addr or Lot No. ... .. Address es J Installer Address d Type of Building Size Lot.,/.;-/ .......Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building _17! :: __ No. of persons...........-•............... Showers ( ) — Cafeteria ( ) dOther fixtures ....................... ------------•-•----•----------••••---------•-•----•-••-•••--------------.......-----.......---------•......-----............. W Design Flow.............SS_._.....................gallons per person per da . Total daily flow---___3-3®.........................gallons. WSeptic Tank—Liquid capacity.&M.gallons Length_A."6... Width..tiJ_Xl. Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length................. Total leaching area................ ft„ Seepage Pit No...........I......... Diameter.......g_......... Depth below inlet.....�-�3_�____ Total leaching area.,�' S. > Z Other Distribution box ( )) Dosing t plc ( ) v�7// aPercolation Test Results Performed by._.../-.(_ lt-v!:�«'°�-..._____.�.c__�.- Date________________________________________ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_.__1'-V.... .: r•>~ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water./....._ - (_ T •-------------- ---------------•---- ---•------------- •----------- •-------------- •------------- ..... D Description of Soil...-------------------- .'-_ ..... 4 - j.14�5::•!.. ....------•-••-•--•---•---•----------------------------------------•--------------------......-----._......-•------ - L 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 TITS 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•• ''� t_/ ��!` .�.% 11 rJ Date o Application Approved By.....----- •• :..K ---- ............. __•__-•--- ..... .......... r Date Application Disapproved for the following reasons:..............................-............................................................................... ...........................••---...._......---------•--•-•------..........•----•---•••-------•---•-•----•'--------•---------•---•-•--•-•--••----•----------•----••-......_.....------ ---•---------- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ,( .:)^ ..............OF....... !��-/1JS 7 C�..4�. ............................. Trrtif iratr of ToutpliFanrr T{�S IS TO c dFY, hat the dividual Sewage Disposal System constructed ( ) or Repaired ( ) by- :_J.....(1,t'o....../-_mil fd /H/?:a s . -- -•-•••--••- • - ------------••-------.....-----------....•••---_______ -------- ........... .-----------•----------------- ------- �J Installer at__.._: `7/4 /!•flies/c' -- /- �f has been installed in accordance with the provisions of TI,T ' 5 of The State Sanitary Code as described// ''in the application for Disposal Works Construction Permit No.= _..____ __v.__. '__._ dated_..._.__/-.�__3....:�`_5 ........... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................... -d1l_.5111..... Inspector..............----------.....----•----•--------------....--•••-•-- THE COMMONWEALTH OF MASSACHUSETTS ) �/ BOARD OF HEALT� /iv c) No......................... Disposal/ urhu (gongtrnrtixin amit Permission is hereby granted......7.- �`�t''?G1. t LG �r�t ---- i ................................. to Constr ct or Repair (, ) an•Individ .1 Sewage DispW, Stezr� �� at No... /Gt. Gt�'��C ��sj> - ` J ��' :.... �••------------ - -- .....-........................• --- Street -1 .g ry_ ,�..� C ci 3 as shown on the application for Disposal Works Construction Perm t-1o.____--.-_y/�11"Dated.._.._._.'.............................. ti.. y v c ........................................ Board of Health f c_ DATE....................... --•- . FORM 1255 HOBBS & WARREN. INC., PUBLISHERS :,• �--- ---- �, ��-41..t._ F-l.�E�/. s}•4C�k/.J AR.rc t�t�o►eJ SSA. L.G�/6i t... �_ 2�- P1TGN Au. t,-i►JES P, tit f►J t M Vo� of= / - � ,�� vr.I�ESS C�T'�EP�+J t5 E �P'�rGtFtlG•'t7. •::j, O o G)— A t.� Pt P� To o►�D t►..l THE SYSTEM S 4}1rl.a_ r5E CAST tRn*J cc- 5 aSDuLr=: go ALL- sEPTtC ra�+�s, ots,r9!% st. Tw► J i6ox, A, ao t•.,EI►.c N t.J6r P crs SHA.LL_ ESE v+Est�...,E o F'oiz. CJ � Do ---- - - - _ - - -- I t2 Etb✓1E Au` UrJSv t TA3�.E t`1ATEiz l A t..._ ��eJ Es�►T1-1 • O O ® ® c c -TI-W- ELEVA-rtO"S of LEACH t,Jc� PrTS fo - Lo —y ,,_ n) O ® O O _ A e4C)l uS OF Z `S' /►,rJC> Q4LICFt LA- \,Cj t-n4 C L.,ay- Flt'1K �-r , �} e i 5,1►"'p A04 a a P..s.%lEL- 1 i @ O ® 6 -rt F3A2 sY�, t_�• D ©� -ram MUST • - N ` � � MCSrtFf t� WHttJJ Tt••4�. 3ySTEN� tS NEAP. ,Q. 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