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HomeMy WebLinkAbout59A BODICK ROAD - Health OMNI Scape 0 Date: TOXIC AND HAZARDOUS MATERIALS REGISTR TION FORM > NAMEOFBUSINESS: v BUSINESS LOCATION: S MAILINGADDRESS: i_ SSl) Pq , Mail To: TELEPHONE NUMBER: Board of Health CONTACTPERSON: 1. 21 CyTown of Barnstable r !MQZj 7 P.O.PO Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: Hyannis, MA 02601 TYPEOFBUSINESS: LA0 SCCCjptT- Does your firm store 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 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 _.k- 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 1rMhs 1 _,T Rustproof ers Lye or caustic soda Car wash detergents Jewelry cleaners C6M Car waxes and polishes Leather dyes Asphalt & roofing tar f `Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Any other products with "poison" labels Paint brush cleaners (including chloroform, formaldehyde, Floor& furniture strippers hydrochloric acid, other acids) Caji 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 fluids (dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS J TOWN OF BARNSTABLE (OMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair 2.Printers BOAR OF EAL H satisfactory 3.Auto Body Shops d' O unsatisfactory- 4.Manufacturers COMPANY (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS Class: 7.Miscellaneous 1 0 QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors) MAJOR MA Case lots 1 , IN OUT IN OUT IN OUT #&gallons Age Test '�asohri6, et Fuel (A) Diesel, Kerosene, #2 (B) ste motor oil C new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: _L_j_ DISPOSAUR.ECLAMATION REMARKS: 01L, 1. Sanitary Sewage 2trivate ter Supply v Town Sewer ublic On-site 0 3. Indoor Floor Drains YES N0)( Holding ® 5/ O tank: MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: O Holding tank:MDC O Catch basin/Dry well O On-site system 5. Waste Transporter Name of Hauler Destination Waste Product YES NO 1. 2. P r n (s) Intervie e Inspector" e " ASSESSORSMAPNQ PARCEL Q 5 TOWN OF BARNSTABLE COMPLIANCE: CLASS: is Marine,Gas Stations,Repair BOARD OF HEALTH (2) satisfactory 3.Auto Body Shops - O unsatisfactory- 4.Manufacturers COMPANY o �' Gr �.% . " ` ram.L, (see"Orders") 5.Retail Stores � i> �4 � , :1r 6.Fuel Suppliers ADDRESS -7V C18SS' 7.Miscellaneous ""QUANTITIES AND STORAGE (IN= indoors;OUT-outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground Tanks IN I OUT IN I OUTI IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) t Heavy Oils: waste motor oil (C) new motor oil (C) transmission/bydraulic, 2 1-1: 5 Synthetic Organics: degreasers Miscellaneous: III DISP OSAL/REGLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply t f�.1 ..��s' C'��.i3 �' �r /�� tea✓'-1 :k s.=. O Town Sewer OPublic IE O On-site OPrivate 3. Indoor Floor Drains YES NO O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO X ORDERS: O Holding tank:MDC O Catch basin/Dry well O On-site system r 5.Waste Transporter Name of Hauler Destination Waste Product 1 YES NO 2. Person (s) Interviewed Inspector Date No...... .......�/7 r Finc............................. j THE CAMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ...............OF....4. /-7_5 >. Appliration for Bigvuiia1 10orkii Tomitrur#ion Prrmit �j Application is hereby made for a Permit to Construct ( &Ylr Repair ( ) an Individual Sewage Disposal System at: 0Ll ......., ..---•-•='�------•--- -- c5 ............. Loc 'on-Address or.Lot No. Owner Address a n- - _ Installer Address d Type of Building Size Lot..2:.5.26?..Sq. feet V Dwelling—No. of Bedrooms--------------------------------- ,.._.....Expansion Attic ( ) Garbage Grinder ( ) 134 Other—Type of Building i(t_✓,41Z6 Imo. of persons____________________________ Showers ( ) — Cafeteria ( ) Q' Other, fi tures ------------- ----- --- W Design Flow. .,C ....._.gallons per person per day. Total daily flow' _ �° flo __--�' � ,_t .............gallons. . 1:4 Septic Tank—Liquid capacity kallons Length-__ ... Width._.` .- _ Diameter________________ Depth_.4/a-S'-_.! Disposal Trench—No. .... ........... Width../Z..�........ Total Length...3..Z.`... Total leaching ---sq. ft. Seepage Pit No-----------------_-- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( A6j-'�" Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I......47.t-rninutes 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........................ P4 -----------------------•-•...-------•---...-----.....-••----------•----------------.......................................................................... 0 Description of Soil.................................................................................----------------------------------------------------------------------•---------------- 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 TI'i 1L- 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance een issu byr7 -,- a health. Signed. Yd - ° `' ate Application Approved By---.....-.— ! - e/!G%✓% ..... ... -1� �4. - .--._.- Date Application Disapproved for the following reasons:.................................................................................... ........................... ...............................................•.......................................................................................................................................................... Date PermitNo......................................................... Issued....................................................... Date 35 No.....�J......'.S/7 :+ j FEs.. ............................. THE C014MONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliration for Disposal Works Tunstrurtintt "trutit Application is hereby made for a Permit to Construct ( e-r`6r Repair ( ) an Individual Sewage Disposal System at: _ Loc 'on-Address Owner _ _ Add ......................... ..-.1,�'�'Y / Installer Address U Type of Building Size Lot..2.3.2 q.Sq. feet �-, Dwelling—No. of Bedrooms..............................v,, --------Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e� yp of Building .�C./��Z�1� o. of persons............................ Showers ( ) — Cafeteria ( ) � Other fi tures .....1:..-••--•-------•--•-•-•-•••-•-•••-••••-••--•--------••-•----•----•-......--•---•---------••-••-•---•-•-.....--•-•-......•-•.._..••••..•••••. Design Flow._,__ .,/nCX.;.>._:•5 gallons per person per day. Total dailyf flow---_--_.5`. ,.,5............gallons. P4 Septic Tank—Liquid capacity._.� allons Length--- Width---- Diameter................ Depth..... W r- -� � x Disposal Trench—No...... .......... Width..f.C<.'__._�_...... Total Length____W.�_ _..._..- Total leaching area...4. . �. sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( 4� Dosing tank ( ) a Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1........ per inch Depth of Test Pit.................... Depth to ground water....................... �%4 Test Pit No. 2_....'.�"' `.minutes per inch Depth of Test Pit.................... Depth to ground water........................ Of� -----------•---•- Description of Soil----•----------•.............•.....------•----------.........-•---------•-••---------------------------------......--------••-•--------------------------•----•-•-•••-- 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 TITLL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance een issu by t a walth. Signed ApplicationApproved By.................................................. ............................................. ........................................ Date Application Disapproved for the following reasons:..................... -•- ---•••--•••-••••-•-•••--.......--•-••--•••-•---••-•••----•----••........-•-•---•-•-•••--•----••-•---•••---•••-•••--•-•••----------•-...-••-•-•-•---••------•----------•-••----••-----------••--••--••--- Date PermitNo.......................................................- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....... ( t ✓ ti�........OF...... ................. Trrtifiratr laf (tuutpliugtrr TBIns TO CERT FY, That the In ividual Sewage isposal System constructed ( or Repaired ( ) at........ ..r ......... . .....C,R?_ - �Cif In r has been installed in accordance with the provisions of TITLE z5.gf// to State Sanitary Code as described in the application for Disposal,Works Construction Permit No......................................... da.ted_..........-.----____-___-__.__--_--__-_--_-_--- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WI FU TION SATISFACTORY. DATE.... 17...._ 1'----••-••-•-•--•.....................•---....-----. Inspector-- .. ....•-------•--------------.....-•---------.....................-•-•--•---- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7'�'. ' -� O F... � �, .� ........................... .......... ........... FEE........................ Disposal Works To str wi u frrutit Permission is hereby granted....�� ............................ =r _!T ' . to Construct ( r Repair ) Individua.l Sewa Disposal System at No..•-•-• �'�r -�` / c ,( /Cf��.....g eAO_ fi . , /r ............... Street as shown on the application for Disposal Works Construction Permit No...................... Dated.......................................... Board of Healthlth DATE...................................... ......................... FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS T v4a� L O C AT ION - S E W A G E PERMIT NO. VILLAGE Yyhyo INSTA LLE.R' NAME & ADDRESS IUILDEN OR OWNER DA T E P ERMIT I Y E D DATE COMPLIANCE ISSUED lv O ZrJ n � i I I I - � — _ _ . - I � - ___ _____ -__�.__�_ - - � � _l X, _ __- I­ - . . , r*�. . I . . � I "- . �� �. I , - I'k. I . I �I ,vd, I . I" . . (�, � N - 4 -,�,� I , (�O. - t 1. � � I I i ,_ f, ,- -I , I . I I I � � I �� ,?, "... .. - . I I � .d . I 1, I .y, .1. 'I � . . � � 44-4 i.,'I.,� 1, i � . 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