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Home My WebLink About0344 LAKESIDE DRIVE - Health 3 �l r L 0 C A T 1 5EW'A`0E PIRMIT " NO. 3Y� lag, NILLA6E -, vIs ' � i'` ;:ADDR S R �' A E S S -L S M E IN TAL E M , ld Ly c 4 wso B UILDERo- OR OWNER 4 vyy� �j t• ,:=-.DATE PERMIT ISSUED DATE COMPLIANCE ISSUED V ,,. FROG . No...�1..!..��'2'� Fps......... .. . THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ........... .......OF........../ Applutt#ion for Uhiposal Works Tnnolrnrtion Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: �/Location-Address __________________________________________or Lot No. .......................................................... ----....... --........................---- Owner Address 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 ( ) 04 Other fixtures ---------------------------------------------------------------------------------------------------------............................................ 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 Results Performed by.......................................................................... Date........................................ a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Lz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a .............................................................-......... ......-------. -- --------........ ..... .--............•----------------------------- 0 Description of Soil........................................................•--•----•------•---••-------------- ------------------------•---------•-----•-------••----------•.....---...._.. U ---------------•----•-•...--••••--••----------•-----•-•-----•-•-----•-•-•••-•......•---------------•----•-•-•------------••-••---••-•------•--••-•-•-------•-•----••--------•......-----•--•...-•-•----- l -•----------------------------------•--------------------------------------------------------.............................................................•------...----------------------- ........._. 'U Nature of Repairs or Alterations—Answer when applicable...../Q4?®.--.._-Se,.&7a..-_--_.-_--_-0-.-1.ej-k................. ----•....................._------..Z o-------/_P-.0ae.----------------------------•------------•-•----........-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI APIE 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 board of 1 ealth. Signed .... '--• /azt Application Approved By................ ".--- ---- •. . . ---•-•�� --------------------------- at ....... Application Disapproved for the following reasons---------------••----•------•----....------------------------•-------------------•••-•--•----------............_ ---------••---------•-----••--------•----•................................•-------......_..........-------------•-----------------•••-••----••--•--•-----•-•---•••-••-----••----....................... Date PermitNo......................................................... Issued....................................................... Date ---- -- ------ --- ---------------------------a —_ _---- ---------------- 4- No.. .. �.. FEs. .... ......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF,n HEALTH --------- 1?.!�2✓........OF..........1, ,,,14'4v'3�5% O ,C+.""............. Appliratiun for 1ispuuFal Works Tongtrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at 22 •Location-Address •••••••••--•---•-------_--•-•-------'-..or.Lot No. ------- .�...... --- ................................................. .---..........--------------•--.............. W � wSo Owner Address a ......... ......... ......... Installer Address Q Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms..__._..........................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria G4 Other fixtures .----••......-•--•---•----•----• . - 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......................... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W ----•••••--------------•••-----••--•••-•--•••••.............--•..._.........•-----•••••••••-----.......••---------•••-•-•-•-•-•--••••--••••----•--•.......... 0 Description of Soil........................................................................................................................................................................ x U ---••-•-••---•--•---......---••---•-••--•------------------------•--•------•---•-....•••-•-••--•--•-••...----•---•--••-•-----••---•---•--•---•--•---•------•-•-•-----•---•---•...----••-•--••--------- W x ---------------------------------•---------------•-------•------•----•----------•-•-•--••-•-•••---••----------/f.................................;...................................................... U Nature of Repairs or Alterations—Answer when applicable.____ .�Vd....__..Sel_o —it........... ---/5p.k.................. ° --------------------------------------------------------•--• 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 Compliance has been 's�y the board of ealth. Signed • ••..... �,..�.._ ....... /a�W 1 Application Approved B ..>..= ................... ---... . ............................. Date Application Disapproved for the following reasons:..............................................................._ , •---------------------•-•--•-----•--------•-------....--------------.........--------•---•-•----•-----------------•-•--••--------••-------•---- ......-------•---•----...---------------------•-••••-•- Date PermitNo...................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r ........................................OF....... ..... v...... U Trnifiratr of TontlrliFanrr T I S TO CER�IFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ""' --=-- - ------------------------------------------------------------------------------------------------ Aov f Installer at....Y!tv-el--__---- has been installed in accordance with the provisions of TITS. 5 of The State Sanitary Code as described 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. 1' Z�' e ..... Inspector DATE__....... f ......-- •.--- -----------•----•--•--------------------••-•-----------••.•••-- ` ••. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH/ �j tc�. ./.............OF........ ``t' Y '0 - --...............---.. ..... .......... No.•••••-......•......�=P FEE....,. aiopoo Works �unrnr#ion rranit Permission is hereby granted------.--�` -C��':............ '/ .................................................................. to Construct ( ) or a air (4--ran jndividual Sewage Disposal System Street as shown on the application for Disposal Works Construction Permit—No..................... Dated...f, .A. $'.y..... .........- .e-�-----------------------------------•------------•---•--•- /L // Board of Health --------------------------------------------------------- DATE........................... �---/•--------��----•-•--------•--- FORM 1255 A. M. SULKIN. INC., BOSTON �, w TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF FIRM: MAILING ADDRESS: 3qq 1,4KC TELEPHONE NUMBER: '?_T '_ '? CONTACT PERSON: e A ue e, Does-.-youra irm 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 i 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: 1&4 7 �',g� ,m,��ry Sri TELEPHONE: l W 74 LIST OF TOXIC AND HAZARDOUS .MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous characteristics and must be registered when stored in quantities totalling more than 50 gallons liquid volume or 25 pounds dry weight. Please put a check beside each product that you store: Antifreeze (for gasline or coolant systems) Refrigerants Automatic transmission fluid Pesticides (insecticide"s, Engine and Radiator flushes herbicides,rodenticides) Hydraulic fluid (including brake fluid) Photochemicals Motor oils/waste oils Printing Ink Gasoline, Jet fuel Wood preservatives Diesel fuel, Kerosene, #2 heating oil (creosote) Other petroleum products: grease, i Swimming Pool chlorine lubricants Lye or caustic soda Degreasers for engines and metal Jewelry cleaners Degreasers for driveways & garages Leather dyes Battery acid (electrolyte) Fertilizers (if stored Rustproofers outdoors) PCB' s Car wash detergents Car waxes and polishes Other chlorinated hydro- Asphalt & roofing tar carbons, (inc.carbon Paints, varnishes, stains, dyes tetrachloride) Paint and lacquer thinners Any other products with Paint & Varnish removers, deglossers "Poison" labels (including !. Paint brush cleaners chloroform, formaldehyde, Floor & Furniture strippers hydrochloric acid, other Metal polishes acids) Laundry soil & stain removers Other products not listed (including bleach) Spot removers & cleaning fluids which you feel may be (dry cleaners) P. E C E I.V E ® toxic or hazardous (please Other cleaning solvents HEALTH DEPT. listl.L Bug and tar removers TOWN OF BARNSTABLE — Household cleansers, oven cleaners Drain cleaners Toilet cleaners 1 !/ Cesspool cleaner sU(rVx C- �c/J Disinfectants AY 1 4 1981 Road Salt (Halite) W:.,TOWWOF BARNSTA8L-E BOARD OF HEALTH CO NTR L OF TOXIC D HAZARDOUS MATERIALS - INSPE N SHEET FIRM u4UX— ADDRESS Major types of materials: 1) 3 a) / 6) I, Description of material P al(s) use: II. Storage (denote product by n er listed above) A. Containers metal glass paper plastic cans,bottles,jars drums,barrels p aboveground tanks underground tanks bags,boxes open,loose,uncovered ' inadequate labelling B. Storage Facility . - ✓or # Remarks/Recommen.c "L ions 1. Indoor a) separat8, contained room b} stored in general work area elrL , i) inadequate ventilation ii)- floor drains-- ii )_. inadequate--fire protection_ 2 :-Outdoor-- a) uncovered, exposed to weather b): pervious: surface/:catch-=basins-- = - Dispos��_- A. Reclamation/Recycling unit B. On-site disposal I. Town sewer 2. Regular septic system 3. Separate holding tank C. Off-site disposal I. hauled by own firm 2, hired hauler a) name of hauler b) address or disposal site Persc.n(s) Interviewed — — — — — — — - — — — — — — Inspecto Date ��- - - - - - - - b 30 81 - - -, - - - - - - - - - -