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HomeMy WebLinkAbout0006 POND MEADOW DRIVE - Health 6 Pond Meadow Drive, Date: TT� TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OFBUSINESS: BUSINESS LOCATION: V,4///ca MAILINGADDRESS: p2��h/f �A�L c Mail To: Board of Health TELEPHONE NUMBER: _�/�_��—�— � Town of Barnstable CONTACT PERSON: (�}v <.1, �,� ,����i P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: Hyannis, MA 02601 TYPEOFBUSINESS: Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own use? YES NO X 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 Antif reeze(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 An other products-with " Paint brush cleaners y p 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 fluids (dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS ai-15 033 T, �� � � 7� �3 LO AT ON \ SEWAGE PERMIT NO. VILLAGE /n INSTA LLER'S NAME A ADDRESS BUILDER OR OWNER DATE PERMIT ISSUED CT Lg719 © ATE COMPLIANCE ISSUED �A,pv, & �S�.F S 14 - 1 0 37 LO CAT IO SEWAGE PERMIT NO. VILLAGE INSTA LLP'S NAME i ADDRESS BUILDER OR OWNER A � jqssDt--_ � DATE PERMIT ISSUED ATE COMPLIANCE ISSUED 1/..,/o1- 7d' 33 55 n 70 2J Y THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH IOU')N . -----OF......7819R.N.STA.__6-L&F................................... Aplifiratiutt -fur Riipuiitt1 Norkii Totwtrurtiutt 1hrutit Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ... --- ... . .-- ..... 0-7 --•----------------------------------------------------------------•-- Location Addr or'Lot No. -- O ner Address IL a --------------------••------------•---- 2R ST��- P'd�.d.�S ---"------ Installer Address d Type of Building Size Lot.... -----Sq. feet V Dwelling—No. of Bedrooms....___._. ...._.._.... ..Expansion Attic ( ) Garbage Grinder ( ) p`1, Other—Type of Building ------------- - -_-_--- No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures __________________________________ __ ZOOA ._gallons. W Design Flow----------f1.0.........................gallons per j194n per day. Total dail flow_________ 0 kr' r � �„ 0 OJ 9 Septic Tank—Liquid capacity.icoo.gallons Length____ ____- Width.4.10 Diameter..... Depth _. ....... xDisposal Trench—No. .................... Width-------------------- Total Length-------------------- Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter-----/0----_.___ Depth below inlet---:3!-.s_....._ Total leaching area.__/10._..sq. ft. _ Z Other Distribution box ( ) :.Dosing tank ( ) , •• a Percolation Test Results Performed by._ Q.�4ii��_____/_Q_�___�$;_`_{f0_C�d_fL5. Date...._71,2-,61-27-------. Test Pit No. 1.4_1....minutes per inch Depth of Pest Pit..../V........... Depth to ground water.....?._..._...---- fX4 Test Pit No. 2.c., ._...minutes per inch Depth of Test Pit.../Z............ Depth to ground water--- ----------------------- ---------- ----------------•----------------------------------------..------......................................................... Description of ...........4.0-AQ -----.6.6 Ib..----. -..-...0O3 RSe..... x .�. Ada-� = �' y.... w V 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 Article \I of the State Sanitary Code— /he undersignPea er agr es not to place the system in operation until a Certificate of Compliance has been ' u b he b o . Si ed-- --- --- 1 Application Approved BY-----=r- Date Application Disapproved for the following reasons------------------- .. . ...-- .--. . ------------------....._......------•---•----------------- ------•••------••-----------•--------------------•---•-•--------------------------............. ----------------------------------------------------------------------------------------------------- Date PermitNo......................................=................... Issued......................--................................ Date k THE COMMONWEALTH OF MASSACHUSETTS x* BOARD OF HEALTH Q.S .iV. j ........ -- ..OF....... App irat oo -for Biiipoott1 Workii Ton,itrurtion Virruift Application is hereby'made for a Permit to Construct ( ') or Repair ( ) an Individual Sewage Disposal System at: Location Address or Lot No . .° - , ���` Address s ........................ f_ TAddress UT -pe o Building Size Lot.... ----Sq. feet Dwelling—No. of edrooms----------- _____............................Expansion Attic (. ) Garbage Grinder ( ) pa, Other—Type of Building ___ ----------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Pa fixtures ----- --•-----•--•- ---- --- ------ --------- --- - -------------------------- ----- Design Flow_Other O tllons er XV da . Total dail flow__ W g g" P �,P Y , Y -2-a O ----_ _.gallon,, WSeptic Tank—Liquid capacity_1_00 gallons Length_�.?____�__._. Width_-�-.e4. . Diameter......'-`-"-'...... Deptli-'f� 6-__ . x Disposal Trench—No_ ____________________ Width-------------------- Total Length..................... Total leaching area_____...____-_-_____sq. ft. Seepage Pit No_________________, ,,._- Diameter._.__ ,Q_ ..... Depth below inlet.... s_.._. Total leaching area---f.90....sq. ft. z Other Distribution box ( ) Dosin$gt�ank ( ) r�, '-' Percolation Test Results Performed by-__..i�Q1�11_L_ __-_ (�,'$aFQR_ �_9._S, Date...... 4 -. 1L_-__ a Test Pit No. 1. _:__minutes per inch Depth of Test Pit_-__-efif -------- Depth to ground water.-----`7-___-__-. r3:4 Test Pit No. 2__4::A___minutes per inch Depth of Test Pit.-_4 _ .......... Depth to ground water_..p_f------------- P4 -----.....-•-------------------------------------•-----•----------------•-•------------------------------•----•---•------------.._---------••---•--•------ - D Description of Soil----1�_-`-'_14�.......,�_!'�/Q!�"if---...4'ab------ cx� ��AN.b._-----..._AA►$l � u.��;, /41,�� ----- --- - W _ A . v 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 Article XI of the State Sanitary Code— ie undersigned f er agrees not to place the system-in operation until a Certificate of Compliance has been ;Ae yWebof ea i. gne .•---- --- I ate Application Approved B "=--.. ate Application Disapproved for the following reasoni---------------------- --=-=------ ------------;--------------------------------------- ------------_----- ......................................................-------------------------------------------------------------------------------------------------------------------------------------------------- Date PermitNo......................................................... Issued.-------- .............................................. Date THE COMMONWEALTH OF MASSACHUSETTS t BOARD F HEALTH .......................................OF.... ............................................................... Qrrtifirttte of Oompliaurr THIS IS TO CERTIFY, That the Individual Sewage Disp System constructed ( ) or Repaired ( ) at.~ ...... ...fi..'j..................... "I ---------- ----------------------------------------------------- has been installed in accordance with the provisions of Article XI 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. DATE----- ? -------------------- Inspector---- '" " THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH + ?.. . 0. No=-........................ FEE........................ �i��o�tti ork,� �oo�tr�trtioat �rrmit Permissio�' herebty granted•----- ----- ----- --------- ------- ----------- ---- ---••- - ---- - - ---•--- --- - to Co iea a I ewa e s ste ;' /� atNo.. ------------------- -------------------------------------------------, --------•--- Street �b as shown on the application for Disposal Works Construction Per 4�je -*I,- ------ -------------------- - Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS A� No........................ ......�1..................... THE COMMONWEALTH OF MASSACHUSETT.S O � BOARD OF HEALTH .-- ...........OF.......R.4.RAI.S.T.,4.8.�..F...................................... Appliratiuu -fur Ui�puual urkii Tomi#rurtiuu Vrrntit Application is hereby'made for a Permit to Construct (V/ or Repair ( ) an Individual Sewage Disposal System at: )uex TICA 0 -Xro�O n�ea Ac�cv l�JZ f7�1 Q� --------------- o - o .............. Location-Address or Lot No. .N-----4 .'6e" . .. ...................................... ---.ADJUZ--...•�1-E.�_�rx1,.1----•--DR.--------------------------------- W ----------------------•-•-••-------------•----•Owner Address x ��............................................. � Installer Address Q Type of Building Size Lot_: 0 0�....5 fee U Dwelling-RNo. of Bedrooms--------- --__-Expansion Attic ( ) VV Garbage Grinder aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures --------------------------•--- - ,A W Design Flow........//0...........................gallons per x per day. Total daily flow__.__..... ._re�_l -----------------gallons. WSeptic Tank—Liquid capacitv./Ooogallons Length,�_ _6_____ Widtlif--1Q:._.. Diameter................ Depth.-.q___lri.--- x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area..--.---_--_.-._--__sq. ft. Seepage Pit No-------/---------- Diameier...10_.......... Depth below inlet__l._.5'.... Total leaching area_.49 ------- fi. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------R0,m .LW__1 6- f�.l j;.I.' .._ Date----- W minutes per inch Depth of Test Pit...../!._'o-____-- Depth to round water...-_ -.-------------- ,.a Test Pit No. 1.�._.;�„_.__ p p p g � (l, Test Pit No. 2./—.Z....minutes per inch Depth of Test Pit---//............. Depth to ground water...P------------------ P4 ---------- ----------------------------------------------------------•----••--....----------------•....................................................... 0 Description of Soil----d--"--- ......AW a.......TV.8SO'e.k...JV .. _ _�- --- -----C'_0A' S F----------- vSAN.D---------4N.-D�--------&-&/A-V-eL---------------------------------------------------------------------------------------------------------------------------------- W vNature 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 Article XI of the State Sanitary Code—The undersigned f er agrees not to place the system in operation until a Certificate of Compliance has bee s b thobof a i. Signed--- --- =r • -- ------ - -------- --- ApplicationApproved By..........................................................--•-------••----------••--------------- --------------------.................... Date Application Disapproved for the following reasons:-------•-----------------------------------------------------------------------------------•------------------- ....-----•----------------------•-•-------•....--•------ --••-------------•------------------•----............................................................•......................................... Date PermitNo......................................................... Issued....................... ................................ Date No......................... FEs....N................. THE COMMONWEALTH OF MASSACHUSETTS., BOARD OF, HEALTH TOW.M. ... .... .._._..oF..... �.��.1�.�.7.�q�.��. ...--............................ Application -for,Dispoiial Worko Tomitrurtion Vrrmiit Application is hereby'made for'a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at • ----------••---------•................•----•-----•-••---- ------•-- -----------------------------•--------- , ,.:Location-Ad ress or Lot No. 'vX...... .e. ------------------------------------- ---- � ... 1 t_ .a� ... . w Owner Address Installer Address UType of Building Size Lot..Q.Q.j.p�,.._.Sq. fee Dwelling No. of Bedrooms...----- -----------------------------Expansion Attic ( ) *019 Garbage Grinder aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) G4 Other fixtures ------------------------ w Design Flow__:.-.-1Zo----..a.....................gallons per III per day. Total daily flow r .. } ........_..-gallons. WSeptic T.Ink—Liquid cap city try gallons Lengthi6.1.6.---- Width. Diameter._ � Depth..4.'if.."' x Disposal Trench—No..................... Width_........._......... Total Length.................... Total leachingarea-_-------._-_-.-sq. fI. Seepage Pit No-------/---------- Diamete'r.._.lQ.-------- Depth below inlet-31-,a_,:.... Total leaching area..?T !......sq. ft. z Other Distribution box Dosing tank Percolation Test Results ) Performed b AlvAld--- .:_.�'!.e. l4AL ( ` ) �. // Test Pit No. 1: ._..2-----minutes per inch Depth of "Pest Pit----- -_........ Depth to ground water-----7---_.._------- rX, Test Pit No. 2-,G..4R-----minutes per inch;` Depth of Test Pit--- f------------- Depth to ground water...I----_.--.__...-- a -------- .. ............ ---•--.. ..•. ......----••......-•----................................................... D Description of Soil--- "` dZ ` F...... AIM. .-----.6AO ......SOLO 5044----r .... -- 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 Article XI of the State Sanitary Code— he undersigned f i r agree/not to place the system in operation until a Certificate of Compliance has been b. b of e r. Signed- ----- . . . ...... --. . .. .•C-- Application Approved By.................-------------•--- -•---------------•------------------------------------------- ....................... --------- ace Application Disapproved for the following reasons----- ----------------------------------------------------------- ----------------------- D ---------••--- -------------------------------------------------------------------------------------•----------------------- ----------------------------------------------------------------------------------------- Date PermitNo.......................................................... Issued........................................................ Date X THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH ............OF...........:.. ................................................ Trrtifirate of Oulimpliaure THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) bY ........................................................ ......................................... �y I ta�ler al has ffecn installed in accordance with the provisions of Ar�j« �XI of The State Sanitary Codes described in the application for Disposal Works Construction Permit No---- -'------- ;u........... dated.--.-- 77.---- 3..`..- . THE ISSUANCE OF THIS CERTIFICATE SHALL NOT RE CONSTRUED AS A GUARANTEE THAT THE SYSTEM,`WILL FUNCTION SATISFACTORY. DATE-----�.�_-_../0 ---------------------------,••--------_.... Inspector.-- ..��"- ><.:_............................... THE COMMONWEALTH OF MASSACHUSETTS BOARD 9f HEALTH ... N/ .M........ ........................................ N .... FEE .............. Di.sVoiittl lVarkii ClIunstrurtion Prrntit Permission,is hereby granted".-.' '------------------------------------------•-.......•-••--••------••-••---------------••-•---------.........--••••.to ConO r ct o Repair ( an I /ivual Se ge Disposal at No.":i --' �9 `- rdK `-- � t�reec as shown on the application for Disposal Works Construction P rt N .-_. Dated----,�. .'"... "-.7-7-- x --...� {. ............................... ---•...... ........................................................ Board:of,Health DATE---•---•=`�-- - :. : . FORM 1255 HOBBS & WARREN. 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