The URL can be used to link to this page

Home My WebLink About0046 RIDGE ROAD - Health (2) �69 Rid Road 6tn 2 � � 0 i i O®® E M rL A KEEPING YOU ORGANIZED No.10M 2-153L MADEINUSA c,ummMaSMEAD.COM TOWN OF BARNSTABLE LOCATION 4(_R iR ibr e SEWAGE# 000 -3&9 VILLAGE ASSESSOR'S MAP&PARCELi�, INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 15= LEACHING FACILITY:(type) S_Q0 \,&I,-g► 1A-J(D (size) 1163 X NO.OF BEDROOMS OWNER �fJwJk.�-oAc>AC7, PERMIT DATE: I I i 1 C,)-Xd COMPLIANCE DATE: —I Separation Distance Between the: ` Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility k Cos LO &Y-ON OF Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within. 300 feet of leaching facility) Feet FURNISHED BY �a A fCAk��) 14 IW-0.+al f rl ------------ /CjI ,g,,�_ A i � , Date: / 1Z,003 T TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: NK? I L/)0l/ Ph//V l?.-,P-S, BUSINESS LOCATION: q6 R idG e, " W , AFAR 11�5�"A MAILINGADDRESS: PO lox 6Q5 Mail To: TELEPHONE NUMBER: Board of Health CONTACT PERSON: Mp 1 Se- re-S � Q P. Town of Barnstable lR� P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: g5a 776-0-40OHyannis, MA 02601 TYPEOFBUSINESS: �OxlNrf Nq cc Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own use? YES NO /-" S4e'C -Mq4 �O G. \`A-iJ 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) 0 Drain cleaners NEW USED _ 0 Cesspool cleaners Automatic transmission fluid 0 Disinfectants Engine and radiator flushes tQ Road Salt (Halite) 0 Hydraulic fluid (including brake fluid) Q 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, o 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 0 Jewelry cleaners Car waxes and polishes 0 Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes 0 PCB's Lacquer thinners 0 Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) 5 Paint & varnish removers, deglossers 0 Any other products with "poison" labels Paint brush cleaners (including chloroform, formaldehyde, _ Floor & furniture strippers hydrochloric acid, other acids) 0 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 Date: TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: A942 I Lj AAJ Yh I AJ-12_ ,P-S BUSINESS LOCATION: rr�q jq Id G�' �N • P RR NS�"�}'P�e MAILING ADDRESS: PO ' goX 05 Mail To: TELEPHONE NUMBER: Board of Health CONTACT'PER Town of Barnstable r-� �3�P.0. Box 534 'EMERGENCY CONTACT TELEPHONE NUMBER: e09 0 7�6- Hyannis, MA 02601 TYPE OF BUSINESS: Q`1fV'0 cc) Does your firm store any of the toxic or hazardous materials,listed below, either for sale or for you own use? YES NO / s4e* Tni4tt )'M .CL v A(J 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 otherthan 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 Q Cesspool cleaners Automatic transmission fluid Disinfectants Q Engine and radiator flushes 0 Road Salt (Halite) Hydraulic fluid (including brake fluid) y 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, o Photochemicals (Developer) lubricants, gear oil NEW USED t Degreasers for engines and metal Printing ink ' Degreasers for driveways.&r garages,.. Wood.preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers 0 Lye or caustic soda Car wash detergents 0 Jewelry cleaners Car waxes and polishes Q Leather dyes Asphalt & roofing tar Q Fertilizers Paints, varnishes, stains, dyes _ PCB's thinners Lacquer q � Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) 5 Paint & varnish removers, deglossers n V Any other products with "poison" labels 1 Paint brush cleaners (including chloroform; formaldehyde, _ Floor& furniture strippers hydrochloric acid, other acids) . Metal polishes x Other products not Listed which you feel �- Laundry soil & stain removers i (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents 0 Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY'-BUSINESS