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Home My WebLink About0921 IYANNOUGH ROAD/RTE132 - HAZMAT ko,94, TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH 0 satisfactory 2.Printers 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY (see"Orders") 5.Retail Stores + — 6.Fuel Suppliers ADDRESS Class: 7.Miscellaneous QUANTITIES AND STORAGE (IN= indoors; OUT-outdoors) MAJOR MATERIALS 1 Case lots Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: DISPOSAIJRECI.AMATION REMARKS: 1. Sanitary Sewage 2. Water Supply O Town Sewer Public '2COn-site OPrivate 3. Indoor Floor Drains YES N O Holding 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 N0 1. 2. vl ��Gftiw✓r� T^ 4t Pers (s) Interviewed Inspector- Date lA a TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM (� l Mail To: NAME OF BUSINESS: PY4AIAII Board of Health MAILING ADDRESS: I Our- /3, Town of Barnstable TELEPHONE NUMBER: PU -�J4U P.O. Box 534 CONTACT PERSON: Hyannis, MA 02601 Does your firm 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 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 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 gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants f/Diesel fuel, kerosene,=heafing Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda , Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners P.CB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon,tetrachloride) Floor & furniture strippers Any'other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business TOWw OP BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH satisfactory 2.Printers 3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANY (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS lass: 7.Miscellaneous U ITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: It �® lop a JO ) 5',0 It " ,Vb DISPOSALIRECLAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply :Town Sewer 9(Public 0 On-site OPrivate 3. Indoor Floor Drains YES_NO 0 Holding tank: MDC 0 Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES_X —NO ORDERS: 0 Holding tank:MDC S Tr*►No O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product YES NO 1. 2. erson (s) Interviewed Inspector Date s TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM ,1/11A, Mail To:�� NAME OF BUSINESS: ,yam Board of Health MAILING ADDRESS: Town of Barnstable TELEPHONE NUMBER: 77S P.O. Box 534 CONTACT PERSON: = z� %yv�S Hyannis, MA 02601 Does your firm 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 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 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 gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) k"" Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) _Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy- Health Department Cana ryCopy Business ess No.._Zj-...y y Fps.�.. ........:. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . ................................................... Allp iratiun for Diupuutti Vorko Tomitrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal ..a y.I/An Loc •Address g� l((�C�y or.)Lot ., - - - r. '...E............................................. W - ................ /- � i..'�:.47: re.. 1.. //.... .. 1/ Installer Address q d n�, /6 Type of Build. U'`�TS - ��Oti aaui3 �"� v"' T Size Lot.............. S feet U Bart use; -•--•-........ �ae�H No. of Bedrooms.............f�c.._SC NCO__J.Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures .-_ .< ----------•----------------------•--------------------------------------------------------------•----• ................ _ W Design. Flow..... 3, llons per person per day. Total daily.flow__......Y/�---D....................gallons. W Septic Tank—Liquid capacity....: allons 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........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground r......................... ----------------------------------- -...........--------•--------•----•--------- . J, Description of Soil.......... .... a .:�f �i ................ ... . .. . ......y�'-r...... /` .. — �n B .. V g W .•. .......... UNature of epairs or Alterations—Answer when applicable............................................................................................... .. ... ...--••.•---•-•......._. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iIHE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b en iss, by the board of health. Signe ; i .. •--•-•............................•----..........._ f�;� Application Approved By......_. ___ �.:.................. �" Date Application Disapproved for the following reasons------------------------••--......---•-----------------••---••----------------•-•-------......................... ....................•----.......---------....---........................................................................................................................................................ Date Permit No.....Y S y Date No.....1�..`s ._..��. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Z� ,! �,"''"'"'+'.? ..............OF..7,46-f.1.Rs�-.... ............................................... Appliration for Di_qpoiittl Workii Tonotrurtion Frrmit Application.,is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage,Disposal System at: p.... .............................. ' Loc Address ner e ` , „dre /C a -......rae�'ate...------•-•---•--••-•--- ------•-•-- -•---. . .- • ...... .......... �.- •-•---_-------•---..- Installer Address UT e of Buildin 1 - 0A,I rs " /� ��r�' c��cys Gn-C f� Size Lot............................Sq. feet No. of Bedrooms.............. J OOw -Ex Expansion Attic Garbage Grinder y�. P ( ) g ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures 41 W Design Flow_' '..... r„ allons per person per day. Total daily flow......... �_` . ....................gallons. W Septicq capacity '�`-- g g Width................ Diameter---------------- Depth................ p ............... Total leaching area....................sq. ft. r .r'A. , � Disposal Trench Liquid ca acitv.-------Width Length Total Length Seepage Pit No __--.._ Diameter. Depth below inlet ................ Total leaching area..................sq. ft. z Other Distribution box ( )s Dosing taiik?(�'_ ) ' ` Percolation Test Results Performed bY-------- -------------------------•-•--------•---•------•----..---------- Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth ato ground water........................ M•'� - {Yi'• �.' _ .............................................................. ....................................... .. O Description of Soil r`---•-- ' A G ••• *;�� V _.. � " ... ....................................... UNature of2epairs or Alterations—Answer when applicable............................................................................................... ---------------------------------•-------••••••---•••----•---------••••-•••••••-•-•---......---•-•..................-•--------•--•---••--••--•--••••-••----•-...........------••-•--........._---•----•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLi; 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until„a Certificate of Compliance has be�en;�iss by the board of health. Signed" ' t ... ............ Approved BY------.. ./1---------------•- ` J" 6 ate?,S- Date Application Disapproved for the following reasons------------------------------•-••-----.....-•----------•---...------------•-•---....•-••..:......:....---•---•- .....---•--.---•••-••------•--------------•---•••---•----•----•------------...------------•--------......•--....--------------•-....-----•----••---•----••-•-•------••---------•---•--•-••-........-_-•- Date PermitNo..... :.. --------------------••-.---- Issued....................................................... Date bd " THE COMMONWEALTH OF MASSACHUSETTS t` t�s I'• �-- -~�'r-•—�^ BOARD OF HEALTH .............. O F.... '. -• � � "............................. Trrtif iratr of Tontpliatta THIS I$XM CFRTI & Tha the Individual wage Disposal System constructed ( ) or Repaired ( ) . -.a.1- ......------•--....`........... .... .. . ... n at.....� .....-•-----•........ .. . � �j has been installed in accordance with the provisions ofQfITLE 5 of The State 6anitary Code as described in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONS UIED S GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................... — .•....-----..--.. Inspector--•-•-•--•--•. . -Z -=.....�g - - THE COMMONWEALTH OF MASSACH `SETTS BOAI�� F HEALTH .5 y O F . ................... .................. �� ts`_ �_ No........ -• .......... FEE........................ Rap 1 rk (9 Mnsj�!urtio_ runt ted.... .: .....:........... Permission is hereby gran to Con ... )�or an I di ' al S e isposal st �F at No.. ..:7:. � �- s 4.. j Street !''J'-UN as shown on the application for Disposal Works Construe Permit No..................... Dat , ........................................ �/� yT f 4'S! r�^ Board of Health DATE........ ----------1-"•--.-----•-------•-•!-'--J....---.........-•--------••--• FORM 1255 A. M. SULKIN, INC., BOSTON _ 1 '2 0 -2 ` LO ATION SE ,)AGE PERMIT NO. 11 VILLAGE r, 02 _ - INS;-TEA LLLLER'S NAME i ADDRESS BUILDER OR OWNER l e /Oayo� DATE PERMIT ISSUED DATE COMPLIANCE ISSUED c eta � � � 1 <vew �PJd�v a No. ` / (J (� -, Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes " PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for ZigpooY *p9tem Cutt!trurtion Permit Application for a Permit to Construct( )Repair(116grade( )Abandon( ) ❑Complete System El Individual Components Location Address or Lot No. &o Owner's Name,Address and Tel.No. 1�y.4nrris 4dk x Aho6xa Assessor's Map/Parcel _ a S,am 2 Installer's Name,Address,andAINS CANCO Designer's Name,Address and Tel.No. 350 Main Street W. Yarmouth, Type of Building: —Dwelling No.of Bedrooms e<-3 Lot Size sq.ft. Garbage Grinder( ) _ Other Type of Building 4�kcdnle.t f No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date AjZA Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. - 5 0O A!f /eg-cti CA4,-n lS Description of Soil *iew tjA�1� Nature of Repairs or Alterations(Answer when applicable) _7 AjiA/( /- d caoo GA-l. 1 i7 13aX J-o a tot 5 3 - ,SOo cpg/. lead, c11s►v" 6zi/` t,J W S t-ax.e_ Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of eal Signed 41� _ Date Application Approved by Date , Application Disapproved for tv following reasons Permit No. ?- to Date Issued _ff—r__-- TOWN OF BARNSTABLE LOCATION 5(o gesl- SEWAGE # r VILLAGE ASSESSOR'S MAP & LOT iI INSTALLER'S NAME&PHONE NO. �, � C��G U 77 2a Ira,) — j SEPTIC TANK.CAPACITY 2=2Raw Is f LEACHING FACILITY: (ty (size) I NO.OF BEDROOMS _ BUIL.DER OR OWNER ,yam PERMITDATE: COMPLIANCE DATE: l— ✓ Separation Distance Between the:. Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet 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 ------------ I i� t. a No. I Fee `J V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Application for �Digaal *pgtem Congtructton Permit Application for a Permit to Construct( )Repair( ,,y6pgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 5&0 INS ? S f '' ` Owner's Name,Address and Tel.No. Assessor's Map/Parcel ^ I s., OJ A/7I Installer's Name,Address,*N.150.CANCO Designer's Name,Address and Tel.No. 350 Main Street , W. Yarrncuti, MA 02673 Type of Building: Dwelling No.of Bedrooms_ec3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building d 2dln rr t No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design•Flow gallons per day. Calculated daily flow eJ-e�d gallons. Plan Date w/za Number of sheets Revision Date -� Title Size of Septic Tank a G U Type of S.A.S. I' Y00 iW l•Pa c 1, e-A4 -,A 1 S z Description of Soil �'cP soh e" Nature of Repairs or Alterations(Answer when applicable) �j o x o 2'� _2 0 Li - G o le-64 irll,41ti 1" cl r 1 r 1 Date last inspdcted: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental'Code and not to place the system•in operation until a Certifi- cate of Compliance has been issued by this Board of Heal Signed J I Date /a Application Approved by Date. 3 .Application Disapproved for following reasons .1' Permit No. 7- 3 It, Date Issued < THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS - F- (Certificate of (Compliance ' THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired (—TtUpgraded( ) Abandoned( )by l'/-/loCCU at 5-60 LJ, lPa,:7 S/. ZW_"1, �5 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer The issuance of this a lPsInotobconstrued as a uarantee that the s 11 functi 9esi eDate p( tig Inspector O g �r J _ 4 ' ----------------------------- No. U Fee Sd THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS ligpogal *pgtem Congtruction)Permitf Permission is hereby granted to Construct( )Repair(",,-Upgrade( )Abandon( ) System located at_ _S-6 r-) and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. 1 Date: a - 3 - !q 7 Approved by �L a 1/6199 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. - CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) h J /) (OVIAon hereby certify that the application for'disposal-works PP construction permit signed by me dated 14 - 3 -S' concerning the e property located at -&o /_/(/ meets all of the following criteria: i The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • Theieare no wetlands within'100 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system fThere is no increase in flow and/or change in use proposed ✓ There are no variances requested or needed. / e e • The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be.located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete,the following: A) Top of Ground Surface Elevation(using GIS information) c)S• 3 B) G.W. Elevation Sol. / +the MAX. High G.W. Adjustment. J. 9, 7 DIFFERENCE BETWEEN A and B oZ q. SIGNED : y DATE: Id. 3- ` 9 [Sketch proposed plan of system on back]. �, q:health folder.cert v iy �'a I U11t�S a �PoayvtS -eac. v aUa�-o sT cu/ C( o I� S r � � A