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RUN',DATE: 12-MAY-11 10:28:40 AIRGAS EAST PAGE 000001
USER: NEAJJASON
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STOCK STATUS REPORT
Backorder code: N = item may not be backordered (blank means item may be backordered)
Stock status: RE _ (Reorder) if the item is at or below order point OS = out of stock
Value of inventory is based on price level 1
Print column or bracket price: Column Costing method column or bracket: Column
Prod Avg Price Price Price Price 00n?Hd
tyOrd Invntry B/O Stk A Unit
Item Number Loc Description Cat Cost 1 2 3 , 4mm Pt Value Cd Sts B Meas
AC 3 Q57 02 67.444 67.444 47.669 26.424 ' 0 2 RE I CL
ACETYLENE SIZE 3 (CL UOM) CGA 510
AC 3N300 Q57 02 67.444 67.444 47.672 26.428 4 0 1 I CL
ACETYLENE SIZE 3 (CL UOM) CGA 300
AC 4FT Q57 04 90.191 90.191 69.739 80.548 5 0 1 I CF
ACETYLENE SIZE 4FT FLAT TOP CGA 510
AC- 4N300 Q57 ACETYLENE SIZE 4 CGA 3 04 100.00 100.00 69.73 53.54 1 0 2 RE I CF
AC 5 Q57 ACETYLENE SIZE 5 CGA 5 04 198.418 198.418 188.497 178.576 2 0 0 Q CF
AC 5N300 Q57 ACETYLENE SIZE 5 CGA 3 04 201.63 201.63 191.55 181.47 1 0 0 Q CF
AC B Q57 02 40.735 40.735 37.513 37.513 4 1 5 RE I CL
ACETYLENE SIZE B (CL UOM) CGA 520
AC MC Q57 02 28.059 28.059 18.852 23.916 3 0 4 RE I CL
ACETYLENE SIZE MC (CL UOM) CGA 200
AI D300 Q57 C2 70.08 65.93 73.59 58.56 2 0 0 N CL
AIR DRY SIZE 300 (DEW POINT -80F) CGA 590
AR .,125 Q57 22 84.48 84.48 49.06 56.09 3 0 3 RE I CL
ARGON INDUSTRIAL SIZE 125 CGA 580
rN C-V1,1.T--
AR 150 Q57 1 h�pLN A'SF�IiYX f!}NT 22 78.84 78.84 53.35 65.82 2 0 1 I CL
ARGON INDUSTRIAL SIZE 150 CGA 580
AR 20 Q57 ARGON INDUSTRIAL SIZE 20 39.44 39.44 37.47 35.50 4 0 1 I CL
AR 300 Q57 22 131.42 131.42 89.43 83.79 4 0 3 I CL
ARGON INDUSTRIAL SIZE 300 CGA 580
AR 60 Q57 ARGON INDUSTRIAL SIZE 20 39.90 35.63 28.51 24.94 3 0 2 I CL
AR CD25125 Q57 AO 82.49 82.49 82.49 82.49 1 0 1 RE I CL
ARGON 75 CD 25 SIZE 125 CGA 580 CGA 580
AR CD25300 Q57 ARGON 75 CD 25 SIZE 30 AO 161.46 161.46 87.91 131.07 3 0 1 I CL
AR CD2580 Q57 ARGON 75 CD 25 SIZE 80 AO 65.73 65.73 62.44 59.16 1 0 1 RE I CL
AR CD8300 Q57 ARGON 92 CD 8 SIZE 300 AO 137.04 137.04 123.15 106.45 3 0 0 I CL
AR HE2300 Q57 ARGON 98 HE 2 SIZE 300 AO 126.91 113.29 90.64 79.33 2 0 0 Q CL
RUN•DATE: 12-MAY-11 10:28:40 STOCK STATUS REPORT PAGE 000002
Print column or bracket price: Column Costing method column or bracket: Column
Prod Avg Price Price Price Price Qty Qty Ord Invntry B/O Stk A Unit
Item Number Loc Description Cat Cost 1 2 3 4 On-Hd Comm Pt Value Cd Sts B Meas
AR HE25300 Q57 ARGON 75 HE 25 SIZE 30 AO 202.75 202.75 192.61 182.48 2 0 0 Q CL
CD 10 Q57 CARBON DIOXIDE 10LBS C 30 22.95 22.95 27.09 16.65 1 0 0 I CL
CD 20 Q57 CARBON DIOXIDE 20LBS C 30 31.72 31.72 37.19 23.79 10 0 5 I CL
CD 20S Q57 30 31.72 31.72 23.79 23.79 3 0 1 I CL
CARBON DIOXIDE 20LBS SIPHON CGA 320
CD 5 Q57 CARBON DIOXIDE SLBS CG 30 21.15 21.15 11.73 13.73 7 1 5 I CL
jCD 50 Q57 CARBON DIOXIDE 50LBS C 30 52.04 52.04 44.81 31.21 2 0 1 I CL
i
CD SOS Q57 30 52.04 52.04 44.81 31.21 9 0 6 I CL
CARBON DIOXIDE 50LBS SIPHON CGA 320
GG BBTRI125 Q57 AO 132.39 132.39 132.39 132.39 1 0 0 Q CL
GG HBTRIMIX SIZE 125 HELIUM 90 AR 7.5 CD 2.5 CGA 580
GG HBTRI20 Q57 AO 41.77 37.30 29.85 26.13 2 0 0 Q CL
GG HBTRIMIX SIZE 20 HELIUM 90 AR 7.5 CD 2.5 CGA 580
GG BBTRI300 Q57 AO 212.94 212.94 154.08 197.29 3 0 0 I CL
GG HBTRIMIX SIZE 300 HELIUM 90 AR 7.5 CD 2.5 CGA 580
GG HBTRI80 Q57 AO 170.74 170.74 162.20 153.67 1 0 0 Q CL
GG HBTRIMIX SIZE 80 HELIUM 90 AR 7.5 CD 2.5 CGA 580
GG STEEL125 Q57 AO 95.74 95.74 48.72 48.72 3 0 3 RE I CL
GG STEELMIX SIZE 125 ARGON 84 CD 16 CGA 580
GG STEEL150 Q57 AO_ 88.24 88.24 83.83 79.42 2 0 1 I CL
GG STEELMIX SIZE 150 ARGON 84 CD 16 CGA 580
GG STEEL20 Q57 AO 50.70 50.70 35.67 35.67 5 0 1 I CL
GG STEELMIX SIZE 20 ARGON 84 CD 16 CGA 580
GG STEEL60 Q57 AO 61.94 61.94 58.84 55.75 7 0 5 I CL
GG STEELMIX SIZE 60 ARGON 84 CD 16 CGA 580
GG STEEL80 Q57 AO 65.73 65.73 62.44 59.16 8 0 4 I CL
GG STEELMIX SIZE 80 ARGON 84 CD 16 CGA 580
HE AR25300 Q57 HELIUM 75 AR 25 SIZE 3 AO 187.47 187.47 178.10 168.72 3 0 1 I CL
HE BL125 Q57Y 41 110.88 110.88 99.79 88.70 1 0 1 RE I CL
HELIUM BALLOON GR SIZE 125 CGA 580
HE BL200 Q57 41 166.33 166.33 158.02 149.70 2 0 2 RE I CL
HELIUM BALLOON GR SIZE 200 CGA 580
HE BL300 Q57 41 221.78 221.78 221.78 199.60 2 0 2 RE I CL
HELIUM BALLOON GR SIZE 300 CGA 580
RUN-DATE: 12-MAY-11 10:28:40 STOCK STATUS REPORT PAGE 000003
Print column or bracket price: Column Costing method column or bracket: Column
Prod Avg Price Price Price Price Qty Qty Ord Invntry B/O Stk A Unit
Item Number Loc Description Cat Cost 1 2 3 4 On-Hd Comm Pt Value Cd Sts B Meas
HE BL40 Q57 40 69.30 69.30 35.43 47.15 1 0 0 I CL
HELIUM BALLOON GR SIZE 40 CGA 580
HE BL60 Q57 40 52.70 52.70 47.07 37.65 3 0 3 RE I CL
HELIUM BALLOON GR SIZE 60 CGA 580
HE BL80 Q57 40 92.40 92.40 83.16 73.92 2 0 3 RE I CL
HELIUM BALLOON GR SIZE 80 CGA 580
NI 125 Q57 62 38.78 38.78 29.29 23.79 5 0 0 I CL
NITROGEN INDUSTRIAL SIZE 125 CGA 580
NI 20 Q57 '51 Me A5 PH-yX1+0-q 60 28.22 28.22 20.80 16.46 5 0 1 I, CL
NITROGEN INDUSTRIAL SIZE 20 CGA 580
NI 200 Q57 62 51.13 51.13 48.57 46.02 5 1 1 I CL
NITROGEN INDUSTRIAL SIZE 200 CGA 580
NI 300 Q57 62 56.42 56.42 41.05 32.95 5 0 1 I CL
NITROGEN INDUSTRIAL SIZE 300 CGA 580
NI 40 Q57 60 28.22 28.22 20.80 17.44 16 0 14 I CL
NITROGEN INDUSTRIAL SIZE 40 CGA 580
NI 60 Q57 60 29.89 26.69 21.36 18.69 2 0 4 RE I CL
NITROGEN INDUSTRIAL SIZE 60 CGA 580
NI 80 Q57 60 35.26 35.26 23.83 26.29 5 0 0 I CL
NITROGEN INDUSTRIAL SIZE 80 CGA 580
NI CD2560 Q57 A6 35.86 35.86 34.07 32.27 3 0 0 Q CL
NITROGEN 75 CD 25 SIZE 60 CGA 580
NI FGCD25200 Q57 A6 71.01 71.01 67.46 63.91 4 0 0 I CL
NITROGEN 75 CD 25 SIZE 200 FOOD GRADE CGA 580
NI FGCD2580 Q57 A6 54.91 54.91 52.16 49.42 4 0 4 RE I CL
NITROGEN 75 CD 25 SIZE 80 FOOD GRADE CGA 580
NI NF300 Q57 99 57.90 57.90 57.90 48.28 2 0 0 I CL
NITROGEN NF SIZE 300 CGA 580
OX 125 Q57 72 33.52 33.52 27.17 18.28 10 0 4 I CL
OXYGEN INDUSTRIAL SIZE 125 CGA 540
OX 150 Q57 72 45.8326 45.8326 29.4232 38.7576 8 1 3 I CL
OXYGEN INDUSTRIAL SIZE 150 CGA 540
OX 20 Q57 70 29.98 29.98 20.80 11.01 4 0 5 RE I CL
OXYGEN INDUSTRIAL SIZE 20 CGA 540
OX 200 Q57 72 54.67 54.67 36.12 36.61 10 0 2 I CL
OXYGEN INDUSTRIAL SIZE 200 CGA 540
RUN•DATE: 12-MAY-11 10:28:40 STOCK STATUS REPORT PAGE 000004
Print column or bracket price: Column Costing method column or bracket: Column
Prod Avg Price Price Price Price Qty Qty Ord Invntry B/O Stk A Unit
Item Number Loc Description Cat Cost 1 2 3 4 On-Hd Comm Pt Value Cd Sts B Meas
OX 300 Q57 72 61.73 61.73 37.29 38.43 9 0 7 I CL
OXYGEN INDUSTRIAL SIZE 300 CGA 540
OX 40 Q57 70 31.72 31.72 21.21 21..74 2 0 1 I CL
OXYGEN INDUSTRIAL SIZE 40 CGA 540
OX 60 Q57 70 31.72 31.72 21.95 21.95 9 0 11 RE I CL
OXYGEN INDUSTRIAL SIZE 60 CGA 540
OX 80 Q57 70 31.72 31.72 22.25 21.95 11 0 8 I CL
OXYGEN INDUSTRIAL SIZE 80 CGA 540
OX AV300 Q57 72 66.99 66.99 40.58 55.85 6 0 5 I CL
OXYGEN AVIATOR BREATHING SIZE 300 CGA 540
OX USP125 Q57 OXYGEN USP SIZE 125 CG 96 35.26 35.26 33.35 27.42 3 0 0 Q CL
OX USP200 Q57 OXYGEN USP SIZE 200 CG 96 61.73 61.73 45.55 27.93 2 0 0 Q CL
OX USP300 Q57 OXYGEN USP SIZE 300 CG 96 82.87 82.87 47.34 29.57 2 0 0 Q CL
OX USPD Q57 OXYGEN USP SIZE D CGA 95 26.43 26.43 25.11 23.79 4 0 0 Q CL
OX USPE Q57 OXYGEN USP SIZE E CGA 95 29.98 29.98 28.48 26.98 4 0 0 Q CL
PP 25 Q57 PROPYLENE 25LBS CGA 51 83 118.75 106.88 100.94 95.00 2 0 0 Q CL
PP 7.5 Q57 PROPYLENE 7LBS CGA 510 83 36.37 32.73 30.91 29.10 2 0 1 I CL
PR 100 Q57 PROPANE 95LBS CGA 510 86 107.69 96.92 91.54 86.15 4 0 0 P CL
PR 20 Q57 PROPANE 17LBS CGA 510 86 19.28 .17.35 16.39 15.42 2 0 1 P CL
PR 33 Q57 PROPANE 32LBS 86 36.29 32.66 30.85 29.03 2 0 0 P CL
PR 7.5 Q57 PROPANE 7LBS CGA 510 86 14.08 12.67 11.97 11.26 1 0 0 P CL
73 Items
Category Total Amount Total Neg
02 584.34 0.00
04 1,149.42 0.00
20 277.46 0.00
22 936.80 0.00
30 1,155.80 0.00
40 412.20 0.00
41 887.10 0.00
60 828.70 0.00
62 731.65 0.00
70 817.76 0.00
72 2,206.07 0.00
RUN•DATE: 12-MAY-11 10:28:40 STOCK STATUS REPORT PAGE 000005
I
Category Total Amount Total Neg
83 310.24 0.00
86 555.98 0.00
95 225.64 0.00 '
96 394.98 0.00
99 115.80 0.00
AO 4,967.56 0.00
A6 611.26 0.00
C2 140.16 0.00
Grand total: 17,308.92 0.00
I
I
i
Town of Barnstable
�FTHE T Regulatory Services
'L Thomas F. Geiler,Director
Public Health Division
BARNSTABLE, Thomas McKean,Director
v� 1 MASS.. ,�� 200 Main Street, Hyannis,MA 02601
ArFD MA'1 A
Phone: 508-862-4644
Email: health(a,town.bamstable.ma.us
Fax: 508-790-6304
Office Hours: M-F 8:00—4:30
March 27, 2007
Mr.Tom Dumican M Q 31 Z 'CO3
Airgas
PO Box 335
15 Colony Drive
Walpole,MA 02081
Re: Airgas East, 127 Airport Road,Hyannis,MA 02601 /
Dear Mr. Dumican:
Thank you for your time and cooperation during the hazardous materials inventory and site visit
at Airgas East on March 18, 2007. This letter contains information from that visit that will help
you become compliant with the Town of Barnstable Ordinance Chapter 108: Hazardous
Materials.
Enclosed are copies of the Chapter 108: Hazardous Materials ordinance, an application for permit
to store and/or utilize 111 gallons or more of Hazardous Materials, and a copy of the Toxic and
Hazardous Materials On-Site Inventory form from the visit to your business. Please note the
observations at the Airgas during the hazardous materials inspection listed below:
OBSERVATIONS:
• No Hazardous Materials permit on site. Please obtain a Hazardous Materials permit for
the fiscal year 2007-2008. The fiscal year begins on July 1, 2007.
• Emergency phone numbers are posted in the facility near the telephone.
• Emergency evacuation plan is posted.
• Emergency evacuation kit is prepared.
• Material Safety Data Sheets are on site.
• Extinguishers are up to date.
• No public access to the cylinders in the locked garage.
• All cylinders are handled by the site professional.
• Safety training takes place once a month to cover all areas of concern.
On Site Inventory Total
The Toxic and Hazardous Materials On-Site Inventory from March 13,2007 shows that you have
approximately 500 gallons of toxic and hazardous materials being used or stored at Airgas East,
127 Airport Road.,Hyannis,MA(Please see enclosed Toxic and Hazardous Materials On- Site
Inventory sheet).
The Board of Health has determined that the using, storing, generating and disposing of over 111
gallons of hazardous materials per month requires businesses in the Town of Barnstable to obtain
an annual Hazardous Materials License. This license should be purchased within the next 30
days from the Town of Barnstable Town Offices, 200 Main Street,Hyannis,MA 02601
(application enclosed).
If you have any questions about these observations or you need further information, guidance or
assistance,please do not hesitate to contact the Public Health Division.
Sincerely,
Aqa
Alisha L. Parker
Hazardous Materials Specialist
All orders to correct violations of Chapter 108 of the Town of Barnstable Ordinance: Hazardous
Materials shall be completed upon receipt of this letter.
Thomas A. McKean,RS,CHO
Director of Public Health
Cc. Jean A. Jason(Cover Letter Only)
Enc. On-Site Inventory(copy)
Chapter 108 (copy)
Hazardous Materials Permit Application
I
a 11
Date:
TOWN OF BARNSTABLE
TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY
NAME OF BUSINESS: A'
BUSINESS LOCATION: I?s7 —�o[ d ebad o HVA i't--i Ll INVENTORY
MAILING ADDRESS: \t I I# TOTAL AMOUNT:
TELEPHONE NUMBER: 5C)2— :771 — 031 to 5 J'
CONTACT PERSON: c)la g A. ( ),'Sa-vt 6VA In& "a_,ica a r
EMERGENCY CONTACT TELEPHONE NUMBER: C55Dg — =P.195 ,Zi7la MSDS ON SITE?
TYPE OF BUSINESS: Weld ln4 ,�IA nn lips I Imu- fPma 1 M60S
INFORMATION/RECOMMENDATIONS: obf u lA a h Gtmr DUS Fire District:
ki1 0,l5 - I n 15
Waste Transportation: Last shipment of hazar ous waste: "-
Name of Hauler: Destination:
Waste Product: — Licensed? Yes No _
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use,
storage and disposal of 111 gallons or more a month requires a license from the Public Health Division.
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health and the Public Health Division have determined that the following products exhibit toxic
or hazardous characteristics and must be registered regardless of volume.
Observed/Maximum Observed/Maximum
Antifreeze (for gasoline or coolant systems) Misc. Corrosive
NEW USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road Salts (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor Oils Pesticides
NEW USED (insecticides, herbicides, rodenticides)
Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers)
Diesel Fuel, kerosene, #2 heating oil NEW USED
Misc. petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil NEW USED
Degreasers for engines and metal Printing ink
Degreasers for driveways &garages Wood preservatives (creosote)
Caulk/Grout Swimming pool chlorine
Battery acid (electrolyte)/Batteries Lye or caustic soda
Rustproofers Misc. Combustible
Car wash detergents Leather dyes
Car waxes and polishes Fertilizers
Asphalt & roofing tar PCB's
Paints, varnishes, stains, dyes Other chlorinated hydrocarbons,
Lacquer thinners (inc. carbon tetrachloride)
NEW USED _ Any other products with "poison" labels
Paint &varnish removers, deglossers (including chloroform, formaldehyde,
Misc. Flammables hydrochloric acid, other acids)
Floor &furniture strippers Other products not listed which you feel
Metal polishes may be toxic or hazardous (please list):
Laundry soil & stain removers 96 R A II"s
(including bleach)
Spot removers &cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
Windshield wash
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
lf�
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Hazar us Materials Inventory Sheet Checklist
7Date
=4:4hysical Street Address-Check database to ensure it exists
Aorking Phone Number
ctual Amounts-(le.gas being used to fuel machines,thinner to
I/lean brushes all counf as hazardous materials)
torage Information-location of storage,how long is storage for?
If none,note.that:
Disposal Information-where and who?If none,note that.
el Applicant Signature-understand what is listed and noted
—7 Staff Initial-any questions,know who to ask
p!/Gib Vehicle Washing/Rinsing? -provide a vehicle washing
g policy and
LL
explain it-note that it was given - -
Attach the Business Certificate with your sign off and comments
"The Inventory form should explain what the business consists of and the procedures
they are doing. Notes need to be left to explain what you discussed with them.
HazMat On-Site Inventory/inspection: j/ h VI�''�
Records to Review for SQGs and CESQGs yv
DBA: (/l✓(,V _ V 2Q,vl JG��'llri� i(�C. /
Location:
Site visit date: �/ P� °F
• Hazardous Waste
Manifests: fV
• Employee training documentation (if required):
Z19L I, l x YY1 vyvf k% �e- /)C reChyr
Hazardous substance spill control and contingency plan:
• MSDS on site? All
C 046� 'StPJL
HazMat Inventory records (if applicable):
• HazMat Waste Shipping documentation: /v
Spill records (if applicable):
�y
les,
Jean Jason
Branch Manager
YOU WISH TO OPEN A BUSINESS?
Airgas East b
Air
gas
127AirpartRoad / s (cost$30.00 for 4.years). A.business certificate ONLYREGISTERS YOUR NAME in town (which
Hyannis.MA02661 ermissionto operate.) Business Certificates are available at the Town Clerk's Office 1- FL., 367
Phone:508-778-0316 )
FAX:508-778-1922
Toll Free:800-562-3815 3 bs
f
www.airgas.com oA�-E:
&�}nl �4Sc /��/�� ��77
YOUR NAME: _ 2 S® 1'
BUSINESS YOUR HOME.ADDRESS: / 1�6�5 utJG ^
a D-707`1
Rao". TELEPHON # Home Tele hone. �1-- --
NAME OF NEW.BUSINE55 S PE OF SI
TYPE. BU NESS: 5
IS THIS A HOME OCCUPATION?. YEs. NO
HaVe a ..... 11
ADDRESS OF BUSINESS b MAP/PARCEL NUMBER "D
When starting a new business there'are several things you must do in order.to be in compliance with the rules and regulations'of the Town of
Barnstable. This form.is intended to assist you in obtaining the information you Inay.need. You MUST GO TO 2�0 Main St. - (corner of Yarmouth
Rd. & Main Street).to make sure you have the appropriate permits and licenses-required to legally operate your business in this town:
. 1. BUILDING CO a
R'S OFFICEThis.individ al � o m d f`any ermit requir s that pertain to this type of business.
thorize nature**
COMMENTS:
2. BOARD OF HEALTH
This individual ha4"�&
med th mit require ents that pertain to.this type of business.
ed Signature**
COMMENTS: . .L
F�
3. CONSUMER.AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature.*
COMMENTS:
Date: 3 //.S-/07
TOWN OF BARNSTABLE
TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY
NAME OF BUSINESS:
BUSINESS LOCATION: /6k 7 .4rRa"1 QA6+:AY/�A1&,,rX*4 0-1601 INVENTORY
MAILING ADDRESS: TOTAL AMOUNT-
TELEPHONE NUMBER:
CONTACT PERSON: A - �_ 7,4s,9AJ �S Qom! �G�•
EMERGENCY CONTACT TELEPHONE NUMBER: SOS- s 7 MSDS ON SITE?
TYPE OF BUSINESS: 10,1AJ(o
INFORMATION/RECOMMENDATIONS: Fire District:
Waste Transportation: Last shipment of hazardous.waste:
Name of Hauler: Destination:
Waste Product: Licensed? Yes No
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use,
storage and disposal of 111 gallons or more a month requires a license from the Public Health Division.
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health and the Public Health Division have determined that the following products exhibit toxic
or hazardous characteristics and must be registered regardless of volume.
Observed/Maximum Observed/Maximum
Antifreeze (for gasoline or coolant systems) Misc. Corrosive
NEW USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road Salts (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor Oils Pesticides
NEW USED (insecticides, herbicides, rodenticides)
Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers)
Diesel Fuel, kerosene, #2 heating oil NEW USED
Misc. petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil NEW USED
Degreasers for engines and metal Printing ink
Degreasers for driveways &garages Wood preservatives (creosote)
Caulk/Grout Swimming pool chlorine
Battery acid (electrolyte)/Batteries Lye or caustic soda
Rustproofers Misc. Combustible
Car wash detergents Leather dyes
Car waxes and polishes Fertilizers
Asphalt & roofing tar PCB's
Paints, varnishes, stains, dyes Other chlorinated hydrocarbons,
Lacquer thinners (inc. carbon tetrachloride)
NEW - USED Any other products with "poison" labels
Paint &varnish removers, deglossers (including chloroform, formaldehyde,
Misc. Flammables 5-00 &M— r9leap'47j"5' hydrochloric acid, other acids)
020Pyj_eXAE,/Au6 c4c
Floor &furniture strippers GYLi�� s Other products not listed which you feel
Metal polishes may be toxic or hazardous (please list):
Laundry soil & stain removers
(including bleach)
Spot removers &cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
Windshield wash
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations;Rep •r
satisfactory 2.Printers
BOARD OF HEALTH 3.Auto Body shops
O unsatisfactory- 4.Manufacturers
COMPANY.-.0�4' ��-s' �° (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS Class: 7.Miscellaneous
/ ANTITIES AND STORAGE (IN=indoors; OUT=outdoors)
MAJOR MATE IALS Case lots Drums Above Tanks Underground
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels:
_ Heavy Oils:
C)
�A2vp�i4nror�l_-�)
lic
Synthetic Organics:
degre ers
sa�d.�-ram44�_41 z&
Miscellane us
<71
�.
DISPOSAURECLAMATION REMARKS:
1.,Sanitary Sewage 2. ter Supply
J Town Sewer Public
0 On-site OPrivate
�/ Q
3. Indoor Floor Drains YES NO !i G
0 Holding tank:MDC
I
0 Catch basin/Dry well -
0 On-site system
4. Outdoor Surface drains:YES NO ORDERS:
0 Holding tank:MDC
0 Catch basin/Dry well
0 On-site system
5.Waste Transporter
Name of Hauler Destination Waste Product
YES NO
1.
2. oe
Person (s) Interviewed Inspector Date
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
p� satisfactory 2.Printers
BOARD OF HEALTH Da 3.Auto Body Shops
unsatisfactory- 4.Manufacturers
COMPANY 0 c, &P-� O (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS Class: 7•Miscellaneous
QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors)
MAJOR MATERIALS Case lots Drums Above Tanks Underg-round
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
o► V"_
A(is�cedlaneous:
DISPOSAIJRECLAMATION REMARKS: ve 10Ue11
1. Sanitary Sewage 2.Water Supply S 0� h
Town Sewer Public
O On-site OPrivate
ih c7 C v f ch 1,4,,e_f-
3. Indoor Floor Drains YES NO_x_
O Holding tank:MDC V t t tz a
O Catch basin/Dry well hY *tA U, o�d-� aLt' a t-4 iJ rises ( a1
O On-site system r•S Cvs `
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.
Person (s) to wed Inspect6r Date
TOWN OF BARNSTABLE
CF THE
OFFICE OF
Desa7TsaL i BOARD OF HEALTH
y MAML
0o i639• 367 MAIN STREET
�oM�rw HYANNIS, MASS.02601
December 2, 1997
Edward H. Kneale, III
Classic Kitchen Design, Inc.
127 Airport Road
Hyannis, MA 02601
Dear Mr. Kneale:
You are granted a one-year extension, until November 30, 1998, to connect the building
located at 127 Airport Road, Hyannis to town sewer.
This one-year extension is granted because you testified that you purchased the property
in May of 1994 but you were not notified of the sewer.betterment assessment until
December of 1994. Also, major roof repairs are needed at this time and the costs
associated with the repairs has caused you financial hardship. You stated a one-year
extension would provide you sufficient time to connect the building to town sewer.
Sincerely yours,
/'0'��rj
Ra'sk
Susan G. , R.S.
Chairman
Board of Health
Town of Barnstable
I
kneale3
Nov-03-97 11 : 17A (508) 778-0965 P-03
Classic Kitchen Design. Inc.
FACSIMILE TRANSMISSION 127AtrportRoad
Hyannis.Massachusetts 0Z601
508,-775-3076
# PAGES 3 - - FAX 508 778 0965
( Including cover sheet ) Classic Kitchen Design
ow
DATE: 10/3/97
T 0: Mr. McKean
FROM: F.dvaaxd Kneal.e
MESSAGE:: Received in todays Mail notice of Board Of HmIth yrxting
_ scteffillud for tomorxow at 7:00 P.M. This notifi.cation is -
the only xesponse I have had to my letter to your office
dated 10/7/97. (copy tnclosed) I an sorrX to advise you
that I will be out of town thxu Wednesday of this week
and unavailable to attend this meeting. It would be
_greatly app�eiate�d if this could be postpondd until your
_ you Noveffber 18th meting. ^
_- Thanks for. ?"A help.
SHOULD ANY PROBLEMS WITH THIS' TRANSMISSION EX1-ST, PLEASE NU'!'IFY IMNEDIATF:!;y
PHONE: 508-775-3075 �
FAX: .508-778-0965
Nov-03-97 11 : 17A (509) 77B-0965 P.02
Susan G. Rask, R.S., Chairman e-
Town of Barnstable Board of Health
367 Main Street ��\
Hyannis, MA 02601 �\
October 74 1997
Dear Ms. Rask:
This letter is in regard to the property I own at 127 Airport Road in Hyannis. My
company, Classic Kitchen Design, operates its showroom in this building. I have enclosed
a copy of a letter from your office to me, which has to do with connecting to Town
Sewer.
I purchased the property in May of 1993 from the Federal Deposit Insurance Corporation
acting as Liquidating Agent of American Bank for Savings. Negotiations with the Seller
and its agent, Fidelity Real Estate,were ongoing for a number of months prior to closing.
At no time during negotiations or at the'closing was 1 made aware of the pending Sewer
Project in the area.
My attorney contacted the Town in May of 1994 and discovered that the Seller(F_D.I.C.)
had in fact been properly notified by the Town. I believe that this information was
intentionally withheld from me as it would have had a great impact on my decision to
purchase the property which was in need of substantial repairs. We contacted the Seller in
an effort to get some financial relief and got nowhere, as one mifht expect when dealing
with the F.D.I.C..
i
In December of 19941 received a Notice of a Betterment Assessment in the amount of
$10,597.33 which I am obligated to pay, with interest, over the next ten years. This
unexpected expense was not budgeted for nor was the connection to Town Sewer.
As the building is in need of major roof repairs,it is my hope that the connection to Town
Sewer can be postponed for at least two years at which time the Sewer Connection would
be less of a financial hardship. I have enclosed copies of recent water bills which I hope
will demonstrate the minimum impact of the continued use of the existing System.
Thank you for your help in this matter.
Yours Trt,I ,
•. is it� Y..•;'f:.t !I:•'rl•:' .:i.
Edward H. Rncale III
Ted Kneale
Nov-03-97 11 : 17A (508) 778-0965 P.01
Town of Barnstable
Board of Health
1
61 367 Main Strict,Hyannis Mn 02601
office: 309-79"265 Susan d.Rask R.S.
FAX: 508.790-6104 Ralph A.Mwphy.M.D.
Arian R Or*.R.S.
Board or Health Meeting Agenda
November 4,1997
7:00 P.M.
Selectmens Conference Room
Town Hail Building
1. Hearin
7:00 roposed Revisions to Regulation Part VIII,Section 12-00: Monitoring of
Alternative Septic Technologies
I1. Variance Re uests Old Business):
7:10 Stanley Nowak, 55 mountain Ash Road Marstons Mills -New
construction requests variances to install'soil absorption systems 109 feet
from an onsite well and 114 feet from a neighbor's well, lot size is 0.55
acre.
7:20 (B) Craig R. Short P.E., 116 Coddin�jon Road Centerville-Requests a
variance to rep)ace cesspools, 50 from wetlands, also to decrease the
application rate to 0.50 square feet per gallon.
Ili, Variance Reuss New Business
7:30 l^ William Robinson,F' 89, Centerville Requests a variance to install
a grease recovery device at Goodfella's.Restaurant, 334 Main Street,
1 lyannis.
7:40 (B) Gerald Elovitz, Lot 14 Buttonwood Lane, W. Barnstable-Leaching
facility to be located 111 feet from existing well.
7:50 (C) John D. Pope, 172 Attucks Lane, Hyannis -Requests a 60 day extension to
connect to town sewer.
8:00 (D) John F. Cabana, 157 Falmouth Road,Hyannis-Requests a modification to
the Board of 11calth's decision at the previous meeting.
8:10 (E) Borders Books Hyannis Associates,Ltd. 990 Route 132, Hyannis-
Requests a variance from Regulation#1d, Grease trap.
8:20 (F) Edward H. Kneale, 127 Airport Road, Hyannis -Extension of time to
connect to town sewer_
Next scheduled meeting November 18, 1997.
agend doc
Classic Kitchen Design, Inc.
127 Airport Road
Hyannis, Massachusetts 02601
508 7753075
FAX 508 778 0965 rr
tr
J
Ted.Kneale - -
Susan G. Rask,R.S., Chairman
Town of Barnstable Board of Health
367 Main Street
Hyannis,MA 02601
October 7, 1997
Dear Ms. Rask:
This letter is in regard to the property I own at 127 Airport Road in Hyannis. My
company, Classic Kitchen Design, operates its,showroom in this building. I have enclosed
a copy of a letter from your office to me, which has to do with connecting to Town
Sewer.
I purchased the property in May of 1993 from the Federal Deposit Insurance Corporation
acting as Liquidating Agent of American Bank for Savings. Negotiations with the Seller
and its agent,Fidelity Real Estate, were ongoing for a number of months prior to closing.
At no time during negotiations or at the closing was I made aware of the pending Sewer
Project in the area.
My attorney contacted the Town in May of 1994 and discovered that the Seller(F.D.I.C)
had in fact been properly.notified by the.Town. I believe that this information was
intentionally withheld from me.as it would have had a great impact on my decision to
purchase the property which was in need of substantial repairs. We contacted the Seller in
an effort to get some financial relief and got nowhere, as one might expect when dealing
with the F.D.I.C..
In December of 1994 I received a Notice of a Betterment Assessment in the amount of
$10,597.33 which:I am obligated to pay, with interest, over the next ten years. This
unexpected expense was not budgeted for nor was the connection to Town Sewer.
As the building is in need of major roof repairs, it is my hope that the connection to Town
Sewer can be postponed for at least two years at which time the Sewer Connection would
be less of a financial-hardship. I have enclosed copies of recent water bills which I hope
will demonstrate the minimum impact of the continued.use of the existing System.
Thank you for your help in this matter.
AsT 1 ,
Edward H. eale III
P
"�tO Town'.of Barnstable
BAMSTABLF. Department of Health, Safety, and Environmental Services
314 Public Health Division
367 Main Street, Hyannis MA 02601
Office: 508-790-6265 Thomas A.McKean
FAX: 508-775-3344 Director of Public Health
May 6, 1997
KNEALE EDWARD H III TRS
375 PLEASANT PINES AVE
CENTERVILLE, MA 02632
RE: Map & Parcel 312003
ORDER TO CONNECT TO TOWN SEWER
Dear Property Owner:
You are directed to connect your building located at 127 AIRPORT RD,-(listed as Assessor's Map and
Parcel 312003)to public sewer on or before November 6, 1997.
The Superintendent of the Department of Public Works has notified us that your property abuts Town
sewer lines. The lines were extended because of the density, and the size of the lots in the area, and the
potential for serious health problems.
Acting under the authority of Chapter 83-11, of the General Laws of Massachusetts, and Regulation 15.02,
of 310 CMR State Environmental Code, you are hereby directed to connect to the town sewer system on or
before November 6, 1997.
Failure to comply with this order will result in a court complaint against you for failure to comply with a
Board of Health Order.
If you should have any questions, please telephone me at 790-6265.
PER ORDER OF THE B ARD OF HEALTH
Thomas A. McKean, RS, CHO
Health Agent for
TOWN OF BARNSTABLE BOARD OF HEALTH
Susan G. Rask, R.S., Chairman
Brian R. Grady, R.S. .
Ralph A. Murphy, M.D.
copy: Peter Doyle '
Return receipt requested �,
Barnstable Water Company 47 Old Yarmouth Road, Hyannis,MA 02601-0326 508/775-0063
CUSTOMER NAME SERVICE LOCATION ACCOUNT NUMBER
CLASSIC KITCHEN DESIGN 127 AIRPORT ROAD 312 - 003
CUSTOMER TYPE RATE WATER SERVICE DAYS METER READING CONSUMPTION
From To Previous Current cu.R.
GEN.L BUSINESS C1 7/31/97 8/29/97 29 143000 143400 400
Consumption TOTAL DAYS c TOTAL'
Analysis cu.R. cu.ft.Idi 11 .68
THIS ;4001 29 1.3 -
YEAR.
YEAR 6001 291 20 - -
.. f
_ YOUR WATER CHARGE INCLUDES ,
MINIMUM CHARGE 6.60
SUCCESS HAS A SIMPLE
FORMULA: DO YOUR BES"f AND
PEOPLE::: MAY LI:F;E: IT.
SAI'l- EWING AFTER 4S DAYS UNPAID CHARGES MAY
BE SUBJECT TO INTEREST AT THE RAT ::
OF 1 S % PER YEAR.
BILLING DATE: TERMS: All charges are due when rendered.
9/04/97 Please pay by 0119 ' 11 .68
i
• I
Barnstable Water Company 47 Old Yarmouth Road, Hyannis,MA 02601-0326 50,
CUSTOMER NAME SERVICE LOCATION ACCOUNT NUMBER
CLASSIC KITCHEN DESIGN 127 AIRPORT ROAD 312 003
CUSTOMER TYPE RATE WATER SERVICE DAYS METER READING CONSUMPTION
From To Previous Current cu.ft.
GEN'L BUSINESS C1 S/30/97 7/01/97 32 141400 142100 700
Consumption TOTAL 'DAYS = TOTAL
Analysis cu.R. cu.ft./da 1S.49
YEAR 700 32 . 21 - -
YEAR S001 281 17
YOUR WATER CHARGE INCLU UY '
MINIMUM CHARGE 6.
SOME ARE BORN GREAT,
SOME ACHIEVE GREATNESS, '
AND SOME HIRE
PUBLIC—RELATIONS WRITERS. AFTER 45 DAYS UNPAID CH
DANIEL J BOORSTIN BE SUBJECT TO INTEREST AT THE ' RAT
OF 15 % PER YEAR.
BILLING DATE: TERMS: All charges ure due when rendered. TOTAL AMOUNT
7/03/97 Please pay hy� 8/03/97 NOW DUE iS.49
Barnstable Water Company 47 Old Yarmouth Road, Hyannis,MA 0260170126 f. 5081775-0063
CUSTOMER NAME SERVICE LOCATION . f ACCOUNT NUMBER-
CLASSIC- KITCHEN DESIGN 127 AIRPORT ROAD 312 . . .`003 ;
CUSTOMER TYPE RATE WATER SERVICE DAYS ME R READING ' CONSUMPTION
From To Previous urrent cu.ft.
GEN 'L BUSINESS C1 7/01/97 7/31/97 30 142100 143000 900
Consumption TOTAL DAYS = '.TOTAL
Analysis cu.ft. (Cu.ft./da 18.03
YEAR goo 301 30 '
LAST
YEAR
YOUR, WATER CHARGE INCLUDES .-
MINIMUM CHARGE 6.60
MAN IS STILL THE MOST .
EXTRAORDINARY COMPUTER
OF ALL.
JOHN K KENNEDY AFTER 45 DAYS UNPAID CHARGES MAY
BE SUBJECT TO INTEREST AT THE RAT
I OF 15 % PER YEAR.
BILLING DATE: TERMS: All charges are due when rendered. • •
8/05/97 Please payhy—� q/03/97 • 18.03
ASSESSOR'S MAP NO. PARCEL oc
•LO CAT ION SEWAGE PERMIT NO. .
VILLAGE 4,4h "7
r S `Ie �7i a
INSTAL R S N/Ao�M E 6 A D D R E SkrjAjr���17
wv & Il -
e UILDER OR
4- 11W
, oars
DATE PERMIT ISSUED
DA"TE COMPLIANCE ISSUED
r
$CM to o� PILO `S} Te /I.a n i
Vc LL, '� B
cd.
y S
C/o
c� } /-ao
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dile
CCU 3 �
LOC ION SEWAGE PE MIT NO.
V`1LLAGE
1,11ISTA L ER'S NAME i ADDRESS %
i �' QP
UILD RI OR OWNER
DATE PERMIT I S S U E D
DATE COMPLIANCE ISSUED
1
'ZIP
ASSESSORS MAP NO:
- PARCEL f10..
N F�s.... :Za:. .......
THE COMMONWEALTH OF MASSACHUSETTS
'BOAR® OF HEALTH
..................OF` - 1 ---------------------------------------------------------
ApplirFation for Dispaii al,Works Tonstrnrtinn Frrmit
Application is hereby made for a Permit to Construct ( ) 'or Repair (*) an Individual Sewage Disposal
System at:��
�--Oaa°-4A,-,11
sk --• wylxxi4....................... ---------------------------------•---•--•----•-- ------_---•-------__---
c �' 1, Location- hdd�, ss or Lot No.
..........................................
............------------------------ .........__--........... .........................
Own Address
--------------- -vner..........................................
Installer Address
d Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms.............................. .. .Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons.........................--- Showers ( ) Cafeteria ( )
a' Other fixtures -------------------------------- -
d
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 ( )
PercolationTest Results Performed by.......................................................................... Date........................................
aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.........................
Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
•--•-•-•--••..................•----•-•-•---....---•---•----------------••---•--_----_--__----•--•---------------------------
•--------------------------------
0 Description of Soil............................................---------...--•-----...----•-••------------------------------------------------------------------------•--•................
W ----••--•........................•--....------........••••-------------------•------•--......_......-----•-•--•- • • ........................................................------
UNature of Repairs or Alterations—Answer when appl•cable._-ls -------:_O._-.IOoo____ -[7a___ _ 'ct__.
Agreement:TQ kc,,k jmc .":— rA4
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of'T L, . of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by th board of health. n
Si ..�. ........................... .../.- Da��
Application Approved By--------------------- ..................v/1�--............... ---•--•-------••• ��
Date
Application Disapproved for the following reasons-------------------------------------••---••----•--•-•-----••--- ------•------•------------••-••--------------
..............................................•...........................................................................................................................--............................
Date
Permit No.- -- ---•••..... Issued............. .............
Date
N6--! .._. �0 FEs...'ZC'................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF `HEALTH
....................oF...f w a" � ..........................................................
Appliration for Disposal Works Toustrurtion Verntit
Application is hereby made for a Permit to Construct ( ) or Repair *) an Individual Sewage Disposal
System at:
\ Location Address or Lot No.
s..I . _. �..o. -------------------------------------------- -------------------.....---_.
owner A Address
266
Installer Address
UType of Building Size Lot.....:......................Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
'4 Other—T e of Building No. of persons............................ Showers — Cafeteria
a' Other fixtures .....................0..........._.
w Design Flow............................................gallons per person per day. Total daily flow-----.......................................gallons.
1:: Septic Tank—Liquid'capacity........--_-gallons Length......0......... Width................ Diameter.-.--.-.----_- Depth................
Disposal Trench—No. .................... Width...........-........ Total Length.................... Total leaching area...........-........sq. ft.
3 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. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.........................
((Z4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 --------•---••-• ---------•-•--•----•--•-••..............••-•-------•-............. ----------------
•-----------------
•-----------•--
0 Description of Soil--.......................................................................•.......................-.-......................--.......................-....................
x
U --•-•-•-----•---•------•--•--------•---------••-----•-•---------•---•-•--•---------••..............•---•-•••-----••.........•-•-••--•--••------•---•---•--•••-••-•-••-------•-•-•-------•---------------
w
U Nature of Repairs or Alterations—Answer when applli_cable?�r �l..�..ff-: °....1.aoo - - `.5,pp
N'.2o...IGc f2 .. !.t.D_ Oi-` Sony, a0. F..rA.c/
Agreement: Ica. etc �/ar.w �(a,� �. -r->� ^
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the-provisions of TI?'L: 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
G_^��..
— " f� f DaApplication Approved By----•-•--•-••------- -•• -- ��---•--------_..
Date
Application Disapproved for the following reasons:.......0.........................0.....................
...........................................
.... -
-•--•-----•---•-----------•• •-•--------•-••-•-••-•-•--••---•............. ..........•---------•-•-------------•--•-•-•-•-------•------------------------•------------- •------------------•---•--
�,-/� Date
PermitNo.................................... ................... Issued................ ...........
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
S> I own.................0F.....tS�.'v'>o14�L
�ertifirate of Tomplianre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by----------------- MW......---............. ..------.... . ......-..................................................................................-..........
f� Installer
' ,'C ......................\
at........ ? � -•------------------------- ---------••-•-------•--•---------•-------•------•-•-•----•------------•--.....-•-•------------
has been installed in accordance with the provisions of TT T E j•of The State Sanitary Code as des! "bed in the
application for Disposal Works Construction Permit No .-..`�tea' 1 ��
-------•----------. dated--------
ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT ifHE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE..............................�Cl�.... •----- .. Inspector.......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF y�HEALTH
NOFEE:.......................
Disposal �1wPoN
rkn Tontrurtion ermit
C_
Permission is hereby granted ----------------- -------•-.--•--•-----•------•--------------.....-•••--•--------------........---•---•...........•.._....
to Construct ( ) or Repair 4 � ) an Ind* Id al Sewage Disposal System
f
arT ��� C>
at \o...l. " .. S
......................0.............-•••-------•-----................--•---•-•---------0..............0...........
Street C—
as shown on the application for Disposal Works Construction Permit NVO. . __ Dated......:F 1:y
.................. ..................................—
Board
Board of Health
DATE......... ........'�.J.9���
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS