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HomeMy WebLinkAbout0091 BARNSTABLE ROAD - Health 91 BARNSTABLE,ROAI� Hyannis ($arnstable,Rd A tilt -1 epair') ,a A =. 327 - 026 a o . Date: -1 //® /-10,6y TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: 6�►�cN�TAtE /�'�o�tT// 7' � BUSINESS LOCATION: 9/ /3,49,Js at,� �-'�Ca�1'1 1� INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPEOFBUSINESS: .4u� �NSPECTIo�t1S .�Ayh KEf'A i� �IrS INFORMATION/RECOMMENDATIONS: F/X66-x77AJ6yis/ems Up_7v_b*7L' � Fire District: ,fLc I-IA4¢jrvoyS Ag,+7 Ai*t_ 15 S?DR-l'P IAIO6CA'S 1,N c0tvcAerc-nev,l�;,v&, &. MAID 4 69R11fCb A I76AfS '- DQ7-4-/J c�''O01-`�B� Z-ICE—AjS a- POST ptA±L SPILL K . LA Q f7 A57E 61L n fi 1z,, c/L c,+D p a.0 &C, Waste T �`° ✓� 0O L Last shipment f hazardous waste: ZOOS Name of Hauler• N 01cr Destination: C x/ alL Stu rzN Waste Product: te2c k%7-r Licensed? es 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 C `'ov oNe 4A-4"A 4_1 ��a1r�p�.u��5 Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes ii� ni�vT Road Salts (Halite) Hydraulic fluid (including brake fluid)teo,vn4i,je7P Refrigerants Motor Oils w14-S%r OIL /s Pesticides �N �Q sr NEW //B USED �`��`�'� �'``�~`�" Insecticides, herbicides, rodenticides MACGasoline, Jet fuel, Aviation gals rNo� bu s 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 I N� Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Ota_t )S Misc. Combustible Car wash detergents suPPu 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, 5 PgAf e.A,3s o F Misc. Flammables 5e4Y_c xtEID0 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 2 o&C Ac � ��. KI7- ea (including bleach) Na7tS lS 4 /36xogg j &OA17XIAIA4� Spot removers & cleaning fluids ,¢.RiA /-T ME REA4 X­YM24o9- OA-_ 7-#t 6A E. (dry cleaners) Other cleaning solvents IA411. 6-14LE��� A-P,-7W6 PNIPq Bug and tar removers 5 411_Lulu bjUAIs oeCU Py1AJ6. 7W,s 5P i,v oNE CA-L"AJ 0- No +,hbAe4_:5'5 15 A Windshield wash Co VIX-IAJ432�5 WHITE COPY-HEALTH DEPARTMENT!CANARY COPY-BUSINESS Wl+-5rE 317-E wlo-leg 6 fit//7P A ,SG/i- Wbe_ R E"C�regy NCNB T, r%, t F ' s_;�"� + ; aA�A.^ :�.• . ?�i'".t�: C§�:_=wi: a` .�.. i'^'' d...�,�.a„�:n•t...4r ,1 .u: :'� Date: 3 //e 1-ge TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF�BUSINESS: 5,gRAJ57"16 BUSINESS LOCATION: g� (3,�9,ys ��, ���1an o INVENTORY �(s A3r,vE MAILING ADDRESS: TOTAL AMOUNT: . ^* -TELEPHONE NUMBER: SGS � � - ��� �`��6A2"-,j S ,CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: Au7) -LN5��c77Gu5 Avb 16 Al r� ,'/Ric Ex77,ulu/SI,�75 vp-TU-�rire. INFORMATION/RECOMMENDATIONS: Fire gistrict: /5 ST 9-e-P 1A1&,cR-5 oN e o)uc e&7Z A/AlAr !f CD.kME�A 76A1 S:t.,P TIC/ �00 S Dt1 L-/Ct:'A .5C P65 T PCA A Odj/`7t/� � SPILL K/T, L.4} clE WASrr 6/L 0,1241A(S AND KJAS Iz 6/t- C14 r-?P 1_4A)4LAr_r jat2av/pt't5 Cc1 '� 0AY GF IA_j517e,1 Mlu) Waste lra"Fis or a Hof H,4v"00 76YSI Last shipment f hazardous waste: �U`� Name of Hauler• `' '`� �'� Destination- Waste X/ 0 , S 1PUCj/i7r1,1 j(A Waste Product: S7� Licensed .�Y - 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. max; 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 Omer 1,A24,f,13 NEW USED �ec/J7iuS Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes lit/ �zy- Road Salts (Halite) / Hydraulic fluid (including brake fluid �'G'�' 0^'�S Refrigerants Motor Oils Wstsr °` �S yrzz��iN rwo 3g Pesticides NEW M USED j (insecticides, herbicides,,rodenticides) ll d1/LW O/c S T7iKE/) � ` � ��Gt",.EGCGcti �ST• fj�7YA/.u/yG'>? Gasoline, Jet fuel, Aviation gases 1*cA_ AmieT Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil C c,UTA tuts s 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)/Bat .vies _&Ira-a/6s , Lye or caustic soda Rustproofers /5 Misc. Combustible s Uf'nu rr7+\ 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 deglloksssers� (including chloroform, formaldehyde, ` Misc. FlammablesItWAKt- Kura 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 •� 9A16 ° c t.j - KI7- (including bleach) A16It S: 77k9c- ./5 4 136-xm6---,> eeA/TA'IAJAiek)r Spot removers &cleaning fluids 4Rr-_A „+7- ?Jet` R,A,-- "7Z7z/Gk oy 77/E eMe,44E. (dry cleaners) /T yt/As G/zJl/Aq-GI y 4SID CcAe TXf Pt9f774,6/6 Other cleaning solvents ?� ,i/K, tutKRl XJZy 77fKE A-ge 7W.1 t-N f Bug and tar remov rs 5- G��I-cv t��6tttJS o c 0 P Y I 7-HI5 5 cE , I,ti GA1 �Acc a� ( 71L-72E 4ge- Iva 41.5rr- 7"HC 4,6/)e 5'S S A Windshield washe6�'� WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS W14 5 tE 5/7E ( Mee Al 6 A-tA,tJ l�pf�� W 1774 A ,SG/L Y/k(*tz K Eu.vt� uNt T. afar ous Materials Inventory Sheet Checklist Date �-- Physical Street Address:Check database to ensure it.exists i-- Working Phone Number L- Actual Amounts.-( ie. gas being used.to'fuel machines, thinner to clean brushes all.count as hazardous-materials-no blanks) Storage Information location of storage, how long is:storage for? ` If none',--note that. /---Disposal information.-where and w.hoTIf none;:note that Applicant Signature:- understand what is Listed and:noted Staff Initial -.any.questionsiknow who to ask Vehicle Washing/Rinsing? -..give a vehicle.wash.ing.policy and plain it. 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. 1� Date: 8/ 13 / 12 TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE NAME OF BUSINESS: 6uali'-�u-..BUSINESS LOCATION: rf Gl Clfi 1 OIINVENTORY n MAILING ADDRESS: _! I Y1S TOTAL AMOUNT- TELEPHONE NUMBER: 508 - 7 71 CONTACT PERSON: EMERGENCY CONTACT TELEP O E NUMBER: -506 2 - 700 MSDS ON SITE? TYPE OF BUSINESS: es Ciw INFORMATION/RECOMMENDATI NS: 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 material 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) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) IRefrigerants F556 otor Oils Pesticides NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous 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 Miscellaneous 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 (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, - Paint&-varnish removers, deglossers hydrochloric acid, other.acids)- Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes 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 is ignat e' Staff's Initials YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $40.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in the Town (WHICH YOU MUST DO according to M.G.L. - it does not give you permission to operate). You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st FI., 367 Main St., Hyannis, MA 02601(Town Hall) and get the Business Certificate that is required by law. Fill in please: DATE August 2012 APPLICANT'S YOUR NAME/CORPORATE NAME Said S. Alharthy BUSINESS TY auto sales repai BUSINESS YOUR HOME ADDRESS: 174 Forest Foad, est armou 508 280-7003 TELEPHONE # Home Tele hone Number 508 280-7003 NAME OF NEW BUSINESS f P r f � Have you been given approval from the building division? YES x NO ADDRESS OF BUSINESS_ 91 Barnstable Road, Hyannis MAP/PARCEL NUMBER 327026 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 may need. You MUST GO TO 200 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 MISSIO ER'S OFFIC This indivi ual h en-info of a y p rmit requirements that pertain to this type of business. A horized Signatu COMMENTS: 2. BOARD OF HEALTH This individual h en in med f the rmi�req rements that pertain to this type of business. Authorize Signature** COMMENTS: MUST „T MATERIALS REGUtA 3. CONSUMER AFFAIRS (LICENSI G AUTHORITY) This individual has bEe inf rm the licensing requirements that pertain to this type of business. Aut orized Signal re** ' COMMENTS: ._ L ) cw se Date: //3 TOWN OF BARNSTABL" --o„TOXIC AND HAZARDOUS MATERIALSN FORM NAME OF BUSINESS: OU441 I IAQED Cew4�L l BUSINESS LOCATION: 1 INVENTORY MAILING ADDRESS: S~o&A- TOTAL AMOUNT: TELEPHONE NUMBER: _moo - -7'1 1 - o03 3 o8 94,1 CONTACT PERSON: a aQ ae- EMERGENCY CONTACT TELEPHONE N MBER: r08 - 7.80-7003 M DS ON SITE? TYPE OF BUSINESS: A o- , re pr rr o,JGS A10 INFORMATION / RECOMMENDATIO S: rkee,p ,M5W oK. 6,'I 0"I ,-X1c- Fire District: �.�/0.i�alo�� �o <-yv�(mve.eS . ZGD►'K►'k2H�X fC���tl�- � �� uxt.g�e_ of � N i5 Waste Transportation: �I IQODSDDOz•S-c-' Last shipment of hazardous waste: Z /3 Name of Hauler: �.J�_s+��� f>, 1 . --CK e- Destination: OleOG(K.68 /- L1!1c10/1t,, IQT T- Waste Product: ryas+�_ o� ��Cow�bus�-�ble� Licensed . es No __14V6-0$-7'71 0033 NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Healt Division. LIST OF TOXIC AND HAZARDOUS MATERIALS * No license— I-ejv,fe -,t- 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 13 Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive 21 NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts(Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides a' NEW 25/CAUSED Z,<' (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous 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 / Miscellaneous 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 (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes a 11415 ... S ;- r oPL S/t-e- Laundry soil &stain removers nn (including bleach) t 1 � l le-r s n/ o,- 2-3 �cayS WA.S d., o r � GYCa� Spot removers&cleaning fluids II nn I nn (dry cleaners) 6C�or�o�►SAasa( a5 ►'loK.l�q.�l.��Co�s 1.J�ts� . Other cleaning solvents Bug and tar removers JVD otCL We s f e Z., Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials rT- L Town of Barnstable Regulatory Services o� Thomas F.Geiler,Director • BARNSTABLE, 9� , : ,�� Public Health Division ACED MA'S A Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 November 1, 2002 BARNSTABLE ROAD AUTO REPAIR INC. 91 BARNSTABLE RD NIP HYANNIS MA 02601 1;?.21 ;2-A ATTENTION: PETER DEMERS Your food service/retail permit(s) will be invalid after December 31,2002. ESTABLISHMENTS FEE Number of Seats: FOOD SERVICE RETAIL 15.00 FROZEN DESSERT MOBILE FOOD BED&BREAKFAST TOTAL DUE 15.00 Food establishment inspections are ongoing by a Health Inspector; therefore, it is not necessary to make an appointment with the Health Division. However, if your establishment is not open during normal working hours (8:00 - 4:30 p.m.), please call 862-4644 between (8:00-9:30 a.m. or 1:00-2:00 p.m.) to schedule an inspection. Enclosed is a food permit application form. Please complete the form and mail it along with the required payment on or before December 15,2002 to the Town of Barnstable, addressed to the Public Health Division, 200 Main Street, Hyannis,MA 02601. Upon satisfactory compliance and receipt of your payment and copies of current Servsafe Certificate, you will be sent, via mail, the food/retail permit(s)for calendar year 2003. Failure to renew permit on or before January 1, 2003 will result in an additional fee of $10.00 late charge. If you should have any questions,please feel free to call the Public Health Division office at 862-4644. Q✓health/wpfiles/allrest PERMIT NO TOWN OF BARNSTABLE 650 BOARD OF HEALTH PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 395A and Chapter 111,Section 5 of the General Laws,a permit is hereby granted to: PETER DEMERS D/B/A: BARNSTABLE ROAD AUTO REPAIR INC. Whose place of business is: 91 BARNSTABLE RD , HYANNIS MA 02601 Type of business and any restrictions: RETAIL ESTABLISHMENT To operate a food establishment in the TOWN OF BARNSTABLE RESTRICTIONS IF ANY SEATING: ANNUAL: YES SEASONAL: TEMPORARY: FEES BOARD OF HEALTH RETAIL FOOD STORE: $15.00 Susan G. Rask, R.S.,Chairperson FOOD SERVICE ESTABLISHMENT RESIDENTIAL KITCHEN FOR RETAIL SALE Ralph A. Murphy,M.D. RESIDENTIAL KITCHEN FOR BED+BREAKFAST Sumner Kaufman, M.S.P.H. MOBILE FOOD UNIT: Permit expires: TOBACCO SALES: $14.00 December 31, 2001 � FROZEN DESSERT: Thomas A. McKean, RS, CHO MILK`CATERER: Director of Public Health ***REMINDER*** IF OUTSIDE DINING YOU MUSTE APPROVED BY THE BOARD OF HEALTH AND LICENSING AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? CONTACT INFORMATION: ���� FULL NAME OF APPLICANT � � (/�'c-9'"/ SOLE OWNER: YES /NO ADDRESS ' `T° d� ('� A,I •/ PHONE # Cj2b -2')/ - 002 IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.0 Y - 3 STATE OF INCORPORATION FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DON'T PREPARE FOOD AND CONTINENTAL BREAKFAST): LIST THE NAMES OF YOUR FOOD SANITATION CERTIFIED STAFF (I.E. SERV-SAFE) EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO FOOD SANITATION CERTIFIED STAFF. AT LEAST ONE FOOD SANITATION CERTIFIED STAFF IS REQUIRED ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON THE CERTIFICATE*** 1. EXPIRATION DATE: - / / 2. EXPIRATION DATE: 3. EXPIRATION DATE: / / k 4. EXPIRATION DATE: SIGNATURE OF APPLICANT AND DATE Q:\HealthWpplication Forms\Foodappi.doc Town of Barnstable VzC-1 ,oFt► Tas. Regulatory Services Q RECEIVED Thomas F. Geiler Director c, 9 9 Public Health Division NOV 1 6 2004 ArFG '�A Thomas McKean,Director Q TOWN OF BARNSTABLE HEALTH DEPT. 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE: tz L&07 Barnstable Road Auto Repair 91 Barnstable Road NAME OF FOOD ESTABLISHMENT: Hyannis, MA 02601 ADDRESS OF FOOD ESTABLISHMENT: MAP AND PARCEL OF FOOD ESTABLISHMENT: MAP: 3�7 PARCEL(S) 0 TELEPHONE NUMBER OF FOOD ESTABLISHMENT: NUMBER OF SEATS: INSIDE: ,' OUTSIDE: O TOTAL: 0 TOTAL NUMBER OF BATHROOMS: 2 ANNUAL OR SEASONAL OPERATION: z2zZ4^— TYPICAL HOURS OF OPERATION MON-FRI:2,"-,: /)-n TO _2_: DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) f UY71)j IF SEASONAL: APPROXIMATE DATES OF OPERATION: / / TO / / ***REMINDER*** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY FOOD SERVICE ,--nTAIL FOOD BED & BREAKFAST CONTINENTAL BREAKFAST RESIDENTIAL KITCHEN MOBILE FOOD -TOBACCO SALES FROZEN DAIRY DESSERT MACHINES CATERING OUTSIDE DINING (OVER—+) Q:\Health\Application Forms\Foodappl.doc Ii f IME � Town of Barnstable Regulatory Services • snxxsrnsLe, 9 Mnss. Thomas F. Geiler,Director i639. ♦� Public Health Division Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 - - Fax: 508 790 6304 November 20, 2007 l b J PETER DEMERS BARNSTABLE ROAD AUTO REPAIR INC. 91 BARNSTABLE ROAD HYANNIS MA 02601 - Y ATTENTION: Your food service/retail permit(s) will be invalid after December 31, 2007. ESTABLISHMENTS FEE FOOD SERVICE RETAIL 20.00 FROZEN bESSERT ' MOBILE*O'O_ D BED BREAKFAST TOBACCO 50:00 TOTAL DUE $70.00 Food establishment inspections are ongoing by a Health Inspector; therefore, it is not necessary to make an appointment with the Health Division. However, if your establishment is not open during normal working hours (8:30 - 4:30p.m.), please call 508-862-4644 during these hours to schedule an inspection. Enclosed is a food permit application form. Please complete and sign the form, and mail it along with the required payment on or before December 20, 2007 to the Town of Barnstable, addressed to the Public Health Division, 200 Main Street, Hyannis, MA 02601. Upon satisfactory compliance and receipt of your payment and copies of two current ServSafe Certificates, you will be sent, via mail, the food/retail permit(s) for calendar year 2008. Important: If you are on a Private Well for Drinking Water (not Public Water Service), be sure,to have your well test completed pior to our inspection. Rernindbe to All: 1) Maintain your logs. 2) Establishments with 25+ seats are requ"ired to have a-person trained in anti-choking procedures on premise while food is being'served and to have insurance covering person with training. Failure to renew permit on or before January 1, 2008 will result in an additional fee of $10.00 late charge. If you should have any questions, please call 508-862-4644. torts Rc:.>t Total " es F-es A ,­1 lett:s f �pFTHElp Town of Barnstable y�P pm Department of Health, Safety, and Environmental Se vice?EC 'VED • EARNSTABLE '�: ��r Public Health Division A'E0N1°�A 200 Main Street NOV 17 2004 HyanmS,MA 02601 TOWN OF BARNSTABLE HEALTH DEPT. Office: 508-8624644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health MAIL TO:TOWN OF BARNSTABLE PUBLIC HEALTH DIVISION 200 MAIN STREET ID j HYANNIS,MA 02601 Lj PLEASE INCLUDE THE REQUIRED FEE OF: $50.00 FEE: $50.00 APPLICATION TO RENEW TOBACCO SALES PERMIT LAST NAME OF APPLICANT FIRST NAME MIDDLE INITIAL Barnstable Read .Auto Repair DB/A 91 Barnstable Road Hyannis, MA 02601 STREET ADDRESS TELEPHONE# 0 IV 67 07 L7 FID# Do you currently possess a state license to sell tobacco products? Yes No Each employee who sells tobacco products must receive and understand the Sections VIIb.And VHc. of the Board of Health Prohibition of Smoking Regulation, and the Massachusetts General Law Chapter 270, Section 6.00 (copy provided on next page.) Each employee who sells tobacco products must sign the Employee Signature Form(provided herein.) Signature Date tobaccapp/q/health TOBACCO SALES PERMIT ACKNOWLEDGMENT This form must be initialed and signed by the owner/operator of the establishment applying for a Barnstable Board of Health Tobacco Sales Permit. No permit will be issued until this checklist has been initialed and signed. I have read and understand all subsections within Barnstable Board of Health Regulations regarding the sale and distribution of tobacco products. �j Initials 1/� I understand that it is against the law to sell cigarettes or any tobacco product to anyone less than eighteen (18)years of age,regardless of how old the person looks. 711— Initials I understand that the Barnstable regulation requires anyone selling tobacco products to conclusively establish the customer's age. This means the clerk must ask for and see identification provin the person is at least eighteen(18)years of age. Initials I understand that the Barnstable Tobacco Control Program conducts frequent compliance checks of all tobacco merchants'businesses to ensure that tobacco products are not being sold to minors. This means: a. The Barnstable Tobacco Control Program will send minors into my establishment to attempt the purchase of tobacco. b. These minors will not possess any identification,but will respond truthfully when asked their age. c. Any reported confrontational behavior towards the minor or the enforcement agent during or after the compliance check may result in a permanent revocation of the tobacc�ales permit. Initials I understand that if I am caught selling tobacco products to minors,I will be subject to a warning,fine, and/or permit suspension as set forth in the Board of Health Tobacco Sales Regulations. Initials_��-- I understand that the Barnstable regulations prohibit self-service displays of all tobacco products from which any tobacco products may be selected. (PENDING TUNE 11,2002 BOH MEETING)_ Initials 0 `�— I understand that my tobacco sales permit must be posted at all times in a manner conspicuous to the public. Initials--/—q--- I understand that my Tobacco Sales Employee Signature Form must be read and signed by all employees selling tobacco products,kept on site at all times,and be in a known location by all employees for inspection. Initials By signing this form,I acknowledge that I have read and understand all of the above statements and I further understand that failure to abide by these conditions may jeopardize my Tobacco Sales Per 't. Sarnsfable Road Auto Repair 91 Barnstable Road Hi/?nnis, MA 02ew-- lr G/ (Name of Business) (Owner/Operator Signature) (Date) PERMIT NO: TOWN OF BARNSTABLE =FormatDateTime 650 BOARD OF HEALTH PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 395A and Chapter 111,Section 5 of the General Laws, a permit is hereby granted to: PETER DEMERS D/B/A: BARNSTABLE ROAD AUTO REPAIR INC. Whose place of business is: 91 BARNSTABLE RD , HYANNIS MA 02601 Type of business and any restrictions: RETAIL FOOD ESTABLISHMENT To operate a food establishment in the TOWN OF BARNSTABLE RESTRICTIONS IF ANY: SEATING: ANNUAL: YES SEASONAL: TEMPORARY: F E E S BOARD OF HEALTH RETAIL FOOD STORE: $20.00 Wayne Miller, M.D., Chairperson FOOD SERVICE ESTABLISHMENT: RESIDENTIAL KITCHEN FOR RETAIL SALE: Sumner Kaufman, M.S.P.H. RESIDENTIAL KITCHEN FOR BED+BREAKFAST Susan Rask, R.S. MOBILE FOOD UNIT: Permit expires: TOBACCO SALES: $50.00 December 31, 2005 � FROZEN DESSERT: Thomas A. McKean, RS, CHO CATERER: Director of Public Health f r -o.�d t °FfHE 1 (R ti Town of Barnstable �O REC-EIVED Department of Health, Safety, and Environmental Services + DAMSTABLE, + 9� . Public Health Division DEC 2 3 2003 ATED MA't e 200 Main Street TOWN OF BARNSTABLE Hyannis,MA 02601 HEALTH DEPT. Office: 508-8624644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health MAIL TO:TOWN OF BARNSTABLE PUBLIC HEALTH DIVISION 200 MAIN STREET HYANNIS,MA 02601 PLEASE INCLUDE THE REQUIRED FEE OF: $50.00 FEE: $50.00 APPLICATION TO RENEW TOBACCO SALES PERMIT LAST NAME OF APPLICANT FIRST NAME MIDDLE INITIAL Barnstable Road Auto Repair .91' Barnstable Read DBiA Hyannis, MA 02601 STREET ADDRESS TELEPHONE# FM# a y I D,G, '�3 Do you currently possess a state license to sell tobacco products? Yes `� No Each employee who sells tobacco products must receive and understand the Sections VHb.And VIIc. of the Board of Health Prohibition of Smoking Regulation, and the Massachusetts General Law Chapter 270, Section 6.00 (copy provided on nest page.) Each employee who sells tobacco products must sign the Employee Signature Form(provided herein.) Signature D to tobaccapp/q/health TOBACCO SALES PERMIT ACKNOWLEDGMENT This form must be initialed and signed by the owner/operator of the establishment applying for a Barnstable Board of Health Tobacco Sales Permit. No permit will be issued until this checklist has been initialed and signed. I have read and understand all subsections within Barnstable Board of Health Regulations re ding the sale ' and distribution of tobacco products. 6� Initials (J� I understand that it is against the law to sell cigarettes or any tobacco product to anyone less than eighteen (18)years of age,regardless of how old the person looks. Initials (v� I understand that the Barnstable regulation requires anyone selling tobacco products to conclusively establish the customer's age. This means the clerk must ask for and see identification proving a person is at least eighteen(18)years of age. Initials l dL I understand that the Barnstable Tobacco Control Program conducts frequent compliance checks of all tobacco merchants'businesses to ensure that tobacco products are not being sold to minors. This means: a. The Barnstable Tobacco Control Program will send minors into my establishment to attempt the purchase of tobacco. b. These minors will not possess any identification,but will respond truthfully when asked their age. c. Any reported confrontational behavior towards the minor or the enforcement agent during or after the compliance check may result in a permanent revocation of the tobacco a permit. Initials - I understand that if I am caught selling tobacco products to minors,I will be subject to a warning,fine, and/or permit suspension as set forth in the Board of Health Tobacco Sales Regulations. Initials I understand that the Barnstable regulations prohibit self-service displays of all tobacco products from which any tobacco products may be selected. (PENDING TUNE 11,2002 BOH NIEETIN Initials !'1 I understand that my tobacco sales permit must be posted at all times in a manner conspicuous to the public. Initials 9 I understand that my Tobacco Sales Employee Signature Form must be read and signed by all employees selling tobacco products,kept on site at all times,and be in a known location by all employees for inspection. Initials By signing this form,I acknowledge that I have read and understand all of the above statements and I further understand that failure to abide by these conditions may jeopardize my Tobacco Sales Permit. 7'3*)'7(1-.ft le (Name of Business) ( caner/Operator Signature) (Date) PERMIT NO TOWN OF BARNSTABLE ANUARY 1,2003 650 BOARD OF HEALTH 40 PERMIT TO OPERATE A FOOD.3,ESTABLISHMENT O In accordance with re d under authority of Chapter 94, Section 395A and Chaptefj ,ld,Section 5 of>1'a Oemethl Laws a permit is hereby granted to: PETER DEMERS M D/�/A" BARNSTA�LE GOAD AUTO REPAIR INC. 101 Whose place of business Is �1 BARNSTABLE;,RD, HYANNIS MA 02601 Typean of business and res#rig ions` r RETAIL ESTABLISHMENT Y To operate a food establishment m fhe TOWN fOF..B ►RNS'ITAI3LB RESTRICTIONS IF ANY a; �3 K; SEATING: ANNUAL YES 5 SEASONAL: TEMPORARY.; F E E s, "V BOARD OF HEALTH RETAIL FOOD STORE: $15 b0 FOOD SERVICE ESTABLISHMENT _ Susan G. Rask,R.S.,Chairperson RESIDENTIAL KITCHEN FOR RETAIL SALE v k s s' Ralph A. Murphy,M.D. RESIDENTIAL KITCHEN FOR BED+BREAKFAST "Sumner Kaufman, M.S.P.H. MOBILE FOOD UNIT: �?erI1U1:eXplreS � TOBACCO SALES: December 31;.2003Q FROZEN DESSERT: Thomas A. McKean, RS, CHO MILK` Director of Public Health CATERER: THE - 'o TOWN OF BARNSTABLE HEALTH INSPECTOR'S dr O OFFICE HOURS: Establishment Name Date Page of Pt1�IC HEALTH DIVISION 8:00-9:30A.M �p�367 MAIN STREET t 0o-2AoRI. bb YANNIS,MA 02601 M8624644 1 �, e� C heat el, C E R i !'�Ci► la# C�I:N► O)1 1 FLJ�W � R � �} ' to fQ l ' o � FOOD ESTABtISHnAEf�T PE TION REPORTRaleren ; :rl#etrt; �. �{' n Name 1 - ate a of Operation(s) T A of Inspect on Food Service outine Address Risk MR tail Re-inspection Tele hone Level sidential Kitchen Previous Inspection p ❑ Mobile Date: r ❑ Pre-operation Owner HACCP Y/N ❑Temporary ' ❑ LOW Caterer ❑ Suspect Illness Person in Charge(PIC) Time �❑ Bed&Breakfast ❑ General Complaint In: ❑ HACCP Inspector `hut: Permit No. ❑ other aal Each violation checked requires an eiplanation on the r1affartive pages)and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking Tobacco �-� Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F)❑ Al Pl r Action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14. Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMErrEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4.Food and Water from Approved Source ❑ 5.Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ B.Separation/Segregation/Protection ❑ 20. Time As a Public Health Control ❑ 9.Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 10.Proper Adequate Handwashing ❑ 21. Food and Food Preparation for HSP ❑ 11.Good Hygienic Practices CONSUMER ADVISORY Violations Related to Good Retail Practices(Blue Items) ❑ 22• Posting of Consumer Advisories Critical(C)violations marked must be corrected immediately. Number of Violated Provisions Related Non-critical(N)violations must be corrected immediately or To Foodborne Illnesses Interventions within 90 days as determined by the Board of Health. and Risk Factors(Red Items 1-22): C Official Order for Correction: Based on an inspection today, 23. Management and Personnel (FC-2)(590.003) the items checked indicate violations of 105 CMR 590.000/federal 24. Food and Food Protection (FG3)(590.004) Food Code.This report,when signed below by a Board of Health 25. Equipment and Utensils (FG4)(590.005) member or its agent constitutes an order of the Board of Health. Failure to correct violations cited in this report may result in sus z . �\ a \ ;\V \ a ' 26. Water,Plumbing and Waste (FGS)(590.006) pension or revocation of the food establishment permit and ces t: +� j+Ek!' ? ` a =_\ fe ��\��W N PP \ Y\ i::.\:. .....:.:�F\,..,\: \:.. ..:\ \ :iv. ` :: \3.... a 27. Physical Facility (FG6)(590.007) sation of food establishment operations. If aggrieved by this or \` " """\ ' "` 28. Poisonous or Toxic Materials (FG7)(590.008) der,you have a right to a hearing. Your request must be in writ- ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension 29. Special Requirements (590.009) ing and submitted to the Board of Health at the above address 30. Other within 10 days of receipt of this order. mbargo Emergency Closure ❑ Voluntary Disposal ❑ Other: DATE OF RE-INSPECTION: In is Si to rint: Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered? Y N /I///Ill7 #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature 61:S) Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Violations Related to Foodbome Illness 3-501.14(C) I PHFs Received at Temperatures Interventions and Risk Factors(Red Items 1-22) Violations Related to Foodbome Illness Interventions and Risk r According to Law Cooled to PROTECTION FROM CONTAMINATION Factors(Red Items 1-22) (Cont.) 41°F/45°F Within 4 Hours. FOOD PROTECTION MANAGEMENT 8 Cross-contamination 3-501.15 Cooling Methods for PHFs 1 590.003 A Assignment of Responsibility* 3-302.11(AX1) Raw Animal Foods Separated from PROTECTION FROM CHEMICALS 19 t CooPHF Hot and Cold Holding 590.003 Demonstration of Knowledge* Cooked and RTE Foods* 14 Food or Color Additives' 1 3-501.16(B): Cold PHFs Maintained i or below 2-103.1 I Person in charge-duties Contamination from Raw Ingredients 3-202.12,- Additives* 590.0016( Cold4 1 °F* 1 3-302.11(Ax2) Raw Animal Foods Separated from Each 3-302.14 Protection from Unapproved Additives* 3-501.16(A) Hot PHFs Maintained at or above EMPLOYEE HEALTH Other* 15 Poisonous or Toxic Substances Contamination from the Environment 7-101.1 1 Identifying Information-Original 140°F.* 2 590.003(C) Responsibility of the person in charge to �in g* g 3-501.16(A) Roasts Held at or above 130°F. require reporting by food employees and 3-302.11 A Food Protection* Containers applicants* 3-302.15 Washing Fruits and Vegetables 7-102.11 Common Name-Working Containers* F20 Time as a Public Health Control 590.003(F) Responsibility Of A Food Employee Or An. 3-304.11 Food Contact with Equipment and 7-201.1 1 Separation-Storage* 1 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Utensils* 7-202.1 1 Restriction-Presence and Use! 590.004(H) Variance Requirement Charge* Contamination from the Consumer 7-202.12 Conditions of Use* - 590.003 G Reporting by Person in Charge* 3-306.14 A B Returned Food and Reservice of Food* 7-203.1 1 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 3.1 590.003D Exclusions and Restrictions* Disposition of Adulterated or Contaminated 7-204.11 Sanitizers,Criteria-Chemicals• POPULATIONS(HSP) I 590.00 Removal of Exclusions and Restrictions Food 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.1 1(A) Unpasteurized Pre-packaged Juices and 3-701.11 Discarding or Reconditioning Unsafe 7-204.14 Drying Agents,Criteria* Beverages with Waring Labels* FOOD FROM APPROVED SOURCE Fes* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(B) Use of Pasteurized Eggs* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.1 1 Restricted Use Pesticides,Criteria* 3-801.1 I(D) Raw or Partially Cooked Animal Food and 590.004 A-B Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7-206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served.* 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) Unopened Food Package Not Re-served. 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashmg-Hot Water I Monitoring* 3-202.13 Shell Eggs* Sanitization Temperatures* CONSUMER ADVISORY 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH TIME/TEMPERATURE CONTROLS 22 3-603.1 1 Consumer Advisory Posted for Consumption of .* Animal Foods That are Raw,Undercooked or 3-202.16 Ice Made From Potable concentration and hardness. 16 Proper Cooking Temperatures for 5-101.11 Drinking Water from an Approved System* 4-601-11(A) Equipment Food Contact Surfaces and PHFs Not Otherwise Processed to Eliminate Utensils Clean* Pathogens.*Eflecli�e 1na°01 590. A Bottled Water* 3-401.1 IA(1)(2) Eggs- I55°F 15 Sec. 4-602.11 Cleaning Frequency of Equipment Food- * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* 590.0 B Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Eggs-Immediate Service 145°F I Ssec 3-401.11 A 2 Shelfish and Fish From an Approved Source ( )O Comminuted Fish,Meats&Game 4-702.11 Frequency of Sanitization of Utensils and Animals-155°F 15 sec.* SPECIAL REQUIREMENTS 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in Shellfish* 3-401.1 1(B)(1)(2) Pork and Beef Roast-130°F 121 min* 4-703.]1 Methods of Sanitization-Hot Wader and catering,mobile food,temporary and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec. Sources* . residential kitchen operations should be roper Game and Md Mushrooms Approved b 10 'Adequate Harmdwashlrg O y 2-301.11 Clean Condition-Hands and Arms* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections R u Au th * Stuffing Containing Fish,Meat, above if related to foodborne illness 3-202.18 Shellstst ock Identification Present* 2-301.12 Cl Procedure 2-301.14 When to Wash* Poultry or Ratites-165°F 15 sec.* interventions and risk factors. Other 3-2 01.17 Game Animals* 1 Good Hygienic Practices C Wild Mushrooms 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail -21 RecelvlmmglCondltion 2401.11 Eating,Drinking or Using Tobacco* 145°F* practices should be debited under#29- 3-202.11 PHFs Received at Pr Temperatures* 2401.12 Discharges From the Eyes,Nose and 3401.12 Raw Animal Foods Cooked in a Special Requirements. Mouth* Microwave 165°F* 3-202.15 Package Integrity* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-101.11 Food Safe and Unadulterated 3-301.12 Preventing Contamination When T • 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec.* 6' Tags/Records:Shellstock 12 Prevention of Contanmirmatlon from Hands 17 Reheating for Hot Holding Blue Items 23-30) 590.004(E) Preventing Contamination from 3-403.11(A)&(D) PHFs 165°F 15 sec.* Critical and non-critical violations,which do not relate to the 3-202.18 Shellstock Identification* Employees* 3 403.11(B) Microwave-165°F 2 Minute Standing. joodborne illness interventions and risk factors listed above,can be 3-203.12 Shellstock Identification Maintained* 13 ���FadlMies * found in the following sections of the Food Code and 105 CMR Time Tags/Records:Fish Products 590.000. Conveniently located and Accessible 3-403.11(C) Commercially Processed RTE Food- 3�02.11 Parasite Destruction* Item Good Retail Practices FC 590.000 3402.12 Records,Creation and Retention* 5-203.11 Numbers and ties* I 140°F* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-403.11 E Remaining Unsliced Portions of Beef 24. Food and Food Protection FC-3 .004 590. J Labeling of tngredierrts' ( ) g Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance Roasts* 25. Equipment and Utensils FC-4 .005 IHACCP Plans Suppled wrtlm Soap and Hand Drying 1g Proper Cooling of PHFs 26. Water,Plumbing and Waste FC-5 .006 * Devices 27. Physical Facility FC-6 .007 3-502.11 Specialized Methods 3-501.14(A) Cooling Cooked PHFs from 140°F to 6-301.11 Handwas Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 OOtI 3-502.12 Reduced oxygen ,criteria' 2g. S Requirements 009 ecial (r301.12 Hand Provisio 70°F Within 2 Hours and From 70°F n 8-]03.12 Conformance with Approved Procedures' to 41°F/45°F Within 4 Hours.• 1 30. 1 Other 3-501.14(B) Cooling PHFs Made From Ambient s:5Wo 2.m. Temperature Ingredients to 41°F/45°F 11 Within 4 Hours* •Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. PERMIT NO TOWN OF BARNSTABLE JANUARY 1, 2004 650 BOARD OF HEALTH PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 395A and Chapter 111,Section 5 of the General Laws,a permit is hereby granted to: PETER DEMERS D/B/A: BARNSTABLE ROAD AUTO REPAIR INC. Whose place of business is: 91 BARNSTABLE RD , HYANNIS MA 02601 Type of business and any restrictions: RETAIL ESTABLISHMENT To operate a food establishment in the TOWN OF BARNSTABLE RESTRICTIONS IF ANY SEATING: ANNUAL: YES SEASONAL: TEMPORARY: F E E S BOARD OF HEALTH RETAIL FOOD STORE: $15.00 Wayne Miller,M.D.,Chairperson FOOD SERVICE ESTABLISHMENT RESIDENTIAL KITCHEN FOR RETAIL SALE Sumner Kaufman, M.S.P.H. RESIDENTIAL KITCHEN FOR BED+BREAKFAST Susan Rask, R.S. MOBILE FOOD UNIT: Permit expires: TOBACCO SALES: $50.00 December 31, 2004 � FROZEN DESSERT: Thomas A. McKean, RS, CHO MILK:CATERER: Director of Public Health I Town of Barnstable +' ' Regulatory Services6a�_-- Thomas F. Geiler,Director � ,� DEC 2 3 2003 9'" * AB '� Public Health Division Q��t63g. Aim TOWN OF BARNSTABLE Thomas McKean,Director HEALTH KEPT. 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERIM TO OPERATE A FOOD ESTABLISHMENT Barnstable Road Auto Repair DATE: \-- 91 Barnstable Road Hyannis, MA 02601 ti NAME OF FOOD ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMENT: MAP AND PARCEL OF FOOD ESTABLISHMENT: MAP: PARCEL(S) O TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 9 7/ - 0032 NUMBER OF SEATS: INSIDE: OUTSIDE: . TOTAL: TOTAL NUMBER OF BATHROOMS: 2— f ANN[TAL OR SEASONAL OPERATION: /I�PNo-t- TYPICAL HOURS OF OPERATION MON-FRI: �: TO DAYS CLOSED EXCLUDING HOLIDAYS(I.E. MONDAYS) L fZ IF SEASONAL: APPROXIMATE DATES OF OPERATION: / / TO ***REMMER*** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY FOOD SERVICE s✓ffETAIL FOOD e-hV_r 4— C AA9,4- rw j J 174-e-ly 0r7`t/ BED &BREAKFAST CONTINENTAL BREAKFAST RESIDENTIAL KITCHEN MOBILE FOOD TOBACCO SALES FROZEN DAIRY DESSERT MACHINES CATERING (OVER---4 ) OUTSIDE DINING QAHedWApplication FornslFoodappl.doc ***REMINDER*** IF OUTSIDE DINING,YOU MUST BE-APPROVED BY THE BOARD OF HEALTH AND LICENSING,AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? CONTACT INFORMATION: FULL NAME OF APPLICANT �L � C" SOLE OWNER::YES/NO Cry ADDRESS �U�o�G�7 r �3 ,ow- G� PHONE# ([ia 3) IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION A m FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DON'T PREPARE FOOD AND CONTINENTAL BREAKFAST): LIST THE NAMES OF YOUR FOOD SANITATION CERTIFIED STAFF (I.E. SERV-SAFE) EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO FOOD SANITATION CERTIFIED STAFF. AT LEAS& ONE FOOD SANITATION CERTIFIED STAFF IS REQUIRED ONSITE DURING ALLMURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON VHE CERTIFICATE*** 1. EXPIRATION DATE: / / 2. EXPIRATION DATE: / / 3. EXPIRATION DATE: / 4. EXPIRATION DATE: SIGNATURE OF APPLICANT AND DATE Q:\IealthWpplication Forms\Foodappl.doc Town of Ba^R."' 1{e °FINE r°y, ' Regulatory Services ti Thomas F. Geiler,Director '^'MASS. � ' Public Health Division per AjFO 39. Thomas McKean,Director 367 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Renewal: No Fee SEATING ANNUAL SEASONAL ASSESSORS MAP AND PARCEL NO. 7 14 DATE 4k— APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT FULL NAME OF APPLICANT Barnstable Road Auto Repair 91 Barnstable Road NAME OF FOOD ESTABLISHMENT Hyannis, MA 02-601 ADDRESS OF FOOD ESTABLISHMENT TELEPHONE NUMBER �'� 7�^ � TYPE OF ESTABLISHMENT: FOOD SERVICE RETAIL FOOD MILK BED AND BREAKFAST CONT.BR. RES.KITCHEN MOBILE FOOD TOBACCO SALES FROZEN DESSERT �_ CATERING SOLE OWNER: YES --NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. ® Y-302! � STATE OF INCORPORATION ei4 FULL NAME AND HOME ADDRESS OF: PRESIDENT F&72= 7 o t� d" ! 14— TREASURER CLERK SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# �� Foodesdwp/q Town of �OFTHETp�� Regulatory �.ervices � Thomas F. Geiler, Director IARNSTABLE, • \ i639. �, Public Health Division. �\ `0 AlFo►�a�°i Thomas McKean, Director 367 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 1 SEATING `' ANNUAL C/ SEASONAL ASSESSORS MAP AND PARCEL No. DATE APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT FULL NAME OF APPLICANT &E e/2�R 0C-W1 011 NAME OF FOOD ESTABLISHMENT _�� hS3�� Aa ?� ADDRESS OF FOOD ESTABLISHMENT �/f R,*hJ-AW Ze- A-.7, TELEPHONE NUMBER 2 7/ - Ob 3 3 TYPE OF ESTABLISHMENT: FOOD SERVICE RETAIL FOOD -MILK BED AND BREAKFAST CONT.BR. RES.KITCHEN MOBILE FOOD TOBACCO SALES ---'FROZEN DESSERT CATERING -SOLE OWNER: YES NO v IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. O.Y-36 702d3 STATE OF INCORPORATION /"hf} FULL NAME AND HOME ADDRESS OF: PRESIDENT EE/� 707761's /7yn Gc j J!'r A, . G-,,. TREASURER ► CLERK f^V�' SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS I2Ya Otv s 4' hk e� fir,lL�I& HOME TELEPHONE# _fVf- Foodesdwp/q HIBIT a c� w ,( a III PETER A.DEMERS _ ASE CERTIFIED MECHANIC UNOC Barnstable Rd. Auto Repair Inc. 91 BARNSTAELE RD. HYANNIS,MA.02601 (508)771-0033 STATE INSPECTIONS•TUNE UPS•BRAKES•EXHAUST- KERR LEGAL GROUP, LLC 100 Grandview Road,Suite 302 . Braintree,Massachusetts 02184 PH:(781)849-6780 FAX:(781)849-0680 E-Mail:jlk@kerrlegalgroup.com BY FEDEX OVERNIGHT TRACKING NO: 8750 8364 3602 May 19, 2011 David Stanton. Barnstable Board of Health 200 Main Street Hyannis, Massachusetts RE: Barnstable Road Auto Repair, Inc. vs. Xcel Environmental, Inc. Our File Number: 09-023-JK Dear Mr. Stanton: Enclosed please find your original file with documents which were produced as Exhibits at your deposition on May 4, 2011 with regard to the above-referenced matter. As your file is marked.with'the "original" Exhibit labels, kindly keep this file and its documents available should this matter go to trial. Should you have any questions, please do not hesitate to contact me. Very truly yours, John L. Kerr JLK:dcm ; i Enclosures EXHIBIT Commonwealth of Massachusetts BARNSTABLE ss. SUPERIOR Court Docket No. 2009-301 BARNSTABLE ROAD AUTO REFAIR,INC. Plaintiff(s) M.R.C.P. VS. Rule 30(a) &,p q Rule 45 �p p T9(j XCEL ENVIRONMENTAL,INC. ' 9/yp10 q)- NCO Defendant(s) �`S�iVTF F AO q� 9STFASSp To: DAVID STANTON F9S N�pR BARNSTABLE BOARD OF HEALTH 200 MAIN STREET HYANNIS,MA Greetings: YOU ARE HEREBY COMMANDED in the name of the Commonwealth of Massachusetts in accordance with the provisions of Rule 45 of the Massachusetts Rules of Civil Procedure to appear and testify on behalf of DEFENDANT before a Notary Public of the Commonwealth, at the office of THOMAS M.GRIMMER Attorney JOHN L.KERR ,No. 149 MAIN STREET , in the City of HYANNIS,MA , on the 4TH day of MAY , 2011 at 10:00 o'clock AM , and to testify as to your knowledge, at the taking of the deposition in the above-entitled action. PLEASE CONTACT ATTORNEY JOHN L. KERR AT (781)849-6780 UPON RECEIPT. Hereof fail not as you will alswer your default.under the pains and penalties in the law in that behalf made and provided o I I ►I Dated APRIL 2 , 2011j\0 AY4I���, JOHN L. KERR Q oxsSioti 0 Attorney for DEFENDANT 100 GRANDVIEW ROAD, SUIT E 302 — = Address J � BRAINTREE,MA 02184 My Commission expires January 1 'f,201y3 City or Town '. � �,� '> •�'+'� va 04/01/2011 19:22 7818490680 KERR PAGE 04/17 COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, SS SUPERIOR COURT DEPARTMENT CIVIL ACTION NO: 2009-301 BARNSTABLE ROAD AUTO REPAIR, INC., Plaintiff Vs. * RE-NOTICE OF TAKING * DEPOSITION XCEL ENVIRONMENTAL, INC., Defendant To: Thomas M. Cgmuner, Esquire 149 Main Street Hyannis, Massachusetts 02601 Please take notice that at 10:00 a.m on Wednesday. May 4, 2011, at the law offices of Thomas M. Grimmer, Esquire, 149 Main Street, Hyannis, Massachusetts 02601, the Defendant, Xcel Environmental, Inc., in this action by its attorney John L. Kerr, Esquire, will take the deposition upon oral examination of David Stanton of Barnstable Board of Health 200 Main Street aI annis Massachusetts 02601, pursuant to the applicable provisions of the Massachusetts Rules of Civil Procedure, before G & M Court Reporters, Ltd., Notary Public.. in and for the Commonwealth of Massachusetts, or before some other officer authorized by law to administer oaths. "The deponent is required to produce some form of identification incorporating a photograph at the deposition. You are invited to attend and cross-examine. Respectfully Submitted, JoTh L. Kerr, Esquire KERR LEGAL GROUP, LLC 100 Grandview Road, Suite 302 Braintree, Massachusetts 02184 Tel: (781) 849-6780 Fax: (781) 849-0680 E-mail:jlk@kerrlegalgroup.com BBO#546175 cc: G& M Court Reporters, Ltd. 04/01/2011 19:22 7818490680 KERR PAGE 05/17 CERTIFICATE OF SERVICE 1, John L. Kerr, attorney for the defendant, Xcel Environmental, Inc. hereby certify that on this day..1 have served a copy of the Re-Notice of Taking Deposition of David Stanton of Barnstable Board of Health upon the parties to this action by first class mail, to: Thomas M. Grimmer,Esquire 149 Main Street Hyannis, Massachusetts 02601 Date: } Joa L, Kerr, 12squire KERR LEGAL GROUP, LLC 100 Grandview Road, Suite 302 Braintree, Massachusetts 02184 Tel: (781) 849-6780 Fax: (781) 849-0680 E-Maid: jlkakerrlegalgroup com BBO#546175 EXHIBI� s aS // Health Complaints 03-May-11 Time: 8:10:00 AM Date: 3/22/2006 Complaint Number: 18705 Referred To: ALISHA PARKER Taken By: THOMAS MCKEAN Complaint Type: ARTICLE XXXIX HAZARDOUS WASTE Article X Detail: PRODUCT INTEGRITY Business Name: SUNDCO\BARN RD AUTO REPAIR Number: 91 Street: BARNSTABLE ROAD Village: HYANNIS Assessors Map Parcel: 327-026 Complainant's Name: HYANNIS FIRE, ERIC H. Address: Telephone Number: Complaint Description: A LEAKING GASOLINE TANK PRESENT, REQUEST BOH REPS. Actions Taken/Results., AP WENT TO SAID LOCATION AND MET WITH HYANNIS FIRE (ERIC H)AND GAS STATION OWNER PETER DEMERS. DS MET UP AT SAID LOCATION AT 9:40 AM. DS BROUGHT RESIDENTIAL FILE, HMTANK RECORDS, ZOC LOCATION AND TAPE MEASURE TO CHECK MONITORING WELLS ONSITE. DEP ARRIVED (MICHAEL WHITESIDE AND JAMIE) BETH OF CLEAN HARBORS ALSO ARRIVED TO SURVEY AND :'GIVE AN ESTIMATE FOR TANK REMOVAL. SINGLE WALL STEEL TANK. RECENTLY NOTICED THAT HIS NIGHTLY MONITORING SYSTEM (11 PM TO 5AM)WAS SHOWING A POSSIBLE SMALL LOSS OF PRODUCT. OWNER CONTACTED TESTING COMPANY- XCEL-THAT ROUTINELY TEST TANKS FOR ANNUAL INSPECTIONS - LAST TEST- JANUARY OF 2006) TO LET THEM KNOW HE WAS HAVING A CONCERN OVER HIS NIGHTLY TESTING INFORMATION. XCEL ; TESTED THE TANKS ON 3/21/06 AND DIDN'T 1 Health Complaints 03-May-11 FIND ANYTHING. THEY TOLD HIM TO DISCONNECT TANK 1 FROM TANK 2 TO KEEP IT ISOLATED AND TO LEAVE THE PUMP OFF OVERNIGHT. PETER CHECKED THE LEVEL IN THE MORNING. BY MORINING IT APPEARED THAT .APPROXIMATELY 50 GALLONS OF GASOLINE HAD BEEN LOST OVER NIGHT. =IRE DEPT. WAS NOTIFIED. FIRE DEPT. ESTIMATED THAT APPROXIMATELY 10 .GALS\HOUR WERE BEING LOST. A PUMP OUT COMPANY WAS NOTIFIED IMMEDIATELY BY PETER DEMERS. A CHECK 3 HOURS LATER SHOWED APPROXIMATELY 80 GALLONS HAD BEEN LOST SINCE THE FIRST DETECTION. 3 MONITORING WELLS LOCATED ONSITE. WELL TO THE SOUTH OF TANK WAS APPROXIMATELY 34' DEEP AND HAD A STRONG ODOR OF GASOLINE PRESENT. WELL TO THE WEST OF THE TANK HAD LITTLE TO NO GASOLINE ODOR PRESENT. ANOTHER WELL WAS LOCATED THAT WAS NOT ON THE PLANS, AND HAD A HOLE IN THE TOP OF IT, WHICH WILL NEED A PROPER CAP INSTALLED ON IT. THE PUMP OUT COMPANY(MARTINI'S) ARRIVED AT AROUND 11:45 AM AND PUMPED OUT THE LEAKING TANK. THEY WERE GOING TO PUMP OUT ALL 3 TANKS. OWNER AWAITING CONTRACT BIDS FOR REMOVAL OF TANKS, AND CONTAMINATED SOILS. AWAITING A CALL FROM THE OWNER OR HY FIRE WHEN REMOVAL OCCURS. THERE ARE THREE 4,000 GALLON UNDERGROUND GASOLINE STORAGE TANKS PRESENT AT SAID LOCATION, ALL INSTALLED ON 6/18/1981. LOCATED OUTSIDE OF ZOC. THEREFORE REQUIRED REMOVAL MANDATORY BY 6/18/2011, AS THEY ARE SINGLE WALL SS TANK CONSTRUCTION PER BOH FUEL TANK REGULATION. THE OWNER PLANS ON REMOVING ALL THREE TANKS ASAP AND INSTALLING NEW UP TO CODE TANKS. ON 5/16/06, AP WENT TO SAID LOCATION WITH DEPUTY DEAN MELANSON OF HYANNIS FIRE, ROBERT DANCKERT (LSP REP FROM GEO INSIGHT), 2 Health Complaints 03-May-11 ENVIROSAFE (PUMPING\HAZMAT COMPANY), CHILDS EXCAVATION (TANK REMOVAL AND HAULING)AND PETER DEMERS (OWNER OF GASOLINE\AUTO REPAIR STATION) HYANNIS FIRE IS SHORT STAFFED, AND DEAN MELANSON HAD OTHER DETAILS TO DO, AND HAD AP STAY ONSIGHT DURING REMOVAL AND TO CALL IF ANY PROBLEMS AROSE. IDS RELIEVED AP AT 1:30 PM SO SHE COULD GO TO LUNCH AND GATHER INFORMATION IFOR HER BOH HEARING REGARDING CUMBERLAND FARMS GASOLINE STORAGE TANKS. DEAN MELANSON AND AP ARRIVED BACK ON SITE AFTER THEIR PORTION OF THE BOH HEARING WAS COMPLETED. AT 4:45 PM ALL THREE TANKS HAD BEEN REMOVED. PHOTOS ON FILE. SOIL EXCAVATION TO COMMENCE ON 5/17/06. SAMPLES WERE TAKEN BY ROBERT. THERE WERE NO OBVIOUS SIGNS OF LEAKAGE FROM ANY OF THE TANKS. THE CAUSE OF RELEASE MAY HAVE BEEN FROM A CRACKED MANIFOLD AND NOT A LEAKING TANK. THE TANKS WERE PURGED OF AIR VIA AIR COMPRESSOR AND VENTURI CONE. THE TANKS WERE SAMPLED FOR LEL. DRY ICE WAS ADDED TO THE TANKS. TANKS WERE HAULED AWAY TO DENNIS TO BE CUT UP. AT THIS TIME, OWNER DOES NOT PLAN ON INSTALLING NEW GASOLINE TANKS. ON 5/17/06 IDS WENT BACK TO SAID LOCATION AND MET WITH THE ROB (FROM LSP COMPANY) SOIL REMOVAL HAS BEGUN. THE READINGS WERE STILL PRETTY HIGH, AND GOT STONGER AS THEY GOT DEEPER INTO THE SOILS. THE CONTAMINATED SOIL WAS PILED UP ON A PLASTIC SHEET ONSITE. GROUND WATER ANALYTICAL WILL BE DOING THE LAB SOIL TESTS (TAKES ABOUT 5 DAYS) AND THE SOILS SHOULD BE REMOVED IN ABOUT 2 WEEKS. CLEAN FILL WAS USED TO FILL IN AREAS AFTER THE EXCAVATION OCCURRED. IDS STOPPED BY A COUPLE TIMES ON HIS WAY IN AND OUT OF THE OFFICE TO SEE HOW THE PROCESS WAS GOING. ON 5/17/06 ALL OF THE.TANK 3 Health Complaints 03-May-11 AREA HAD BEEN EXCAVATED. ON 5/18/06 THEY PLAN ON EXCAVATING AROUND THE. tPUMP AREA. DS STOPPED BY AGAIN ON 15/18/06. THE LSP WAS TAKING MORE SAMPLES FROM THE BOTTOM EXCAVATION AREA NEAR THE GAS PUMP LOCATION. ALL SAMPLES TAKEN, AND CONTAMINATED SOIL PILED UP ON PLASTIC AWAITING LAB RESULTS. SITE IS CURRENTLY BEING FILLED BACK IN WITH CLEAN FILL. IT WILL NOW BE A WHILE UNTIL THEY CHOOSE A METHOD OF TREATMENT FOR THE CONTAMINATED GROUND WATER. Investigation Date: 3/22/2006 Investigation Time: 8:20:00 AM 4 TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION MAP NO. 3� -7 PARCEL NO. ---1 6 ADDRESS OF TANK: /` w%/7-� r'r'1r'' ''S pry ' VILLAGE: 1 MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) : OWNER NAME: 'f ' �� PHONE: 7 INSTALLATION DATE: (� �, BY: I.NSTALLER ADDRESS: Y `"'' ' �� "'� � � '` ' -CERT.140. *TANK LOCATION: /?,ram f^' ds �''`r ; sg, �• �' s << t7., 6 (DCQOizuw TANK LOQATSON WSTH I4QO70Troa UiLDiNO) CAPACITY ��-" TYPE OF TANK . AGE YRS. FUECHEMICAL ,T TESTING CERTIFICATION C I PASS C I FAIL DATE LEAK DETECTION C I CHECK IF N/A TYPE/BRAND ZONE OF CONTRIBUTION C 7 YES C I NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED [A' YES C ] NO DATE CONSERVATION CHECK IF N/A DATE I BOARD OF HEALTH TAG NO. [ q6 I DATE 6/� W?q PLEASE PROVIDE A SKETCH 'SHOWING THE TANK LOCATION ON THE HACK OF THIS CARD PENGAD SM431-6M u r TOWN OF BARNSTABLE UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION v' MAP NO. -3 7 PARCEL NO. RDDRESS OF TANK: �� /'rt �, ` ` ' J VILLAGE: �r}` .�••t J Nurrb4mr YtP-w MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) : Moto RAVIA9 91.9"r—Rc OWNER NAME: / - < s i PHONE: 7 ? / G u 2 2 INSTALLATION DATE: f7�J/ BY INSTALLER ADDRESS: z,> `"' • *TANK LOCATION: ic c acmoPi z a¢ TANK {_OQAT 2 ON WITH PtQOPQCT TO mlJ I LD I N0) CAPACITY TYPE OF TANK , - AGE ef-f YRS. FUEL/CHEMICAL Gig_1 TESTING CERTIFICATION C I PASS C ] FAIL DATE LEAK DETECTION C ] CHECK IF N/A TYPE/BRAND ZONE OF CONTRIBUTION [X, YES C I NO DATE TO BE REMOVED 400 / FIRE DEPT. PERMIT ISSUED C ] YES C I NO DATE CONSERVATION C ] CHECK IF N/A DATE / BOARD OF HEALTH TAG "0. C /) / 7 , ' ] DATE C i . PLEASE,;PRO.VIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF ,THIS CARD /' r• �, 'omrrxort ni,4 t1� af. ag�acfjugett�i S l 'DP,ARTMENT fJF;PU �:IIG SAFir:TY--QIVISI ON of PIRG PiiRVN' ICN j - 1 r „ r d �Q1Id ,QMMQNWwbTH'AVRNtlR(, : �� t ? j tys�j t C y or Tgvm t r PER IT ,,n.K ordance with the.provisions of thapter 148'G L. as provided in .. •,:T this Oirmit is granted to ZeC2 Inc. _ A wa Uas Barnstable Rd. Ou (Full nam, 0 person, fi„n at eonwatlon granted p�mil�) fibnstall_ 3-- t Q.40..9a1 anks._. for�_� rie.- .. e) -Lcgi State Clearly .• why irpo permit -- 4 u granted i Reittric ions: wa Gas , l3arnstable Rd. b,^Louis St. r at.; .9 X _ . _�- - IGive location by Waist and no.;or doienbe in such manner as to provide ado den . t of loceti I fee Paid. 'oa' _- -- � ��t ISiQnatur0 of offiaa g,anlai c,m,t q. ' "(`his permit will ON, Ire, 18a/ ,tle, . W.ATM$ PK1k.M!T MUST 13E,;CONSPICUOIVSLY.POSTED UPON THE PRtMISES.I °,del 4Or y-ir-.� '+i 'mom —..��-�+�a�..�C.•il �:?'� �_. -�ai. � r...:..I,s�!l': ��•��f� sk R 84. - �; Ito, "1 w z CALl\� o � R a � �' a i TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION MAP NO. 3,1 7 PARCEL NO. -2 6 ADDRESS OF TANK: �� .�.r �^, r VILLAGE• A Y'.d? -r( ' ✓ Nurwb�r Ytrwmt MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) : nfbjco /��i�oP�7la,.Z�v� OWNER NAME: _ � r PHONE: GG �� INSTALLATION DATE: 6, � � BY: 2c INSTALLER ADDRESS• ?�� � �i° Ntf?rf' A, 0 -CERT.iJ0. *TANK LOCATION: (DC®OPt Z nG TANK LOQAT Z ON W I Thl mmomQOT TO wu Z LLD I NO) C CAPACITY � TYPE OF TANK AGE iJ YRS. FUEL/CHEMICAL ` TESTING CERTIFICATION C ] PASS C ] FAIL= 1,� DATE LEAK DETECTION C7 CHECK IF N/A TYPE/BRAND ZONE OF CONTRIBUTION [ YES [ ] NO DATE TO BE REMOVED .l FIRE DEPT. PERMIT ISSUED YES C ] NO DATE CONSERVATION [ 1 CHECK IF N/A DATE BOARD OF HEALTH TAG No. Cq6 ] DATE 1 11 /91 #3PLEASE .PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE HACK OF THIS CARD PENGAD gpp.ggiasg fn 1.� COMMONWEALTH OF THE COMMONWEALTH OF ( Autumn S.Sarzana,Esquire MASSACHUSETTS MASSACHUSETTS 150 California Street L AD COURT LAND COURT Newton,MA 02458 DEPARTMENT OF THE TRIAL DEPARTMENT OF THE TRIAL (617)558-0500 The Bamst; COURT COURT The Barnstable Patriot March 10,1 March 10,*March 17 and March 24,2006 ' Case No.318594 t Case No.:319077 To Michael G.Cavic;Helen C.Cavic and fb:Michael T.Robinson and to all persons to all persons entitled to the benefit of the LEGAL 40TICES _ entitled to the benefit of the Servicemem- Servicemembers Civil ReliefAct.National bars Civil Relief Act.First Horizon Home City Mortgage,.Inc. f/k/a National City TOWN OF BARNSTABLE LoanCorporation claimingto bathe holder Mortgage Co.claiming to be the holder BOARD Oil'HEALTH of a Mortgage covering real property in of a.Mortgage covering_real property in Hyannis (Barnstable), numbered 11 Centerville(Bamstable),nurnbere d79Au- Under the authority of M.G.L.Chapter 111 ;Section 31,the Town of Barnstable Board Greenwood Avenue given by Michael tumn Drive given by Michael G.Cavic and of Health held public hearings on February 28,2006 and adopted revisions to Sections mortgage c 307-4,318-1,322-4,322-7,322-8.326-2 and 326-3 of the Town of Barnstable Code. Registratior ,T. Robinson to Mortgage Electronic Helen C.Cavic to National City Mortgage dated Septa Registration Systems, Inc,dated July 8; Co.,dated May6,2004,and registeredwith Below are these sections as adopted: Deeds in tc 2005, and recorded with the Barnstable the Barnstable County Registry District of Systems,In County Registry of Deeds at Book 20027, the Land Court as Document No.966648 Chapter 307:,BODY ART ESTABLISHMElt'TS holder for bi Page 251 and now held by the plaintiff and noted on CertificateofTdle No.148746 §3074.Prohibited practices. by assignment has filed with said court a has filed with said court a complaint for E.The.following practices are hereby prohibited unless performed.by a medical doctor the same,0 complaint for authority to foreclose said authorityto foreclose said mortgage in the licensed,"by the Commonwealth of Massachusetts:tongue splitting;branding;three Massachusf mortgage in the manner following: by mannerfollowing:by entry and possession . dime nsibnal/beading/implementation,tooth filing/fracturing/removaUtattooing;cartilage mortgaged modification;genital modification;introduction of saline or other liquids. described it entry and possession and exercise of and exercise of power of sale. 9 q All that cert power of.sale. If you are entitled to the If you are entitled to the benefits of the Ser- Barnstable; benefitsoftheServicemembersCivilRelief vicemembers Civil Relief Act asamended Chapte�318:FEESCHEDULE Nortstable; Act as amended and you object to'such, and you object to such foreclosure you . §3184,t Fees enumerated. Northeaster foreclosure you or your attorney.should or your attorney should file a written Type. Southeaster file a written appearance and answer in appearance and answer in said court at Retail food store/wholesale food less than 1,000 cubic feet of display area;only Southbaste said court at Boston on or before the 24" Boston on or before the 24th day of April where the selling of food is kept in one area of the business and is incidental to the Being Lot e day of April 2006 or you may be forever 2006,or you may be forever barred from Primary business. barred from claiming that such foreclosure claiming that such foreclosure is invalid Fee:$20.00 Barnstable,_ N.Sstablavery,li is invalid under said act. under said act. which said Witness, KARYN F. SCHEIER, Chief Witness,.KARYN F. SCHEIER, Chief. Chaper 322:FOOD ESTABLISHMENTS I m ARTICLE I Minimum Sanitation Standards Book 239 P; Justice of said Court this 13 day of Justice of said Court this 10th day of Also descriE March 2006. March 2006. §322$.Toilet facilities. The land in All food-service establishments shall provide adequate, conveniently located toilet .and describ; Deborah J.Patterson Deborah J.Patterson facilities for its employees. NORTHWE; Recorder Recorder All food-service establishments shall provide adequate, conveniently located toilet feet; facilities for its patrons at any locations where seating is provided. NORTHERS The Barnstable Patriot § 22,7.Vending machines.mu H 3E 38 eight and March 24,2006 March 24 2006 Any:establishment with vending machines dispensing potentially hazardous food or drink must be licensed by the Board of Health. SOUT SOOT 141 §322AS =8.violations and penalties. SOUTHWE; NOTICES • A. This regulation may be enforced by the provisions.of MGL Chapter 40.§21 D '? feet. B. The fine for any violation under this regulation shall'be$106.00 TOWN OF.BARNSTABLE TOWN OF BARNSTABLE C. Each day shall constitute a separate violation. Containing< LICENSING AUTHORITY. LICENSING AUTHORITY land entitled NOTICE OF PUBLIC HEARING , NOTICE OF PUBLIC HEARING Chapter 326:FUEL AND CHEMICAL STORAGE TANKS Scale 1"-1( TRANSFER OF ANNUAL CHANGE OF DESCRIPTION AND §32q-2.Definitions. and Surveys COMMON VICTUALER WINE& CHANGE OF MANAGER For the purpose of this regulation,the following terms shall have the meanings as- MALT MALT LICENSE sign d to them: Subject to ai ZONT OF CONTRIBUTION=Designated area contributing to public supply record insofr In accordance with Chapters 136,138 and i 9 g p pply wells, he Barnstable Licensing Authority will on alma showing State a roved zone II locations and town designated zones of PropertyAdr old a.public hearing on the application 140 of the General Laws, as amended, P. 9 PP 9 F P g pP Mad Hatter, LLC d/b/a. Greenhouse contributions,entitled"Zones of Contribution to Public Water Supply Wells,Town f Scott Eurenius,d/b/a Scottie's Famous of.Bamstable,Massachusetts,"dated February 1,2006,and prepared b Town of of Deeds in I 'izza,2441 annou h Road„Hyannis,MA,.. Restaurant, amp Route nag Hyannis; ry P P y The remise y 9 Y Christopher Campbell,Manager,holding Barnstable G.I.S.Unit. � P colt Eurenius,Manager,for Transfer of 326-3.Regulations more strip se.ssments a an Annual All Alcohol Innholder License, §. 9 gent than or in addition to state regulations. he Annual Common Victualer Wine & Thi section is intended tote in addition to and more restrictive than the rovisions of record entitk Salt License to Holt Pizza,Inc./Ste hen has petitioned the Barnstable Licensing e P of all easem P Authority for a Change of Description 5271CMR 9.00 et seq. tenancies ar Holt,Jr.,d/b/a Scottie's Famous Pizza, proposed to read as follows,196unitmotel B. i Existing tanks.This subsection shall apply to tanks in place on the effective 'tephen M.Holt,Jr.,Manager. with 2 stories, basement and 4 function date of this regulation and which complete documentation as described in Subseo• T aid hearing will be held on Monday,April tiort A is available.Within zones of contribution,such tanks,that do not satisfy the as a deposit rooms,pool&deck area. Basement: 3 ' ty 2006 at 9:30 a.m.or as soon following function.rooms;firstfloor-kitchen,lounge; construction requirements of Subsection D of section 326-8,may be maintained bidder(the r s practical in the Town Hall Building,2nd restaurant,pool&deckarea;secondtloor. fon20 years,'provided that proper testing reveals no leakage.Outside of zones of high bidder I loon Hearing Room,.367.Main Street, 1 function room. 'Entrance/exit Route contribution;such tanks,that do not satisfy the construction requirements of Subsec Purchase tt lyannis. tion D.of Section 326-8,maybe maintained for 30 ears,provided that proper testingthe sale at th 132 and Bearse's Way;and a Change'of Y Y P P P Road,Suite Manager to Christopher Connolly. . reveals no leakage. Martin E.Hoxie, 0. Underground fuel and chemical storage tanks and stems,in lace on the as may be d. Said hearing will be held on Monday,April 9 9 Y P Chairperson 3,2006 at 9:30 a.m.or as soon following effective data of this regulation and 20 years of age or older,located in zones of C Gene Burman as practical in the Town Hall Building,2nd` contribution to public,supply wells,that do not satisfy the construction requirements Paul Sullivan Floor Hearing Room, 367 Main Street, of Subsection D of section 326-8,shall be removed under the direction of the Fire Barnstable Licensing Authority Hyannis. Chief. P. Underground fuel and chemical storage tanks and systems 30 years of ahe'Bge arch 2 ,able200 Patriot Martin E.Hoxie, or older,that do not satisfy the construction requirements of Subsection D of section arch 24,2006 Chair. k6-8,shall be removed under the direction of the Fire Chief. Gene Burman Paul Sullivan Wayne Miller M.D. tttal� Bamstable Licensing Authority Sumner Kaufman,MSPH " Paul Canni f,D.M.D. al ads f The Barnstable Patriot The Barnstable Patriot EXHIBIT The Bamstal 1 March 24,2006 March 24,2006 March 10,M • W Town of Barnstable KAM • snirrsrxe�. • Board of Health 200 Main Street, Hyannis MA 02601 i Office: 508-862-4644 Wayne Miller,M.D.. FAX: 509-790-6304 Sumner Kaufman,MSPH Paul Canniff,D.M.D. March 20,2006 AMENDMENTS ADOPTED BY THE BOARD OF HEALTH AT THE PUBLIC MEETING HELD ON FEBRUARY 28, 2006 Chapter 326: FUEL AND CHEMICAL STORAGE TANKS §326-2. Definitions. For the purpose of this regulation, the following terms shall have the meanings assigned to them: ZONE OF CONTRIEUTION—Designated area contributing to public supply wells, on a map showing State approved zone II locations and town designated zones of contributions, entitled "Zones of Contribution to Public Water Supply Wells, Town of Barnstable, Massachusetts," dated February 1, 2006, and prepared by Town of Barnstable G.I.S. Unit. §326-3. Regulations more stringent than or in addition to state regulations. This section is intended to be in addition to and more restrictive than the provisions of 527 CMR 9.00 et seq. B. Existing tanks. Th s subsection shall apply to tanks in place on the effective date of this regulation and wh,ch complete documentation as described in Subsection A is available. Within zones of contribution, such tanks, that do not satisfy the construction requirements of Subsection D of section 326-8, may be maintained for 20 years, provided that proper testing reveals no leakage. Outside of zones of contribution, such tanks, that do not satisfy the construction requirements of Subsection D of Section 326-8, may be maintained for 30 years, provided that proper testing reveals no leakage. O. Underground fuel and chemical storage tanks and systems, in place on the effective date of this regulation and 20 years of age or older, located in zones of contribution to public supply wells, that do not satisfy the construction requirements of Subsection D of section 326-8, shall be removed under the direction of the Fire Chief. P. Underground fue,.,and chemical storage tanks and systems 30 years of age or older, that do PLEGALNOTICE FUELTANKAMENDMENTS22806 i n •J.'J� Y not satisfy the construction requirements of Subsection D of section 326-8, shall be removed under the direction of the Fire Chief. Wayne Miller, M.D. Sumner Kaufrnan, MSPH Paul Canniff, D.M.D. i i l I:LEGALNOTICE FUELTANSAMENDMENTS22806 PENGAD 8OD-631.6989 tl a 1r�1 k . S {i� � 5*+f t tv s y,; Y {f ' IL {S' SI G �►\ ,�} R1{� S t' hd :7 ' "�5{ � f"'r14s t +,r { K art' . fit} t:;} ` y 41,y nt" a �si' '} y� + , L' % }t4Z�. �(S t{t Ft� h • K� 3� ) V 1( aY W \. « "' L•7 +L{ Y' x'> E.h p� Y F:, /'n' f� ", ty.,, � ,j ' r'<. • c.�► v .q`i #, tz t r=.R. 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This regulation shall apply to the desIgn,construction,installation,tasting,and maintenance of tanks and containers.The intent is to protect our drinking water and other water resources from contamination.The Town's entire drinking water supply is derived from groundwater,ar d the United States Environmental Protection Agency has designated all of Cape Cod as a"sole source aquifer"requiring special care and protection. The regulation is also intended to protbct the public from the dangers of fire and/or explosion due to tank or container leakage of flammable liquids.This regulation is based on and derived from 527 CMR 9.00,but regulates matters not covered in 527 dMR 9.00,and regulates some matters more stringently than 527 CMR 9,00. §326-2 Definitions. For the purpose of this regulation,the following terms shall have the meanings assigned to them: ABANDONED Out of service for a continuous period in excess of six months in the case of storage facility for which a license from the local licensing authority is required under the provisions of MGL C.148,§13,and for a period in excess of 24 months in the case of any other storage facility. APPROVED Approved by the Board of Health and Fire Chief. BOARD The Board of Health. CATHODIC PROTECTION A system which inhibits the corrosion of a lank or its components either through the sacrificial anode or the impressed current method of creating a corrosion-inhibiting electrical current.(Reference:API (American Petroleum Institute)Publication 1632,First Editic-n 1983) COMMERCIAL TANK Any tank utilized for nonconsumptive purposes. COMPONENTS Piping,pumps,and other related storing,conveyancing and dispensing elements which,together with one or more tanks any cathodic protection or monitoring system,constitute a storage facility. ENGINEER A Massachusetts registered professional engineer. EXISTING FACILITY A facility whose construction,installation,or operation began prior to the effective date of this regulation. FIRE CHIEF The chief of the fire district in which a tank is or is to be located. FLAMMABLE LIQUID Any liquid occurring at normal temperature and pressure which will emit a vapor which can be ignited by a flame or spark.(Reference:527 CMR 14,00) FUEL OIL Oil of grade Nos.1,2,4,5,and 6 established in accordance with MGL C.94,§249H. LEAKAGE or LEAK Any uncontrolled movement,measurable by a final or precision test,as described in the current Pamphlet No.329 of the National Fire Protection Association,which can accurately detect a leak of 0.05 gallon per hour or any uncontrolled movement of water into a tar.(or its components. MONITORING SYSTEM A full-time approved system installed for the purpose of eerly detection of leaks,such as observation wells,visual or audible alarms,or their equivalent.Minimum standards of in-tank monitoring systems shall consist of in-tank equipment which provides continuous monitoring of any liquid from the tank at a minimum rate of 0.05 gallons per hour or equivalent leakage over a longer period of time. OBSERVATION WELL A dug or drilled cased well which can be used for detecting the presence of flammable liquids,which is drilled to a depth intercepting the water table,and which is installed and maintained in an approved manner. OPERATOR The lessee of a storage facility,or the person or persons:esponsible for the daily operation of a storage facility. OUT OF SERVICE Not in use in that no filling or withdrawal is occurring. OWNER The person or persons or government entity having legal ownership of a storage facility. PERSON Any agency or political subdivision of the federal government or Commonwealth of Massachusetts;any state,public or private corporation or authority,individual,trust,firm,joint-stock company,partnership, association or other entity;and any officer,employee or E.gent of said person,and any group of said persons. PRODUCT LINE LEAK DETECTOR A device designed to detect product or pressure losses ie a pressurized product line of a remote pumping system. PSI Pounds per square inch gauge. QUALIFIED PERSON A representative certified by the manufacturer of the product being installed or tested. REMOTE PUMPING SYSTEM A pressurized product line system in which flammable liouids are supplied to a point away from the tank by means of a pumping unit. REPLACEMENT AND SUBSTANTIAL MODIFICATION The construction of any additions to an existing storage`acility,or any restoration,refurbishment,or renovation which significantly impairs or affects the physical integrity of the storage facility or its monitoring system. SECONDARY CONTAINMENT or EQUIVALENT PROTE•TION Techniques that may include impervious liners,double-walled tanks,or equivalent methods approved by the Board of Health and the Fire Chief. STORAGE FACILITY One or more tanks at a particular site,together with all components thereof,used or designed to be used for the underground storage of toxic,hazardous or flammable liquids. TANK Any structure above-or below ground used or designec to be used for the storage of any liquids other than water. UL-LISTED Included in a current list or report of approved equipment,materials,or methods published by Underwriters Laboratories,Inc. UNDERGROUND STORAGE Where t 10%or more of the tank volume and piping is buried Delow the ground surface but which shall not include storage in a freestanding container within a building. WATER SUPPLY Any existing or potential source of potable water as identifiec by the local water authority. ZONE OF CONTRIBUTION Designated area contributing to public supply wells,on a me-)showing slate-approved Zone II locations and Town-designated zones of contributions,entitled'Zones of Contribution to Public Water Supply Wells,Town of Barnstable,Massachusetts,"dated February 1,2006,and prepared by Town of Barnstable G.I.S.Unit. [Amended 2-28-20061 §326-3 Regulations more stringent than or in addition to state regulations. This section is intended to be in addition to and more restrictive than the provisions of 527 CMR 9.00 at seq. A. Documentation. u The design,construction and history of every tank shall be completely documented.On or before May 31,1988,every owner of an underground fuel or chemical storage system shall file with the Board of Health and the Fire Chief a notice disclosing the size,type,age and location a each lank and the type of material stored.Evidence of date of purchase and installation,including the permit from the Fire Chief,shall be included, along with a sketch map showing the location of such tanks on the property.See Regulation 22. LL In zones of contribution,tanks without complete documentation sh3II be removed forthwith.Outside of zones of contribution,tanks without complete documentation shall be properly tested forthwith and annually thereafter.If any such test reveals leakage or at the end of five years from the effective date of this regulation,whichever occurs first,such tank shall be removed. B. Existing tanks.This subsection shall apply to tanks in place on the effective date of this regulation and for which complete documentation as described in Subsection A is available.Within zones of contribution,such tanks,that do not satisfy the construction requirements of Subsection D of§326-8,may be maintained for 20 years,provided that proper testing reveals no leakage.Outside of zones of contribution,such tanks,that do not satisfy the construction requirements of Subsection D of§326-8,may be maintained for 30 years,provided that proper testing reveals no leakage. [Amended 2-28-20061 C. No tanks.No underground tank shall be installed after the effectiv3 date of this regulation without the permission of the Board of Health.Such permission shall be granted only with respect to commercial tanks outside zones of contribution. D. Replacement tanks.No underground tank shall be installed witho it the permission of the Board of Health.Such permission shall be granted only with respect to commercial tanks. E. All applicants proposing installation of the underground fuel or chemical storage tanks shall file plans therefor with the Board of Health prior to obtaining a permit from the Fire Department or the Board of Selectmen. F. All tanks shall be properly tested according to these regulations.Any tank which fails a test shall be removed forthwith. G. All suppliers of fuel oil or other petroleum products shall provide s:listing of the names and addresses of customers with underground fuel tanks upon the request of the Board of Health or the Fire Chief, H. All underground fuel or chemical tanks must have a permanent ta.g issued by the Board of Health affixed to the fill pipe. I_ All suppliers of fuel oil or other petroleum products shall notify the Board of Health and the Fire Chief whenever they are required to fill an underground lank which is not identified by a tag. J. Any spill or loss of fuel shall be reported immediately to the Fire Department and within two hours to the Board of Health. K. New tank installations shall not be permitted within five feet of lh3 maximum high-water table or within 500 feet of a surface water body.The maximum groundwater elevation shall be determined by utilizing the formula contained in the United States Geological Survey publication,"Estimating Highest Groundwater Levels for Construction and Land Use Planning—a Cape Cod Massachusetts Example,"dated September 1983,or by observing the height of the groundwater table when it is at its maximum level or elevation.Maximum groundwater determinations shall be made during the wettest season of the year normally March or April. Allowances shall be made for high water level if the Board of Health permits the determination to be made outside the wettest season.Replacement tanks shall comply with this section insofar as practicable. L. Underground fuel or chemical storage tanks are prohibited in zo ies of contribution to public supply wells,except as permitted in Subsection M. M. Zones of contribution include those land areas which contribute-echarge(precipitation which has percolated to the water table)to public water supply wells.The boundaries of zones of contribution shall be determined by the Board. N. Underground fuel and chemical storage systems are prohibited within 500 feet of a private water supply. 0. Underground fuel and chemical storage tanks and systems,in place on the effective date of this regulation and 20 years of age or older,located in zones of contribution to public supply wells,that do not satisfy the construction requirements of Subsection D of§326-8,shall be removed under the direction of the Fire Chief. [Amended 2-28-2006] P. Underground fuel and chemical storage tanks and systems 30 e'ears of age or older,that do not satisfy the construction requirements of Subsection D of§326-8,shall be removed under the direction of the Fire Chief. [Amended 2-28-20061 §326-4 Pressure vessels. The construction of any tank subject to pressure in addition to t.�e static head pressure shall conform to good engineering practice.NOTE:A tank built in accordance with the requirements of the current American Society of Mechanical Engineers Unfired Pressure Vessels Code will be approved by the Commissioner.A lank to be used for storage of petroleum products built in accordance with the requirements of the American Society of Mechanical Engineers Unfired Pressure Vessels Code or the American Petroleum Institute Unfired Pressure Vessels Code will be approved by the Commissioner. §326-5 Aboveground fuel storage tanks. All above-ground fuel storage tanks shall have the following: A. Provisions shall be made to protect the tanks from the elemen-ts.Rustproofing must be applied to all tank surfaces. B. Every aboveground fuel and chemical storage tank shall be placed and secured onto a foundation capable of supporting the tank.The foundation must be larger than the size of the tank in length and width to prevent spillage and leakage onto pervious surfaces. C. The tanks shall be securely anchored. [Added 7-5-1988,effective 7-6-1988] §326-6 Material and construction for all tanks and containers. A i All materials used in the construction of any tank shall be suitable bx the purpose,and such tank or container shall be designed and constructed to withstand any normal stress to which it may be subjected. B. Every tank shall be supported by a foundation capable of supporting the tank. C. Any vertical metal tank of over 10,000 gallons capacity shall be of such material and construction as to give a factor of safety of not less than 2.62.The thickness of any shell or bottom plate shall be not less than 3/16 inch and the thickness of any roof plate not less than 1/8 inch.The:thickness of shell plates shall be figured in accordance with the following formula: 1=2.604x(H-1)xDxFxS/TxE in which t = Thickness of plate in in H = Height of tank in feet at D = Diameter of tank in feel F = Factor of safety. S = One or the specific gra, T _ = Tensile strength of plat. E = Efficiency of vertical joi approved by the Fire Chief.Such approval will specify minimum gauges,lengths,diameters,and materials of the tanks.The requirements of the manufacturer shall be closely followed when said tanks are installed.All piping connected thereto shall otherwise comply with all pertinent sections of this regulation as they would apply to steel tanks. §326-7 Soil vapor analysis test contamination four d:order to remove. (Added 11-26-1991,effective 12-5-1991] A. Once a tank owner receives notification that contamination was fcund and that his/her underground fuel storage may be leaking,the owner has the option to: Have the tank removed within 21 days of receipt of the contamination notification;or Have the tank precision tested within 14 days of receipt of the contamination notification;or The tank owner shall prove the tank is not leaking by some other means approved by the Board of Health within 14 days of receipt of the contamination notification. B. If the tank is found to be leaking,the tank contents shall be emptied immediately.The tank shall be removed within six months,if the Town requires a license to own said tank.The tank shall be removed within 24 months if no license is required to own the tank or if the tank is located above ground and has a capacity under 10,000 gallons. §326-8 Design and construction of new or replacement underground tanks. A. All new and replacement tanks must be equipped with a metallic or nonmetallic striker plate attached to the bottom of the tank at each opening.Such striker plate shall be at least 12 inches by 12 inches in area and at least 1/4 inch thick. B. Underground tanks shall be designed and built in accordance wirh approved engineering standards for the materials of construction being used,and in accordance with§326E of this regulation. C. A tank having a capacity of over 10,000 gallons shall be provided with a manhole.A full-face cover gasket shall be provided on the manway cover.An opening in the shell plate of a vertical tank for a manhole,nozzle or other similar opening shall be reinforced to compensate for the metal removed.Such an opening in the shell plate of a horizontal tank shall likewise be reinforced when the tank is subject to any pressure in addition to head pressure. D. All tank shall be designed and constructed to minimize the risk a corrosion and leakage.The following tank construction shall be approved: 11 UL-listed double-walled steel tank with cathodic protection or bonded fiberglass coating and with electrical isolation,a vacuum or air pressure in the interstitial space with continuous monitoring of the vacuum or air pressure. (2) UL-listed fiberglass reinforced plastic(FPR)double-walled with:a hydrostatic pressure monitoring system approved by the Board and the Fire Chief.The tank must be constructed using materials compatible with the product stored therein. u Any other state-of-the-art type of tank construction providing equal or better protection against leakage other than the above-mentioned tanks if approved by the Fire Chief and the Board of Health. E. The owner of any underground fuel or chemical storage tanks that do not satisfy the construction requirements of Subsection D of this section shall have each tank and its piping tested at the owners'expense during the 10th,13th,15N,171h and 191h year after installation and annually thereafter.Results of the testing will be filed with the Board of Health and the Fire Department.The owner of a new or existing lank which satisfied all the construction requirements of Subsection D of this section shall have the tank and its piping tested at the owners'expense during the 151h and 201h year following the date of installation and at two-year intervals thereafter. F. All tanks shall be tested by any final or precision test not involving air pressure,which can accurately detect a leak of 0.05 gallon per hour or less after adjustment for relevant a variables such as temperature change and tank deflection and which has been approved by the Fire(lief and the Board of Health. G. Horizontal steel tanks located underground shall not exceed thel capacities,diameter,or lengths for the corresponding gauges of metal outlined in the following table and shall be equipped with cathodic protection: r Table 1 H. ertical steel tanks located underground Underground Horizontal Tanks shall not exceed the maximum capacities, iameters,or heights for the corresponding Capacity Over(gallons) Not Over(gallons) Maxi-mum Diameter(inches) Maxi-mum Length(feet) Thick-ness of Shell Thick-ness of Hoods gauges of metal outlined in the following able and shall be equipped with cathodic 10 270 42 6 10 USS gauge 14 USS gaugeprotection: 270 560 48 11 10 USS gauge 12 USS gauge 560 1,100 64 14 10 USS gauge 10 USS gauge 1,100 4.000 84 24 3/16 inch 3/16 inch Capacity Over(gallons) Not Over(I 4,000 12,000 126 32 1/4 inch 1/4 inch 10 60 I 12,600 20,000 132 42 5/16 inch 5/16 inch 60 270 20,000 35,000 132 50 3/8 inch 3/8 inch 270 560 560 1,10 1,100 4,00 4,000 12,0( 12,000 20,0( 2,000 25,0C tanks and containers. A. Each storage tank shall be provided with a filler pipe,a draft pipe—aid a vent pipe,and may have a gauge pipe.If gauge pipe terminates within a building,the opening to same shall be protected. B. Filler pipes of tanks shall be not less than 1 1/4 inches in diameter and shall extend down to within three inches of the bottom of the tanks. C. The receiving end of the filler pipe of a storage tank shall be desig ied to provide for a light connection between a discharge hose and inlet.A filler pipe shall be located outside the building and shall be provided with a screw plug or cap which shall be kept wrench-tight when not in use. D. Where a filler pipe runs to a sidewalk,alley,private way,or public highway,it shall terminate in a metal box with a metal cover set flush with the surface of the sidewalk at the curb,alley,private way,or highway;and it shall be provided with a screw plug or cap which shall be kept wre-ich-tight when not in use. E. Vent pipes of tanks shall not be less than 1 1/4 inches in diameter shall be carried up to a point not less than 12 feet above the ground level at the filling point of the tank,shall terminate not less than five feet from any door or window opening,and shall be fitted with an approved weal her hood screened with noncorrosive wire not coarser than 30 mesh.(Reference:Subsection F of this section) F. The provisions of Subsection E and§326-110A of this regulation notwithstanding,the vent pipes of underground storage tanks may be manifolded for the purpose of effecting a vapor recovery system,provided that the pipe size shall be such as to discharge,within the maximum p-essure limitations of the system,the vapors they may be required to handle when manifolded tanks are filled simultaneously.The use of pressure vacuum valves on vent pipes shall not be permitted as the underground storage system must be able to vent to atmosphere during periods of static storage.The person supplying the vapor recovery system shall specify the minimum vent pipe size to conform to these requirements,and such specifications shall be followed by the installer. G. All tanks shall have one or more vents large enough to relieve an,undue pressure to which they may be subjected.The vent pipe shall be arranged to discharge to the open air and to pitch toward the storage tank.If such tanks are used for the storage of any flammable liquid with s flashpoint below 100°Fahrenheit,such vents shall be protected with fire-protective devices. §326-10 Piping for all tanks and containers. (Reference:527 CMR 4.0,0 where applicable) A. All metallic piping,fittings,valves,and tanks used in connection with approved nonmetallic piping,fittings,valves,and tanks shall be grounded in the following manner. 11 By means of an approved driven ground rod in accordance with Ina provisions of the current Massachusetts Electrical Code,527 CMR 12.00. LL The ground rod and all metallic piping shall be bonded together t,y means of approved ground fittings and a copper conductor not smaller than No.4 AWG(American Wire Gauge). B. Cast-iron valves or fittings shall not be used in any pipe connecton to the tank. C. All piping,fittings,and valves shall be constructed of materials that are compatible with the product to be stored in the tank to which the piping is connected. §326-11 Underground piping. A. All new and replacement piping shall be constructed of noncorodible materials such as fiberglass reinforced plastic(FRP)or its equivalent,or shall be protected against corrosion by use of a steel system cathodically protected by impressed current or sacrificial anodes or by some other type of equivalent protection.All piping shall be provided secondary containment approved by the Board and the Fire Chief.(Reference:§326-91' of this regulation) B. Product lines shall be installed in a trench between the tank area and the pump island.Similarly,underground vent lines shall be installed in a trench. C. Before underground piping is installed,the trench shall receive a minimum six-inch-deep bed of well-compacted noncorrosive material such as clean washed sand or gravel.All trenches shall be wide enough to permit at leas six inches of noncorrosive backfill material around all lines. D. r All pipes connected to such tanks shall lead from the tops of tar:ks,and tops of all tanks shall be below the level of the lowest horizontal pipe used in connection therewith. E. All pipes used for the conveyance of flammable liquid shall decfne to tanks without traps or pockets and shall be protected against injury. §326-12 Pumoing system. A. No flammable liquid shall be delivered to any storage tank by rr,eons of a pump or under pressure unless such storage tank is designed to withstand the additional stress to which it may be subjected or unless the vent pipe for such tanks is of sufficient size to relieve the tank of any undue pressure. B. No suction pumping system shall be equipped with more than one check valve,and any such check valve shall be installed at the tank end only and shall be so installed that it may be tested or replaced without disturbing other elements of the storage facility.In no case shall there be a return waste pipe from the pump to the tank which has any opening to the atmosphere.When a pump is located within a building,it shall be in a well ventilated portion thereof. C. Remote pumping systems shall be designed or equipped so that no part of the system will be subjected to pressures above its allowable working pressure. D. All remote pumping systems shall be equipped with a product ine leak detector. E. On a remote pumping system,a listed rigidly anchored emergency shutoff valve incorporating a fusible link or other thermally actuated device designed to close automatically in event of severe impact or fire exposure shall be properly installed in the supply line at the base of eac'i individual island-type dispenser.The automatic closing feature of this valve shall be checked by a qualified person at the time of initial installation and at least once a year thereafter by manually tripping the hold open linkage. F. The operator%hall immediately advise the owner should a leak detector signal a suspected product loss or a suction product system indicate a potential symptom of a leak(i.e.,meter display jumping or skipping,liquid not being pumped when pump is on,initial pump overspeed followei by slow pumping,erratic liquid flow indicating air and liquid mixture,continued loss of prime in the pumping unit,etc.). G. The owner and/or operator shall take immediate action to verify the operation of the pumping system when advised of a suspected leak by the operator.Should a loss be determined,the owner and/or operator shall take immediate corrective action.The affected pumping system shall be taken out of service until the necessary corrective action has been taken. §326-13 Location of tanks. An underground tank used for the storage of Class A flammable liquid,if within 10 feet of a building having a cellar or basement,shall be placed below the level of the floor of such cellar or basement. §326-14 Underground tank installation. A. No new or replacement tank or piping shall be installed,whether as part of a new or existing storage facility,unless the owner has given notice of its installation to the head of the local Fire Department and the Board of Health after submitted plans are approved indicating the location and design of the tank and its monitoring system,and no new or replacement tank or piping shall be buried or concealed until it has been inspected for damage and external defects,tested for tightness under§326-17 0 this regulation,and approved by the head of the local Fire Department or his designee. B. No new or replacement tank shall be installed except by a contractor who has been certified in writing by the manufacturer or a petroleum equipment association as qualified for the purpose.The contractor shall,prior to any installation,submit to the head of the local Fire Department and the Board a copy of such certificate. C. The installation of a new replacement tank,including anchoring of the tank whenever water saturation of any part of the excavation reasonably be anticipated,shall be carried out in accordance with the manufacturer's recommendation,accepted engineering practices,and the provisions of§326-14 of this regulation,`provided that the backfill material for FRP(fiberglass reinforced plastic)tanks shall be pea,gravel or crushed stone and that the backfill material for all other tanks shall be either pea,gravel or clean noncorrosive sand free of cinders,stones,and any other foreign material,with the material under the tank to be compacted and contoured to the shape of the tank before the tank is installed,and the balance to be thoroughly compacted. D. Any damage to the exterior of a tank or its coating shall be repaired before the tank is covered. E. Every new or replacement tank and its piping shall be tested separately,at the owner's expense,prior to its being buried.The tank shall be tested by air pressure at not less than three pounds and not more than five pounds per square inch.The piping shall be tested hydrostatically.to 150%of the maximum anticipated pressure of the system but not less than 50 pounds per square inch gauge at the highest point of the system. After the tank and piping have been fully buried,all subsequent testing of underground tanks shall be done by the precision test in accordance with the provisions of Pamphlet No.329,Chapter 4-3.10,of the National Fire Protection Association,or other lest of equivalent or superior accuracy.The owner shall furnish the head of the local Fire Department with a certified copy of the results of all testing required by§326-14 of this regulation,which the head of the local Fire Department shall keep with the records of the storage facility. F. Steel tanks completely underground shall be covered with a minimum of two feet of earth or shall be covered with not less than one foot of earth,on top of which shall be placed a slab of reinforced concrete not less than four inches thick.When they are or are likely to be subjected to traffic,they shall be protected against damage from vehicles passing over them by at least three feet of earth cover,or 18 inches of well-tamped earth plus six inches of reinforced concrete or eight inches of asphaltic concrete.When asphaltic or reinforced concrete paving is used as part of the protection,it shall extend at least one foot horizontally beyond the outline of the tank in all directions. §326-15 Leak detection equipment,testing and/or inventory requirements for underground storage. All tanks excepting those used for storing heating oil for consumptive use on the premises where stored shall satisfy the following options: A. Mandatory inventory recordkeeping as defined in§326-16 of this regulation,in addition to periodic tightness testing as defined in§326-17 of this regulation. B. The installation and maintenance of an approved monitoring system installed by a qualified person. C. The installation of an approved double-walled tank with interstitia:space monitoring system and liquid removal port.Secondary containment and an approved in-tank or interstitial space monitoring system shall be required for new or replacement tanks in sale source aquifer areas.The Environmental Protection Agency mandates this requirement in all sole source aquifer areas such as the Town of Barnstable.Tanks storing heating oil for consumption on the premises are exempt from Suasection A. §326-16 Inventory methods for underground tanks. A. The operator of every,new and existing storage facility shall prepare,reconcile and maintain daily inventory control records for each tank and for each combination of interconnected tanks with a common level of product(hereinafter,a"combination"),for the purpose of prevention and early detection of leaks.The preparation,reconciliation,and maintenance of such records shall be done in accordance with the provisions of 527 CMR 5.05(3)as amended,with the following additions and modfications: M At the close of each calendar month,the operator shall determine,for that month and for each tank or combination,the number of days in which any amount of product was dispensed and the number of days in which a loss of product was recorded.These records shall include the nspeclion details on monitoring wells and leak-detection systems. LL An abnormal loss of product shall mean a loss not explainable ty spillage,temperature variations or other causes,as provided in CMR 5.05(3)(d). In the event of any abnormal loss of product,the following steps shall be taken,with the investigation not to stop until the source of the discrepancy has been found,the tank has been tested,repaired or replaced,or the entire procedure has been completed: Inventory input and output records shall be checked by the owner of the tank for arithmetical error. LL Inventory shall be checked by the owner of the lank for error in measurement. If abnormal loss is not reconcilable by Steps 1 and 2 in Subsections(a)and(b)above,or cannot be affirmatively demonstrated to be the result of theft,the accessible parts of the storage system shall be checked for damage or leaks. Monitoring wells and leak detection systems shall be checked for signs of a discharge. (a) Calibration of the inventory measuring system and any dispensers shall be checked. 11 The entire storage system,excluding the vent but including joirts and remote fill lines,shall be tested in accordance with the applicable sections of this regulation. LCIL If a discharge,leak,or threat of release is discovered,the requrements of the applicable paragraphs of§326-18 shall be met by the owner of the tank. u An abnormal gain of water shall be a gain in the water level ins ide any tank of more than one inch in a twenty-four-hour period. In the event of any abnormal gain of water,the owner shall,atthe owners expense,have the water removed from the tank and disposed of in a manner as directed by the Department of Environmental Quality Engineering(DEQE)and have the water checked 24 hours later,during which time no product shall be added. Apart,from abr?ormal gains of water,the owner of any tank in which water has accumulated to a depth of three inches or more shall,at the owner's expense,have the water removed and disposed of in a manner as directed by DEQE. B. For failure to comply with§326-16 of this regulation,see§326-17C of this regulation. C. Tanks used for storing healing oil for consumptive use on the prerrises are exempt from§326-16 except for subsections deemed pertinent by the Board. §326-17 Testing for tightness of underground tanks. A. If any of the testing discloses a leak or a loss which is not reconcilEble,the operator and the owner shall comply immediately with the requirements of§326-18 of this regulation,and the local Fire Department,or the Board,may direct the owner,at the owner's expense,to have all orher tanks on the premises and their components tested in the same manner. B. If the owner of any existing storage facility,pursuant to the provisic ns of§§326-8 and 326-11 of this regulation,provides cathodic protection and electrical isolation for each tank in the facility,subsequent testing requirements shall be in accordance with the provisions of§326 of this regulation. C. With respect to any tank to which the inventory control requirements of§326-16 of this regulation are applicable,the head of the local Fire Department or the Board shall require the operator to have it and its piping promptly tested,at the owner's expense,whenever the operator fails to prepare,reconcile,and maintain the daily inventory records or fails to perform the required monthly calculations.With respect to any tank to which the inventory control requirements of§326-16 of this regulation are not applicable,the head of the local Fire Department or the Board may if they have probable cause to believe that such lank is leaking,require the owner to have it and its piping promptly tested at the owner's expense. D. The head of the local Fire Department or the Board of Health may require the owner of any existing tank to have it and its piping tested,at the owner's expense,in any case in which the owner has failed to make timely application for a permit as required under§326-23 of this regulation. E. Except for testing performed on a lank and its piping prior to their Being covered,a tank shall be tested by any final or precision test not involving air pressure which can accurately detect a leak of 0.05 gallon per hour or less after adjustment for relevant variables such as temperature change and tank-end deflection,and which has been approved by the Marshal,the Board of Health and Fire Chief, F. All tests shall be approved and administered by qualified persons and any such person shall notify the head of the local Fire Department prior to administering a test. G. The person performing any test under§326-17 of this regulation shall promptly supply the owner and the head of the local Fire Department and the Board of Health with certified copies of all test results for a tank and its piping.The head of the local Fire Department shall keep his copy with the records of that storage facility. §326-18 Response to leaks. A. In the event of a leak,whether determined by testing or otherwise,the following steps shall be taken: u The operator shall immediately notify the owner. LL The owner or operator shall immediately notify the head of the local Fire Department,the Board and the Office of Incident Response of the Department of Environmental Quality Engineering(OIR-DEQE). LL If testing has confirmed that the source of the leak is the piping for a particular tank,the operator shall take that tank out of service immediately. If testing has confirmed that the source of the leak is a particular tank,the owner shall within 24 hours cause that tank to be emptied of all its product. B. The head of the local Fire Department shall take charge of all erergency containment procedures,and shall take whatever measures are necessary to prevent fire and explosion,or,in the case of a fire or explosion,to protect the persons and property within the vicinity from such ha:_ards. C. The head of the local Fire Department shall verify that the requirements of§326-18A of this regulation are compiled with. D. Upon the arrival of the representative of OIR-DEQE,the head of the local Fire Department shall advise him of the conditions at the site and the results of the investigations required by§326-18A of this regulation. E. The owner and the operator shall cooperate with the representa,ive of OIR-DEQE in all efforts to locate the source of the leak,to contain it,etc. F. The head of the local Fire Department shall have the responsibility of the containment procedures as long as,in his opinion,a fire or explosion hazard exists.During this period,the elimination of the fire/explosion hazard will have priority over all other concerns,at all times.Once such hazards cease,the representative of OIR-DEQE shall assume all responsibility. §326-19 Tank repair and relining. A. No underground tank can be relined but must be replaced. B. If the head of the local Fire Department or the Board determine::that a tank and its components shall be removed,the owner shall first obtain a permit the Fire Department,pursuant to MGL C.148,§38A.Any removal shall be completed within 90 days after the head of the local Fire Department has notified the owner of his decision. §326-20 Tanks abandoned or temporarily out of service. A. If the owner decides to abandon a tank which is either located under a building and cannot be removed from the ground without first removing the building or which is so located that it cannot be removed from the ground without endangering the structural integrity of another to nk,the owner shall promptly notify the head of the local Fire Department of this decision.Under the direction of the head of the local Fire Department,the owner shall have all product removed from the tank,by hand pump if necessary,and shall have the tank filled with sand or other inert material as prescribed by the head of the local Fire Department.Requirements of §326-20 of this regulation shall be in accordance with 527 CMR 10.12(2).The owner shall be required to have a soil vapor analysis test performed in order to prove the underground fuel or chemical storage tank did not leak prior to permanent abandonment approval from the Fir Department.All the contents of the tank,including oil and sludge,shall be removed from the tank under the supervision of a Fire Department inspector. [Amended 11-26-1991,effective 12-15-1991] B. Except as provided in§326-20A of this regulation,no tank may be abandoned in place.Any owner of a tank who has decided to abandon it and any owner of a tank which has in fact been out of service for a period of time constituting abandonment,as defined in§326-2 of this regulation,shall immediately obtain a permit from the head of the local Fire Department pursuant to MGL C.148,§38A,and,subject to the directions of the head of the local Fire Department,shall have any product rem•Dved from the lank,all lank openings properly secured,and the tank removed from the ground.The product and lank shall be disposed of in accordance with 310 CMR 30.00"Hazardous Waste Regulations,"at the owner's expense,as directed by the head of the local Fire Department.The owner shall return the metal identification tag to the Board. C. The owner of a tank licensed under MGL C.148,which the owner has decided to lake out of service for a period of less than six months,shall promptly notify the head of the local Fire Department of the decision,and shall have all product removed from the tank and disposed of n accordance with 310 CMR 30.00"Hazardous Waste Regulations,"as directed by the head of the local Fire Department,and shall have all tank openings properly secured and the tank rendered inert.The metal identification lag must be returned to the Board.Before any such tank may be restored to service,the owner of the tank shall notify the head of the local Fire Department,who may require that the owner have the tank and its piping tested,at the owner's expense,in accordance with the provisions of§326-17 of this regulation. §326-21 = Tank removal. A. Any'person granted a permit by the Fire Chief to remove a tank under the provisions of MGL C.148,or this regulation,shall within 72 hours provide the permit-granting authority with a receipt for delivery of said tank to the site designated on the permit. B. Before any person is granted a permit by the Marshal or the head of a local Fire Department to remove a tank under the provisions of MGL C.148,or this regulation,and said tank is not being transported to an approved tank yard,the person requesting the permit shall provide the permit-granting authority with written approval for the designated site of disposition.(Reference:502 CMR 3.00 for tank removal and disposal procedure) §326-22 Enforcement and appeals. A. Any owner or operator who violated any provision of this regulation shall be subject to the penalties provided under MGL C.111§31,as amended.Each day during which such violation continues shall constitute a separate offense.Upon request of the head of the local Fire Depa tment or the Board of Health,the licensing authority and the Town counsel shall take any such legal action as may be necessary to enforce the provisions of this regulation. B. In the event of the violation of this regulation by the owner or operator of a storage facility,the head of the local Fire Department or the Board of Health,instead of or in addition to requesting enforcement under§326- 22A of this regulation,may recommend revoking or suspend the owner's permit or may require more frequent testing than would otherwise be required under§326-17 of this regulation.and if a permit is revoked or if a storage facility has been installed or maintained without a permit,'he head of the local Fire Department may order that the storage facility be removed from the ground.Before revoking or suspending an owner's license or requiring removal of a storage facility from the ground,the licensing authority shall hold a public hearing on the proposed action,and shall be certified mail give the owner at least 10 days,advance notice of the hearing and shall render its decision in writing with a brief statement of the reasons therefor. C. After a public hearing,the Board of Health may,with the concurrence of the Fire Chief,vary the application of any provision of this regulation,not in conflict with 527 CMR 9.00 unless otherwise required by law when in their opinion the applicant has demonstrated that an equivalent degree of protection will still be provided to public and private water supplies. D. All tanks used for the storage of flammable liquids shall be subjec:to the rules and regulations of the Board of Fire Prevention Regulations. E. All tanks and their appurtenances shall be maintained in a safe condition at all times. F. No tank for which a permit has been issued for the storage of any liquid with a specific gravity of one or less shall be used for the storage of any liquid with a specified gravity of more than one. G. No wooden tank shall be used for the storage of any flammable liquid. H. No open tank shall be used for the storage of flammable liquid. §326-23 Permits. A. Either the original or photographic copy of all permits granted under the provisions of this regulation shall be conspicuously posted or kept on the premises. B. New storage facilities: u No storage facility shall be installed unless the owner shall first have obtained a permit from the head of the local Fire Department after approval of the Board of Health.This permit shall be in addition to any license or any other permit required by MGL C.148,or by any regulations issued thereunder. LL The application for a permit shall be on a form obtained from the Board of Health and shall include the following information and any other information the Board may require: Name,address,and telephone numbers(day and night)of the c vner. (b) Name,address,and telephone numbers(day and night)of the cperalor. LL The number of tanks in the proposed facility and the capacity and contents of each proposed tank. u The proposed type of construction of each tank and its piping,tc gether with the tank's approval number,taken from the tag issued,if any,and a description of any provisions made for cathodic protection,electrical isolation and early detection of leaks through a monitoring syste-n. The depth below ground level of the lowest and highest points df each proposed tank. u In a storage facility with more than one proposed tank,the applicant shall furnish the Board of Health and the appropriate Fire Chief,with a certificate signed by a qualified person stating that the proposed facility meets all the design and construction requirements of 527 CMR 9.00 s.nd this regulation. The applicant shall also furnish a plot plan of the site and the area surrounding it,showing the location of each proposed tank and its components and of any building on the site,and the approximate location of any public or private well and of any body of surface water within 1,-D00 feet of the proposed storage facility. C. Existing storage facilities: (1) Owners of single-family and duplex dwellings need not comply with Subsection C(1)(a)and(b). 11 Name,address,and telephone numbers(day and night of the cwner. u Name,address,and telephone numbers(day and night)of the operator. LL The number of tanks in the facility and the capacity and contents of each tank. u The type of construction for each tank and its piping,together with a description of any provisions made for cathodic protection,electrical isolation,and early detection of leaks through a monitoring system. Let The depth below ground level of the lowest and highest points;of each tank. u The date of installation of each tank. (2) . TRe dwner shall furnish evidence of the date of installation.Such Evidence may include,but is not limited to,a copy of any license or permit issued by the local licensing authority and the head of the local Fire Department.If no substantial evidence of the date of installation is supplied,the tank shall be presumed to have been installed 20 years prior to the effective date of this regulation.See§326-3A. Replacement and substantial modification: L1 If the head of the local Fire Department or Board of Health deters nes that the proposed replacement or modification constitutes a danger to a public or private water supply because of its proximity to any public or private well,aquifer,recharge area or body of surface water,or for any other reason the head of the local Fire Department or the Board may deny the application or approve it subject to conditions that he may determine are necessary to protect such public or private water supply. The head of the local Fire Department or the Board of Health may require that existing tanks other than those used for heating purposes shall be equipped with observation wells or other detection system 4 in his opinion the location of the tanks could jeopardize the safety of the public. (4) Renewal of permits and changes of ownership: (a) The owner of any new or existing facility for which a permit has been issued under§326-23B or C must apply to the head of the local Fire Department and the Board of Health for renewal of the permit at five-year intervals from the date on which the original permit was granted.—he application for renewal must include any changes required under§326-23B(2)and C. (b) The owner of any storage facility,except individual homeowners,shall within seven working days notify the head of the local Fire Department and the Board of any change in the name,address,or telephone numbers of the owner or of the operator.In the case of any transfer of ownership,the new owner shall be responsible for the notification. §326-24 Varying of provisions by Board of Health. The Board of Health may vary the application of any provision of-his regulation except where expressly forbidden in 527 CMR 9.00 if in its opinion strict enforcement thereof would do manifest injustice to the applicant, and the applicant has proved that the same amount of environme-rtal protection required under this regulation can be achieved without strict application of the particular provision. §326-25 Severability. Each regulation shall be construed as separate to the end if any Pegulation or sentence,clause,or phase thereof shall be held invalid for any reason,the remainder of that regulation and all other regulations shall continue in full force. §326-26 When effective. This regulation is to take effect on the date of publication of this notice. .j . 0 s Q� TOWN ,OF BARNSTABLE Q Health Division— 200 Main Street - Hyannis, MA 02601 �F THE 1p� FAX ` Date: 1/03/11 * BARNSTABLE, 9� MASS. Number of pages including cover sheet: 7 1639. 10 AIFD��p To Attorney Dave Houghton From: Legal Town of Barnstable Health Division Mail to: 200 Main Street Phone: 508-862-4608 Hyannis,MA 02601 Fax phone: 508-862-4724 Phone: CC: Fax phone: 508-790-6304 REMARKS: ❑ Urgent ❑ For your review ❑ Reply ASAP ❑ Please comment Attached is the deposition'we have been served regarding Barnstable Road Auto Repair vs Xcel Environmental. The Deposition is for January 12, 2011 in Braintree. a Commonwealth of Massachusetts BARNSTABLE SS. SUPERIOR Court Docket No.2009-301 B,ARNSTABLE ROAD AUTOREPAIR, INC. Plaintiff M.R.C.P. O vs. Rule 30(b)(6) 0 p � o XCEL ENVIRONMENTAL, INC. Defendant O,q To: B 0ARNSTALE MAIN STRE BOARD OF HEALTH NOO/Sj�� 0C HYANNIS,MA gFsT��F S�gVF gSQN q Greetings: YOU ARE HERE3Y COMMANDED in the name of the Commonwealth of Massachusetts in accordance with the provisions of Rule 30(b)(6) of the Massachusetts Rules of Civil Procedure to appear and testify on behalf of DEFENDANT before a Notary Public of the Commonwealth, at the office of KERR LEGAL GROUP, LLC, Attorney JOHN L. KERR, No. 100 GRANDVIEW ROAD, SUITE 302, in the City of BRAINTREE,MA 02184, on the 12TH day of JANUARY, 2011 at 1:00 o'clock PM, and to testify as to your knowledge, at the taking cf the deposition in the above-entitled action. * And you are further required to bring with you: SEE SCHEDULES "A" AND "B" PLEASE CONTACT ATTORNEY JOHN L. KERR AT(781)849-6780 UPON RECEIPT TO CONFIRM YOUR APPEARANCE AT YOUR DEPOSITION. Hereof fail not as you will answer your default under the pains and penalties in the law in that behalf made and provided. Dated NOVEMBER 23 ;r 2010 JOHN L. KERR u3 Attorney for DEFENDANT 100 GRANDVIEW ROAD, SUITE 302 'Sr- Address BRAINTREE, MA 02184 M mrDissioxi s�Janua 18 20) - City or Town 4 Commonwealth of Massachusetts BARNSTABLE SS., SUPERIOR Court Docket No.2009-301 BARNSTABLE ROAD AUTO-REPAIR,.INC. Plaintiff M.R.C.P. vs. Rule 30(b)(6) XCEL ENVIRONMENTAL, 114C. Defendant O,q q.TAU D F To: BARNSTABLE BOARD OF HEALTH pq rq�F HYANN S, M200 MAIN REET Fq�ST�ASS& FRSO�FR Greetings: YOU ARE HEREBY COMMANDED in the name of the Commonwealth of Massachusetts in accordance with the provisions of Rule 30(b)(6) of the Massachusetts Rules of Civil Procedure to appear and testify on behalf of DEFENDANT before a Notary Public of the Commonwealth, at the office of KERR LEGAL GROUP,LLC, Attorney JOHN L. KERR,No. 100 GRANDVIEW ROAD, SUITE 302, in the City of BRAINTREE,MA 02184, on the 12T` day of JANUARY, 2011 at i m o'clock PM, and to testify as to your knowledge, at the taking o-the deposition in the above-entitled action. * And you are further required to bring with you: SEE SCHEDULES "A" AND "B" PLEASE CONTACT ATTORNEY JOHN L. KERR AT(781)849-6780 UPON RECEIPT TO CONFIRM YOUR APPEARANCE AT YOUR DEPOSITION. Hereof fail not as you will answer your default under the pains and penalties in the law in that behalf made and provided. , Dated NOVEMBER 23 ,'2010 JOHN L. KERR Attorney for DEFENDANT �V` 100 GRANDVIEW ROAD, SUITE 302 Address BRAINTREE,MA 02184 M mr isslq_n '�C' TV� 4A,,uar�tl8,20j-� City or Town COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, SS SUPERIOR COURT DEPARTMENT CIVIL ACTION NO: 2009-301 BARNSTABLE ROAD AUTO REPAIR, INC., Plaintiff Vs. * NOTICE OF TAKING. * RULE 30(b)(6) DEPOSITION XCEL ENVIRO'19MENTAL,.INC., Defendant To: Thomas M Grimmer, Esquire 149 Main Street Hyannis;Massachusetts 02601 Please take notice that at 1:00 p.m on Wednesday, January 12, 2011, at the law offices of KERR LEGAL , GROUP, LLC, 100 Grandview Road, Suite 302, Braintree, Massachusetts 02184, the Defendant, .Xcel Environmental, .Inc., in this action by its attorney, will take the Rule 30(b)(6) deposition upon oral examination of the Designee of Barnstable Board of Health, 200 Main Street, Hyannis, Massachusetts 02601, pursuant to the applicable provisions of the Massachusetts Rules of Civil Procedure, before G & M Court Reporters, Ltd., Notary Public, in and for the Commonwealth of Massachusetts, or before some other officer authorized by law to administer oaths. Pursuant to Rule 30(b)(6), the Deponent is to produce for the deposition the p-Irson(s) within the corporation with the most knowledge about those areas referenced in the "Schedule A" attached. Further, the deponent is requested bring any and all documents' relating to the requests referenced in the attached ".Schedule B" to the deposition. *"The deponent is required to produce some form of identification incorporating a photograph at the.deposition. You are.invited to attend and cross-examine. Respectfully Submitted, L. Kerr, Nquire KERR LEGAL GROUP, LLC 100 Grandview Road, Suite 302 Braintree, Massachusetts 02184 Tel: (781) 849-6780 . Fax: (781) 849-0680 E-mail:jlk@kerrlegalgroup.com BBO 9546175 cc: G & M Ccurt Reporters, Ltd. SCHEDULE "A" 1. Any and all testing, investigation or monitoring regarding a potential discharge of petroleum products from March 21, 2005 to the present. 2. The decision to remove the gasoline tanks ("the UST's") at 91 Barnstable Road, Hyannis, Massachusetts ("the property") on or about May 16, 2006—May 18, 2006. 3. The testing for leaks of any of the UST's or associated piping components of the gasoline dispensing system, and/or the removal of the UST's at the property. 4. Any and all testing or examination of the UST's before or after the removal of the UST's. 5. Any and a'll Department of Environmental Protection regulations, Hyannis Fire Department regulations, Massachusetts Fire Department regulations, Hyannis Board of Health regulations regarding the testing and/or removal of the UST's. 6. Any and all testing and clean-up or remediation of petroleum products at 91 Barnstable Road, Hyannis, Massachusetts. 7. The cause of discharge of petroleum products at the property. 8. Any and all monitoring of contamination at the premises. 9. Any evidence that one or more of the UST's were leaking as of March 21, 2006 —March 22, 2006. 10. Any and all conversations or communications between Barnstable Board of Health personnel and anyone else including but not limited to Peter Demers regarding the decision to remove the UST's. 11. Any and all conversations or communications with any municipal or state employees regarding the removal of the UST's. ' SCHEDULE 66B9' 1. Any and Gll documents and/or photographs relating to testing, examination or removal of the DST's of or monitoring at 91 Barnstable Road Hyannis, Massachusetts "the property") before and Y � after they were removed. 2. Any and all documents and/or photographs regarding the removal of gasoline tanks at the property. 3. Any and all documents received by or filed with any town, municipal state or federal agency or received from said agencies regarding the presence of or leaking of petroleum products from the gasoline tanks at the property at any time. 4. Any and all documents received by or filed with any town, municipal state or federal agency or received from said agencies regarding the testing and/or removal of DST's at the property at any time. 5. Any and all documents and photographs whatsoever relating to gasoline leaks from underground storage tanks at the property. 6. Any and all documents, reports, photographs, e-mails, written protocols relating to the discharge of gasoline at and the removal of DST's at the property on or about March—May of 2006. 7. Any and all copies relating to all regulations governing the removal of the underground storage tanks at the property on or about May 16, 2006 —May 18 2006. 8. Any and all photographs relating to the property, the UST's and/or the removal of the DST's. CERTIFICATE OF SERVICE I, John L. Kerr, attorney for the defendant, Xcel Environmental, Inc. hereby certify that on this day, I have served a copy of the Notice of Taking Rule 30(b)(6) Deposition of the D--signee of Barnstable Board of Health upon the parties to this action by first class mail, to: Thomas M. Grimmer, Esquire 149 Main Street Hyannis, Massachusetts 02601 Date: 11 Zz. 17 Jol�nL, Kerr, Esquire KERR LEGAL GROUP,LLC 100 Grandview Road, Suite 302 Braintree, Massachusetts 02184 Tel: (781) 849-6780 Fax: (781) 849-0680 E-Mail:jlk@kerrlegalgr� oup.com BBO#546175 CHAPTER 381 TOXIC AND HAZARDOUS MATERIALS [HISTORY: Adopted by the Town of Barnstable Board of Health as indicated in article histories. Amendments noted where applicable.] GENERALREFERENCES Hazardous materials— See Ch. 108. ARTICLE I Floor Drains & 381-1 —§ 381-9) [Adopted 9-28-1999, effective 10-8-1999 (Section 1.00 of Part XI of the 1991 Codification as updated through 6-1-1996)] § 381-1 Findings. A. Floor drains in industrial and commercial facilities are often tied to a system leading to a leaching structure (e.g., dry well, cesspool, leach field) or a septic system. B. Poor management practices and accidental and/or intentional discharges may lead petroleum and other toxic or hazardous materials into these drainage systems i-i facilities managing these products. C. Improper maintenance or inappropriate:use of these systems may allow the passage of contaminants or pollutants entering the drain to discharge from the leaching structure or septic system to the ground. D. Discharges of hazardous wastes and other pollutants to floor drains leading to leaching structures and septic systems have repeatedly threatened surface and ground water quality throughout Town of Barnstable. E. Surface and ground water resources in the Town of Barnstable contribute to the Town's drinking water supplies. § 381-2 Purpose. The Town of Barnstable adopts the following regulation, under its authority as specified in § 381-3, as a preventive measure for the purpose of preserving and protecting the Town of Barnstable's drinking water resources from discharges of pollutants to the ground via floor drains, and minimizing the threat of economic losses to the Town due to such discharges. § 381-3 Scope of authority. The Town of Barnstable Board of Health adopts the following regulation pursuant to authorization granted by MGL C. 111 §§ 31 and 122. The regulation shall apply, as specified herein, to all applicable facilities, existing and new, within the Town of Barnstable. § 381-4 Definitions. For the purposes of this regulation, the following words and phrases shall have the following meanings: COMMERCIAL AND INDUSTRIAL FACILITY A public or private establishment where the principal use is the supply, sale, and/or manufacture of services, products, or information, including but not limited to, manufacturing, processing, or other industrial operations; service or retail establishments; printing or publishing establishments; research and development facilities; very small or large quantity generators of hazardous waste; laboratories; hospitals. DEPARTMENT The Massachusetts Department of Environmental Protection. i DISCHARGE The accidental or intentional disposal, deposit, injection, dumping, spilling, leaking, incineration, or placing of toxic or hazardous material or waste upon or into any land or water so that such hazardous waste or any constituent thereof may enter the land or waters of the commonwealth. Discharge includes, without limitation, leakage of such materials from failed or discarded containers or storage systems and disposal of such materials into any on-site leaching structure or sewage disposal system. f FL-60R DRAIN An intended drainage point on a floor constructed to be otherwise impervious which serves as the point of entry into any subsurface drainage, treatment, disposal, containment, or other plumbing system. LEACHING STRUCTURE Any subsurface structure through which a fluid that is introduced will pass and enter the environment, including, but not limited to, dry wells, leaching catch basins, cesspools, leach fields, and oil/water separators that are not watertight. OIL/WATER SEPARATOR A device designed and installed so as to separate and retain petroleum-based oil or grease, flammable wastes as well as sand and particles from normal wastes while permitting normal sewage or liquid wastes to discharge into the drainage system by gravity. Other common names for such systems include MDC traps, gasoline and sand traps, grit and oil separators, grease traps, and in-erceptors. TOXIC OR HAZARDOUS MATERIAL Any substance or mixture of physical, chemical, or infectious characteristics posing a significant, actual, or potential hazard to water supplies or other hazards to human health if such substance or mixture were discharged to land or water of the Town of Barnstable. Toxic or hazardous materials include, without limitation, synthetic organic chemicals, petroleum products, heavy metals, radioactive or infectious wastes, acids and alkalis, and all substances defined as toxic or hazardous under Massachusetts General Laws (MGL) Chapter 21C and 21E or Massachusetts hazardous waste regulations (310 CMR 30.000), and also include such products as solvents, thinners, and pesticides in quantities greater than normal household use. USE OF TOXIC OR HAZARDOUS MATERIAL The handling, generation, treatment, storage, or management of toxic or hazardous materials. § 381-5 Discharge prohibited: exception. With the exception of discharges that have received (or have applied and will receive) a Department-issued permit prior to the effective date of this regulation, no floor drain(s) shall be allowed to discharge, with or without pretreatment(such as an oil/water separator), to the ground, a leaching structure, or septic system in any industrial or commercial facility if such floor drain is located in either: A. An industrial or commercial process area; B. A petroleum, toxic, hazardous material's, or waste storage area; or C. A leased facility without either A or B of this section, but in which the potential for a change of use of the property to a use which does have either A or B is, in the opinion of the Board of Health, sufficient to warrant the elimination of the ground discharge at the present. § 381-6 Requirements for existing facilities. A. The owner of a facility in operation prier to the effective date of this regulation with a prohibited (as defined under§ 381-5)floor drain system shall: Disconnect and block all applicable in ets to and outlets from applicable leaching structures, oil/water separators, and/or septic systems, in accordance with the Massachusetts Plumbing Code and after obtaining permit to conduct plumbing work; Remove all existing sludge in oil/water separators, septic systems, and, where accessible, leaching structures. Any sludge determined to be a hazardous waste Shall be disposed of in accordance with state hazardous waste regulations (310 CMR 30.000). Remedial activity involving aaiy excavation and soil or groundwater sampling must be performed in accordance with appropriate Department policies (310 CMR 27.00); Alter the floor drain system so that the floor drain shall be either: '� A Connected to a holding tank that meets•all applicable requirements of Department policies and regulations, with hauling records submitted to the Barnstable Board of Health at the time of hauling; Connected to a municipal sanitary sewer line with all applicable Department and local permits including a permit from the Town of Barnstable Department of Public Work; Engineering Division; or LL Permanently sealed. Any facility sealing a drain shall be required to submit for approval to the Board of Health a hazardous waste management plan detailing the means Df collecting, storing, and disposing of any hazardous waste generated by the facility, including any spill or other discharge of hazardous materials or wastes. B. Any oil water separator remaining in use shall be monitored monthly, cleaned not less than every 90 days, and restored to proper conditions after cleaning so as to insure proper functioning. Records of the hauling of the removed contents of the separator shall be submitted to the Board of Health at:he time of hauling. C. Compliance with all provisions of this regulation must be accomplished in a manner consistent with Massachusetts Plumbing, Building, and Fire Code requirements and Chapter 108, Hazardous Materials, of the Code of the Town of Barnstable. D. Upon complying with one of the options listed under Subsection A(3)of this section, the owner/operator of the facility shall notify the Department of the closure of said system by filing the Department's UIC Notification Form with the Department, and sending a copy to the Barnstable Board of Health. § 381-7 Deadlines for compliance by existing and new facilities. A. Existing facilities. Owners/operators of a facility affected by this regulation shall comply with all of its provisions within 90 days of the effective date. All applicable discharges to the leaching structures and septic systems shall be discontinued immediately through temporary isolation or sealing of the floor drain. B. New facilities. M As of the effective date of the regulation, all new construction and/or applicable change of use within the Town of Barnstable shall comply with the provisions of this regulation. Certification of conformance with the provisions of this regulation by the Board of Health shall be required prior to issuance of construction and occupancy permits. The use of any new oil/water separator shall comply with the same requirements as for existing systems, as specified above in § 381-6B. § 381-8 Violations and penalties. Failure to comply with provisions of tl-is regulation will result in the levy of fines of not less than $200, but no more than $1,000. Each day's failure to comply with the provisions of this regulation shall constitute a separate violation. § 381-9 Severability. Each provision of this regulation shall be construed as separate to the end that, if any provision, or sentence, clause or phrase thereof, shall be held invalid for any reason, the remainder of that section and all other sections shall continue in full force and of It LE y�P� 0, Town of Barnstable 1* mw%is-raBLE, 9 639 �bg9• - public Health Division cb\L �� lFD MA'S�" 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 January 7, 2010 John L. Kerr, Esquire Kerr Legal Group, LLC 100 Grandview Road, Suite# 302 Braintree, MA 02184 RE: Barnstable Road Alto Repair, Inc., Plaintiff, Vs Xcel Environmental Inc. Property: 91 Barnstable Road, Hyannis Dear Attorney Kerr: I am enclosing cc-pies of all items in our file for 91 Barnstable Road, Hyannis, as requested from the Town of Barnstable Public Health Division. This letter is signed under the pains and penalties of perjury. The enclosed records are the true records of the Town of Barnstable Department of Public Health for 91 Barnstable Road, Hyannis. Sincerely; Sharon Crocker Administrative Assistant Keeper of Records Q:\Legal\Let-Barnstable Rd Auto Repair Case 91 Bamstable Rd Jan20IO.doc �p THE Taw " Town of Barnstable * DARVSTAt3LE, "ASS a Public Health Division O Tf0 MAt A, 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 January 7, 2010 John L. Kerr, Esquire, Kerr Legal Group; LLC 100 Grandview Road, Suite#302 Braintree, MA 02184 RE: Barnstable Road A--ito Repair, Inc., Plaintiff, Vs Xcel Environmental Inc. Property: 91 Barnstable Road, Hyannis Dear Attorney Kerr: Attached are the copies requested. The two people from the Public Health Division who went out to the location were David Stanton and Alisha Parker Stanley. Alisha Stanley has since transferred to the Growth Management Department. Their mailing addresses, along with our legal department, are: T. David Houghton First Asst. Town Attorney David Stanton Alisha Stanley Town of Barnstable Town of Barnstable Town of Barnstable Legal Department Public Health Division Growth Management 367 Main Street 200 Main Street 367 Main Street Hyannis, MA 62601 Hyannis, MA 02601 Hyannis, MA 02601 508-862-4620 Sincerely,, Sharon Crocker Administrative Assistan. Q:\Legal\Let-Case 91 Barnstable Rd Jan 7 2010.doc tea[ � • LJ� � t�� t ■ 1 A ■ v�� O AL ff 'M Insig-fit GeoInsight,Inc. Robert P.Danckert 5 Lan Drive,Suite 200 Project Geologist Westford,MA 01886 TEL 978-692-1114 FAX 978-692-1115 CELL 339-221-0916 rpdanckert@geoinc.com Environmental Solutions At Work www.geoinsightinc.com i GeoInsight Services ■ Environmental:site assessments,risk characterization, and remediation;regulatory compliance and permitting; UST/AST closures;and litigation support. ■ Geotechnical:foundation investigations,construction oversight,soil engineering,landfill design,earth support systems,and geosynthetic applications. ■ Water Supply:Hydrogeological assessments including source evaluation,development,and protection; permitting;and design. n i .' e dC r Massachusetts Department of Conservation and Recreation ,.z—s—h—tts Office of Water Resources Well Completion Report 11-APR-08 11:56:03 WELL LOCATION 251421 GPS North: 410 39.345' GPS West:_ 700 17.015' Address: 91-,--Barnstable=Roadd' Property Owner/Client: c/o Geo Insight _Inc Subdivision Name:corner of Louis St Mailing Address: 5 Lan Drive Ste 200 City/Town: Barnstable City/Town, State:Westford MA Assessors Map: Assessors Lot #: Permit Number: Board of Health permit obtained: N Date Issued: Work Performed Proposed use Drilling Method Overburden Drilling Method Bedrock New Well Monitoring- .ltwellsAat:this,location.9 Auger �- - -- - CASING From (ft) To (ft) Type Thickness Diameter .00 -8.00 PVC Schedule 40 4.00 SCREEN From (ft) To (ft) Type Slot Size Diameter -8.00 -28.0�D Slotted PVC .010 4.00 ,WELL SEAL / FILTER PACK / ABANDONMENT MATERIAL From (ft) To (ft) Material Description Purpose;_ . " =4._0.0. _ _.__ _ =6`:_: Bentonite-Chips/Pellets Seal WELL TEST DATA (ALL SECTIONS MANDATORY FOR PRODUCTION WELLS) Date Method Yield Time Pumped Pumping Level Time to Recover Re4very (GPM) (hrs & min) (Ft. BGS) (Hrs & Mi ) (Ft:BGS)`l STATIC WATER LEVEL (ALL WELLS) PERMANENT PUMP (IF AVAILABLE) Date Depth Below ground Pump Description: Measured Surface (ft) Type: Intake Depth: 03/27/2008 23 Nominal Pump Capacity: Horsepower: WELL DRILLER'S STATEMENT ADDITIONAL WELL INFORMATION Driller: Patrick Desmond Developed: No Fracture Enhancement:No Supervisor: Patrick Desmond Rig #: 36 Disinfected:No Well Seal Type:None Firm: Desmond Well Drilling Inc. Total Well Depth: 28.000 Depth to Bedrock: Registration #: 877 Date Complete:,03/27/2008" 'Comments: this is an extraction we-1 OVERBURDEN From To Description Color 'Comment Water Loss/Add Drill Drill (ft) (ft) _ Zone of Fluid Stem Drop Rate .00 5.00 Sand & Graver. Brown No N/A 5.00 28.00 Fine to Coarse Sand Brown Yes N/A BEDROCK From To Code Comment Water Drill Extra Drill Rust Loss/ # of (ft) (ft) Zone Stem Large Rate Stain Add of Frac Dron per.ft 1�1 GeoInsight° Environmental Strategy&Engineering Practical in Nature April 3, 2009 GeoInsight Project 4743-004 Delivered Via Certified Mail Thomas McKean Health Division 200 Main Street Hyannis, Massachusetts 02601 RE: Notice of Document Availability Barnstable Road Auto Repair, Inc. 19-1-Bffarn`stable Road Hyannis, Massachusetts RTN 4-19670 Dear Mr. McKean: In accordance with Public Notification requirements of the Massachusetts Contingency Plan C=5 (MCP; 310 CMR 40.140'),please accept this letter as notification that a Phase H Comprehensive to Assessment(Phase H CSA)report has been filed and is available for your review at: : C5 Massachusetts Department of Environmental Protection(MADEP) Cn Southeast Regional Office =1 Bureau of Waste Site CleanupCO N 20 Riverside Drive O Lakeville, Massachusetts 02347 The Summary of Findings section of the Phase II CSA report is attached to this letter. The Phase II CSA report is also available for review electronically via the MADEP website at: http://www.mass.gov/dep.. If you have any questions,or would like to discuss the project, please contact us at 978-692-1114. Sincerely, GEOINSIGHT, INC. ?RobeP. anckert Kevin D. Trainer, C.P.G., P.G.,L.S.P. Project Geologist Associate cc: Peter Demers -Barnstable Road Auto Repair, Inc. Attachment: Summary of Findings GeoInsight,Inc. GeoInsight,Inc. GeoInsight,Inc. 25 Sundial Ave.,Suite 515 West 5 Lan Drive,Suite 200 Corporate Ten Center Manchester,NH 03103-7244 Westford,MA 01886-3538 1781 Highland Ave.,Suite 207 Tel(603)314-0820 Tel(978)692-1114 Cheshire,CT 06410-1254 Fax(603)314-0821 Fax(978)692-1115 Tel(203)271-8036 www.geoinsightine.com Fax(203)271-8038 12.0 CONCLUSIONS AND PHASE R COMPLETION STATEMENT 12.1 SUMMARY OF FINDINGS i • In March 2006,the former in-tank UST monitoring system indicated the presence of a leak in one of the three former gasoline USTs that were located at the Site. Subsequent testing confirmed a leak in the UST. In April and May 2006, gasoline i LNAPL was detected in a Site monitoring well. The three gasoline USTs,piping, and approximately 105 yards of petroleum-impacted soil were removed from the Site in May 2006. Low concentrations of VPH fractions and MTBE were detected in post-excavation soil samples. • In February 2007, five soil borings were advanced downgradient of the former USTs. Three of the soil borings were completed as ground water monitoring wells(MW-1 through MW-3). LNAPL was measured in two of the wells. Six soil samples collected from the borings were submitted for laboratory analyses. MTBE was detected in five of the six soil samples, and other gasoline hydrocarbons were detected.in two of the six soil samples. • A SVE s-stem was installed at the Site in February 2008 under an IRA to remove gasoline 1;NAPL and remediate.impacts in the vadose zone soils. Vapors were initially extracted from monitoring well EW-2. This well was removed from the SVE system because of water infiltration, and was replaced with extraction well SVE-1. The SVE system is currently active. • In September 2008, six soil borings (BRS-1 through BRS-6) were advanced as part of Prase 11 CSA activities downgradient of the release area to collect in-situ ground water samples. Ground water data were used to evaluate the locations for additional permanent monitoring wells. Constituent concentrations were greatest in ground water samples collected hydraulically downgradient (i.e., to the southeast)of the former USTs. • In Octol er 2008, Geolnsight oversaw the advancement of five soil borings (SB-4 through SB-8) that were completed as ground water monitoring wells MW-4 through MW-8. Elevated PID measurements were observed in borings SB-6 and SB-8 at concentrations ranging from 9.1 to 309 ppm at depths ranging from 22 to 28 feet BGS. • In November 2008, ground water samples were collected from 11 of the 12 monitor- g wells installed at the Site and downgradient locations. Ground water samples were not collected from EW-3 because of the presence of 0.23 feet of LNAPL. Target analytes and VPH fractions were detected in samples collected from monitoring wells MW-2,MW-3, MW-6, and MW-8 below applicable April 3,2009 Geolnsight Project 4743-004 Page 44 Method l 3W-3 Risk Characterization standards. Total xylenes were detected above the CW-3 Risk Characterization standard in the sample collected from monitoring well EW-2. • The estimated direction of ground water flow on November 10, 2008 was to the south-southeast under an average horizontal gradient of approximately 0.0035 foot/foot. GeoInsight estimated the seepage velocity at the Site to be approximately 0.35 feet/day(128 feet per year). i • Potential receptors will not likely be exposed to residual gasoline-impacted soil, ground water, or LNAPL. The exposure pathways for potential receptors for soil, ground water, and indoor air under current conditions are incomplete. Utilities � are not a preferential exposure pathway and are considered an incomplete exposure pathway. I • Soil EPC3 are below applicable MCP Method 1 S-1 or S-3 Risk Characterization standards. The EPCs for the ground water samples collected from monitoring well EW-2 exceeded the MCP Method 1 GW-3 Risk Characterization standard for xylen'-s. EPCs for ground water in other wells are below applicable MCP Method 1 Risk Characterization standards. • A condition of No Significant Risk has been achieved for safety and the environment. LNAPL has been consistently observed in monitoring well EW-3 at thicknesses greater than the UCL of 0.5 inch and therefore, a condition of No Significant Risk to public welfare has not been achieved. • Results of the Risk Characterization process were used to evaluate the need to implement additional response actions that will reduce or manage exposures and risks assDeiated with residual gasoline constituents at the disposal site. Based upon the conclusions of the MCP Method 1 Risk Characterization, additional response actions are necessary to achieve a Permanent Solution. • A SRM, CEP, and conditions that may constitute an IH have not been observed at the disposal site based upon additional data obtained as part of Phase II CSA activities. April 3, 2009 Geolnsight Project 4743-004 Page 45 G" --sigh w Oa5.320 Environmental Strategy&Engineering '�,� U11111111111 _ I 7005 '116.0 0003 72 0004582506 APR 03 2009 MAILED FROMZIPCODE01886 14A.111&D I � g sZe.-Oi''�"'•Fl•.0-02 ��s,ccl v !1'��titt•11.1�1,1itti•�Ifltelliltlttllil�tli.�tt tti�t����tt t��tiittltilli Ill Hill 'A R ME C-98810 VW P�?PSOm 007 a}tns anuQ u>✓Z - auI `4 �lsuIoaf) -A \ ----- J GeoInsight - R- - Environmental Strategy&EnginFering Practical in Nature December 17, 2007 GeoInsight Project 4743-002 Delivered Certified-Mail Linda E. Hutchenrider, Town Clerk Town Hall, Town of Barastable 367 Main Street Hyannis, Massachusetts 02601 RE: Notice of Implementation of Release Abatement Measure Activities Barnstable Road Auto Repair, Inc. 91 Barnstable Road Hyannis, Massa&=-Iusetts RTN 4-19670 Dear Ms. Hutchenrider: In accordance with Public Notification requirements of the Massachusetts Contingency Plan (MCP; 310 CMR 40.1403), please accept this letter as notification that implementation of Release Abatement Measure (RAM) activities are scheduled to begin within 20 days at 91 Barnstable Road located in Hyannis, Massachusetts (Site). RAM activities will be initiated to address a:release.of.gasoline into the subsurface that•.occurred-as,a result of,a failure of former underground storage tanks at the Site. RAM activities will implement soil vapor extraction (SVE) - methods to facilitate remediation of subsurface petroleum impacts. At this time, it is expected that SVE will be conducted ever a period of one to two years. p If you have any questions or would like to discuss the project, please contact us at a g 978-692-1114. M �i ri � Sincerely, ram: GEOINSIGHT, INC. == I .Robert P. Danckert Kevin D. Trainer, C.P.G., P.G., L.S.P. Project Geologist Senior Geologist cc: Peter Demers—Barnstable Road Auto Repair, Inc. (Thomas,A..McK--an, Health Division, Town-of.Barnstable,.Massachusetts Massachusetts Department of Environmental Protection- Southeast Regional Office GeoInsight,Inc. GeoInsight,Inc. GeoInsight,Inc. 25 Sundial Ave.,Suite 515 West 5 Lan Drive,Suite 200 Corporate Ten Center Manchester,NH 03103-7244 Westford,MA 01886-3538 1781 Highland Ave.,Suite 207 Tel(603)314-0820 Tel(978)692-1114 Cheshire,.CT 06410-1254 Fax(603)314-0821 Fax(978)692-1115 Tel(203)271-8036 www.geoinsightinc.com Fax(203)271-8038 Af �1�1- 0)(-/ GeoInsight Environmental Strategy&Engineering Practical in Nature March 28,2007 Geoh sight Project 4743-001 Thomas A. McKean Health Division, Town of Hyannis 200-Main Street Hyannis, Massachusetts 02601 RE: Notice of Document Availability Barnstable Road Auto Repair,Inc. �9r1 B stable Road Hyannis, Massachusetts RTNs 4-19670 and 4-19709 .Dear Mr. McKean: In accordance with Public Notification requirements of the Massachusetts Contingency Plan (MCP; 310 CMR 40.1403), please accept this letter as notification that a Phase I Initial Site Investigation(Prase I) and Tier Classification have been filed and are available for your review at: Massachusetts Department of Environmental Protection Southeast Regional Office Bureau of Waste Site Cleanup 20 Riverside Drive Lakeville, Massachusetts 02347 A copy of a Notice of Initial Site Investigation and Tier II Classification is attached and will be published in the Cape Cod Times on April 4, 2007. A Disposal Site Boundary Plan and the Summary and Conclusions section of the Phase I report are also attached to this letter. GeoInsight,Inc. . GeoInsight,Inc. GeoInsight,Inc. 25 Sundial Ave.;Suite 515 West 5 Lan Drive,Suite 200 Corporate Ten Center Manchester,NH 03103-7244 Westford,MA 01886-3538 1781 Highland Ave.,Suite 207 Tel(603)314-0820 Tel(978)692-1114 Cheshire,CT 06410-1254 Fax(603)314-0821 Fax(978)692-1115. Tel(203)271-8036 www.geoinsightine.com Fax(203)271-8038 If you have any questions or would like to discuss the project, please contact us at 978-692-1114. Sincerely, GEOINSIGHT; INC. Robert P. D c ert Kevin D. Trainer, C.P.G., P.G., L.S.P. Project Geologist Senior Geologist cc: Peter Demers - Barnstable Road Auto Repair, Inc. Attachments Phase I Initial Site Investigation— Summary and Conclusions Public Nctice-Notice of Initial Site Investigation and Tier II Classification Figure 5 —Disposal Site Boundary Plan March 28, 2007 Geolnsight Project 4743-001 . Page 2 of 2 PHASE I INITIAL SITE INVESTIGATION SUMMARY AND CONCLUSIONS BARNSTABLE ROAD AUTO REPAIR, INC. 91 BARNSTABLE ROAD HYANNIS, MASSACHUSETTS RTNs 4-19670 AND 4-19709 Geolnsight, Inc. (Geolnsight)prepared a Phase I Initial Site Investigation(Phase I) for the release of gasoline from an underground storage tank(UST) at the property located at 91 Barnstable Road,in Hyannis, Massachusetts (the Site). A summary of Immediate Repsonse Actions (IRA) and Phase I activities conducted at the Site are presented below. • The Site is currently used as an automobile repair facility and is located in a mixed commercial and residential area of Barnstable, Massachusetts. The Site consists of 0.2 acres of land on the west side of Barnstable Road and the north side of Louis Street. A one-story, slab-on-grade building is present at the Site. • In March 2006, the in-tank monitoring system indicated the presence of a leak in one of the three former gasoline USTs that were located at the Site. Subsequent testing confirmed a leak in the UST. • Durir._g April and May 2006, LNAPL was detected in a monitoring well at thicknesses of 1.39 and 0.78 feet. Based upon physical characteristics of the LNAPL and close proximity of the well to the USTs, the LNAPL appeared to be gasoline. • Three 4,000-gallon gasoline USTs,piping, and petroleum-impacted soil were removed from the Site in May 2006. VPH fractions and target analytes were detected in one of the nine confirmatory soil samples. The gasoline additive MTBE was detected in five of the nine post-excavation soil samples. • In February 2007, five soil borings were advanced downgradient of the former USTs. Three of the soil borings were completed as ground water monitoring wells. Analytical results of soil samples collected from the borings advanced indicated elevated VPH fractions and/or target analytes in so-1 samples collected from borings advanced downgradient of the former USTs (i.e., GI-3 and GI-5) at depths ranging from 22 to 25 feet BGS. The detected concentrations were below applicable S-3/GW-3 Method 1 Risk Characterization standards. March 28, 2007 Geolnsight Project 4743-001 Page 1 of 2 • In February 2007, LNAPL was detected in three monitoring wells at thickn.-sses ranging from 0.9 to 1.2 feet. Gauging data indicated ground water flow was generally toward the south-southeast. Concentrations of dissolved gasoline hydrocarbons were below the applicable Method 1 GW-3 Risk Characterization standards in ground water samples collected from crossgradient and downgradient wells. • Based up on a qualitative evaluation, Imminent Hazards or.conditions of SRM were not identified as a result of the release at the Site. • Further Response Actions are necessary at the Site to achieve a Response Action Outcome pursuant to the MCP. l t March 28, 2007 GeoInsight Project-4743-001 Page 2 of 2 NOTICE OF AN INITIAL SITE INVESTIGATION AND TIER II CLASSIFICATION BARNSTABLE ROAD AUTO REPAIR, INC. 91 BARNSTABLE ROAD, HYANNIS, MASSACHUSETTS 4-19670 and 4-19709 A release of oil a,-id/or hazardous materials has occurred at this location, which is a disposal site as defined by M.G.L. c. 21E, Section 2 and the Massachusetts Contingency Plan, 310 CMR 40.0000. To evaluate the release, a Phase I Initial Site Investigation was performed pursuant to 310 CMR 40.0480. As a result of this investigation, the site has been classified as Tier II pursuant to 310 CMR 40.0500. On March 28, 2007, Barnstable Road Auto Repair, Inc. filed a Tier II Classification Submittal with the Department of Environmental Protection (MassDEP). To obtain more information on this disposal site, please contact Kevin D. Trainer,LSP, GeoInsight, Inc., 5 Lan Drive, Suite 200,Westford, Massachusetts, 01886, at (978)-692-1114. The Tier II Classification Submittal and the disposal site file can be reviewed at MassDEP Southeast Region Main Office, 20 Riverside Drive, Lakeville, Massachusetts, 02347, (508)-946-2700. Additional public involvement opportunities are available under 310 CMR 40.1403(9) and 10 CMR 40.1404. Yr�oiiuyr.n-r.taectllL o�����r/JJCIf�u�efif - _ c�irrofnrcrrfo, 'fii<< < �r.r�n.t Aotification for Removal or Closure of In Place Storage Tanks Regulated Under 527 CMR 9.00 a Forward completed form,signed by local fire department,to: Mass. UST Compliance Unit, Fire Dept. Only Dept, of Fire Services,P.O. Box 1025-State Road, Stow, MA 01775 Telephone (978) 567-3710 R� � � e : /2a - t Fire Department retains one copy of FP-290R {ng"_ � irr�t<jSlg This form is to be used for notification for removal of Underground Std e`T�1i A) - Only Piping.' If a storage facility has UST's which are to remain in use, an entire amended FP-290 A. Facility Number (long form) must be filed. B. Date Entered Note: "Facility street address" must include both a street number and a street name. C. Clerk's Initials Post office box numbers are not.acceptable, and will cause a registration to be D. Comments returned. If geographic location of facility is not provided,'`please indicate distance and direction from closest intersection, e.g., (facility at 199 North Street is located) 400 yards southeast of Commons Road (intersection). I. OWNERSHIP OF TANK(S) II. LOCATION OF TANK(S) Owner Name(Corporation, Individual, Public Agency,or Other Entity) If known,give the geographic location of tanks by degrees,minutes,and seconds.Example:Lat.42,36,12 N Long.85,24, 17W Barnstab-1e ,Rd . Aut°c Regair Latitude Longitude 91 Barnstable Road _ 3a 7 �® Street Address Distance and direction from closest intersection(see note above) Barnstable Rd Auto Repair Facility Name or Company Site identifier,as applicable Hyannis . MA 02601 91 Rarnstable Read City state, Zip Code Street Address(P.O.Box not acceptable-see note above) couBarnstable Hyannis , MA 02601' nlY City Slate Zip Code ( 508) 771 -0031 09,7'9 Barnstable Phone Number(Include Area Code) Owner's Employer Federal ID k County III. TANKS/PIPING REMOVED OR FILLED IN PLACE Tank Number' Tank No. 1 Tank No.2_ Tank No. Tank No. Tank No. 1.Tank/Piping removed or filled n place (mark all that apply) A. Substance last stored [a a s l 0 B.Tank capacity gallons 4000 4000 4000 C. Estimated date last used (mo./day/yr.) 51/161/06 � /�Cti 5,/16,/06 D. Estimated date of removal (mo./day/yr.) 5 17 06 5 17/06 5 17 06 ————— ———— ————E.Tank was removed from ground F. Tank was not removed from ground 0 Tank was filled with inert material _ Describe material used: G.Piping was removed from ground — [X H. Piping was not removed from ground 0 I. Other, please specify T FP-29OR(revised 5/98) OVEF Make application to local Fire Department. Fire Department retains original application and issues duplicate as Permit. <, `"e�=���'��ne�iG`o��t�xe�t�%W.csed-- ✓c�4cr�xl.�4�C1'�ce .:/'" aye��,��ayt APPLICATION and PERMIT for storage tank removal and transportation to approved tank disposal yard in accordance with the provisions of M.G.L. Chapter 148, Section 38A, 527 CMR 9.00, application is hereby made by: Tank Owner Name-(please print) Barnstable Rd Auto Repairx Address 91 Barnstable Road, Hyannis, MA 02601 9nar�re(d appywg jorperml Sneer Ci,, . . Slate Zip LtHij Company Name Enviro—Safe Corporation- on Co. or Individual Print . Address 14B Jan Sebastian Dr, Sandwich, MA 02%3 Prim phn c (/ Address Sign ' applying for pem-it °� U J�l,� P�TM Signature(if applying for permit) ❑ IFCI'Certifi Other ❑ IFCI'Certified ❑ LSP# Other Tank Location H annis Sunoco, 91 Barnstable Rd , Hyannis , MA �yy SreerAddsss ✓ �oa.�Cary Tank Capacity(gallons) 4000 7nderaround Substance Last Stored gasoline Tank Dimensions(.diameter x length) Remarks: FFirm transporting waste Enviro—Safe Corp State Lic.# MA329 Hazardous waste manifest# - M A 0 6 4 2 4r, E.P.A.#—MAC300001617 Approved tank disposal yard Mid City Scrap Tank yard# 12889 Type of inert gas Tank yard address 548 State Road, Westport, MA . Conservatto Dept. : ` City or Town Date: f+ --- FDID# Permit#__ Date of issue j/ Date of expiration Dig safe approval number. 20061611564 ��' Aq��Dig Safe Toll Free Tel.Nu r-800-322-4844 d Signature 1 Title of Officer ranti�n e.mit,.'=:¢�"; � G t �� JN After removal(s)("Consumptive Use"fuel off tank"s egri '�sekjd Form FP-2908 signed by Local Fire Department to Office of the State Fire Marshal, UST Regulatcry Compliance Unrt, P.O.Box 1025, Sto ,MA 01775. 'International Fire Code Institute ��� Make application to local Fire Department. Fire Department retains original application and issues duplicate as Permit. �e�za���%rne72l'af'C-�rixe C��a�uices— �c aa�x�a��axe ✓"�ei���arL APPLICATION and PERMIT Fee: i-g—g.c, for storage tank removal and transportation to approved tank disposal yard in accordance with the provisions of M.G.L. Chapter 148, Section 38A, 527 CMR 9.00, application is hereby made by: Tank Owner Name:(please print) _ Barnstable Rd Auto Repairx Signature p apptywg orpennii Address 91 Barnstable Road, Hyannis , MA 02601 Street City Slate Zip 1114114 • • • • • Company Name Enviro—Sa€e Corporation Co.or Individual Print Print Address 14B Jan Sebastian Dr, Sand4ilcch, MA 02563 Address Prin Print Signat re i ap ' for permit) Signature(if applying for permit) t / ❑ IFCI Certified Other ❑ IFCI'Certified ❑ LSP# Other Tank Location Hyannis Sunoco, 91 Barnstable Rd , Hyannis , MA 3oZ� QoZ( Sleet Address City Tank Capacity(gallons) -4000 Underground Substance Last Stored gasoline Tank Dimensions(diameter x length) Remarks: -- . . ti Firm transporting waste Enviro—Safi Corp. State Lic.# MA329 Hazardous waste manifest# MA0654246 E.P.A.# MAC300001617 Approved tank disposal yard_ Mid City ,Scrap Tank yard# 12889 Type of inert gas Tank yard address 548 State Road, Westport, MA 7Ci.,.or Conservation DepT--. : 00, Date• ����Towniy/( FDID# Permit# of issue �� �� (j Date of expiration Dig safe approval number. 20061611564 _,�t� t' Dig Safe Toll Free Tel. Numb r 800 322-4844 Signature lTitle of Officer granting permit_,::.;"``�. t,.. i't, 1`�11t1 After removal(s) ("Consumptive Use"fuel oal tanks exam e ) e�a�Form FP- After signed by Local Fire Department to Office of the State Fire Marshal, UST Regulatory Compl ance Unit, P1.Box 1025, Stow, MA 01775. 'International Fire Code Institute GZjy �� �� �� P y Make application to local Fire Department. Fire Department retains original application and issues duplicate as Permit. 0 &Ye C� :�cces— ✓c�oaixc`a� r�xe APPLICATION and PERMIT Fee: a .° for storage tank removal anc transportation to approved tank disposal yard in accordance with the provisions of M.G.L. Chapter 148, Sect on 38A, 527 CMR 9.00, application is hereby made by: Tank Owner Name(please print, Barnstable Rd Auto Repairx gnafure fr aPPfYn9 arpermir Address 91 Barnstable Road, Hyannis, MA 02601 Street city State Zip • IL • • 7or Company Name Enviro—Safe Corporationual Print Print Address 14B Jan Sel�stiari Dr, andAcch, ,MA 02563 Address Print✓(/�!/t�t v Sighatur I ing for permit) Signature(if applying for permit) ❑ IFCI•Certified Other ❑ IFCI'Certified ❑ LSP# Other froTFE Tank Location H. annis Sunoco, 91 Barnstable Rd, . H annis , MA 17 Sleet Address City Tank Capacity(gallons) 4000 Underground Substance Last Stored Gasoline Tank Dimensions(.diameter x length) Remarks: 7transporting waste- Enviro—Safe Corp State Lic.# MA329 ste manifest# M A o 6 5 4 2 4 6 E.P.A.# MAC300001617 Approved tank disposal yard ."lid City .Scrap Tank yard# 12889 Type of inert gas Tank yard address 5.48 State Road, Westport, MA . • Conservat_on Date: City or Town FDID# Permit# Date of issue J ✓ , ( � Date of expiration $� Q Dig safe approval number. 20061611564 ° fit' „�.vgEwt' i� d'x� g Safe Toll Free Tel. Nurrger-800-322-4844 Gap - }ie .ss �G ? Signature/Title of Officer grant ng permit' . ,, ' :I , i After removal(s)("Consumptive lse"fuel oil tanks send Form FP-29OR signed by Local Fire Department to Office of the State Fire Marshal, UST Regulatory Compliance Unit, P.O. Box 10 5, Stow,MA 01775. 'International Fire Code Institute t�1� r �ii. Z FmdlMaplParcel 327026 Syr Heal#h Department H�aNth Sy�e�mf �� �€i� 't fly - gMap/Parcel 327026 _ <` Tank Nbr 02 Ta Nbr 00968 Installed 06/18/1981dw Location B ` g, IU { Testotlfication©ate 09/16/1994 Status s << Date ».> Removal Notification Date 01/05/2006 � 10/31/1996 M W TestItm Abandon , s, Remouat 05/16/2006 s � a UarMe ianc a Store G Fuel Storage ReasonB i i r �' Capaclayfi, C�onstructlon Leak Detection Cat od� Detect o�n WIll Sll toragetTa I Info 004000 SS s Additional Details TEST#2 101096 f _m Add � r Change�Record� " * A `t // Fmd MaplParcel 32702E Town-qf Barnstable .P a Health Departirient Health System x' a / f. � xna a/ - , ,a . � '•. �c ors�g � MaplParcel' 327026 flf ' � �'� Tank N rb r 03 , wag Nbi� 00969 Installed ,': 06/18/1981 Location 41 Vest Notification Date 09/16/1994 f Status c / Date Removal Noti�ficafron Date 01/05/2006v I west: 3 i f Abandon: h � ; N/ Removah 05/16/2006 � a Variance ,, ,� Keep / F �Stor�ed y e Fuel Storage�Reason B Capac ty Cgnstructron Leal( eD tectionCathodic Detection Storage'Tanklnfo 04000 SS 9 `!r ti ditional Details, l TEST#2 101096 Add''' Change Record? "N�//fyy9 /� _ ta f ,,.- „_7'� - bay ...: ..,.�.y,__� e,,,., ��w�,,,, -.,,a-a !�.._.�",zaN r y FindRamaPM, ap/Parcel 32702E Town of Barnstable ` � � Hea)Ak, epartmenv 'Aa,th System-,,` � �f y Map/Parcel; 327026 Tank Nbr 06 Tag Nuff-D 00000 Installedn B d t �w Test�NoUficabo pn ante Statuses FF x pate Removal Nofifi�cation pate Si11/23/1998 Test 3 6 10/31/1996 66 o banuo Removal 05/16/2006 Vanance. papIRA Fuel Stored Fuel Storage Reason f , y E y Capac ty Construction eak®etection , Cathodic Detect�ori Storage,TanW1' 004000 � va• F Additionaletatls TEST#2 101096 y / x Add Change MAY-08-2006 15:34 GEOINSIGHT INC. yfm b8W 1115 r.we THE COMMONWEALTH OF MASSACRUSETTS DEPARTMENT OF REVENUE Underground Storage Tank Petroleum Prodact Cleanup Fund 100 Cambridge Street,7th Floor Boston,lNlassachuaetts 02114 CERTIFICATE OF COMPLIANCE 100% Reimbursement FOR PETROLEUM DISPENSING FACILITIES !Date imw-. 51812006 Dan Expires:p' • 5181201 .._._............M... 1--- Certirwate of Compliance Number: , ,1095_p-- 91 BARNSTABLE RD Suzd Addrras of t 1ST Feebly 13ARNSTA13LE ROAD AUTO REPAIR INC FW11V Now (Cotpotatltm,fwividaai,Or Otht:r Errcityj PADCO_P_RO_P_ER_T_IES INC - I ...._------............•-----.......-----•--t7wncr at Time of Certification...._.---.........__ ................ HYANNIS BARNSTABLE MA 02601 State zip Code ....................._..._---------.........(5081771-0033 ........ N..... ........... ............. w...a..Y N•Y N..._.. a4l"U118 .G , Executive Director This Cer�leate 94 Cornp6anoe is Fwftd in aaoord nw with the prorissions of M.ML..Char 21J. Ths U6T Facillgr Idant�ed tpsrpin is preau�d lry the OepWtraent of Revenue b Rave nut the fall reguhatory OOmp�rtoa requln;menb of 603 CZAR 2.00.and at Suef1,is preg%ur d to t o apple to un the urgeW Wnd Storage Tank Pet otewn pm" Cleanup Fund as a mechanism of Ftnanctai Re3ponsw%that meela the MWm%wft 01$27 GMR 9.07(L)ac 0 plRairt9 m Peeroterun Pr�ttct tetetot fi�eL Ttua ttiesunlption of compitartce�rr'buea6le. tasuanee d thta Crattificate Of COrt►p Ilr=13 CO too the abM idt•Mrmd UST Facility maintatrdey a valid FP-=and aU other requirements so too M IR CMR 4A0.503 CMR 2.00.527 Multi 5.00,CMR 9.00,and CMR 15.00. ('1'415 Cetrti�t ate Must Be Folded or Available on the Premises) Forth 21J.0001 Rev.349= Page t of 7 TOTRL P.02 _.— --- ---- THE COMMONWEALTH OF MASSAC]H[USETTS DEPARTMENT OF REVENUE Underground Storage Tank Petroleum Product Cleanup Fund I"Ca uW*e Stre4 76 Floor Rostout Manachusetts 02114 CERTIFICATE OF COMPLIANCE 100% Reimbursement FOR PETROLEUM DISPENSMG FACILITIES Date Ined: 51812006 Date Expires: 518/2011 certirKate of Compliance Number: ,,,_._,1095....� 91 BARNSTABLE RD Saud Address of t 1ST Fasality 13ARNSTA13LE ROAD AUTO REPAIR INC Fadfity N4= (Cowmilop,lndsviduat,or Other Enmity) ._..PADCO PROPERTIES INC Oww at nme of ceni!'ufion HYANNis BARNSTABLE MA 02601 seam Zip Coda (5 08j 771-0033 ..«..................._..._...................... . .I.....N..N.............................w...NwN N.NH...u.. Issued By: _._... r utive Dimeator This CGYWI=ts d Compftmce is ww ted in aeaordonce with tfro provisions of M ML..Chspbr 21J. The tt6T Facft Identified t>arein is p,eawtwo bytne ospamtot Revenue to mere met the tad rely oomptianoa eequln;meab of 503 CpIR 2.00.and=suet,is pmwAnad to be orgittly to use Inn UR011 9Mund SLoroga Tank t$hoteum ptuaucf Clump Fund as a mechspim of F aanctat Respenswity that meet ale mt**rp ol 3i27 CRItR 9.OT{L)as n OMMIS tt►Petroleum PrWW motor fse t TN s wasumaion of comes is rt but*k. tasuane�of tMo 4"BR7f+Citt1 of Ca"orm to comdNlo*ttw ft abow.►iderttitsed UST Facilfir mainta"a valid FP.290 and ad other faquiremenfs sat fM in 502 C R 4.0k SU CMR 2.00.S27 CM 5.0%GmR 9.W.and CQm 15.01l. (ThIS CeKirwate Must Be Posted or AvaMbk on the Pretaises) Form 21J-COCI Rev.VAN Page t of i TOTAL. P.O2 •,OtV COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION SOUTHEAST REGIONAL OFFICE s 20 RIVERSIDE DRIVE,LAKEVILLE,MA 02347 508-946-2700 MITT ROMNEY STEPHEN R.PRITCHARD Governor Secretary KERRY HEALEY ROBERT W.GOLLEDGE,Jr. Lieutenant Governor Commissioner URGENT LEGAL MATTER:PROMPT ACTION NECESSARY March 29,2006 Barnstable Road Auto Repair Inc. RE: HYANNIS—BWSC ATTN: Peter Demers 91 Barnstable Road 91 Barnstable Road RTN#4-19670 Hyannis,Massachusetts 02601 NOTICE OF RESPONSIBILITY M.G.L. c. 21E,310 CMR 40.0000 Dear Mr.Demers On March 22, 2006 the Department of Environmental Protection (the "Department") received oral notification that there is a substantial likelihood of a release of oil and/or hazardous material from an underground storage tank: at the location referenced above. It was reported that a release to the environment may have occurred from of an underground storage tank (UST), as established by a tank tightness test and inventory loss of in excess 0.05 gallons per hour. The Massachusetts Oil and Hazardous Material Release Prevention and Response Act, M.G.L. c.21E, and the Massachusetts Contingency Plan (the "MCP"), 310 CMR 40.0000, require the performance of response actions to prevent harm to health, safety, public welfare and the environment which may result from this release and/or threat of release and govern the conduct of such actions. The purpose of this notice is to inform you of your legal responsibilities under State law for assessing and/or remediating the release at this property. For purpos s of this Notice of Responsibility, the terms and phrases used herein shall have the meaning ascribed to such terms and phrases by the MCP unless the context clearly indicates otherwise. The Department ras reason to believe that the release and/or threat of release which has been reported is or may be a diEposal site as defined by the M.C.P. The Department also has reason to believe that you(as used in this letter, "you"refers to Barnstable Road Auto Repair Inc.)are a Potentially Responsible Party(a"PRP")with liability under M.G.L. c.21E §5,for response action costs. This liability is"strict",meaning that it is not based on fault,but solely on your status as owner, operator,generator, transporter,disposer or ot-aer person specified in M.G.L.c.21E §5. This liability is also "joint and several", This information is available in alternate format.Call Donald M.Games,ADA Coordinator at 617-556-1057.TDD Service-1-800-298-2207. MassDEP on the World Wide Web: http://www.mass.gov/dep 0 Printed on Recycled Paper 2 meaning that you may be liable for all response action costs incurred at a disposal site regardless of the existence of any other liabl;parties. The Department encourages parties with liabilities under M.G.L. c.21E to take prompt and appropriate actions in response to releases and threats of release of oil and/or hazardous materials.By taking prompt action, you may significantly lower your assessment and cleanup costs and/or avoid liability for costs incurred by the Department in taking such actions. You may also avoid the imposition of,the amount of or reduce certain permit and/or annual compliance assurance fees payable under 310 CW 4.00. Please refer to M.G.L. c.21E for L complete description of potential liability. For your convenience, a summary of liability under M.G.L. c.21E is attached to this notice. You should be aware that you may have claims against third parties for damages, including claims for contribution or reimbursement for the costs of cleanup. Such claims do not exist indefinitely but are governed by laws which establish the time allowed for bringing litigation. The Department encourages you to take any action necessary to protect any such claims you may have against third parties. At the time of notification to the Department, you were given approval to conduct the following response actions,which were approved as an Immediate Response Action(ERA): • Pump gasoline from UST in question. • Remove UST and determine if a release has occurred. • All Remediation Waste must be properly stored/handled and disposed of within 120 days from the date of generation per 310 CMR 40.0030. ACTIONS REQUIRED Additional submittals are necessary with regard to this notification including, but not limited to,the filing of a written Immediate Response Action (IRA) Plan, IRA Completion Statement and/or a Response Action Outcome (RAO) statement. The MCP requires that a fee of $1200.00 be submitted to the Department when an RAO statement is filed greater than 120 days from the date of initial notification. Specific approval is required from the Department for the implementation of all IRAs, pursuant to 310 CMR 40.0420. Assessment activities, the construction of a fence and/or the posting of signs are actions that are exempt from this approval requirement. In addition to oral notification, 310 CMR 40.0333 requires that a completed Release Notification Form (BWSC-103, attached)be submitted to the Department within sixty(60) calendar days of March 22, 2006. You must employ or engage a Licensed Site Professional (LSP) to manage, supervise or actually perform the necessary response actions at this site. You may obtain a list of the names and addresses of these licensed professionals from the Board of Registration of Hazardous Waste Site Cleanup Professionals by calling(617) 556-1145 or visiting http://www.state.ma.us/lsp. Unless otherwise provided by the Department, potentially responsible parties ("PRP's") have one year from the initial date of notification to the Department of a release or threat of a release, pursuant to 310 CMR 40.0300, or from the date the Department issues a Notice of Responsibility,whichever occurs earlier, to file with the Department one of the following submittals: (1) a completed Tier Classification Submittal; 3 (2) a Response Action Outcome Statement or, if applicable, (3) a Downgradient Property Status. The deadline for either of the first two submittals for this disposal site is March 22, 2007. If required by the MCP,a completed Tier I Permit Application must also accompany a Tier Classification Submittal. This site shall not be deemed to have had all the necessary and required response actions taken unless and until all substantial hazards presented by the release and/or threat of release have been eliminated and a level of No Significant Risk exists or has been achieved in compliance with M.G.L. c.21E and the MCP. If you have any questions relative to this Notice,please contact Michael Whiteside at the letterhead address or at (508) 946-2.704. All future communications regarding this release must reference the following Release Tracking Number: 4-19670. Very truly yours, This final document copy is being provided to you electronically by the Department of Environmental Protection,A signed copy of this document is on file at the DPP office listed on the letterhead. Richard F.Packard,Chief Emergency Response Release Notification Section P/MCW/ noMhour.Doc Attachments: Summary of Liability under M.G.L. c.21E fc: Hyannis Fire Department ATTN: Lt.Eric Hubler 508-778-6448 ec: Barnstable David Stanton david.sta.nton a,to,vn.barnstable.ma.us Barnstable Town Council council@town.barnstable.ma.us I Health Complaints 23-Mar-06 Time: 8:10:00 AM Date: 3/22/2006 Complaint Number: 18705 Referred To: ALISHA PARKER Taken By: THOMAS MCKEAN Complaint Type: ARTIC_E XXXIX HAZARDOUS WASTE Article X Detail: PRODUCT INTEGRITY Business Name: &W*6EO\BARN RD AUTO REPAIRG�r�S Number: 91 Street: BARNSTABLE ROAD Village: HYANNIS Assessors Map Parcel: 327-026 T Complainant's Name: HYANNIS FIRE, ERIC H. Address: Telephone Number: Complaint Description:. A LEAKING GASOLINE TANK PRESENT, REQUEST BOH REPS. Actions Taken/Results: AP WENT TO SAID LOCATION AND MET WITH HYANNIS FIRE(ERIC H)AND GAS STATION OWNER PETER DEMERS. DS MET UP AT SAID LOCATION AT 9:40 AM. DS BROUGHT RESIDENTIAL FILE, HMTANK RECORDS, ZOC LOCATION AND TAPE MEASURE TO CHECK MONITORING WELLS ONSITE. DEP ARRIVED (MICHAEL WHITESIDE AND JAMIE) BETH OF CLEAN ` HARBORS ALSO ARRIVED TO SURVEY AND II GIVE AN ESTIMATE FOR TANK REMOVAL. SINGLE WALL STEEL TANK. RECENTLY NOTICED THAT HIS NIGHTLY MONITORING SYSTEM (11 PM TO 5AM)WAS SHOWING A POSSIBLE SMALL LOSS OF PRODUCT. OWNER CONTACTED TESTING COMPANY- XCEL-THAT ROUTINELY TEST TANKS FOR ANNUAL INSPECTIONS- LAST TEST- JANUARY OF 2006)TO LET THEM KNOW HE WAS HAVING A CONCERN OVER HIS NIGHTLY TESTING INFORMATION. XCEL TESTED THE TANKS ON 3/21/06 AND DIDN'T 1 Health Complaints 23=Mar-06 FIND ANYTHING. THEY TOLD HIM TO DISCONNECT TANK 1 FROM TANK 2 TO KEEP IT ISOLATED AND TO LEAVE THE PUMP OFF OVERNIGHT. PETER CHECKED THE LEVEL'IN THE MORNING. BY MORINING IT APPEARED THAT APPROXIMATELY 50 GALLONS OF GASOLINE HAD BEEN LOST OVER NIGHT. FIRE DEPT. WAS NOTIFIED. FIRE DEPT. ESTIMATED THAT APPROXIMATELY 10 GALS\HOUR WERE BEING LOST. A PUMP OUT COMPANY WAS NOTIFIED IMMEDIATELY BY PETER DEMERS. A CHECK 3 HOURS LATER SHOWED APPROXIMATELY 80 GALLONS HAD BEEN LOST SINCE THE FIRST DETECTION. 3 MONITORING WELLS LOCATED ONSITE. WELL TO THE SOUTH OF TANK WAS APPROXIMATELY 34' DEEP AND HAD A STRONG ODOR OF GASOLINE PRESENT. WELL TO THE WEST OF THE TANK HAD LITTLE TO NO GASOLINE ODOR PRESENT. ANOTHER WELL WAS LOCATED THAT WAS NOT ON THE PLANS, AND HAD A HOLE IN THE TOP OF IT, WHICH WILL NEED A PROPER CAP INSTALLED ON IT. THE PUMP OUT COMPANY(MARTINI'S) ARRIVED AT AROUND 11:45 AM AND PUMPED OUT THE LEAKING TANK. THEY WERE GOING TO PUMP OUT ALL 3 TANKS. OWNER AWAITING CONTRACT BIDS FOR REMOVAL OF TANKS, AND CONTAMINATED SOILS. AWAITING A CALL FROM THE OWNER OR HY FIRE WHEN REMOVAL OCCURS. THERE ARE THREE 4,000 GALLON UNDERGROUND GASOLINE STORAGE TANKS PRESENT AT SAID LOCATION, ALL INSTALLED ON 6/18/1981. LOCATED OUTSIDE OF ZOC. THEREFORE REQUIRED REMOVAL MANDATORY BY 6/18/2011, AS THEY ARE SINGLE WALL SS TANK CONSTRUCTION PER BOH FUEL, TANK REGULATION. THE OWNER PLANS ON REMOVING ALL THREE TANKS ASAP AND INSTALLING NEW UP TO CODE TANKS. Investigation Date: 3122/2006 Investigation Time: 8:20:00 AM 2 Health Complaints 23-Mar-06 I 3 4p 3 2 -7/f t,fo l I\Vj e �A k ?,�k�`�y 3 az�o� S f° i9 Y" I J fo�1�nrarer ems' Cam. � 4 M f :k �rl dekc-4ble APt,fAe uji df 3s sCA /� F i►�►un'��.: ws`� LPu r� 4UAlC W� M,'�IIA ql a1�n e 3�ti�► l�S. , TOWN OF BARN STABLE Health Division — 200 Main Street - Hyannis, MA 02601 4 �TME Tp� FAXDate: February 1, 2006 * BARNSfABLE, 9� MASS. g Number of pages including cover sheet: 2 s6;q. ♦� ArfD MA't A To:Diane—Hyannis Fire Department From: Alisha Parker—Hazardous Materials Town of Barnstable Health Division Mail to: 200 Main Street Phone: Hyannis,MA 02601 Fax phone: 508-778-6448 Phone: 1-508-862-4645 CC: Fax phone: 1-508-790-6304 REMARKS: ❑ Urgent ❑ For your review ❑ Reply ASAP ❑ Please comment Diane, Here is information on three UST's that will require testing annually until 2009. In 2009, all UST's will need to be removed. Thank you for your assistance in UST issues. I will be faxing over other informative letters for your files regarding UST's. If you see any discrepancies, please feel free to contact me! Thank you, Alisha Parker Hazardous Materials Specialist Town of Barnstable oFtHEgrp� Regulatory Services 'I! Thomas F. Geiler,Director Public Health Division snxxsrns , * Thomas McKean,Director i639 �0 200 Main Street, Hyannis,MA 02601 prEO MA�� Phone: 508-862-4644 Email: healthAtown.barnstable.ma.us Fax: 508-790-6304 Office Hours: M-F 8:00—4:30 January 31,2006 Mr.Peter Demers 91 Barnstable Road Hyannis,MA 02601 Dear Mr.Demers, Recently a letter has been released to homeowners and commercial business owners regarding the removal of Underground Storage Tanks (UST). When removals, abandonment, and testing of the tanks have occurred, our electronic files are updated. We have found that many files have not been correctly updated and/or the proper notification was not received by our Department. The Town of Barnstable,Health Department,has completed the research on your parcel 327-026 and concluded that the Underground Storage Tanks of Gasoline have been tested but not each year after the 19t`year of installation as required. Testing shall be completed annually per Town of Barnstable Code, chapter 326-8(E). Under the Town of Barnstable Code, chapter 326-3(B),you will be required to remove all three Underground Storage Tanks in the year 2009. We received the copies of the UST testing and permits you gave to us. This information will be placed in your street file and the electronic files will be updated correctly. We thank you for your cooperation in this matter and if you have any questions about this topic or you need further information, guidance or assistance,please do not hesitate to contact the Public Health Division. Sincerely, Alisha L. Parker Hazardous Materials S ecialist mas A.McKean,RS, CHO Director of Public Health . + < FP.6 a o The Commonwealth of Mass achus DEPARTMENT OF FIRE SERVICES , P.O. Box 1025 - State Road Stow, MA 01775 - '" Hyannis, Ma 11/12/99 UPGRADE STORAGE SYSTEMS PERMIT : PERMIT# 99909 PERMIT TYPE In accordance.with the provisions of: -section: -to wit: , This permit is granted to: PCA ENGINEERING: INC. for permission to: INSTALL the following: CATHODIC PROTECTION SYSTEM at the following property: PropertyName BARNSTABLE AUTO REPAIR PHONE 771-0033 No.&Street 91 BARNSTABLE RD. FAX USE GROUP MAP I PARCEL CONTACT PETER DEMERS DESCRIBE UPGRADE CATHODIC PROTECTION SYSTEM ON(3)4,000 GAL.UST PERMIT REF# PROJECT RESTRICTIONS: REQUIREMENTS: CALL DISPATC.HE•R PRIOR TO AND FOLLOWING WORK AND GIVE THE ABOVE PERMIT NO. NOTE ** CALL WHEN COMPLETED FOR FINAL INSPECTION ** APPLICANT INFO PCA ENGINEERING; INC.. ; 152 .Forest St. Norwell,Ma 02061 781-659-7793 LICENSE TYPE LIC.# EXPIRES APP. PHONE APP.FAX 781-659-7246 DREW LAW ell PRINT NAME /�',� ,'b; SIGNATURE PAID $10QI1 /12/99 Will expire on _. _._.. LT. DONALD CHASE, ;��ES,F�y" ���. ,e �'� � " MA:781-659-7793 tel. L�,�'� LOGGED BY DL GRANTING FIRE OFFIC ©�� � ® ® MA:781 659 7246 fax WOW N INSPECTION INFO e PCA ENGINEERING, INC. Hyannis Fire Departmet 508-775-1300 Fax 152 FOREST STREET DREW LAWRENCE NORWELL,MA 02061 4.ASPHALT �� w BUILDING .. nR �y .fiz t � r NOTES: t 1. NO. 10 AWG HMWPE CONNECTING .WIDE - IS TO BE CONNECTED TO THE ANODES �F .R USING CRIMPED CONNECTORS AND TRIPLE WRAP TAPE PROCEDURES.. fi • r`�P ` s 2. ANODES ARE TO BE INSTALLED TO A. Ge h DEPTH OF 10' BELOW GRADE. r n �•. �r � _;t. .: � R�Y�z+p 3. TANKS ARE SWS AND PIPING IS i f STEEL L h f 2 X 60 Anotec Anodes ASPHALT � • PCA ENGINEERING, INC. DRAWING TITLE: NEW ENGLAND DIVISION CATHODIC PROTECTION SYSTEM REPAIR 152 Forest Street Norwell,Ma 02061 BARNSTABLE ROAD AUTO REPAIR, INC. TEL.No.(781) 659-7793 Barnstable Road Hyannis, Ma REVISION 2: DESIGN BY: APPROVED BY: DRAWN BY: DRAWING NUMBER: A BP 19413=01 REVISION 1: ATE: SCALE: DATE: N.T.S. 10l OM DEP Title 5S etba yeas Ma s r , H cur sr � 1� � s 5_ rt '� '•-i �� �i��� ir�1�' F1' � 'ti 1 x fo - � o5(2 :. / M . � PCA ENGINEERING NEW ENGLAND LLC 7 WEST END WAY, NORWELL, MA 02061 Telephone:781-261-9688 •Fax:781-261-9679 ® Regional Offices in PA, NJ, FL&VA ENGINEERING •CORROSION TESTING & MATERIALS • DIVING • ENVIRONMENTAL SERVICES January 13, 2006 Barnstable Road Auto Repair, Inc:. 91 Barnstable Road Hyannis, Ma 02601 Att: Mr. Pete- Demers Re: Cathodic Protection System Survey Barnstable Road Auto Repair PCA Job No. 31336 Dear Mr. Demers : Please find this report and the enclosed data table relative to the survey of the cathodic protection system at the Barnstable Auto Repair located at 91 Barnstable Road in Hyannis, Massachusetts . The results of our survey find treat the STI-P3 type underground storage tanks are receiving adequate levels of cathodic protection. Tank-to-soil potentials obtained from around the tank ranged. from -0. 930 volts to -2 . 99 volts as measured to a Cu\CuSO4 reference cell . The piping is fiberglass and as such requires no cathodic protection. PEOPLE e CAPABILITY 0 ACHIEVEMENT FOR OVER 35 YEARS � I '� r S 1 � � �.a _ _ t G � .y! � ... �� a 1 l�� « ♦ , �. t —� _. • {. Y • e � i I F �y�f ,., t. ti. l� ... 1 � �� � + r � 1 , iR � � � , � � , ti .� . �il .- .. .. ",� x . ` _' .. _. 4 � � e � .. .. _ }.., 1 «, � 'f � � � r _ _ t t !� ~ ` ,� Dept � _ ` ' � � � , F 1 � ~ x �'a - «'n� i r Mr. Demers Re: PCA Job No. 31336 January 17, 2006 Page 2 If you have questions or require additional information, please contact me. Very truly yours, Bertram Jay Phillips Coirosi.on TechnologisL NACE No. 2974 Reviewed by: William Simpson Cathodic Protection Specialist NACE No. 3634 PCA ENGINEERING NE LLC PCA ENGINEERING NE LLC 7 West End Way NORWELL.yL1 02061 (617)261-9688 CATHODIC PROTECTION SYSTEM MAINTENANCE RECORD SHEET OWNER: Barnstable Read Auto Repair PCA JOB NO: 31336. LOCATION OF RECTIFIER: Storage Room TYPE OF RECTIFIER: Air-Cooled MANUFACTURED BY: PCA MODEL NO.: ES 2 SERIAL NO.: 991813 A.C.INPUT: 115 Volts 2.5 Amps Single Phase I K= N= T= D.C. OUTPUT: 40 Vohs 5 Amperes E : 6 SIZE: 2 dia X 60 length TYPE OF ANODES: ANOTEC Q TY DATE SYSTEM ENERGIZED: 11/16/99 COMMENTS: RECTIFIER SETTINGS . DC OUTPUT RECT. TAKEN COARSE FINE VOLTS AMPS EFF.% BY DATE REMARKS 3 5 44.8 0.46 DL 11/16/99 Energize 3 5 43.9 1.4 SL 7/16/02 Survey 3 5 43.9 1.6 SL 7/18/02 Survey after repair 3 5 45.0 1.48 MS 1/13/06 Survey Where: K=\'Batt I lour Meter Constant N=Number of revolutions of watt-hour meter in time T T =Time duration of obscrvation Rectifier Efficiency=100(Outaut Power) = 100(Vdc)(Adc) Input Power K N (3600ff) i 1 � , i ' ' ; ' � � '_ i - � , � -.. � , - - ' 1 � E � � : _ � j � � i ' � - �� e F � � ' t -- . . -� _ Z, � PCA ENGINEERING NE LLC 7 WEST END WAY CORROSION FIELD SURVEY DATA AND TABLES ' . NORWELL MA 02061 781 261-9688 OWNER: Barnstable Road Auto STRUCTURE-TO-SOIL POTENTIALS ARE IN(-)VOLTS PCA JOB NO: 31336 - STRUCTURE: UST's @ 91 Barnstable Rd Hyannis,Ma TO Cu/CuSO4 REFERENCE CELL USING A FLUKE TABLE A DATE OBTAINED: January 13,2006 MODEL 23 MULTIMETER. SHEET 1 OF 1 SURVEYED BY: M.Schmitt REMOTE READINGS DETERMINE CONTINUITY CLOSE ON CLOSE OFF REMOTE COMMENTS Tank A 0.798/0.515 "Stick"Tank Tank Size/Product:4000 gal Super Site Layout @ No. 1 1.528 0.515 0.815 10.515 Fill Tank Installed: 1979 ` @ No.2 1.20 0.477 0:461 !0,526 Vent Overspill Containment-Yes @ No. 3 1.680 0.721 Overfill Protection: Yes @ No.4 2.497 1.09 @ No. 5 1.959 0.946 BUILDING Tank B 0.798/0.515 "Stick"Tank Tank Size/Product:4000 gal Regular @ No. 1 1.200 0.447 0.815/0.515 Fill Tank Installed: 1979 @ No. 2 0.930 0.453 Vent Overspill Containment: Yes @ No. 3 1.160 0.728 Overfill Protection:Yes t ................2................ ................ @ No.4 1.959 0.964 T T T @ No. 5 1.679 0.829 •`• A s A A 3? N i N € N Tank C 0.798/0.515 "Stick"Tank Tank Size/Product:4000 gal Regular K K K @ No. 1 0.930 0.455 0.815/0.515 Fill Tank Installed: 1979 A ? B ! C @ No. 2 1.298 0.799 Vent Overspill Containment: Yes : : 4 @ No. 3 1.308 0.680 Overfill Protection:Yes @ No.4 1.679 0.829 @ No. 5 2.99 0.678 Test locations are similar for each tank Pumps Piping Material: Fiberglass 1.126/0.515 Negative Lug Type Leak Detection: TLS-350 0.815 10.515 Electric 0.815/0.515 Water f r t 4. .� .tip _ t � ' � } f a_ r� . ` �. F..t- �s..a �.__� «... n.- _ ;�,(r.a... r_ _'� - .a.. _. � n �w.. ...o r -�� �r�.r..w.-.�.w ._.r._ s.__ ... ^ � �..�_. ._ _. .. -. � _.._...._. _. _ .�_,._ .M, � . — — _.. _ _y _ _ _ ,. _ _� �. _ .._ _ _. ....... �� ` j.. .. .. _._ - e � � ...._ r...._ - ,_ �_. �__ ...... - � � . __.r._.. _ �.�. . ,• i— #. --— —� ..� � -___ .. _ m _...e.... .. ._ _—. .. _ti._. _ ... .- - . ... --- - .._ _. 1 a _ _ _ t f ,i lake application to local Fire bepartmer� 00 NOT make.application to Depait neht of Fire Services or 6tate Fire Marshal. APPLICATION FOR PERMIT To Maintain an Existing/New Storage Tank Facility Regulated under 527 CMR 9,00 To: Head of Fire Department City, town or district: �- I Date: /a L Application is hereby made for a permit to maintain an existinoew storage tank facility as required by 527 CMR 9.00: . Location of property: Street address . Owner of property: — Pug name at person,Arun or aotporatlon Number of storage tanks: aboveground underground Signature of owner or authorized representative: Fee paid: $ ®;�✓ (M.G.L. Chapter 148,section 10A) (Fire Departments copy-To be filed with FP 290) %�Z6GuZO'"bL(fP�2�Gf2 tY�C���7.fX�SClG�7�� �e �trr�zCv�'�rixe G�r/l�?lZf.P,6 — C:!�LCO O�GJ2�V �LJ'U��l� (,GIiIr ��• _ PERMIT Q L To Maintain an Existing/New Storage Tarok Facility for Storage Tanks Regulated under 527 CMR 9.00 In accordance with the provisions of 527 CMR 9.00 this permit to maintain an existing/neW storage t facility is granted to: r Location of property: - Owner of'property: Go PA4P6-0c C Fd!(Acme Operson,firm or cormmlion Number of storage tanks: (9 aboveground ^ underground Facility to be maintained in accordance with the restrictions described below: Fee paid: $ l01W (M.G.L. Chapter 148,section .10A) - _, Signatol8 0l tis d of Fire ep;agkran go,A ape dd0iigpe911 (Owner's copy-Ta be pasted at the storage facility) 8YANNW) FEr f 0E ARTINis T FP-290 Permit(Misod 3100) `J '� J i s a" . 4�ANINi&�, MA 026.0; Town of Barnstable Regulatory Services R17CEIVED Thomas F. Geiler,Director I =` Public Health Division SEP 2 3 2005 E7'°recNwc°' Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 - - ...._Fax: 508-790-6304 Application Fee:$100.00 ASSESSORS MAP AND PARCEL NO. DATE APPLICATION.FOR PERMIT.TO STORE.AND/OR UTILIZE MORE THAN III GALLONS.OF HAZARDOUS MATERIALS FULL NAME OF APPL I CANT /c A-�1 f71: C ✓tom �� , ��c NAME OF ESTABLISHMENT g4"jAeje `f its A&-0A11 ADDRESS OF ESTABLISHMENT /�i- �fo✓ i ����'1r TELEPHONE NUMBER SOLE OWNER: NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 0V r.?0 L? STATE OF INCORPORATION 4 FULL NAME AND HOME ADDRESS OF: � PRESIDENT jF fD Cal YO CV ,ram- TREASURER S O^ - CLERK SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# , "W-ZZs _ Haz.doc/wp/q Est pad TOWN OF BARNSTABLE P QSS�� Date: q / 7 / ZN wsVENTORY � TOXIC AND HAZARDOUS MATERIALS' ON-SITE NAME OF BUSINESS: Ar Q-Cy 6ju-p.00o) BUSINESS LOCATION: 91 8 rnsfn,12Le_ INVENTORY MAILING ADDRESS: t' // TOTAL AMOUNT: TELEPHONE NUMBER: t5yg'111 ' ®033 6allbins Ir CONTACT PERSON: WL E Deme --s EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: r INFORMATION/RECOMMENDATIONS: Fire District: . s n' (s -CYVM W LA UnLILi Wr► 4a us Wx Waste Transportation: tAes Last shipment of hazardous,waste: Name of Hauler• CkAn OU Destination: Waste Product: VI LA O Licensed? es 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 Pub is 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 flLshes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides di 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 (electroly:e)/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 r=movers tupy (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar remover: Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS PETER A.DEMERS �gm�pcn `ASE CERTIFIEDMECHANIC t Barnstable Rd. Auto Repair Inc. 91 BARNSTABLE RD. HYANNIS,MA 02601 '(508)771-0033 e• STATE INSPECTIONS•TUNE UPS•BRAKES-EXHAUST Town of Barnstable OFtklE T Regulatory Services .. q , Thomas F. Geiler,Director Public Health Division -� " AB * _; Thomas McKean,Director 200 Main Street Hyannis,MA 02601 Phone: 508-862-4644 Email: health(i�town.barnstable.ma.us Fax: 508-790-6304 Office Hours: M-F 8:00—5:00 Barnstable Road Auto Repair Inc. Attention:Peter A. Demers,Manager July 22,2004 91 Barnstable Road Hyannis,MA 02601 RE: Hazardous Materials License Required and OVERDUE. Dear Mr. Demers: The Toxic and Hazardous Materials Inventory conducted on June 3,2004 shows that you have approximately 6,214.75 gallons of toxic and hazardous materials being used/stored/generated/disposed of at your place of business(Please refer to your copy of the Toxic and Hazardous Materials Onsite Inventory). The Town of Barnstable Board of Health has determined that using, storing, generating and/or disposing of over 111 gallons of hazardous materials per month requires businesses in the Town of Barnstable to obtain an annual Hazardous Materials Permit.You were informed verbally on April 28,2004,in writing on April 28,2004 on your inventory form(mailed to you on June 3, . 2004), and by phone on July 15,2004 to obtain your pernut/license. Please obtain your permit. You have 14 days to comply. After this time,you may be issued non-criminal ticket citation in the amount of$75.00 for the first violation and$25.00 for each additional violation. Each day's failure to comply with an order shall constitute a se crate violation. Please refer to Article 39: Control of Toxic and Hazardous Materials, Section 13,and Section 14-1, 14-2, 14-3,and 14-4 (copy enclosed). Passing your Hazardous Materials Inspection and obtaining your license will keep your business compliant,prevent contamination of Barnstable's existing and future drinking water supply, prevent environmental contamination which can bankrupt site owners,lead to future regulatory, and possibly,legal problems,lower or destroy land values,drive out residents and industry, depress local economies and endanger public health. You will receive your Hazardous Materials License certificate after you have passed your inspection and paid the license fee. Your continued cooperation is greatly appreciated. If you have any questions or need further information,please do not hesitate to contact the Public Health Division. X-1 V.-I U Thomas A.McKean,RS,CHO Director of Public Health enc. Hazmat license application Article 39,Sect.13,14 Warning Notice { PETER A.DEMERS ASE CERTIFIED MECHANIC SUFIo�� Barnstable Rd.SAutEo Repair Inc. 91 BA B HYANNIS,MA 02601 (508)771-0033 STATE INSPECTIONS•TUNE UPS•BRAKES•EXHAUST 2 - ,. F �� . . p - � ��a (� ,—y a V�' .. .. �� ��, � � � ''� � � �' r_- � . r Town of Barnstable-Health Department Page 1 HAZARDOUS MATERIALS INVENTORY SITE VISITS ............ ......_.. DBA: Barnstable Road Auto Repair Fax: — Corp Name: Sunoco Station Mailing Address a �J Location: 91 Barnstable Rd. Street: 91 Barnstable Road ........... ......... mappar: 327-026-000-OOC City: Hyannis Contact: Peter A.Demers,Mgr. State: Ma Telephone: '(508)771-0033 Zip: 02601 Emergency: Person Interviewed: Peter Demers .............................................................. .__................................... Business Contact Letter Date: .......... Category: ',VehicleMaintenance Inventory Site Visit Date: 9/7/2005 ­....".."..1.11 . ......... Type: :Auto Repair Follow Up/Inspection Date: ❑ public water ❑ indoor floor drains ❑ outdoor surface drains d❑ license required ❑ private water ❑ incoor holding tank mdc ❑ outdoor holding tank mdc ❑ currently licensed ❑d town sewage ❑ incoor catch basin/drywell ❑ outdoor catch basin/drywell expir ❑ on-site sewage ❑ incoor on-site syste ❑ outdoor onsite system date: ..................... ....... ..................... Remarks: Recycle oil filters,Spills-rags-Acme. Rags in can with compliance: cover. REMARKS: Satisfactory 10/28/98-MAV000007648. Instate or DEKA trade batteries,rags and uniforms by Unifirst. No MSDS, one hydraulic lift,1 electr.Lift. Anfifreeze barrels outside ORDERS: 10/28/98- Stencil or obtain labels from waste haulers. Label W.O..Drums with"Toxic",Hazardous Waste","Waste Oil". Obtain Materials Safety data Sheets from suppliers,retailers,distributors. Move liquid chemical drums inside or provide 2nd.Containment. Comply in 30 days 4/20/04 Need to follow up to see if in compliance of above orders. Need to inventory to obtain HazMat license-never accuired. 4/28/04 Not in compliance with any of the.above. Went over these items again and gave him 60 days to comply. Recommended getting MSDS from internet or from companies and keeping in shop. Move oil filter and waste antrifreeze barrels to secondary containment area in back of shop. Label waste oil and antifreeze drums with TOXIC and WASTE : OIL. Maximum for gasoline can be 12000 gallons. Monthly they have tj 6,000 gallons. Inventory total=6214.75 gallons Check back on/around June 21 for compliance. 6/23/04 Completed all recommendations. Hazwaste moved to large secondary containment in rear of shop. (former containment for heating oil tank) Labelled waste drums. Obtained MSDS sheets-onsite. Very good compliance. Gave him a license application to fill out and pay permit fee. Has 14 days to comply with this. 9/7105 alp-pop in visit,msds on site,manifest available,violation of chpl.108-5 storage controls. Haz waste is stored outdoors with 110%contw'nment,but without roof or coverage to keep free from the elements.Has not paid for permit this year. Needs to pay for late fee too.Recommend obtain a flammables cabinet for storage. Has metal can for oily rags,told him to keep lid on at all times.Label all products that are not in original containers. � � a / wee CIL cr-k" be .p cL -- use Gf Page 2 Town of Barnstable-Health Department HAZARDOUS MATERIALS INVENTORY Chemicals: ❑ Zero Toxic Waste Materials ❑ gty's>•25 Ibs dry or 50 gals liquid but less than 111 gals 0 gty's 1 i11 gals or more m •,,, m,••;, description ;, f Aty umtrof&measure waste oil 120 gallons ._._,...---.____..__._...........__......_.._.....___.__._.._.-.-..._....-_.....-..__...._._._.,.... _...._.....--- _._-..__..__...._._ motor oil 1 21 gallons ._.._._..._......_. .______ waste antifreeze I 55 gallons antifreeze(for gasoline or coolan-,systems) �24 gallons ...._............_............._._...............__..._..._.._.._._._._.._........._..._._.__..._..____...._.._._....._..._._...._..........__....._..._..._____ _...._...._._......__.___..._.._...._.._._.__.. hydraulic fluids(including break fluid) 2 gallons Windshield Wash 48 gallons Misc.Flammable 4 gallons misc.petroleum products:greasy,lubricants . —_____......_......_..._..__......_....._.... Batteries 37 gallons ....... ...... Waste Transporter: Cyn Oil Fire District: Hyannis . _ .......... ......... ...... ......... Last HW Shipment Date 7/14/2005 Waste Hauler Licensed: Yes ,., .. ,_-:_... .::-,-. .. ,- :. :'•. .�. �b�F^�+r�'r.•h.5• _,.*;T.`d!4.^.,.'*h^'.,...'r'rT"h (",�'r��fi'W.'•"�...'�_..,..TY .. Tr` TOWN OF BARNSTABLE BAR-W 3394 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager "e-,e A. jam' Addres€ of Offender 144 _7412 en 0 MV/MB Reg.# Villa r',�/State/Zip yA Business Name ►E e � �.r_ s ( r 1' am/pm, on "7- 2 ;�-20,')1j Business Address Sig'nat9ur =of�,Enforcing Officer Village/State/Zip Location of Offense Enforci-Ig Dept/Division Offense_' )02 e.,jgj"j c r� ?Ri► �f+ c, r1*4,etk .i « / r> l�• <. Facts i2 -t ram ,. �l.P t ��e.'!. 1 N�" 1 '�°y E�s�7, fa, � 'z t� -�a ,� Ja,. . '""V r�; I �fn At 11 111i C This will serve only as a warning. At this time no -legal) act1on has been"takbn. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. Date: `'J TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAMEOFBUSINESS: AC. &eel BUSINESS LOCATION: it CGS INVENTORY .MAILINGADDRESS. .TOTAL AMOUNT: TELEPHONE NUMBER: So 8 - -7-71— 0O-L CONTACTPERSON:_ 2' t �P2�'4, ��rac�!'s ���/`I,7� �anS EMERGENCY CONTACT TELEPHONE NUMBER: TYPEOFBUSINESS: Fii{e D(57jjt �IGT OTHER INFORMATION: �i °u►e 34 Trswnc�n�t:►tancA ne�uii es a ' S 4a a-4mdl cam.s M as*eu al n L-+'CC-rj s-e- b e cab 4-ag4,&--zA cam " �l/a�•! aecd2 "t�h " M 506 oh 54—" 6 a:2 e/S 4v Z-not-&je �i i n b� O A/D. 6,t)ii/ 4,fain Shz s ►'h i rlA-e' y Fes' �i 't'!?iZi is ge-f 0-n 5�`'{¢- • L/}E EL ` Waste Transportation-944 rn +" Name of Hauler: P Destinatio � - /1/1A Waste Product: &Va Fe_ /'�/ � Licensed? e , No s � s Lit , Gcty /� 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. . NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Observed (gallons): Ant if reeze(for gasoline or coolant systems) Drain cleaners 25 S�a�NEW IL�O USED Cesspool cleaners a, utomatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) ,> Hydraulic fluid (including brake fluid) Refrigerants ✓ Motor oils Pesticides ZLj�- 1IEW 1 101o, USED (insecticides, herbicides, rodenticides) a®® Gasoline, Jet Fuel y"/4X.ea.n foe- l-2-� oao 1 Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil ` J NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil , NEW USED Degreasers for encines 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 wakes 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 Any other products with "poison" labels Paint brush cleaners (including chloroform,formaldehyde, Floor&furniture stippers Metal polishes hydrochloric acid, other acids) Laundry soil &stai-i removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids Misc.: cN• (dry cleaners) '7us S U Other cleaning solvents n�cc P�i2.5 e- a.= o� Bug and tar removers hKI , t y_ y TOXIC AND HAZARDOU TERIA WIN I NAMEOFBUSINESS: A-r-� Ian BUSINESS LOCATION: �� - MAILING ADDRESS: �> INVENTORY Zcr y TELEPHONE NUMBER: 50 8 - -7-7/— TOTAL AMOUNT: CONTACT PERSON: e EMERGENCY CONTACT TELEPHONE NUMBER: FIRE p�57�1� TYPE OF BUSINESS: As ���I G� S-�c3 A CDIL OTHER INFORMATION: /4/LA1°Ue 39 �csw»end i�a�ncA Pe�u,Q:� • ���5 � Z.nQc-asyu Ccrrt�-acizri�-it- �n b�c/1� t� �-F� N�12S �l/®. f�r�/ o�Fu•►� D 1.741 ,Sty-s_��h. ir���'�t-Frr �ua.'r1�2C's `�� ��i'�- • G.A�2E'L _Waste Transportation: rnOtt � .w��*e Name of Hauler: �i Destinatio N �-�- /11 A Waste //Product: _ l� s Licensed? e . No 5hoe, ()aa l cryt,c�pZ/1J1 s` La-;7* otcvl e�% —16 --0 y 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. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Observed (gallons): Ant ifreeze(for gasoline or coolant systems) Drain cleaners '�2 S ANEW �USED Cesspool cleaners rt" utomatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) 6-- ✓ Hydraulic fluid (including brake fluid) Refrigerants ✓ Motor oils Pesticides :Z , S" EW 110exU USED (insecticides, herbicides, rodenticides) ao® Gasoline, Jet Fuel(mlgX.ea.n (oe- tz- 000 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 wakes 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 Any other products with "poison" labels Paint brush cleaners (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 Misc (dry cleaners) S -�-� Other cleaning solvents Bug and tar removers C"fie'f�c d�•. Ae, v . �" a N � -� . ,� � ; � �' 4 � � i \ � N �. � �� �, �- ,. ; � ` "�. -PETER A.DEMERS ��OCO ASE CERTIFIED MECHANIC Barnstable Rd. Auto Repair Inc. 91 BARNSTABLE RD. HYANNIS,MA 02601 (508)771-0033 STATE INSPECTIONS•TUNE UPS•BRAKES•EXHAUST / /�� , Town of Barnstable-Health Department Page 1 / '� /Cj' S HAZARDOUS MATERIALS INVENTORY SITE VISITS t DBA: nstable Road Auto Repair Fax: — "Corp N me: Mailing Address i Location: 91 Barnstable Rd. Street: 91 Barnstable Road mappar. City: Hyannis Contact: :Peter Demers,Mgr. State: Ma Telephone: '(508)771-0033 Zip: 02601 Emergency: Person Interviewed: Business Contact Letter Date: Category: VehicleMaintenance Inventory Site Visit Date: Type: :Auto Repair Follow Up/Inspection Date: __....... .. ....... __._... Nb public water ❑ indoor floor drains outdoor surface drains ❑d license required ❑ private water ❑ indoor holding tank mdc ❑,outdoor holding tank mdc ❑ currently licensed d❑ town sewage ❑ indoor catch basin/drywell SW outdoor catch basin/drywell expir - - ❑ on-site sewage ❑ indoor on-site syste ❑ outdoor onsite system date: ......... ..................................... Remarks: Recycle oil filters,Spills-rags-Acme. Rags in can with compliance: cover. REMARKS: Satisfactory 10/28/98-MAV000007648. Instate or DEKA trade batteries,rags and uniforms by Unifirst. No MSDS, one hydraulic lift,1 electr.Lift. Anfifreeze barrels outside. +ORDERS: 10/28/98- Stencil or obtain labels from waste haulers. Label W.O..Drums with"Toxic",Hazardous Waste","Waste Oil". Obtain Materials Safety data Sheets from suppliers,retailers,distributors. Move liquid chemical drums inside or provide 2nd.Containment. Comply in 30 days 4/20/04 Need to follow 0- up to see if in compliance of above orders. Need to inventory to obtain HazMat license-never acquired.t ti /V U ? li es-�'15 e� l 01 ? ^� � .�-- ����- o-zvt-s�`� : off•��s s ��o/ P I � I _ Page 2 Town of Barnstable-Health Department HAZARDOUS MATERIALS INVENTORY Chemicals: ❑ Zero Toxic Waste Materials ❑d gty's>25 Ibs dry or 50 gals liquid but less than 111 gals ❑ gty's 111 gals or more on x- ,� qty unit ofineasure descnpti.. gasoline ..._. ..._........._.._.___...._____._..__ . _. _........ .. ._.__.._...................._........ waste oil 110gallons motor oil 18cases C� r automatic transmission fluid 1 cases J C, .__._..___._._.._...........__...._........_........_.....___.__....._..____.._...._.__.........___.___..._..._._ ____....._.. _.._..__....._..._.............._...._._......... ._..._........ waste antifreeze 55 gallons antifreeze(for gasoline or coolant systems) 72pounds antifreeze(for gasoline or coolant systems)_ 12cases other cleaning solvents 1'cases Waste Transporter: Cyn Oil Fire District: Last HW Shipment Date. (�/��� %�� Waste Hauler Licensed: t4P HazMat On-Site Inventory/inspection: Records to Review for SQGs and CESQGs DBA: � Location: Site visit date: c/- Z -7— O Y • Hazardous Waste Manifests:___ • Employee training documentation: ( Q �� • Hazardous substance spill control and contingency plan: • DS on site? Lv 0 ovk- • HazMat Inventory records (if applicable): �� • HazMat Shipping documentation: I1w �sr` • Spill records (if applicable): N'/� Hazardous Materials On-Site Inventory/inspection For ALL Shops and Businesses: DBA: Location: 6at4-7S"*,>� Date: — 7 o ,-/ v Physical Features to Inspect: 1. Hazardous waste generation sites (production/manufacturing areas): 2. Waste storage areas: 3. Satellite accumulation points throughout: 4. HazMat container storage area: Pits (A, u) 5. HazMat generation points: 6. Shipping and receiving areas: 7. Run down of shop activities: 8. Housekeeping practices: I I r � � � t .tlgO'' 1 1 V `) V � O� OIL WASTE L OIL FILTERS ANTIFREEZE LoolASTE ANI REEZE 13. �. GASOLINE WASTE GAS WASTE W/W FLUID ATF SOLVENT (o nn� �4 .HYDRAULIC MISC. MISC. MISC. MISC. FLUID COMMBUSTIBLE FLAMMABLE CORROSIVE PETROLEUM / d 3 FREON ACETYLENE CAR WASH CAR WASH PAINTS/THINNER WAX DETERGENTS SEALANT CLEANING BATTERIES POISION/TOXIC CAULK/GROUT SOLVENTS FERTALIZERS DIESEL FUEL va 116-1. LAX( cam- w I n t I in ori j(-ha.D @�t am. Pf Cad i _Cjr� 0a Town of Barnstable Qom' °�SHE Regulatory ulato Services I ., ati Thomas F. Geiler,Director MMB Public Health Division i639• �� '°rEn i t: A Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE �3 Oti APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT Barnstable Road.Auto Repair 91 Barnstable Road NAME OF ESTABLISHMENT Hyannis, MA 026011 ADDRESS OF ESTABLISHMENT TELEPHONE NUMBER '-7/ ao 3, SOLE OWNER: t/YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. O Y 2 U) Z STATE OF INCORPORATION Al FULL NAME OME ADDRESS OF: PRESIDENT � ��` d o s- -2 r TREASURER ti CLERK �ec den SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# Haz.doc/wp/q r: ti TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair 2. Printers BOARD OF HEALTH O satisfactory 3.Auto Body Shops �pn O unsatisfactory- 4. Manufacturers JMPA�� `�I�(�� �� see"Orders") 5.Retail Stores 6.Fuel Suppliers hPDRESS Class: 7. Miscellaneous �a..�lS QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors) MAJOR MATERIALSUnderground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline Jet Fuel (A) Diesel, Keros e, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers S Miscellaneo s: S pro DISPOSALIRECLAMATION REMARKS: RLL,_,�kS itary Sewage ater Supply j r D �YS Town Sewer ;30F'ublic - L� I ev ovre F I �l On-site OFrivate 3. Indoor Floor Drains YES N0_�_ f O Holding tank:MDC �� �`` if O Catch basin/Dry well O On-site systemA1Ccft_ ,1_rM=Z 4. Outdoor Surface drains:YES N4/__ :V16Q—A 7 Ui-)`�, O Holding tank:MDC O Catch basin/Dry well ` O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product- % " ,�Q l NO 2. L M AV 0`1 7l0`E S Person(s) Interviewed Inspector ate L - PETER A.DEMERS MECHANIC ASE CERTIFIED MEC �SUNOC _. ` Barnstable Rd. Auto Repair Inc. 91 BARNSTABLE RD. HYANNIS,MA 02601 (508)771-0033 STATE INSPECTIONS•TUNE UPS•BRAKES•EXHAUST MAR-12-2002 08 :35 AM BARNSTABLE RD 5087710033 P. 02 COMMONWEALTH OF MASSACHUSETTS-, ppp INSTATE WASTE DEPARTMENT OF ENVIRONMENTAL PROTECTION OIL ONLY DIVISION OF HAZARDOUS MATERIALS OR One Winter Street I"pm vawl114wi O Boston, MassachusAtts 02108 p;eaqe prig"or type-(Form deslaned for use an elks(12-pliah)typewrltar-) InformadamInthe.show areas UNIFORM HAZARDOUS �A1D N (� �[ MenN 2.Peps 1 mff-� )Sp WASTE MANIFEST 1 p of �[, tenot.evdbvFseerulow. gm-3.Generator's Name and McNrp Atidreaa a(iereorator'sPlwne�� 1' ' '`V`'J� � k; 5.Trsrleporter 1 COmpsoy Nery U811PA 10,14 Number !j � CYN. OIL,,CORPORATIO N _n 7.Treneportar 2 Company Nerve 8. US EPA 10Nu"m b.r nj 9.os*Wd ted FW ty Nam"end Site Address 10. US EPA ID Number` f1 C CYN 131L CORP13RATICIN W1771 WASHINGTON EETr P.O. b X 11 9 a TOUGHTON MA02072 12. Taal ut N 11.US DOToascrIpthm k rB Sh&Or9�,M*=WClan*ad IDMmnba l T T a CO " PETROLEUM OIL COMBUSTIBLE LIQUID NA 1270 Pia III (WASTE OIL) ® TIT plo !3 s WM a E -a m R e. { CC A 3 -A T s c 0 w o "R ca d. to a Z m O V z rl go 16_spew plspticlrarfs aM Additianyd t�Msnnstign C . 1 E 24 HOUR EMERGENCY,SP'ILt,_Ia�9�3N9E '9e1'343'S106 D.Q.T. EMERGENCYOWO� NO• •12e O 1".cf tA►OpStf IflCAa1QN:lheeavd r+s+uAwoeneemeotU+eearelgnmmnarotuarw+deawe y d IN 0, prppyr> ewme ens an aly"eeled.�.meebd.end lebsled.artd ere N ea bey m peeper ea�loe tortranMore tq _ . If l W"0 WN 0-tky vu-m-1 Wdh'wet 1 heW,e program h pfard to ro6me Nre wlwme end temwfy of waere se'braw 10 dM eesree 1 Aare dyt rminato"tNeyene6N0�y tti la �tgeCrnmdtrae�settrese+amcemdaiyepeurren6YerassbteypPw.weirapw�+uar "awe�a an0�atmm dr+afea rne11Y,011.if l iae a a�ee 0oena4y�",I howe niedo7Be°d faiw 000 to mifNMitd"W wKN�M1'er9tl�7 0ed V�e'aeet weybe�wMOaa an sftd. Of�e ® hknea ' c t D "► T 1Z T 1' AdUts _ n A P►bamV?Wodhfpms r C .. vDaft 18.T r 2 AcknowkNAPAU040f eft ma"deN Afanrh Dsy Yta1► f e.Dlanrspawtr Indbetlan 6peas F A C 1 20.fmmy Ownwar 0parator:Cerciftedpa of r�slpt of hesadoua e►tRs cawarod by ext t at kobed to kem i8_ ( name T y Form OMp No,20804= EPA orm$700-22.(Rev.9-94)Previous editions,are obsolete, .COPY>l,:. FACILITY MAILS TO GENERATOR KE t �" '� Town of Barnstable * B^ MASS. Board of Health vq'ArE1 a IN P.O. Box 534, Hyannis MA 02601 Office: 508-8624644 Susan G.Rask,R.S. FAX: 508-790-6304 Ralph A.Murphy,M.D. Sumner Kaufman,M.S.P.H. To: US PROPERTY MANAGEME Date Monday,March 05,2001 %DEMERS,PETER PO BOX 875 W BARNSTABLE MA 02668 RE:Underground Tank at 91 BARNSTABLE ROAD Map/Parcel 327026 Tank NO: 02 Tag NO: 00968 The Town of Barnstable Public Health Division records indicate that your undergroud or chemical storage tank is 19 years of age,and has not been tested as required under section 07:(5)of th health regulation regarding fuel and chemical storage systems. You are directed to have each tank and its piping tested within thirty(30)days of the receipt of this notice. Results of the testing shall be filed with the Board of Health and the Fire Department. You are reminded that you shall have the tank and its piping tested'during the 10th,13th, 15th,17th, and 19th year after installation,and annually thereafter. Failure to comply with this order may result in a fine of up to$300.00.Each day's failure to comply with an order shall constitute a.separate violation. You may request a hearing if a written petition requesting same is received by the Board of Health within ten(10) days after this order is served. Per Order of the Board of Health Thomas A.McKean, RS, CHO Health Agent Xcel Environmen g, Inc. Report No. P . O . BOX 866 Test Date: L-'r- o N . GROSVENORDALE , CT 06255 mes: Run Test Ti ( 800 ) 638-9235 ( 860 ) 935-9171 Run B: SUMMARY OF SOURCE TEST RESULTS Run C: SOURCE INFORMATION FACILITY PARAMETERS Firm Name� and Adrevi I Firm ReprL"rtatNe-+nd Tts PHASE II SYSTEi\rl TYPE L ad a 1 � . �.,1C1 r�} 1r / /C 1 ,1 Balance (Check crQ) ✓ i .a.YA3a ulOLa �I PrmeNa"',* Jacket G I I I/Gc--r Red:r ery sys:em I Hasstech P.mm�.a,cwn. I P1r:NO. Perm::No. I Healy I o=eretes radby a 365 Crrysiyr Manifolded? (Y or N) Operating Parameters: V Tank CaRacity Gallons Present 1 2 4 �t)J 3 t1� Applicable Regulations: VN Recommended: Source Test Results and Comments: Tank 1 2 3 Poduct Grade: 1�N Actual Tank Capacity, gallons J dd U y '- J Gasoline Volume, gallons 3? ? C Ullage, gallons I� �a `� 3 � 2 Initial Pressure, inches H O 2 Pressure After 1 Minute, inches H ZO Pressure Aker 2 Minutes, inches H O Jy Pressure After 3 Minutes, Inches HBO c1 S Pressure After 4 Minutes, inches H2O 9 Final Pressure After 5 Minutes, inches H2O Cr g NO CCMMERCtAL USE OF THESE RESULTS IS AUTHORIZED. ,T st Conducted By: Test Company: Date of Test: XCEL ENVIRONMENTAL •-�L.....•, L 3e?U L F.LL C.a. � �i�� ."--I1`�,., 'mod--��1.��-I+.-�a."�v, ram` I I d_, PW-LBTFRM2 PEASE II BALANCE SYSTEMS PRESSURE DROP DURING FLOW TEST & LIQUID BLOCKAGE TEST Site DBA �, .=,�s�-, bey G �L� l<aP� �^ _ Test Date: Address : � ' ��-� N ag.�G y i� APCD Observer: Test Conductor: Test Contractor: XCE'L ENVIRCNM—ENT`L, INC. `" Office Phone No: (800) 638-9235 (860) 935-9171 { Site Plan: I cv i IIIIIIIIIIII � � I � � � FLOWMETER CFH - AP TEST WET TEST NOZZLE NO. PRODUCT 20 60 100 60 COUNTS (Z Z 22 Z j a 3 13 14 2- =t g a a- Y TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair F 2.Printers BOARD OF HEALTH .Q satisfactory 3.Auto Body Shops unsatisfactory- 4.Manufacturers `-" (see"Orders") 5.Retail Stores COMPANY �AQvS_`cAaC A;m iL 6.Fuel Suppliers ADDRESS !@ T WBVNS�� (Z� Class: 7.Miscellaneous 0 (��� S� QUANTITIES AND STORAGE (IN=indoors;OUT-outdoors) Vo OR MATERIALS . W W a4a) IN OUT IN OUT IN OUT #&gallons Age Test �- 3-yoo© Fuels: k ���' y4s Gasoline ) 1 1 1-2-7S #2 (B) rem • Heavy Oils: waste motor oil (C) 1 new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers r jr Miscellaneous: x LAC,e-lU1�y.o U + �tii 6 DISPOSALIRECI.AMATION REMARKS: 1. Sanitary Sewage 2.Water Supply 00(4 Town Sewer Public ) A- - 0 On-site OPrivate _t AkaAg0(__ 3. Indoor Floor Drains YES NOA 0 Holding tank:MDC_ 6L¢ O Catch basin/Dry well 4u 0 On-site system 4. Outdoor Surface drains:YES NO ORDERS: O Holding tank:MDC O Catch basin/Dry well i 0 On-site system Wr-VaAk CUa,,,<,.. 5.Waste Transporter •d Name of Hauler es inajon Waste,iProauci n eox 2 uw tLA YES iNQ 1k wol lie. � r '1.VINCI 2. �q. 6 y- �. 5� C1� n' Person(s Interviewed Inspector Date I Town. of Barnstable Regulatory Services Thomas F. Geiler,Director eo Public Health Division Thomas McKean,Director r" 200 Main Street, Hyannis,MA 0260 1- !. Office: 508-862-4644 Fax: 508-79 04 Applicabon.Fee:$1D0.00 ASSESSORS MAP AND PARCEL NO. ~3 �� DATE O APPLICATION.FOR PERMIT.TO.STORE.AND/OR UTILIZE.MORE.THAN. 111.GALLONS.OF.HAZARDOUS MATERIALS FULL NAME OF APPLICANT PEI� ' NAME OF ESTABLISHMENT Z ) A '` �r ADDRESS OF ESTABLISHMENT , `/ �� � /� �''� ��I 7A TELEPHONE NUMBER ,�� SOLE OWNER: -YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. Q'I-362 0,-L STATE OF INCORPORATIONi7� FULL NAME AND HOME ADDRESS OF: `10 VL.;p SJ PRESIDENT TREASURER CLERK SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# H=dWwp/q 1 1 i MAIL-IN REQUESTS Please mail the completed application form to the address below. Also include a copy of your,„,ram contingency plan(to handle hazardous waste spills, etc). In addition;please include the required fee of$100. Make check payable to: Town of Barnstable. Allow five to seven(7)working days house processing. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis,MA 02601 FOR FAD REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, please fax us a copy of your contingency plan (to handle hazardous waste spills, etc). In addition, please mail the required fee amount of$100.90. Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. Allow up to`four days for in-house processing. For further assistance on any item above,call(508) 862-4644 1 S (px.��ii1e ���°?"✓"u%�c���..�" ��� ' �om�i>!��zce �0 >dye Notification ''for Storage Tanks Regulated Under 527 CMR 9.0 Forward completed form,signed by local fire.department;to:Mass. UST Program,Dept. - - . - • of Fire Services,P.O. Box 1025-State Road, Stow, MA Oi%-NNIS �Ic PRfET .> E;,f� Use Form FP-290R to notify of tank removals or closur Yf j FIRE.DENTION Date Received: Telephone(978) 567-3710 95 HIGH��HQQL R�.E Fire Dept._ID# r Y (Fire Department retains one copy of FP-290) IS,MA 02601 Fire Dept. Sig. 0 A. New Facility(see instructions,#1) E B. Amended 0 C. Renewal _ • INSTRUCTIONS: Form FP-290(Notification for Aboveground and Underground Storage Tanks)is to be completed for each location containing underground or aboveground storage tanks regulated under 527 CMR 9.60. If more than five tanks are owned at this location,photocopy the following pages and staple continuation sheets to the form. The FP-290 A. Facility Number must be completed In duplicate. Although the form may be photocopied,the facility owner or owner's representative must sign each copy separately;photocopied signatures are not sufficient. Both copies of the FP-290 are to be forwarded B. Date Entered to the local fire department,who will check all information and certify the forms. The fire department will retain one copy of the FP-290 for its.records,and the facility owner shall be responsible for forwarding the other copy to the C. Clerk's Initials Dept.of Fire Services at the addres.,above. The local fire department will issue the permit portion of the FP-290; however,registration is not complete until the FP-290 is received and checked by the UST Regulatory Compliance Unit. D. Comments All questions on this form are to be answered.Incomplete forms will be returned. 1"New Facility"means a tank or tanks located at a site where tanks have not been previously located. 2"Facility street address"must include both a sheet number and a street name. Post office box.numbers are not. acceptable,and will cause a registration to be returned.If geographic location of facility is not provided,,please indicate distance and direction from closest intersection,e.g., (facility at 199 North Street is located)400 yards southeast of Commons Road(intersection). - GEN . . • Notification Required Exception:(a)a farm or residential tank of 1,100 gallons or less capacity used for storing motor .Fire Prevention Form FP-290 is to be used as Notification,Registration,and Permit for fuel for noncommercial purposes,or(b)a tank used for storing heating oil for consumptive aboveground and underground storage tanks and tank facilities regulated under 527 use on the premises wherestored are not required tobe registered under527CMR9.00. Code of Massachusetts Regulations 9.00.No regulated aboveground or underground penalties:Anyownerwhoknowinglyfailstonotifyorsubmitsfalseinformationshallbesubject storage tank facility shall be installed,maintained,replaced,substantially modified or to a civil penalty not to exceed$25,000 for each tank for which notification is not given or for removed without a permit(FP-290)issued by the head of the local fire department. which false information is submitted.(MGL Chapter 148,section 38H,527 CMR 9.00) The owner of any storage facility shall within seven working days notify the head of the local fire department and the Dept.of Fife Services of any change in the name, Aboveground Storage Tanks address,or telephone number of the owner or operator of a storage facility subject to 527 CMR 9.00 requires the registration of any aboveground storage tank which meets the regulation by Chapter 148,Mass.General Law and by 527 CMR 9.00. following definition:a horizontal or vertical tank,equal to or less than 10,000 gallons Underground Storage Tanks capacity,that is intended for fixed installation without back fill above or below grade,and is Each owner of an underground tank first put into operation on or after Jan.1,1991, used for the storage of Hazardous Substances,Hazardous Wastes,or Flammable or shall,within thirty days after the tank is first put into operation,notify the Department of Combustible Liquids. Fire Services(the department)of the existence of such tank,specifying,to the extent Exception#1:Abovegroundtanksof morethan 10,000 gallons capacity regulated by520CMR known,the owner of the tank,date of installation, capacity,type,location,and uses of 12.00(Requirements for the Installation of Tanks Containing Fluids Other Than Water in such tank.By no later than Jan.31,1991,each owner of an underground storage tank Excess of 10,000 Gallons)are not required to be registered under 527 CMR 9.00. that was in operation at any time after Jan..1,1974, regardless of whether or not such a Exception#2:(a)a farm or residential tank of 1,100 gallons or less capacity used for storing tank was removed from beneath the surface of the ground any time,shall notify the motor fuel for noncommercial purposes, or (b) a tank used for storing heating oil for department of the existence of such tank,specifying;to the extent known,the owner of the tank,date of installation,capacity,type,and location of the tank,and the type and consumptive use on the premises where stored are not required to be registered under 527 CMR 9.00. quantity of substances stored in such tank,or which were stored in such tank before the tank ceased being in operation if the tank was removed from beneath the surface Penalties:Any person who knowingly violates any rule or regulation made bythe Board of Fire of the ground prior to the submittal of such notice to the department.Such notice shall Prevention Regulations shall,except as otherwise provided,be punished by a fine of not less also specify,to the extent known,the date the tank was removed from beneath the than one hundred dollars nor more than one thousand dollars. (MGL,Chapter 148,section surface of the ground prior to the submittal of such notice to the department.The 108,and 527 CMR 9.00) operator of any tank that has no owner or whose owner cannot be definitely ascertained,shall notify the department of the existence of such tank,specifying,to the Where to Notify?Two completed notification forms should be signed by both the tank owner extent known,any information relating to ownership of the tank,and date of and the local fire department.One copy will be retained by the fire department,and the tank installation,capacity,type,and location of the tank,and the type and quantity of owner-shall send a separate copy to the address at the top of this page. substances stored in such tank,or which were stored in such tank before the tank When to Notify?1.Owners of storage tanks in use or that have been taken out of operation ceased being in operation if the tank was removed from beneath the surface of the must notify within thirty days. ground prior to the submittal of such notice to`he department.If the tank was abandoned beneath the surface of the ground prior to the submittal of such notice to Owners and Operators of Regulated Storage Tank Systems must maintain records the department,such notice shall also specify,to the extent known to the owner or certifying that all leak detection,inventory control and tightness testing requirements operator,the date the tank was abandoned in the ground and all methods used to for the Regulated Storage Tank System are current.These records must be readily stabilize the tank after the tank ceased being in operation. available for inspection. Jq !. OWNERSHIP OF TANK(S) II. LOCATION OF TANK(S) fi Owner Name(Corporation,Individual,Public Agency,or Other Entity) If known,give the geographic location of tanks by degrees,min' es,and`6 seconds.Example:Lat.42,36,12 N Long.85,24,17W Latitude Longitude t � Street Address Distance and direction from closest intersection(see instructions#2) 0•lZU� .�?J CyAheA, BAnrrr ix- Faoft Name or Company Site identifier,as applicable City State Zip Code Street Address(P.O.Box not acceptable-see instructions#2) ounty City � State Zip Code Phone Number(Include Area Code) Owners Employer Federal ID# County /�4, f,,M)L�, III.-TYPt OF OWN R IV. INDIAN LANDS .feral Government ommercial ❑ . Tanks are located.on land within an Indian Reservation or on (storage and sale) other trust lands. state Government ❑ Private ❑ Tanks are owned by native American nation, tribe,or individual. (Local Government (storage and use) V. TYPE OF FACILITY Select the App riate Facility Description: (check all.that apply) Gas Station Marina Trucking/TransporL Petroleum Distributor. Railroad Utilities Airport Federal-Military Residential Aircraft Owner Industrial Farm Vehicle Dealership Contractor Other(explain) VI. CONTACT PERSON IN CHARGE OF TANKS I 7&V P`J Address: Phone Number(include area code): Name: � � Job Title: /tit 7yo 0 -0 1�Ce � Home: a Business: f VI1. FINANCIAL RESPONSIBILITY ❑ 1 have met the financial responsibility requirements in accordance with 527 CMR 9.00. --------- ---------------r------------- Check all that apply: ❑ Self Insurance ❑ Guarantee ❑ Letter of Credit O Commercial Insurance �Zte ety and ❑ Trust Fund ❑ Risk Retention Group Fund ❑ Other Method Allowed -Specify VIII. ENVIRONMENTAL SITE INFORMATION This information should be available from local health agent, conservation commission, or planning department. 1.Tank site located in wellhead protection area ❑Yes o Unknown 2.Tank site located in surface drinking water supply protection area. . ❑Yes P- o ❑ Unknown 3.Tank site located within 100 feet of.a wetland ❑Yes E5'No ❑ unknown . 4.Tank site located within 300 feet of a stream or water body ❑Yes I n"No ❑ Unknown. IX■ DESCRIPTION OF STORAGE TANKS AND PIPING (COMPLETE FOR EACH TANK AT THIS LOCATION) Tank Identification Number Tank No.j_ Tank No. 1-- Tank No. Tank No. Tank No. 1. Tank status a.Tank mfes serial# (if.known) b..Currently in Use CI S1 —T I C.Temporarily Out of Use (Start Date) d. Permanently Out of Use e, Aboveground storage tank(AST) Or ❑AST ST AST p,dS`T ❑AST G-b TT. ❑AST ❑UST ❑AST ❑ UST Underground storage tank(UST) 2. Date of Installation (mo./day/yr.) P y (9 ) l7 v 3. Estimated.Total Ca acit allons �� OUJ I �- Tank Nd,^ Tank No. Tank No. - Jentification Number(cont.) Tank No. Tank No. pstance Currently or Last Stored a. Gasoline V ❑Marina. �❑ Marina G-a-W ❑ Marina ❑ MV ❑ Marina ❑MV ❑Marina Motor vehicle or other use ❑other ❑other ❑other ❑other 1 ❑other / (b. Diesel Marina- Motor vehicle Or ether use ❑MV ❑Marina ❑ MV El Marina ❑ MV ❑ Marina ❑ MV ❑Marina ❑ MV ❑ Marina ❑other . ❑other ❑other ❑other ❑other c: Kerosene d. Fuei Oil*. `"Consumptive Use"tanks need not be•registered. "Consumptive Use"fuel used exclusively for area heating and/or hot water. e. Waste Oil f. Other, Please specify Hazardous Substance (other than 4a thru 4e.above) CERCLA name and/or CA3 number Mixture of Substances Please specify 5. Material of Construction-Tank(mark only on ) Bare steel (includes asphalt, galvanized r� and epoxy coated) Cathodically protected steel Composite (steel with iberglass) �� 0 Fiberglass reinforced plastic(FRP) Concrete Unknown Other Please specify 6.Type of Construction-Tank . (mark only one) Single walled Double walled Unknown ] �� r Other [� 0 Please specify IS tank lined? ❑Yes Flo ❑Yes EJ Ko ❑Yes C-]-JGo ❑Yes ❑ No ❑Yes ❑,No Does tank have excavation liner? ❑Yes ❑ No ❑Yes ❑ No ❑Yes ❑ No. ❑Yes ❑ No ❑Yes.❑ No Page 3_ FP 290(revised 11/96) Jentification Number(cost.) Tank No. Tank No._& Tank N . Tank No. Tank No. ,erial of Construction-Piping(mark only one Bare steel(includes asphalt, Galvanized and epoxy coated) Cat hodically protected steel 0 Fiberglass reinforced plastic (FRP) 0 Flexible ] Copper �� 0 Unknown Other Please specify 8. Type of Construction-Piping(mar.only one) Sir:gle walled Double walled Unknown Other Please specify Has piping been repaired? O Yes ❑No ❑Yes ❑ No ❑Yes ❑ No 1-1Yes ❑ No 0 Yes ❑No Is piping gravity feed? [:]Yes ❑ No ❑Yes ❑ No ❑Yes ❑ No ❑Yes ❑ No ❑Yes ❑ No Date X. CERTIFICATION OF COMPLIANCE 1. Installation A. Installer certified by tank and piping, manufacturers B. Installer certified or licensed by the implementing agency C.Installation inspected by a registered F7f s Er 0 0 engineer D.Installation inspected and approved by � [ 0 . the implementing agency E.Manufacturers' installation cl-ecklists � 0 0 have been completed F. Another method allowed by E27 CMR 9.00. Please specify 2.Tank Leak Detection Tank - Tank Tank Tank Tank (mark only one) A. Double-wall tank- Interstitial monitoring B.Approved in-tank monitor . C.Soil vapor monitoring (check one below) Cl ❑ Monthly ontinuous E. Inventory record-keeping and tank.testing F. Other method allowed by 527 CMR 9.00: Please specify Fo_oon r.o"�o�t i road . Pace 4 . dentifiCation Number(cont.) Tank No. Tank No.� Tank Tank No. Tank No. ol /ping Leak Detection (mark ordy one) Piping Piping Piping Piping Piping Pressurized a. Interstitial space monitor ❑ ❑ ❑ ❑ ❑ b. Product line leak detector P— ❑ ❑ (mark all that apply below) ZZ �tomatic flow restrictor* . t `Automatic shut-off device* ontinuous alarm* Also requires annual test of device and 00 piping tightness test or mouthy vapor00 monitoring of soil. B.Suction: Check valve at tank only (Requires interstitial space monitor or ❑ ❑ ❑ ❑ ❑ line tightness test every three_ years) Interstitial space monitor ❑ Line tightness.test C. Suction: Check valve at dispenser only ❑ � ❑ _ ❑ ❑ (No-monitor required) D. Other method allowed by 527 CMR 9.00. Please specify 4. Date of last tightness test(tank-& piping) 5. Gravity feed piping ❑ ❑ ❑ ❑ . 6. Spill containment and overfill p-otection Tank Tank Tank Tank Tank A. Spill containment device ins-ailed ET [D- ❑- ❑ El B. Overfill prevention device installed - - - - -- -- --- -- -n 7. Daily Inventory Control.(mark only one) A. Manual gauging by stick and records ❑ ❑ ❑ El ❑ reconciliation B. Mechanical tank gauge and records reconciliation C.Automatic gauging system ❑ ❑ ❑ ❑ ❑ Tank Piping Tank Piping Tank Piping. Tank Piping Tank Piping 8. Cathodic Protecti on.(if applicable) A. Sacrificial Anode Type ❑ ❑ ❑ ❑. ❑ ❑ ❑ El ❑ ❑ B. Impressed Current Type Z. B ❑ 21;01. ❑ . ❑ ❑ ❑ ❑. C. Date of Last Test Certification of Compliance No.: M i. CERTIFICATION .(Read and sign after completing.all sections).. NOTE:Both the copy being sent to the Dept.of Fire Services and the copy retained by the local fire department must be signed separately. A photocopied signature will not be accepted on either document. I declare under penalty of perjury that I have peronally examined and am familiar with the information submitted in this and all attached documents,and that based on my inquiry of those individuals immediately responsible for obtaining the information,I believe that the submitted information is true,accurate,and complete. Name and official title of owner or owner's authorized representative(Print) Signat a Date: FP-290(revised 11/96) Pano F` . S � — Q7ecu�iiue �� o qM �✓"a l�Co V�� — �� ���e �ec�a r / �Qo�y���i a�sue�� G Notification for Storage Tanks Regulated Under 527 CMR 9.00 Forward completed form,signed by local fire department,to: Mass. UST Program,Dept. -• - • of Fire Services,P.O. Box 1025-State Road, Stow, MA 011 FIRE PREVENTION Use Form FP-290R to notify of tank removals or closur'KYA NNIS FIRE DEPARTME iDate Received: Telephone (978)567-3710 95 HI SCHOOL RD.EX Fire Dept. ID# Y (Fire Department retains one copy of FP-290) HIS MA 02601 Fire Dept. Sig. O A. New Facility(see instructions,#1) B. Amended ❑ C. Renewal _ • INSTRUCTIONS: Form FP-290(Notification for Aboveground and Underground Storage Tanks)is to be completed for each location containing underground or aboveground storage tanks regulated under 527 CMR 9.00. If more than five tanks are owned at this location,photocopy the following pages and staple continuation sheets to the form. The FP-290 A. Facility Number must be completed in duplicate. Although the form may be photocopied,the facility owner or owner's representative must sign each copy separately;photocopied signatures are not sufficient. Both copies of the FP-290 are to be forwarded B. Date Entered to the local fire department,who will check all information and certify the forms. The fire department will retain one copy of the FP-290 for its records,and the facility owner shall be responsible for forwarding the other copy to the C. Clerk's Initials Dept.of Fire Services at the addres.,above. The local fire department will issue the permit portion of the FP-290; however,registration is not complete until the FP-290 is received and checked by the UST Regulatory Compliance Unit. D. Comments All questions on this form are to be answered.Incomplete forms will be returned. VNew Facility"means a tank or tanks located at a site where tanks have not been previously located. 2"Facility street address"must include both a street number and a street name. Post office box numbers are not acceptable,and will cause a registration to be returned.If geographic location of facility is not provided,please indicate distance and direction from closest intersection,e.g., (facility at 199 North Street is located)400 yards southeast of Commons Road(intersection). GENERAL INFORMATION, Notification Required Exception*(a)a farm or residential tank of 1,100 gallons or less capacity used for storing motor Fire Prevention Form FP-290 is to be used as Notification,Registration,and Permit for fuel for noncommercialpurposes,or(b)atankusedforstoringheatingoilforconsumptive aboveground and underground storage tanks and tank facilities regulated under 527 use on the premises where stored are not required to be registered under 527 CMR9.00. Code of Massachusetts Regulations 9.00.No regulated aboveground or underground Penalties:Any owner who knowingly fails to notify or submits false information shall be subject storage tank facility shall be installed,maintained,replaced,substantially modified or to a civil penalty not to exceed$25,000 for each tank for which notification is not given or for removed without a permit(FP-290)issued by the head of the local fire department which false information is submitted.(MGL Chapter 148,section 38H,527 CMR 9.00) The owner of any storage facility shall within seven working days notify the head of the local fire department and the Dept.of Fire Services of any change in the name, Aboveground Storage Tanks address,or telephone number of the owner or operator of a storage facility subject to 527 CMR 9.00 requires the registration of any aboveground storage tank which meets the regulation by Chapter 148,Mass.General taw and by 527 CMR 9.00. following definition:a horizontal or vertical tank,equal to or less than 10,000 gallons Underground Storage Tanks capacity,that is intended for fixed installation without back fill above or below grade,and is Each owner of an underground tank first put into operation on or after Jan.1,1991, used for the storage of Hazardous Substances,Hazardous Wastes,or Flammable or shall,within thirty days after the tank is first put into operation,notify the Department of Combustible Liquids. Fire Services(the department)of the existence of such tank,specifying,to the extent Exception#1:Aboveground tanks of morethan 10,000 gallons capacity regulated by520CMR known,the owner of the tank,date of installation, capacity,type,location,and uses of 12.00(Requirements for the Installation of Tanks Containing Fluids Other Than Water in such tank.By no later than Jan.31,1991,each owner of an underground storage tank Excess of 10,000 Gallons)are not required to be registered under 527 CMR 9.00. that was in operation at any time after Jan.1,1974, regardless of whether or not such Exception#2:(a)a farm or residential tank of 1,100 gallons or less capacity used for storing tank was removed from beneath the surface of the ground at any time,shall notify the motor fuel for noncommercial purposes, or (b) a tank used for storing heating oil for department of the existence of such tank,specifying,to the extent known,the owner of consumptive use on the premises where stored are not required to be registered under 527 the tank,date of installation,capacity,type,and location of the tank,and the type and . CMR 9.00. quantity of substances stored in such tank,or which were stored in such tank before the tank ceased being in operation if the tank was removed from beneath the surface Penalties:Any person who knowingly violates any rule or regulation made by the Board of Fire of the ground prior to the submittal of such notice to the department.Such notice shall Prevention Regulations shall,except as otherwise provided,be punished by a fine of not less also specify,to the extent known,the date the tank was removed from beneath the than one hundred dollars nor more than one thousand dollars. (MGL,Chapter 148,section surface of the ground prior to the submittal of such notice to the department.The 10B,and 527 CMR 9.00) operator of any tank that has no owner or whose owner cannot be definitely Where to Notify?Two completed notification forms should be signed by both the tank owner ascertained,shall notify the department of the existence of such tank,specifying,to the and the local fire department.One co will be retained b the fire department,and the tank extent known,any information relating to ownership of the tank,and date of p copy y p installation,capacity,type,and location of the tank,and the type and quantity of owner shall send a separate copy to the address at the top of this page. substances stored in such tank,or which were stored in such tank before the tank When to Notify?1.Owners of storage tanks in use or that have been taken out of operation ceased being in operation if the tank was removed from beneath the surface of the must notify within thirty days. ground prior to the submittal of such notice to the department.If the tank was abandoned beneath the surface of the ground prior to the submittal of such notice to Owners and Operators of Regulated Storage Tank Systems must maintain records the department,such notice shall also specify,to the extent known to the owner or certifying that all leak detection,inventory control and tightness testing requirements operator,the date the tank was abandoned in the ground and all methods used to for the Regulated Storage Tank System are current These records must be readily stabilize the tank after the tank ceased being in operation. available for inspection. 1. OWNERSHIP OF TANK(S) II. LOCATION OF TANK(S) Owner Name(Corporation, Individual,Public Agency,or Other Entity) If known,give the geographic location of tanks by degrees,minutes,and l seconds.Example:Lat.42,36, 12 N Long.85,24,17W Latitude Longitude Street Address / Distance and direction from closest intersection(see instructions#2) Fad"y Name or Company Site identifier,as applicable /s ice? L City State Zip Code _StreetAddress-(P-.O Box-not-acceptable---see.instructions#2) tv-I LxK —� ,r /� O� 6 ff Y q ff ��✓ cam �i County City r; State Zip Code Phone Number(Include Area Code) Owner's Employer Federal ID# Counly—l" n� f_3,w ir! Paae 1 111. TYPE OF OWN R IV. INDIAN LANDS ❑ Federal Government gcommerciai ❑ Tanks are located on land within an Indian Reservation or on (s�orage and sale) other trust lands. O State Government , ❑ Private ❑ Tanks are owned by native American nation,tribe, or individual. ❑ Local Government (storage and use) V. TYPE OF FACILITY Select the Ap nate Facility Description: (check all that apply) Gas Station Marina Trucking/Transport Petroleum Distributor Railroad Utilities Airport Federal-Military Residential Aircraft Owner Industrial Farm Vehicle Dealership Contractor Other(explain) VI. CONTACT PERSON IN CHARGE OF TANKS Name: Pt-7M Address: Phone Number(include area code): Job Title: I''i✓�7iACK I?yo ©Lo J' � or Al Home: �� S /4 A)- 01'64' Business: -f-?'f- 2 21-CV33 VII. FINANCIAL RESPONSIBILITY ❑ 1 have met the financial responsibility requirements in accordance with 527 CMR 9.00. ------- --------------T-------------- Check all that apply: ❑ Self Insurance ❑ Guarantee ❑ Letter of Credit ❑ Commercial Insurance ❑ Surety and ❑ Trust Fund ❑ Risk Retention Group ate Fund ❑ Other Method Allowed -Specify VIII. ENVIRONMENTAL SITE INFORMATION This information should be avai able from local health agent,conservation commission, or planning department. 1.Tank site located in wellhead protection area ❑Yes �; � ❑ Unknown 2.Tank site located in surface drinking water supply protection area ❑Yes 4p- o ❑ Unknown 3.Tank site located withir 100 feet of a wetland ❑Yes -nfNo ❑ Unknown 4.Tank site located within 300 feet of a stream or water body ❑Yes IO No ❑ Unknown IX. DESCRIPTION OF STORAGE TANKS AND PIPING (COMPLETE FOR EACH TANK AT THIS LOCATION) Tank Identification Number Tank No.L Tank No. 1-- Tank No.3 Tank No. Tank No. 1.Tank status a.Tank mfes serial# (if known) b. CLrrently in Use E I ® I c.Temporarily Out of Use (Start Date) 0 0 0 0 0 d. Permanently Out of Use 0 0 0 0 0 e. Aboveground storage1ank(AST) or ❑AST Ld'UST ❑AST QA5T ❑AST [4 l ❑AST ❑ UST ❑AST ❑UST Underground storage tank(UST) 2. Date of Installation (mo./daytyr.) 3. Estimated Total Capacity(gallons) 0 V✓ ylOw �o vJ Tank Identification Number(cont.) Tank No. Tank No. Tank No. Tank No. Tank No. 4. Substance Currently or Last Stored a. Gasoline 0 0 0 0 V ❑Marina C M/'❑ Marina 14- ❑Marina ❑ MV ❑Marina ❑ MV ❑Marina Motor vehicle or other use ❑other ❑other ❑other ❑other ❑other b. Diesel 0 0 0 I 0 ❑ MV ❑Marina ❑ MV El Marina ❑ MV El Marina El MV ❑ Marina ❑MV ❑ Marina Motor vehicle or other use ❑other ❑other ❑other ❑other ❑other c. Kerosene 0 0 0 0 0 d. Fuei Oil' 0 0 0 0 0 "Consumptive Use"tanks need not be registered. "Consumptive Use"fuel used exclusively for area heating and/or hot water. e. Waste Oil 0 0 j 0 0 f. Other, Please specify ---------------- ------------ ------ ----------- Hazardous Substance (other than 4a thru 4e above) CERCLA name and/or CAS number ---------------- ------------ ------ ----------- Mixture of Substances 0 0 0 0 0 Please specify 5. Material of Construction-Tank(mark only on ) Bare steel(includes asphalt, galvanized and epoxy coated) 0 0 0 0 0 Cathodically protected steel 0 0 7 Composite (steel with fiberglass) 0 j 0 0 Fiberglass reinforced plastic (FRP) Concrete 0 0 0 Unknown Other 0 0 0 0 Please specify 6.Type of Construction-Tank (mark only one) Single walled Double walled 0 0 0 0 0 Unknown 0 0 0 0 0 Other 0 0 0 0 0 Please specify Is tank lined? ❑Yes Oslo []Yes Z.Wo ❑Yes 9-No ❑Yes ❑ No ❑Yes ❑No Does tank have excavation liner? ❑Yes ❑ No ❑Yes ❑ No ❑Yes ❑ No ❑Yes ❑ No ❑ Yes ❑No FP-290(revised 11/96) Page 3 T� ank Identification Number(cont.) Tank No. Tank No._& Tank No.3 Tank No. Tank No.- T. Material of Construction-Piping(mark only one Bare steel (includes asphalt, galvanized and epoxy coated) Cathodically protected steel 0 0 0 Fiberglass reinforced plastic (FRP) Q 0 Flexible :1 Copper 0 [_] Unknown 0 0 0 0 Other 0 0 0 0 0 Please specify 8. Type of Construction-Piping(mark only one) Single walled 0 0 0 0 Double walled 0 0 0 0 Unknown 0 0 0 0 Other Please specify Has piping been repaired? ❑Yes ❑ No ❑Yes ❑No ❑Yes ❑ No ❑Yes ❑No ❑Yes ❑No Is piping gravity feed? ❑Yes ❑ No ❑Yes ❑No ❑Yes ❑ No ❑Yes ❑ No ❑Yes ❑No Date X. CERTIFICATION OF COMPLIANCE 1. Installation A. Installer certified by tank and piping �-�=-►—J 0 0 manufacturers B. Installer certified or licensed by the implementing agency C. Installation inspected by a registered engineer D. Installation inspected and approved by 0 0 the implementing agency E. Manufacturers' installation checklists have been completed F. Another method allowed by 527 CMR 9.00. Please specify 2.Tank Leak Detection Tank Tank Tank Tank Tank (mark only one) A. Double-wall tank- Interstitial monitoring B.Approved in-tank monitor C.Soil vapor monitoring (check one below) M ❑ Monthly ontinuous E. Inventory record-keeping and tank testing F. Other method allowed by 527 CMR 9.00. Please specify FP-290(revised 11/96) Page 4 Tank Identification Number(cont.) Tank No. Tank No.___JL Tank No. Tank No. Tank No. 3. Piping Leak Detection (mark only one) Piping Piping Piping Piping Piping A.Pressurized a. Interstitial space monitor ❑ ❑ ❑ ❑ ❑ b. Product line leak detector ❑ ❑ (mark all that apply below) ; tomatic flow restrictrr" Automatic shut-off device' -G�ontinuous alarm" Also requires annual test of device and piping tightness test or monthl-1 vapor monitoring of soil. B. Suction: Check valve at tank only ❑ El ❑ ❑ El interstitial space monitor or line tightness test every three years) 'Interstitial space monitor ❑ Line tightness test C. Suction: Check valve at dispenser only ❑ ❑ ❑ (No monitor required) ❑ ❑ D. Other method allowed by 527 CMR 9.00. Please specify 4. Date of last tightness test(tank&piping) 5. Gravity feed piping ❑ ❑ ❑ ❑ ❑ 6. Spill containment and overfill protection Tank Tank Tank Tank Tank A. Spill containment device installed Er [a 19- ❑ ❑ B.Overfill prevention device installed ❑ ❑ 7. Daily Inventory Control (mark only one) A. Manual gauging by stick aril records ❑ ❑ ❑ ❑ reconciliation B. Mechanical tank gauge and records (� ❑ El u C. Automatic gauging system ❑ ❑ ❑ ❑ ❑ 8. Cathodic Protection (if applicable) Tank Piping Tank Piping Tank Piping Tank Piping Tank Piping A. Sacrificial Anode Type ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ B. Impressed Current Type ❑ ❑� ❑ ❑ ❑ ❑ ❑ C. Date of Last Test o Certification of Compliance No.: X►1. CERTIFICATION (Read and sign after completing all sections) NOTE:Both the copy being sent to the Dept.of Fire Services and the copy retained by the local fire department must be signed separately. A photocopied signature will not be accepted on either document. I declare under penalty of perjury that I have personally examined and am familiar with the information submitted in this and all attached documents,and that based on my inquiry of those individuals immediately responsible for obtaining the information,I believe that the submitted information is true,accurate,and complete. Name and official title of owner or owner's authcrized representative(Print) Signa Date: A�- FP-290(revised 11/96) Page 5 TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair Q satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops p� O unsatisfactory- 4.Manufacturers COMPANY•9zV," 44 f7 d- (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS Xg<2f f&> Z4 Class: 7.Miscellaneous QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) OR ERIALS tCase lots Drums Above Tanks Underip-ound 5l �All IN OUT IN OUT IN OUT #&gallons Age Test Fuels: � `$ ?/ Gasoline Jtt-Ftx1-( Dits , #2 (B) &? Heavy Oils: waste motor oil (C) ' !� f new motor oil(C) transmission/hydraulie Synthetic Organics: degreasers 4 Miscellaneous: &�7 DISPOSAL/RECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply -� �� ,Town Sewer ublic 0 On-site 0Private 3. Indoor Floor Drains YES N0� 0 Holding tank:MDC 0 Catch basin/Dry well if 0 On-site system 4. Outdoor Surface drains:YES NO ORDERS: _ 0 Holding tank:MDC zlw 0 Catch basin/Dry well 0 On-site system f 5.Waste Transporter i � O%4 �27�11 Name of Hauler Destination Waste Product 1. 7 C✓' / �L' YES NO 2. 04 Person(s) Inter4ewed Inspector Date s {{ f x 4 - f ' f • f ' r 3" 3 >- . _ � C — r L { it : � Y•' * �. i } , r T i e r S f ! 3 q e , : - 1 i c 4 2 , off oil! 1 how SUP lit Elm i flitz'—••yp 2 . - -. .. .. .- ' ...-.. - AT ... r a V AN a SO i # f Y Y tea,{ . e - M1 _ ♦ •, WIT *- a y - IfT, < IM ` L ` 4 1 PETER A.DEMERS ,ASE CERTIFIED MECHANIC UNOCO Barnstable Rd. Auto Repair In6 ..- 91 BARNSTABLE RD. -' HYANNIS MA 02601 (508)771-0033 j STATE INSPECTIONS•TUNE UPS•BRAKES+EXHAUST > s j Wpomm omweiza a1G4 as;acXeaetZ - 1_0eAaWm,,zt q1a ,rr�e V ewucceb .N® ficatlon for Removal or Closure of In Place Storage Tanks Regulated Under 527 CM_R 9.00 Forward completed form,signed by local fire department,to: Mass. UST Compliance Unit, Dept.of Fire Services, One Ashburton Place-Room 1310,Boston,M2108-1618 Include copies of FP-292, Fire Department Permit and both sides of Re'g ,r Tank Date Received:`" Disposal Yard Receipt (FP-291). y�.`�i�� Fire Dept. IO# (Fire Department retains one copy of FP-290R) 901 A,, T_ap Fire Dept. Sig. This form is to be used for notification for removal of Underground StoragPif /�F0 _ g nly Piping. � y , If a storage facility has USTs which are to remain in use, an entire amended FP- �, �tYANumber (long form) must be filed. Date wed _ Note: "Facility street address"must include both a street number and a street name. C. Clerk's Initials Post office box numbers are not acceptable,and will cause a registration to be D. Comments returned. If geographic location of facility is not provided, please indicate distance and direction from closest intersection, e.g., (facility at 199 North Street is located)400 yards southeast of Commons -load(intersection). I. OWNERSHIP OF TANKS) He LOCATION OF TANKS) p Owner Name( saon, Nridu ` lc Agency,or Other Entity) If known,give the geographic location of tanks by degrees,minutes,and 17/C h 4I1� seconds.Example:Lat.42,36,12 N Long.85,24, 17W Latitude: Longitude I T�Ate/, ti�, Jr sweet Address om f ie � )�h47 ti1?9ld l /mod ' - Dis a rw + from -„intefa coon tsee note above► ______r 'Facility Name or Company Site identifier,as applicabl y Lfate Zip Code Street Address(P.O.Box not acceptable--see noteabove) 7Z SIT ti r f 1 oun //d77/7/,, ^/9' -0-J d& City, State zip Cotle Phone Number(Include Area Code) Owners Employer federal 10 a County Me TANKS/PIPING REMOVED OR FILLED IN PLACE Tank Number Tank No. Tank No. Tank No. Tank No. Tank No. 1. Tank/Piping removed or filled in place (mark all that apply) A. Substan c-= last stored 7i, E=:= B. Tank capacity gallons - C. Estimated date last used (mo./day/yr.) D. Estimated date of removal ———-- ———— (modday/yr.)E. Tank was removed from ground �� �� C� L F. Tank was not removed from ground Tank was filled with inert material __Describe_material used: ___ �— G.Piping was removed from ground — �� L H. Piping was not removed from ground I. Other, please specify ! •290A(revised 11/96) ianK Number(cont.) Tank No. Tank No. Tank No. Tank No. Tank No. I 2. Tank closed in accordance ' ivth_527 MR 9.00 O Yes No p Yes 'p No O Yes C No O Yes p No C Yes = No A. Evidence of leak detected p Yes O No C Yes 'p No O Yes O No p Yes C No ==Yes _ No B. Mass. DEP notified C Yes -:3 No 7 Yes :1 No ❑Yes O No p Yes p No ="Yes Z No I. Mass. DEP tracking number =- 2.Agency or company performing contamination assessment I declare under penalty of perjury that I have personally examined and am familiar with the information submitted in this and all attached documents, and that based on my inquiry of those individuals immediately responsible for obtaining the informa- tion, I believe that the submitted information is true, accurate, and complete. Name and official title of owner or owners Signature: authorized representative (Print) Date: 'Z'ZL 9oR(revised 11/96) TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair 2.Printers BOARD OF HEALTH O Satisfactory 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY A �A11136 L , Y (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS 9 1 i1�wJ'rw�i� ' Class: 7.Miscellaneous 1 W,,-, QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: -Y& 1?S/ Z r-q f Gasoline Jet Fuel(A) Diesel, Kerosene, #2 (B) Heavy Oils: 2`ST V- waste motor oil (C) 77S �C new motor oil(C) transmission/hydraulic Synthetic Organics: degreasers e- Miscellan pus: EGG> -3T oc f.d, 4 47-u�ze- c 6-"A Ldd 41 -; lj�, loevv- 30 41 DISPOSAIJRE;LAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply 4-vd000®`26` f. °a [`Town Sewer Public Pe t- "I w,J N y C/v,�° �? � c oS® J, O On-site OPrivate / � f 3. Indoor Floor Drains YES NO _ OvJs rL O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO_Z ORDERS: O Holding tank:MDC L tiA.*/ Al.®, OI.�- 1 J"7ejoi=" `WfeZs,o dc".j &&fle,P `TVs O Catch basin/Dry well o o /ti f��-Ap,e/J'G ( IA f'Ap�j? O On-site system W n-t 1 e4 L1 C 441 i. 5.Waste Transporter ""�� av r � Z�. �` /� � ` r . r / l � Name of Hauler '`/v' 2 1 9 67 Ga_4,5 7 6 d ?gqCj cog 1✓�JA l/ Perso (s) Interviewed V_ —Insi6ecior Date le"es TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair r BOARD OF HEALTH satisfactory 2.Printers 3.Auto Body Shops ,�,11 I 1 O unsatisfactory- 4.Manufacturers COMPANY 00) (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS e-v Class: 7.Miscellaneous amcl QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots 1 'Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: — �V, TD311j c(� Gasoline,Jet Fuel (A) f UU� d' Diesel, Kerosene, #2(B) Heavy Oils: �S waste motor oil (C) new motor oil (C) 2- transmission/hydraulic Synthetic Organics: degreasers M1 Miscellgneous: L DISPOSAIJRELLAMATION REMARKS. •._r/ 1. Sanitary Sewage 2.Water Supply Town Sewer (Nublic O On-site OPrivate wi 3. Indoor Floor Drains YES NO O Holding tank:MDC O Catch basin/Dry well O On-site system Y 4. Outdoor Surface drains:YES"' NO ORDERS: O Holding tank:MDC )�atch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Pro e YES NO 2. C2 fto on F Person (s) Interviewed &Z=�-4ran- sp=ktor ' Date �w it PETER A.DEMERS u�OCo ASE"CERTIFIED MECHANIC -0arnstable Rd. Auto Repair Inc. 91 BARNSTABLE RD. HYANNIS,MA 02601 (508)771-0033 STATE INSPECTIONS-TUNE UPS•BRAKES•EXHAUST k d W�At h Oepar*ewt" P. 0. Sox 53 RF. Undervs una TAnk eo fmmixls Tag I � our records joi rats that your un fzr r*vnd uet or vheviC-a1, �aora;t tamh is over L0 ye a s qtdo Togo f as- of s t ate 63tAr v. v*t t "Mie To 4ti`.. " k attt 77 _ x Yo are d-f r o[,t 4 d. to r" v h f ._ x t Y X6 r".'the date �� t i4 ati-ct* rp f` Ali { . lou mA re elst. ,hp4riaa 0r0it#'de'd tte 0 At 11 .01 n �N t-hics .ire ass : dAys, a_ 1 e'r. " ordet er -Or -'r N 0A D C 9- 0 P 0 0 E it T1 lt- M /+ Y J qr from Town of darnstable . P l, D.- box 534 a y ni s VIA U2601 9 � Rh. 1�►tC��'rgrouna tankt.� ��+ ?1#. !� �Yft �€� _ 327OZ6 our re ores ndicat* that your tinder4r=ovol fuart storalo tarok As over 20 re ts, otd* as�€2,. -4 ...rim:.+:�'���*'�.����r��'+'�s'�;}+ Section 3 « G t 0 o of 1airi rerrai red y ; e ut �rficxn a atr i c Fuet' 4 Che i e' 't t ,tSysterts.; ,. frotl the late of this, x�tCic+i x 7' ' r tz �,�try .V After -your tit k ix ran t #: '� ��j #s t�ht a phis c � s d+ in the f Orm of a er,» f.row -deper t me'. 'ithin Ninety € 0 rays of t fs native. You flay request,-O hearing Vid ed .8 Writtel, P0000 f/� + . r~equesting $$M i recQived by the isoar �of Heatth within seven -t Kdays att r this erd r � served* � -T.oz i'A'D a nrROPE TIES !N£ 1740 ODD $CAGE KO Vioma.s RcKOa iregt0r k� W eARNST L A 0,26b a rom Town of barnSta _ _ f C). bolt - . . : Our-' rftords indi gat,* that y lour Uri 'or sou l. fu g reau � :j l." Sic o - • a € ys are .r' eo ir T$ .' 4$. asC39zft �€ F3kf` ' too the data of. After yow- tank tz. re* •�; the r of fir- � fie" L, F t r r r fit t-h k 0 p El RTC h C a► 4,t s 7 r .; , k HYANNIS FIRE DEPARTMENT 95 HIGH SCHOOL ROAD EXTENSION HYANNIS, MASS. 02601 RIGHARD R. FARR£NKOPF .SnZC��2e Oetectvzd Save .C'ived BUSINESS: 775-1300 CHIEF EMERGENCY: 775-2323 PERMIT FOR; FOR REMOVAL AND TRANSPORTATION OF STORAGE TANKS FDID NUMBER 01922 DATE OF APPLICATION Ok) t5, 198 9' PROPERTY OCCUPIED BY : Nu a n n 1�n Sun ocn PHONE : LOCATION q I r'n i�" 1 ts Z d- PROPERTY OWNER t .k Tf`o,-,i- - PHONE : TANKS TO BE REMOVED ALL TANKS SHALL BY INERTED BY THE USE OF DRY ICE AT 1.51bs per 100 1. QUANITY SIZE (GALLONS) FORMER PRODUCT STORED PROJECT SUPERVISOR Jc�F,n Kjol-may) PHONE COMPANY NAME I_C2 Talk 5enlrces ADDRE S S : Tom' au 62=M4 Sa • - z c f fn 4S f2+• -2 8 Cert+erOI I t If- EXCAVATION COMPANY s @-I � ef` PHONE ADDRESS: Cl�51 Pood DIG-SAFE NUMBER_ : 89 3151 5Lo START DATE a_uT; Ict9-2 COMPANY REMOVING USABLE PRODUCT FROM THE TANK(S) . NAME 4-c p- - -.lv\ ✓ 5 er /l cP-5 PHONE : ADDRESS: s�rne as above COMPANY CLEANING THE TANK(S) AND REMOVING THE HAZARDOUS WASTE : NAME : -2% - PHONE : ADDRESS : D.E.Q.E. LICENSE NUMBER: EXPIRES: MANIFEST NUMBER,: kVM COMPANY TRANSPORTING THE TANK(S) NAME: LC-C � ZnIG 5e-r-u ce-.S PHONE : '71�r-loda-Z ADDRESS : Same a5 aboi-p_ THE TANKS SHALL BE TRANSPORTED TO YARD NAME LC(? &aA+ PHONE '7`7Fr - (�DOZ ADDRESS : 2-T Goo l l c.ai ReQdu Ibe- MASS . FIRE MARSHAL' S APPROVAL NUMBER 03So f DATE OF ISSUANCE : Dip ►5 4$ HYLNNS j RTMENT USE ONLY DATE OF EXPIRATION I D SEE LEAK REPORT SSED - NO HAZARD GNATURE OF APPLICANT SIGNATUkt OF ANN .D. OFFICIAL ,I LCR Tank Services, Inc. P.O. Box 765 Morstons Mills, MA 02648 508-420-3365 Storage Tank Removal Receipt Date: 14 -/A A91 TYPE: Oil Gas Other Owner: nit 7° M a r Va Yia o5 Address Ad d it ee:1ry r-1` Tank Size: f".� p ' .. ./--5-d U S Date Removed: FDID #: C2 r r-1�- LCR Tank.# � "' "' � "' Dig Safe # ® C1�� LCR Project # Tank Transported To: L C t� I he Maysl,,2s 1,L,)d (Is 1(4c Inspector: Comments: AnOyek,*Id e 'rain 144 r f'ry or Services •�REGaEIPT��;QF, D�I�POSAI`�..OF�„�'KDfi•RGROU�D_�STEE� �S�QI �] TAId,_ �_ _ .� ; NAME AND ADDRESS OF .., . ., . -- APPROVED TANK YARD READ UE, IMA UT31 APPROVED TANK YARD NO. _owl Tank Yce.rd Ledger 502 CMR 3.03(4) Number: Q �� I certify under penalty of law I have personally examined the underground steel storage tank delivered to this "approved tank yard" by firm, corporation or partnership and accepted same in conformance with Massachusetts Fire Prevention Regulation 502 CMR 3.00 Provisions for Approving Underground Steel Stora a Tank dismantling yards. A valid permit was issued by LOCAL Head of Fire Department FDID# to transport this tank yard. Name ffic title of app tank yard owner or owners authorized representative: ITl,E DATE SIGNED This signedreoeipt of disposal must be returned to the local head of the fire department ;FDID# pursuant to 502 CMR 3:00. (EACH TANK MUST HAVE A Raman OF DISPOSAL) i FORM F.P. 291 (rev. 9188) (OVER) STATE FIRE MARSHAL'S OFFICE � 1 NAME AND ADDRESS 1AMES G. GRANT CO„ INC_ , OF R. 28 WO on ST -- - APPROVED TANK YARD READVII14 MA 02.137 _ APPROVED TANK YARD NO. - Tank Yard Ledger 502 CMR 3.03(4) Number: Q l 2 I certify under penalty of law I have personally examined the undergrounds storage tank delivered to this "approved tank yard" by firm, corporation or partnership Lr[Z 'r[' _ and accepted same in conformance with Massachusetts Fire Prevention Regulation 502 CMR 3.00 Provisions for Approving Underground Steel Storage Tank dismantling yards. A valid permit was issued by LOCAL Head of Fire Department FDID# 0� to transport this tank7fial s yard. Name title of approved tank yard owner or owners authorized representative: ... SIGNED This signed receipt of disposal must be returned to the local head of the fire department FDID# �� aZ�-pursuant to 502 CMR 3:00. (EMM TANK MUST HAVE A RDCEIPT OF DISPOSAL) FORM F.P. 291 (rev. 9/88) (OVER) MASSACHUSETIS STATE FIRE MARSHAL'S OFFICE DIMENSIONS Tank Removed From Width Length G--l"I (no. street) i Tank 1 ----- X -------*0d-% ------------------------- Tank 2 ----- X ----- (city or town) Tank 3 ----- X ----- Fire Department Permit # ----------------------- Tank 4 ----- X ----- (if applicable) Tank 5 ----- X ----- (feet) (feet) Iop� DIMENSIONS Tank Removed From SV, c v Width Length ---ql---CC�.L ���_ s. ------------ (no. street) Tank 1 ----- X --- -- ----� --------------------------- Tank 2 ----- X ----- (city or town) Tank 3 ----- X =---- Fire Department Tank 4 ----- X ----- Permit # ----------------------- (if applicable) Tank 5 ----- X ----- r (feet) (feet) Sov 6v4�4�� Ora, x i F P +ti i r . j d r 10 Ln MID ONION w 1. ru r"1 ru c� J ti 4 'x `k \ a�.''^• wu. �t'c +►,U\ •� �\ n ,�.-. `C'} v �� .J e( ,/ljl• }11 � I/� ALAf 46 ® _ " V lf�" �.• 11 .�r �!+`, /�+. r' tL Sm AWL e r ~low r M .. • ,.,ruts � � n �._ a `J�gy�i a4, Zu r f Y ,�/ rvQ to oi, OW I dList � 1 a6 T rn ;��'� � lr •lbw � ^�f fit �P•( fZ a�^�� r h •, - 1 V f�r fp. W • x Yt. y'y t t ' � j :t,: ;; i 0 �Jr'jf� - �. c• r. x Y y r7xrJ i•y t �'+�� y C � p .t+ x s LEGEND I Ew-1 CATION AND DESIGNATION -N_ CEMETERY � MONITORING WELL LOCATION D GNATION ,y --•� " " i -+ GI-4 SOIL BORING LOCATION AND DESIGNATION AUTOMOBILE DEALERSHIP s-r APPROXIMATE LOCATION OF SEWER LINE GRASS PAVEMENT 92 BARNSTABLE ROAD C APPROXIMATE LOCATION OF VERIZON UTILITY DUCT �I TRAILER LOCATION OF -ABANDONED IEW_4� G ( APPROXIMATE LOCATION OF NATURAL GAS LINE I UTILITY TRENCH w APPROXIMATE LOCATION OF WATER LINE APPROXIMATE LOCATION �` � OF FORMER WASTE OIL x-- APPROXIMATE LOCATION OF FENCE LINE UST APPROXIMATE LOCATION OF PROPERTY BOUNDARY APPROXIMATE LOCATION OF DISPOSAL SITE / BUILDING BOUNDARY AS OF FEBRUARY 27, 2007 91 BARNSTABLE ROAD, •••••••••f••••• w W IN J i APPROXIMATE LOCATION OF OVERHEAD ELECTRICAL RESIDENCE j / OHE ' LINES / � < N APPROXIMATE LOCATION OF CATCH BASIN IGRASS j FORMER PUMP h / / ISLAND I LOCATION OF TWO - a .• • •• "•• •••.. • o z 55-GALLON CONTAINERS OF USED ANTIFREEZE AND 1 •• ••••• � F .� USED OIL FILTERS / •'• o r v •• BOAT DEALERSHIP 84 BARNSTABLE ROAD 0 Z .•.* i EW-3 ' :• N I ? ? I _� •••• V 3 N c L_ J L J J , •�• FORMER 4,000-GALLON NOTE . GASOLINE USTs 1. THIS FIGURE WAS BASED UPON A PLAN PREPARED BY CISTAR ® ASSOCIATES, INC. CANTON, MASSACHUSETTS, DATED DECEMBER 29, EW-2 tiF " N 1989 TITLED "FIGURE 2: SITE PLAN, 91 BARNSTABLE ROAD, HYANNIS, • MASSACHUSETTS." • i s s s s s , 3; s-•_: LOUIS STREET 0 20 40 . MW-1/ GI-2 Mw-2/ , I Mw-3/ APPROX. SCALE IN FEET GI-4 GI-1 GI-3 GI-5 ` G w G w G w G�w—�- a cuENT: BARNSTABLE ROAD AUTO REPAIR, INC LAUNDROMAT PROJECT: 91 BARNSTABLE ROAD 75 BARNSTABLE ROAD IOULn HYANNIS, MASSACHUSETTS a TITLE: DISPOSAL SITE BOUNDARY PLAN_. I DESIGNED: DRA'NN: CHECKED: APPROVED: GeOII1S11t RPD STM LMF MJW Practical in Nature I SCALE: DATE: FILE NO.: PROJECT NO.: FlGURE NO.; �� 1" = 20' 63/22/07 4743DO08 4743-001 5 91 Barnstable R6ad Sewer Acct # 0832 Hyannis A = 327 '026 ti i II 1 AcvcrFa III `77IlPlliC J UPC 17734 Now 2� 15 CR C HASTINa8, YN Massachusetts Departnj8ht of Conservation''a_nd`'Recreation Office of Water Resources O/- 7/ 152844 TYPE OR PRINT ONLY Well Completion Report 1. WELL LOCATION GPS (Required) North West Qo i . Q Address at Well Location: sunpa'O / / `Property Owner/Client: h • Subdivision Name: /I Aaf./73fQt�IL !°OQ'1 Mailing Address: S City/Town: #ado ig ` YA City/Town: 0 1 7� Assessors-Map Assessors Lot#: NOTE: Assessors Map`and Lot# mandatory if no street address available Board of Health permit obtained: Yes ❑ Not Required Q9 Permit Number Date.lssued 2.WORK PERFORMED 3 WELL,TYPE 4. DRILLING METHOD 6.:CASINO r Overbuy en Bedrock. From-(ft) To (ft) Typ �Thickness Diameter —k] [W r�� I — QQ 5. WEIJ LOG OVERBURDEN e— Extra Water Loss or Drop in Fast or � ❑❑❑ LITHOLOGY Bearing Addition' Drill From (ft) To (ft) Code Color Comment" Zone of Fluid Stem Drill Rate 7. SCREEN Y / N Y / N F / S From (ft),, (ft) '" ; pe Slot Size Diameter Y / N Y / N F / S «_� Y / N . Y / N F / S rtN ❑❑❑Y / N Y / N t- NULAR SEAL/FILTER PACK/ABANDONMENT MTL. Y / N ,Y / N F /,S" From°(ft).To (ft) Material De ription _ . Purpo ' Y-/ W Y / N F_ Y / N Y / N F,4,.,S� Q Y / N Y / N `F / S,°` ❑❑ ❑ Y /.N Y /,,N,�,F_/1S ❑❑ ❑❑ � WELL LOG BEDROCK Extra- 9. SITE SKETCH Water Drop in Extra Visible Loss or #of r' Bearing. Drill Large Fast or- LITHOLOGY r Rust Addition Fracture Zone Stem Chipss Slow Staining of Fluid per foot From(ft) To (ft) Code Comment Drill Rate Y / NY/ N F,/ S Y / N Y / N, ? Y / NY,I"N' F / S Y / N Y / N V Y / N Yw./—N F / S Y / N Y / N �p ,, Y,PN,Y /N F / S Y / N Y / N ' kn YhNY / N F / S Y / N Y / N Y %`N Y / N F / S Y / N Y / N YW% NY / N F / S Y / N Y / N N Y / N F / S Y / N Y / N �0 Q Y / NY / N F / S Y / N Y / N Y / N Y / N F / S Y / N Y / N �,> - 10.WELL TEST DATA(ALL SECTIONS MANDATORY FOR;PRODUCTION WELLS) : 1f:STATIC WA*ER LEVEL(ALL WELLS) Yield Time Pumped Pumping Level Time to Recover Recovery Depth Below Date Method (GPM) ,.;(Ivs4"min) (Ft. BGS) (hrs& min) (Ft. BGS) Date Measured Ground Surface (ft) .r , Q 12: PERMANENT PUMP(IFAVAILABLE)' 13.ADDITIONAL`WELL INFORMATION � Pump Description []­0'❑ ❑ Horsepower Developed'Y / racture Enhancement Y / N � ❑ Pump Intake Depth '~ � (ft):Nominal Pump Capacity (gpm) Disinfected Y / N Surf�ce Seal Type 14: COMMENTS $ Total Well Depth Depth to Bedrock 15_WELL DRILLER'S STATEMENT ,_. This well was drilled, altered, and/or abandoned under my supervision, according to applicable { - ] rules and regulations, and thi repo is c mplete and correct to the best of my knowledge.,,, Driller: ' Supervising Driller Signature. /� Registration #: Firm: Y Date.,Complete: Rig Permit#: C. - NOTE: Well Comp Lion-Reports.must be filed by the registered weld duller within 30 days of well completion. BOARD OF HEALTH COPY •r "� . Well Completion Report Codes Section 2 "" Section 3` Section 4 Work "' - Well Drilling Work Performed Type ,. , -� r ; Y Method Performed Code Well Type Code Drilling Method Code Decommission DC Cathodic Protection CTPR Air Hammer 't AH Deepen DP Domestic DMST Air Rotary AR Hydrofracture HF Geoconstruction GCON Auger AG New Well NW Geothermal Closed.1,00p GTCL Cable Tool CT Repair RP Geothermal Open Loop GTOL Casing Advancement CA Replacement RE Industrial INDS Core CR Injection INJC Direct Push DP Irrigation IRRG Drive and Wash DW . Monitoring d MONT- Dug `6 DG. , - Public Water Supply PBW8, `"Mud Rotary Mq - Recovery RCVR Reverse Rotary RR Test Wells TSTW Sonic SN Section'5 Overburden Casing Lithology Overburden Overburden Overburden Bedrock Type Thickness Name (OB).Code Color Color Code Bedrock Name (BR Code) Casing Type Code Thickness (NO CODE) Artificial fill AF Black BL Amphibolite AM Certa-Lok CTL• Schedule 5 Boulders B Bluish Gray BG Basalt BS Fiberglass FBG; Schedule 10 1 Clay- CLF" Brown BR Conglomerate/Breccia CG/BR :. Galvanized Pipe GLP Schedule 40 i Coarse'Sand CS A c'.•: Dark Gray ? DG Diorite DI HDPE HDP; Schedule 80 i Cobbles-, C, Greenish Gray;'"GG Gabbro GB NSF Coated Steel NCS', Schedule 160 Fine'Sand' FS Light Gray '-' 'LG z` Gneiss GN PVC PVC_; SDR 13.5 . A ` Fine to Coarse Sand FCS. Reddish Brown RB Granite GR Stainless Steel SST SDR 17 Gravel G Yellowish Brown YB Limestone LS . Steel STL SDR 21 Medium Sand MS Marble MA SDR 26 Organics „ 0 Quartzite QZ SDR 32.5 Sand&Gravel SG Rhyolite RH SDR 40 Silt Si r Sandstone SS 17# - Silty Clay SICL Schist SC 19# Silty Sand SIS Shale SH Silty Sand&Gravel �SISG Slate/Phyllite SUPH Till T Pegmatite PM Section 7 Section 8 Section 10 S Annular Seal/Filter Screen Annular Seal/Filter Pack/Abandonment Purpose Method Screen Type-, 1. Code " Pack/Abandonment Material Code Purpose Code Method 'Code Carbon Steel CST Bentonite Chips/Pellets BC Fill FL Air Blow with Drill Stem AB Continuous Wire PVC, "' CWP , Bentonite Grout BG Filter FT Air Lift AL Galvanized Wire WrappedGWW Cement/Bentonite Grout CB Seal AS Bailing BL Perforated Pipe PFP 4 Concrete CT Constant Rate Pump CR Pre-pack PVC PPP 1 Sand SD Variable Rate Pump VR Pre-pack Stainless PPS Native Material NM Slug SG Slotted PVC SLIP Stainless Steel Vee Wire SSV Stainless Steel Well Point SS.P• ..I , ':,l :v Section 12 Section 13 Pump Description Well Seal Pump Description Code Horsepower Surface Seal Type Type Code 2 Wire Constant Speed Submersible 2WSS 1/2 20 Cement CM 3 Wire Constant Speed Submersible 3WSS 3/4 25 Cement/Bentonite CB Constant Speed Submersible Turbine CSST 1 30 Concrete CT ._ Variable Speed Submersible Turbine" VSST 1�1/2 040 None NO . 'Jet JET 2 50 `tine Shaft Turbine LST - 3 60 - - Centrifical `CENT 5 75 7.1/2 100 .. 10 125 200