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0089 BASSETT LANE - Health
89 BASSETT LANE;HYANNIS f GROUPER PREPRESS SERVICES m ; ° Hazardous Materials Inventory Sheet Checklist 2— 1u((�l Date'. Physical Street Address-Check database to ensure it exists Working Phone Number Actual Amounts -( ie. gas being used to fuel machines, thinner to clean brushes all count as hazardous materials) Storage Information - location of storage, how long is storage for? If none, note that. Disposal Information-where and who? If none; note that. Applicant Signature - understand what is listed and noted V11 ,Staff Initial any questions, know who to ask Vehicle Washing/Rinsing? - provide a vehicle washing policy and explain it- note that it was given Attach the Business Certificate with your sign off and comments . **The inventory form should explain what the business consists of and the procedures they are doing. Notes need to be left to explain what you discussed with them. YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates COST $30.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in the Town (WHICH YOU MUST DO BY 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, I" Fl., 367 Main St., Hyannis, MA 02601(To' wn Hall) and get the Business Certificate that is.required by law. F j Fill in please: DATE: r y uyAVAPPLICANT'S YOUR NAME: LA fco/i BUSINESS YOUR HOME A D ESS: TELEPHONE # Home Telephone Number: NAME OF NEW BUSINESS/Y Q -4L TYPE OF BUSINESS o(a7-IS THIS A HOME OCCUPATION? YES NO Have you been giver) approval fr m the bu ing division? YES NO l ADDRESS OF BUSINESS 8 �A)r /jJ' MA MAP/PARCEL NUMBER 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 COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 2. BOARD OF HEALTH This individual has"beenf rmed oft e er e . ements t t pertain to this type of business. MUST COMPLY WITH ALL 4A7ARDOUS MATERIALS REGULATIONS Authorized S' ature* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has b&n inf rfne o the licensing requirements that pertain to this type of business. uthorized Sign ,ure** /� COMMENTS: ml Date /4 / //� TOWN OF BARNSTABLE c v TOXIC AND HAZARDOUS MATERIALS ON—SITE INVENTORY NAME OF BUSINESS: f---' a SeL P S BUSINESS LOCATION: 6 ASS 9— A) / 'g!t/OU/� ���NVENTORY MAILING ADDRESS: e// -N / �9�'� �s d�z64OTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: ��� � 3 MSDS ON SITE? TYPE OF BUSINESS: 02�07-a S"gC e S INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Y / Hydraulic fluid (including brake fluid) Refrigerants V Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel.Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor&furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers (including bleach) Spot removers &cleaning fluids 0 (dry cleaners) Other cleaning solvents �. Bug and tar removers 10 44Z Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Hazardous.Materials Inventory Sheet Checklist v Date .Physical Street Address-Check database to ensure it exists Working Phone Number _Actual Amounts-(le.gas being used to fuel machines,thinner to c an brushes all count as hazardous materials) Storage Information-location of storage,how long Is storage for? If none,note that. " Aisposal Information-where and who?If none,note that. pplicant Signature-understand what Is listed and noted J�Staff Initial-any questions,know who to ask LGVehicle Washing/Rinsing? -provide a vehicle washing policy and 6.xplain it-note that it was given {//Attach the Business Certificate with your sign off and comments "The inventory form should explain what the business consists of and the procedures they are doing. Notes need to be left to explain what you discussed with them. YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates.(cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L. : it does not give you per to operate.) Business Certificates are available at the Town Clerk's Office, 1s' FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) DATE: Fill in please: �. APPLICANT'S YOUR.NAME: .74. BUSINESS YOUR HOME ADDRESS LcJq-4 � 6ff--72 5� F1 l e MAN TELEPHONE # Home Telephone Number NAME OF NEW BUSINESS TYPE OF BUSINESS A-1C5 IS THIS A HOME OCCUPATION? YES N.O._p�,_ Have you been given approval from the buildin division? YES NO ? ADDRESS OF BUSINESS f AP/PARCEL NUMBER J When starting a new business there are several things you must dol 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 COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature" COMMENTS: 2. BOARD OF HEALTH This individual ha,?jr info m o the p rmit r uirements that pertain to this type of.business. Authorized i nature"" nature"" MMENTS: ;3. CONSUMER AFFAIRS(LIC SING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized.Signature" COMMENTS: ,t 1 TOWN OF BARNSTABLE MASSACHUSETTS BUSINESS CERTIFICATE ATE ISSUED: 04/17/2000 DATE RENEWED: BOOK 186 RENEWAL BOOK: RENEWAL PAGE:. PAGE: 01-096 DATE DISCONTINUED: CERTIFICATE EXPIRES: 04/17/2005 DISCONTINUED BOOK: DISCONTINUED PAGE: In conformity with the provisions of Chapter One Hundred and Ten(110),Section Five(5)of the General Laws,as amended,the undersigned hereby declares)that a business is conducted under the title below,located as shown,by the following named person,persons or corporation: NANTUCKET AUTO SALES MAILING ADDRESS:. 89 BASSETT LANE HYANNIS,MA 02601 ! N.A.M.E INC DB/A MYRON J SEARS 366 BAXTER NECK RD MARSTONS MILLS,MA 02648 DONALD C.HALLETT 44 EMILY WAY OSTERVILLE,MA 02655 Signatures: --Z-7 THE ABOVE NAMED PERSON(S)PERSONALLY APPE BEFORE ME AND MADE 0 TH THAT THE FOREGOING STATEMENT IS TRUE. / r TITLE )Identification Presented: DATE: June 27,2001 CONDITIONS: SIGN PERMIT REQUIRED,REQUIRES CLASS II LICENSE In accordance with the provisions of Chapter 337 of the Acts of 1985 and Chapter 110,Section 5 of the Mass General Laws,Business Certificates shall be in effect for four years from the date of issue and shall be renewed each four years thereafter. A statement under oath must be filed with the city clerk upon discontinuing,retiring or withdrawing from such business or partnership. Copies of such certificates shall be available at the address at which such business is conducted and shall be furnished on request during regular business hours to any person who has purchased goods or services from such business. Violations are subject to a fine of not more than three hundred dollars($300)for each month during which such violation continues. ---------------------------------------------------------------------------------------------------------------------------------------------------------------- CERTIFICATION CLAUSE I certify under the penalties of perjury that I,to the best of my knowledge and belief,have filed all state tax returns and paid all state taxes required undp law. * Signature of Individu 1 or Corporate Name(Mandatory) By: Corporate Officer(Mandatory if applicable) ** or Federal ID Number * This license will not be issued unless this certification clause is signed by the applicant. ** Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax payment obligations. Licensees who fail to correct their non-filing or delinquency will be subject to license suspension or revocation. This request is made under the authority of Mass.G.L.Cha 62C,S.49A. Pee Paid _ Gr7� Received and recorded at the above time and date in the Office of the Town Clerk;Town of Barnstable, Massachusetts in Book t� page pp A True.Copy Attest Town Clerk i . l Y TOWN OF BARNSTABLE Date: TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: BUSINESS LOCATION: �('S PA INVENTORY MAILING ADDRESS: rn TOTAL AMOUNT: TELEPHONE NUMBER: S( CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: .��� r�'�D/ D MSDS ON SITE? TYPE OF BUSINESS: G4 U- 5 D INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous.waste: OVA— Name of Hauler: iA1 Destination: a/A" Waste Product: j2j A- Licensed? Yes No NOTE: Under the provisions of Ch. .111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) Misc. Corrosive NEW USED Cesspool cleaners d Automatic transmission fluid Disinfectants Engine and radiator flushes d Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants 0 Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Q Gasoline, Jet fuel, Aviation gas 0 Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, V Photochemicals (Developer) lubricants, gear oil NEW USED © Degreasers for engines and metal Printing ink Degreasers for driveways &garages Q Wood preservatives (creosote) © 0 Swimming g pool chlorine 0 Battery acid (electrolyte)/Batteries Lye or caustic soda © Rustproofers Misc. Combustible © Car wash detergents Leather dyes 0 Car waxes and polishes Fertilizers d Asphalt & roofing tar 0 PCB's Paints, varnishes, stains, dyes Q Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED Q Any other products with "poison" labels 0 Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor&furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers O Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS CO.1i110\XVE.ALTH OF MASSACHliSETTS _ r EXECUTIVE OFFICE OF EINVIRONMENTAL AFFAIRS F DEPARTMENT OF ENVIRONMENTAL PROTECTION O\E n'INTER STREET. BOSTOA hLA 0210c (6171 292-550k, TRUDY CONE Secre:a_-.v ARGEO PALL CELLUCCI DAVID B STR'.-??S Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 89 Bassett Lane , Hyannis NamaofOwner Instant Offset Press 3--`off P Address of Owner: Date of Inspection: Name of Inspector:(Please Print)Wm. E . Robinson Sr. I am a DEP approved systerr)inspector rsuant to Section 15.340 of Title 5(310 CMR 15.000) rn copanyNarne: Wm. E . Robinson Meptic Service Marling Address: PO Box 0 9. Centerville , MA Telephone Number: 7 7 5�S-7 7 0 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: �ses Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: W -v 4 Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office�of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS ro 0" <00, CFOT, � r r • c+ revised 5/2/98 Page Iof11 i• �.r ied on Recq•drd Panr. - e _ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(corttinued) 'roperty Address: 89 Ba*ssett Lane , Hyannis ,)wrier: Mark Sunderland. Date of Inspection: INSPECTION SUMMARY: Check 68, C, or D: A. S -STEM PASSES: I have not found any information which indicates that'any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: One r more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system. upon comp etion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes, no or not determined(Y, N, or ND).' Describe basis of determination in all instances. If "not determined', explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached)indicating that the tank was installed within twenty (20) years prior to the date of the inspection: or the septic tank, whether or not metal, is cracked,structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipets). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed revised 9/2/98 Page 2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Icorrtinued) Property Address: 89 Bassett Lane , Hyannis Owner: Mark Sunderland. Date of Inspection: 3"•.�_a2a—�� C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: onditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the ublic health, safety and the environment. 1) S STEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303 11)(b)THAT THE SYSTEM NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to.or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER revised 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 89 Bassett Lane , Hyannis Owner: Mark Sunderland. Date of Inspection: 3_�z rZ 0-1-1 D. SYSTEM FAILS: You` st indicate either "Yes" or "No" to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct,the failure. Yes No _ Backup of sewage into facility-or system component due-to an overloaded or-clogged SAS or cesspool. i Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. . Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. i Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool-or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE YSTEM FAILS: You must in•icate either "Yes" or "No" to each of the following: Th following criteria apply to large systems in addition to the criteria above: Th system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public he th and safety and the environment because one or more of the following conditions exist: Yes N the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of th Department for further information. revised 9/2/98 Page 4ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART B CHECKLIST r'roperty Address: 89 Bassett Lane , Hyannis Owner: Mark Sunderland. Date of Inspection: ? � � Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes / No Pumping information was provided by the owner, occupant, or Board of Health. v _ None of the system components have been pumped for at least two weeks an&the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this / inspection. _ As built plans have been obtained and examined. Note if they are not available with NIA. ✓ _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. _ All system components, excluding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions,depth of liquid, depth of sludge, depth of scum. I / The size and location of the Soil Absorption System on the site has been determined based on: Existing information. For example, Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) f1.5.302(3)lb)] The facility owner (and occupants,if different from owner) were provided with information on the proper maintenances.of Subsurface Disposal Systems. i I revised 9/2/98 page 5ortl SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM w PART C SYSTEM INFORMATION 4operty Address: 89 Bassett Lane , Hyannis Owner: Mark Sunderland. Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow:3G g.p.d./bedroom. Number of bedrooms(design):_ Number of bedrooms (actual):_ Total DESIGN flow Number of current residents:_ Garbage grinder(yes or no):_ Laundry(separate system) (yes or no):_; If yes, separate inspection required Laundry system inspected (yes or no) Seasonal use (yes or no): 199942, 000 gal. Water meter readings, if available (last two year's usage(gpd): Sump Pump(yes or no):_ 1998 36, 000 gal. Last date of occupancy: COMMERCIALIINDUSTRIAL: Type of establishment: EA Iw I p'n Design flow: `;(o O qpd ( Based on/15.203) Basis of design flow T.a, Grease trap present: (yes or no)/L p Industrial Waste Holding Tank present: (yes or no)ZL0 Non•sanitary.waste discharged to the Title 5 system: (yes or no)It O Water meter readings,if available: Last date of occupancy:3 OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pum ed as part of inspection: (yes or no)_Q If yes, volume pumped: gallons Reason for pumping: TYPE OF 581YSTEM Septic tank./distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records;if any) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy'of DEP Approval Other APPROXIMATE AGE of all components, date installed lif known) and source of information: /f) 47dt 3 Sewage odors detected when arriving at the site: (yes or no) d I reVise6 9/2/95 Page 6(if 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Icwwdm ed) wropeny Address: 89 Bassett Lane , Hyannis Ow11ef: Mark Sunderland. Date of Inspection: BOIL ING SEWER: (Loca on site plan) Depth elow grade:_ Materi I of construction: cast iron 40 PVC other(explain) Distan a from private water supply well or suction line Diam er Co ents: (condition of joints, venting, evidence of leakage,-etc.) SEPTIC TANK: (locate on site plan) Depth below grade: Material of construction: vconcrete_metal_Fiberglass _Polyethylene_other(explain) If tank is metal, list age_ Is.age confirmed by Certificate of Compliance_ (Yes/No) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: , Distance from bottom of scum to bottom of outlet tee or baffler How dimensions were determined: t3 �Lvn. 7D u,l� comments: (recommendation for pumping, condition of inlet and outlet tenor baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) 6 .v C,— a e. 13 C t, C GR SE TRAP: (locate on site plan) Depth b low grade:_ Material of construction:_concrete_metal_Fiberglass _Polyethylene_other(explain) Dimensi ns: Scum t ickness: Distanc from top of scum to top of outlet tee or baffle: Distan a from bottom of scum to bottom of outlet tee or baffle: Date last pumping: Co ants: Ire mmendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evid ce of leakage, etc.) revised 9/2/98 Page 7ortl r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Icontinuedl 'roperty Address: 89 Bassett Lane , Hyannis Owner: Mark Sunderland Date of Inspection: 3 c2—zP-0-6.d* TI TOR HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection) (loca on site plan) )ehelow grade:_ of construction:_concrete_metal_Fiberglass_Polyethylene_other(explain) ons: Cy: gallons Dflow: gallons/day AresentAvel: Alarm in working order: Yes No_Dprevious pumping: Cnts: on of inlet tee, condition-of alarm and float switches, etc.) DISTRIBUTION BOX:► (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP CHA BER:_ (locate on s e plan) Pumps in w rking order: (Yes or No) Alarms in w irking order(Yes or No) Comments: (note condi ion of pump chamber, condition of pumps and appurtenances, etc.) I I i revised 9/2/98 page 8or11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) ",rap"Address: 89 Bassett Lane , Hyannis 'wner: Mark Sunderland. .)ate of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) 6AZ 1 � .00 � 1 revised 9/2/98 Page 10of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(corrtinued) 'rop"Address: 89 Bassett Lane , Hyannis Owner: Mark Sunderland. Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): (locate on site plan, if possible; excavation not required,location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits, number: leaching chambers, number:_ leaching galleries, number:_ leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool, number:_ Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ondinq. damp soil, condition of vegetation etc.) p 1 , C a u ,�s, ) 0, C POOLS:_ (locat on site plan) Number d configuration: Depth-top f liquid to inlet invert: depth of s ids layer: )epth of sc m layer: Dimensions f cesspool: Materials of onstruction: Indication of roundwater: infl w (cesspool must be pumped as part of inspection) Comments: (note conditi n of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: (locate o site plan) Materials o construction: Dimensions: Depth of Sol s: Comments: (note conditio of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) i revise 5/2,/7C Page 9ofII 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) lop"Address: 89 Bassett Lane , Hyannis owner: Mark Sunderland. Date of Inspection: NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells X Estimated Depth to Groundwater )- Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site (Abutting property, observation hole, basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators, installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) revised 9/2/96 Page 11of11 LOCATION SEWAGE PE IT NO. VILLAGE A & B CESSPOOL SERVICE y 128 BISHOPS TERRACE, HYANNIS, MA 02601 r BUILDER OR OWNER DATE PERMIT ISSUED � � ��� 4l • DATE COMPLIANCE ISSUED tv Is .r F fi}}ram+. , �� - i• S ; i t3 tic r a ' / t . d TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair 2.Printers BOARD OF HEALTH O Satisfactory 3.Auto Body Shops 1'2rc51 1W unsatisfactory- 4.Manufacturers COMPANY d P�"� (see"Orders") 5.Retail Stores ^� 6.Fuel Suppliers SG c�ADDRESS 01 13A,5 0 14,t Class: C_ 7•Miscellaneous ./Ut 4 de 4- QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS C. Se lots Drurns Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline Jet Fuel (A) Diesel, Kerosene, #2(B) Heavy Oils: waste motor oil(C) /-eSS 0 7(-"Iq.�4A-�a q new motor oil transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: g� RT 5 a 6 10(+- DISPOSAURECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply 44J.D fS 0,, e f ale . O Town Sewer PfPublic 6-V ,i se,,v,CO-) �On-site OPrivate p _ 'lam`' �10_'kfvp) L1 — 'Al if4,u 3. Indoor Floor Drains YES N0 , O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES_NO O ERSi O Holding tank:MDC f(4 j4f&I r( (< kOL3� C Q>e Cx a-S4 O Catch basin/Dry well Q c� Z@eo O On-site system 5.Waste Transporter Name of Hauler Destination Waste Produet Licensed? YES NO 1• K 9F G+�l✓ , jam r/ 2. Person(s) Interviewed Inspector Da e Alimagesetting typesetting layout&design kservices ouper prepress rick sawyer 89-bassett lane•hyannis;ma 02601 , (508)790-0032•fax(508)771-8991 email:grouper®capecod.net TOWN OF BARNSTABLE COMPLIANCE: GLASS: 1.Marine,Gas Stations,Repair satisfactory 2•Printers BOARD OF HEALTH 3.Auto Body Shops � "" O unsatisfactory- 4.Manufacturers COMPANY ✓p� dr���f1�J` (see"Orders") 5.Retail Stores �7 6.Fuel Suppliers ADDRESS Class: , 7.Miscellaneous QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: Z--z.s X T 5e.l DISPOSAURECI AMATION REMARKS: 1. Sanitary Sewage 2. Water Supply /Olf b5 0�10n-site Town Sewer Public j 'ai & rin `,K 0 Private 3. Indoor Floor Drains YES____NO_)(_ 0 Holding tank:MDC 0 Catch basin/Dry well 0 On-site system 4. Outdoor Surface drains:YES_X_NO ORDERS: 0 Holding tank:MDC O Catch basin/Dry well 0 On-site system 5. Waste Transporter Name of Hauler Destination' Waste Product ,. YES- NO 2. y � 7 30 P on(s) Interviewed Tnispector Dat .,..-� T.,,.. ..-.. �.-.. �r. ..,� ''- .tip.. ..,- ..,., _.�.,,�.. -.,. .-..._..,_...• .. - ""T Q � . .. ..r �. ._ .. .. --- . Date: l '"S TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: BUSINESS LOCATION: /PgY 149ae MAILINGADDRESS: /r Mail To: TELEPHONE NUMBER: fW --250 —007 Z Board of Health ,D (� CONTACT PERSON: i�� J�9ryrjel— Town of BarnstableP.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: Hyannis, MA 02601 TYPEOFBUSINESS: %yKm ,_1 , C s Does your firm store any f the toxic or hazardous materials listed below, either for sale or for you own use? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address:. • ADDRESS: TELEPHONE: LIST.OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antifreeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel,.kerosene, #2 heating oil NEW ,/USED Other petroleum products: grease, 9/ P�chemicaDeveloper) j lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED '(inc. carbon tetrachloride) Paint & varnish removers, deglossers 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):' cleaning Spot removers & p 9 fluids (dry cleaners) >---'� Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS i TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: e J� msf a Mail To: BUSINESS LOCATION: Board of Health Town of Barnstable MAILING ADDRESS: A e JllP.O. Box 534 TELEPHONE NUMBER: J-";? - ?q 0 -Do3 Z Hyannis, MA 02601 CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: -X-V� Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store: Quantity/Case Quantity/Case i Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal N4 Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business L`-I• 4 TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2•Printers BOARD OF HEALTH 3.Auto Body Shops p unsatisfactory- 4.Manufacturers COMPANY e 7 IZ6 S3 (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS Sgrrl& Class: 7.Miscellaneous YAIVIu S QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground Tanks IN OUT IN OUT IN OUT #.&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: Lev16 �. �. DISPOSAL/RECLAMATION REMARKS: 1. Sanitary Sewage 2. ater Supply 6 � V O Town Sewer Public SvVieLD XOn-site OPrivate r �� 3. Indoor Floor Drains YES NO C O Holding tank: MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO O E O Holding tank:MDC O Catch basin/Dry well �` Q O On-site system Lt / / 5. Waste Transporter C� D LQLaz- Name of Hauler Destination Waste Product . Sl�. / Pia sOu ow 1 Y>;s o 2. son (s) InterviewedInspector Pat6 hCRIZOwy6 F/ Y.,y L i S TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOAVJ H ALTH 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS lass: 7.Miscellaneous I 13QUANTITIES AND STORAGE (IN= indoors; OUT-outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underg-round Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) O i L transmission/hydraulic Synthetic Organics: degreasers IQ9 a V, NG N /�jj 100 7K Miscellaneous: v �V) nagwaz-i M- 060 �� ld o Ir G �o x DISPOSALIREC;LAMATION REMARKS: 1. Sanitary Sewage 2. 1-1 -*' LDALT6 ater Supply O Town Sewer Nublic *On-site OPrivate r 3. Indoor Floor Drains YES NO O Holding tank: MDC O Catch basin/Dry well O On-site system 6 1 4. Outdoor Surface drains:YES NO ORDERS' O Holding tank: MDC O Catch basin/Dry well \, D O On-site system � S 5. Waste Transporter DestinationName of Hauler 1. 76(77a T 6 Arl W9ti nYESNO 1! � 2. '/�hwjL f Iq Person s Interviewed Inspe or,OS :566f 44_5' 39 xYr-4 TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: ►-eS' t�� ( �c�SS Mail To: BUSINESS LOCATION: 'qc( &CA Lyie_ Board of Health Town of Barnstable MAILING ADDRESS: P.O. Box 534 TELEPHONE NUMBER: OS--1��-�3�5 Hyannis, MA 02601 CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER:' Z6Z-2_993 Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES NO dV This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store: Quantity/Case Quantity/Case Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants 3 Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, JY4_40� Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal /0 9�, Photochemicals (fixers and developers) Degreasers for driveways & garages 10016, Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): c�c] (dry cleaners) l Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business =aN 25 '95 14:31 TBJ GRAPHICS P.1 AW VUR �S s� HOLLAND INK CORFPORATIQN MSDS:1:5 1 PRODPCf, VAN'SON 0WAkMER1 FOUNTAIII STIMULATOR R2 UNION STiJ;r;ET, MINEOLA, NY 11301 ' DATEA/IiR4. MATERIAL SAFETY AND DATA SHEET HAZARD RATINGS HEALTI i1 MINIMAL 0 I SLIGHT 1 MODERATE. 2 FLAMIYAPILITY. . 0 SERIOUS 3 SEVERE 4 REACTI rTy 0 PREPARED BY:G. ONDQUIST, CONSULTANT' SECTION 1.PRODUCT INFORMATION DISTRIBUTOR: MANUFACTURER: VAN SON HOLLAND INK CORP. OF AMERICA VAN SON HOLLAND INK CORP OF AMERICA 92 UNION STREET,;MINEOLA, NY 11561 1 HARRISON SLVD. EMERdENCYT-LEPHONE: 516-294-8811 AVON, MA 02322 I CHEMTREC 24 HOUR EMERGENCY#: PRODUCT CLASS: Printing Ink Additive 800-424.9300 TRADE NAME:Van°Son Fountain Stlmulat�r MANUFACTURER'S CODE 10: i V2151AIS2152 SECTION 1l HA�!ARDO.US INGREDIENTS OSHA HAZARD COMMUNICATION 29'CI=R 1910:1.000: Cobalt Metal as dustr SARA TITLE III Section 313:Up to 15'6 Cobalt Compound present a mes CANADIAN WHMIS: None. Non-controued product, CALIFORNIA PROPOSITION 65: NOn@ TSCA INVENTORY: All ingredients listed. CONED LEGISLATION: Meets all current State Heald Metal Limitation,. SECTION IIA PRINCIPAL INGREDIENTS INGREDIENT CAS NO WT% OSHA(PEL) ACCIHRL CARCINOGEN COBALT ACETATE TETRAHYDRATE 71-48-7 i 8-15 .05m9/M3 ..05mgmi NO i j� SECTION IU PHYSICAL DATA VOLATILE ORGANIC COMPOUNDS: ! 0 LBSJGAL 0 .G MS/LITER METHOD 24 ; . BOILING RANGE °F:>2W FREEZING POINT°F: -10° VAPOR DENSITY v5 AIR: Heavier VAPOR PRESSURE: N/A DENSITY: 8.35 lbs./,gallon ASTM D1475 SPECIFIC GRAVITY: 1�.01 TYPE OF ODOR:Acetic ; ODOR THRESHOLD: Low ,APPEARANCE: Purple Liquid pH: NIA EVAPORATION RATE VS BUTYL ACETATE: slower COEFFICIENT OF WATER\OIL DISTRIBUTION: N/A ? PERCENTAGE VOLATILE WT.- 90% A5TM D2369 T, i '-1Iv ca ..JD 14:32 TBJ 6Ri PHICS P.2 SECTION Ili( FIRE & EXPLOSION DATA FLAMMABILITY CLASSIFICATION: OSHA: NOT REGULATED DOT: NOT REGULATED FLASH POINT OF:>NONE METHOD USED: WA EXPLOSION LIMITS: [AEI.: N/A UEL: N/A AUTO IGNITION TEMPERATURE: N/A EXPLOSION DATA-SENSITIVITY TO MECHANICAL.IMPACT: N/A EXPLOSION DATA-SENSITIVITY TO STATIC DISCHARGE: N/A EXTINGUISHING MEDI : FOAM CO2 DRY CHEMICA WATER FOG UNUSUAL FIRE AND'EXPLOSION HAZARDS: NONE SPECIAL FIREFIGHTING PROCEDURES: Self contained,breathing apparatus recommended SECTION V HEALTH iIAZARD AND TOXICOLOGY DATA EFFECTS OF OVEREXPOSURE: EYE CONTACT:. SKIN CONTACT: May cause irritation INHALATION: PRglonged contact may cause min r irritation INGESTION: 1Y cause .respiratory irritation MEDICAL CONDITIONS'�AGGRAVATED BY NORMAL EXPOS RE : Persons with dery cause io , diarrhea {. contact m tuts should avoid skin ;TARGET ORGANS: Skin,eyes, lungs, 'CARCINOGEN: NO MUTAGEN: NO TgRATOGEN: NO REPRODUCTIVE OXiCITY: NONE :PRIMARY ROUTES OF ENTRY: EYeS, inhalation, dermal, ingestion EMERGENCY FIRST AID!PROCEDURES: ` EYE CONTACT; Flesh with large amounts Of water. SKIN CONTACT:; �sh with soap and water VV INGESTION: D -not Incuce vomiting, Call a physi ]an. INHALATION: Ringve ihdlvidual to fresh air. ' • - i PRODUCT STABILITY:STABLE SECTION�/1 REACTIVITY DATA CONDITIONS TO AVOID::` FREEZING AND EXTRE4E HEAT SECTION VII SMLL OR LEAK PROCEDURES PROCEDURE WHEN MATERIAL SPILLED OR RELEASED: Wipe up. Dispose of wipes in approved waste containers. If petroleum tydrocarbon used, provide sufficlent ventilation. WASTE DISPOSAL METHOD: Dispose Of in accordance with Federal;State and Local regulations. SECTION)n1l SPECI JL PROTECTION INFORMATION V�ILATION: Use,sufficient ventilation P TECTIVE CLOVES: RE p117ATORY PROTECTION: Glgves Recommended EYE PROTECTION: None required OTHER PROTECTIVE EQUIPMENT: G099I.es recommended None required 316CTION`tX SPECIAL PRECAUTIONS HANDLING AND STORAGE: Avoid Storage abgve 900E Keep containers closed Shen not in use and keep from freezing, OTHER PRECAUTIONS: None required. ' T►ds In WICXd The fU►Iulhed M4t110lR +stY.*=Oss ar mod,oxcwt ma ft g Accurae to the bm of tt�g RMUM atlon of IV P rlea The dao W tlbts sheet rain""to the ofvan son"ahw l Ink tni0rlil or>n any Fr0CM&The Nazarco eow"are 4e*Vft Za be those oN�dw4r hereon and doai not rotate to use M 4mbffmon wo any Ink Ink CorPoratlon of Amerlp assumes no resvoestb*tv*oruse a tam On aw��er r ra sor►aew or aauw�r usa of these Mmfi ls,van son Houma PWAgM QY CAA LPMUW.M4ULTiW T it WtTE M34 COMMONWEALTH OF MASSACHUSETTS i DEPARTMENT OF ENVIRONMENTAL PROTECTION DIVISION OF HAZARDOUS WASTE 'One Winter Street Boston, Massachusetts 02108 Please print or type.(Form designed for use on elite It 2-pitch)typewriter.) UNIFORM HAZARDOUS 1.Generator US EPA ID No. Manifest 2.Page 1 Information in the shaded areas WASTE MANIFEST Document No. n 2 of is not required by Federal law. 3.Generator's Name and Mailing Address 4A'State Manifest Document Number' 3 13 3 9 S 8 ' � `! a B State Gen ID' 4.Generator's Phone(J-w 1 7G a , ' ° �i. ' o•u ' �- 5.Transporter 1 Company Name 6. US EPA ID Number C Siate Trans=ID',r; Fri 5 W LLJ .n 7.Transporter 2 Company Name 8. US EPA ID Number 'iD.:Trensporter's Phone("1 .' 1 Ln fateTrans. D it' ri Da 9.Designated FacilityName and Site Address 10. US EPA ID Number " W , a 1�r,� `r I Tilt tb p ?Fjransporter's Phone( ' 7 ), r) /���Jr�/f✓rvr// /�j/9 G'StateFacility'sID .Not Required..-" 'e et N Q/g�3 - �f p ',H.,'Facility's Phona( 7Nt 12.Containers 13. 14. I. W O 11.US DOT Description(Including Proper Shipping Name,Hazard Class,and/ONumber) Total Unit Waste No. 0 No. Type Quantity WtNol tb a. /i/�Z/�I/�uvJ '✓/�J7�' Li f vrl/ r/XB/ ,.:•._y /V�'� - QQ,�'I �'! �� t/ U yE b. r, r1 a N E aNi R c. r x-. tr 8 rg H Cr A C 0 1:d. z ;ice r a) r J.Additional Dascnpfons for Matenals Listed Abovelint/ude physrcalstafe and haiard code./ 3 a;z ;'`" K.Handling Codes for Wastes Listed Above O 'u s ,7 z •s .�S '^4'""'«. U .a st �A rrz dt'c yca »tafr y, w� a t� %tc , >H Est c s a.� .. z+ a Y Inc M ty, .r.n•v S 33.-t'M af"-s. ,� -t t�+t a ,�' , v a- O r,`;��• k, { � d.',A".x�.+ b.- s r u .d. D 15.Special Handling Instructions and Additional Information —1 E O E ;U 0• 16.GENERATOR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by (1) ro proper shipping name and are classified,packed,marked,and labeled,and are in all respects in proper condition for transport b highway � D P PP 9 P D P P Y O according to applicable international and national government regulations. U If I am a large quantity generator,l certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically practicable C and that I have selected the practicable method of treatment,storage.or disposal currently available to me which minimizes the present and future threat to human health and the environ- ment;OR,if I am a sm quantity y generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is available to me andthat I can afford. tV Date (D Piint ypedName Sign re Month Day Year y TT 17.Transporter 1 Acknowledgement of Receipt of Materials �` Date U A /Printed/Typed�ame Sin a Month Day Year O 18.Transporter 2 Acknowledgement of Receipt of Materials /.�" _ Date R - - T Printed/TypedName ; Signature Month Day Year E v R I F 19.Discrepancy Indication Space A C I i L 20.Facility Owner or Operator:Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. i Date T Printed/Typed.iYame Signature_ .� Month Dayy Year I/ txI Form.doproved OMB No.2050-0039.Expires 9-30-92 EPA Form 8700-22 (Rev. 9-88) Previous editions are obsolete. ` COPY>3 : FACILITY MAILS TO GENERATOR must be in.in Ink.in lled This Shipping Order inCarbon alnd rettained by the Agent. Pencil,or J. B. SILVA COMPANY Shipper No. q 61 Nichols Street Carrier No. Q 1216 (Name of carrier) Danvers, MA 01923 O: Date T //,Aq ;��Consignee t o ._I VA 0 E)�:I 1Pr�^,t V Y Sh pM: r E, `t-� Peer � /:r�� Cam! � fir'�.� �•, �� Street sir 1 1 1E3,.r6 .3� i� `-"E: p tv`."" 9 Street Destinations t aV d�`rr,s ` '' i Zip Code 01 ED)2 2i Origin 1 y r . Route /S Vehic e No.Shipping HM, Kind of Packaging,Description of Articles, Number Units Special Marks and Exceptions Weight `y p (subject to correction) Rate CHARGES . I i i i EMIT t O.D.T0: C.O.D.FEE: j DDRESS COD PREPAID ❑ i OTE—where the rate Is dependent on value,shithe Amt'$ COLLECT ❑ $ t required a state property specifically In writing the agreedeor efly�classified,ldescribed packaged markabove named ed,rand ials laDeletl re Prop. Subject to Section 7 of the conditions,if this shipment is to be I :land value of the property. andare In delivered to the consignee without recourse on the consignor,the con• TOTAL 1 �e agreed or declared value of the props My is hereby the applicableeregulatlonsfof or lthesDepartment ortation cofrdTrtans to sTAe carrie shall r s911 the notfmiake following very of this shipment without payment CHARGES: $ I �ciflcally stated by the shipper to be not exceeding portalion. of freight and all other lawful charges. FREIGHT CHARGES: per FREIGHT PREPAID .Check box if charges i Signature except when box at ❑ are to be {RECEIVED,subject to the Classifications and lawfully filed tariffs in effect on the date of the issue rsi nature or consionon right is checketl collect this Bill of Lading,the property described above in apparent good order,except as noted(contents that every service to be performed hereunder shall be subject to all the bill of lading terms n portion of said route to destination and as to each party at any time interested in all or any said property. ;d condition ri contents of packages unknown),marked,consigned,and destined as indicated above in the governing classification on the date of shipment. rich said carrier(the word carrier being understood throughout this contract as meaning an 9 and conditions i corporation in possession of the property under the contract)agrees to carry to its usualapprson i delivery at said destination,if on its route,otherv,ise to deliver to another carrier on the route to Shipper hereby certifies that he is familiar with all the bill of lading terms and conditions in the lace id destination.It is mutually agreed as to each carrier of all or any of,said property over all or any gorerning classification and the said terms and conditions are hereby agreed to by the shipper and l accepted for himself and his assigns. L . SILVA COMPANY CARRIER PER DATE ardous Materials t Agent must detach and retain this Shipping Order and must sign the Original Bill of Lading. O' 16,GENERATOR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by - ` proper shipping name and are classified,packed,marked.and labeled,and are in all respects in proper condition for transport by highway O according to applicable international and national government regulations. U If I am a large quantity generator,I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree 1 have determined to be economically practicable C and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health and the environ- ment;OR,if I am a small quantity � q y generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is available to me and that I can afford. y Date y Print ypedName Sign re Month Day Year O fy T 17.Transporter 1 Acknowledgement of Receipt of Materials R Date y U N Printed/Typed/�ame Si¢nl a Month Day Year P , A 111.Transporter 2 Acknowledgement of Receipt of Materials /i'y Date T Printed/TypedName Signature Month Day Year E R 19.Discrepancy Indication Space F A C I L 20.Facility Owner or Operator:Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. I T Date Y Printed/Typed.Name // J� Signatuie.._ f //%� Month Day Year Form Approved OMB No.2050.0039.Expires 9-30-92 EPA Form 8700-22 (Rev. 9-88) Previous editions are obsolete. COPY>3 : FACILITY MAILS TO GENERATOR MATERIAL. ® ® SAFETY DATA SHEET IDENTITY Name : UNIDEV-Szafarz dt/Developer Number : 520-25, 520-26-SZD2501 Formula : Aqueous mixture` SECTION I MANUFACTURER - Solut9k Corporation 94 Shirley Street Boston, MA 02119 TELEPHONE - emergency or product' information (617) 445-5=75 DATE PREPARED: . /27/9-- Prepared. by: Director of Research SECTION II - HAZARDOUS_INGREDIENTS_•/_IDENTITY_INFORMATION HAZARDOUS_COMPONENT CAS_# OSHA_PEL ACGIH_TLV Hydroquinone 123-31-9 ? mg/M- 2 mg/M3 ;5 Sodium hydroxide 1`10-73-2 2 mq/M 2 MCI, ;1 SECTION III - PHYSICAL_/_CHEMICAL_CHARACTERISTICS Doilinq point: Over l()r_)oC Specific gravity (H2O=1 ) : 1 . 02 Solubility in water : 100 pH: 11 . 6 Form: Clear liquid Color: Straw Odor: None SECTION IV - FIRE_AND_EXPLOSION_HAZARD_DATA FLASH POINT:. None. FLAMMABLE LIMITS:. None FIRE FIGHTING PROCEDURES: This product is non-combustible. Use extinquishinq media applicable to the primary cause of fire. . Evacuate personnel to a safe area removed and upwind of the fire. Fire or- excessive heat might c.ause production of hazardous decomposition products. SECTION_V - REACTIVITY_DATA STABILITY: This product is stable. INCOMPATIBILITY: Strong acids. f HAZARDOUS DECOMPOSITION OR BYPRODUCTS: SUIfUr dioxide. HAZARDOUS POLYMERIZATION: Will not occur . • /G3 ' t SECTION_VI - HEALTH_HAZARD_DATA ROUTES OF ENTRY: Inhalation. Skin or eye contact. Ingestion. HEALTH HAZARDS (Acute and Chronic) : Causes eye and skin irritation. Inhalation of mist or dried residue can irritate the respiratory tract. Ingestion can cause gastrointestinal irritation, nausea, headache and/or weakness. Hydroquinone, in high concentrations, can cause skin disease, and discoloration and corneal opacity of the eyes. However, none of these latter systemic effects has been associated with the use of this product. CARCINOGENICITY: None of the components in this product is listed by NTP, IARC, or OSHA as a carcinogen. SIGNS AND SYMPTOMS OF OVEREXPOSURE: Irritation of eyes, skin, respiratory tract, or mucous membrane. Dermatitis. Coughing. Nausea. Dizziness. Headache. EMERGENCY AND FIFZST AID PROCEDURES: a. Inhalation. If inhaled remove to fresh air. If not breathing , give artificial respiration. Give oxygen if breathing is difficult. Call a physician. b. Skin contact. Flush skin with copious amount of water. c. Eye contact. Flush eyes immediately with plenty of water for at least 15 minutes. Call a physician. d. Ingestion. If swallowed , do not induce vomiting. Give- large quantities of water. Never give anythinq by mouth to an unconscious person. Call a physician. Refer all cases of inq_estion to a poison-control center or a physician. Vomiting should normally be initiated only on their advice and by the means they specify. SECTION_VII - PRECAUTIONS_FOR_SAFE_HANDLINC_AND_USE STEPS TO BE TAKEN IN CASE MATERIAL IS RELEASED OR SPILLED. Contain the spill . Neutralize with sodium bicarbonate. If local effluent laws permit , flush to sewer with larq_e amounts of water. WASTE DISPOSAL- METHOD. - If permitted, flush to sewer with large amounts of water. Pretreatment- might be required. Or , dispose of in an approved and permitted biological treatment system or an approved and permitted deepwell or landfill . PRECAUTIONS TO BE TAKEN IN HANDLING AND STORAGE. Keep container tightly closed when not in use. Do not store or consume food , drinks, or tobacco in areas where they might be contaminated by this product. Avoid storage or contact with strong acids. SECTION_VIII - CONTROL_MEASURES VENTILATION: Good general ventilation ( 10 room volumes per hour) should be sufficient. PROTECTIVE GLOVES: Use rubber or plastic gloves. EYE/FACE PROTECTION: Chemical splash gogqle. 7. SECTION VI - HEALTH HAZARD DATA ROUTES OF ENTRY: Inhalation. Skin or eye contact. Ingestion. HEALTH HAZARDS (Acute and Chronic) : Cause eye and sk-in irritation. Inhalation of mist or dried residue can irritate the respiratory tract . Ingestion can .cause gastrointestinal irritation, nausea, headache and/or weakness. CARCINOGENICITY: None of the components in this product is listed by NTP, IARC, or OSHA as a carcinogen. SIGNS AND SYMPTOMS OF OVEREXPOSURE: Irritation of eyes, skin , respiratory tract , or mucous membrane. Dermatitis. Coughing. Nausea. Diz-_iness. Headache. Emergency and First Aid Procedures a. Inhalation. If inhaled remove to fresh air. If not ,breathing , give artificial respiration. Give Oxygen if breathing is difficult. Call a physician. b. Sk-in contact. Flush skin with copious amount of water. c. Eye contact. Flush eyes imr:ediately with plenty of water for at 1 east 15. rni notes. Call a physician. d. Ingestion. If swallowed , do not induce vomiting. Give larg' ;-- qUantities of water. Never give anything by mouth to an unconscious person. Call a physician. Refer- all cases of ingestion to a poison-control center or a h p ysician. Vomiting should normally be initiated only on their advice and by the means they specify. SECTION VII - PRECAUTIONS FOR SAFE HANDLING AND USE STEPS TO BE TAKEN IN CASE MATERIAL IS RELEASED OR SPILLED. Contain the spill . NeUtralize with sodium bicarbonate. If local effluent laws permit , flush to sewer with large amounts of eater. WASTE DISPOSAL_ .METHOD. If permitted , flush to sewer with large amounts of water. Pretreatment might be required. Or , dispose of ire an approved and permitted biological treatment system or an approved and permitted deepwell or- landfill . PRECAUTIONS TO BE TAKEN IN HANDLING AND STORAGE. k::eep container tightly closed when not in use. Do not store or consume food , dri.nl::s, for- tobacco in areas where they might be contaminated 'by .this product . Avoid storage or contact with strong bases or acids. SECTION ' VII - CONTRDL MEASURES VENTILATION: Good general ventilation ( IC) room volumes per hour ) should be sufficient. PROTECTIVE GLOVES: Use rubber or plastic gloves. EYE/FACE PROTECTION: Chemical splash goggle. MATERIAL SAFETY DATA SHEET IDENTITY Name : RA 3301 F i x er, Szafarz Fixer Number : 519-01 , 519-40 ,SZD4501,SZD4503 Formula : Aqueous mixture SECTION I MANUFACTURER - Solute[.-* Corporation 94 Shirley Street Boston, MA 02119 TELEPHONE = emergency or product information (617) 445-5335 DATE PREPARED: 3/27/89 Prepared by: Director. of Research SECTION II - HAZARDOUS INGREDIENTS / IDENTITY INFORMATION. HAZARDOUS COMPONENT CAS # OSHA F•EL ACGIH TLV Acetic acid -64-19-7 25 mg/M3 25 mg/M'� <5 i SECTION III - P.HYSICAL / CHEMICAL CHARACTERISTICS Boiling point: Over 10(--)-C Specific gravity . (H=0=1 ) : 1 . 10 Solubility in water: 100% pH: 5.2 Form: .Clear liquid' Col or: Col orl ess Odor: Slight vinegar SECTION IV - FIRE AND EXPLOSION HAZARD DATA FLASH POINT: .None FLAMMABLE LIMITS: None FIRE FIGHTING PROCEDURES: This product is non-combustible. Use extinguishing media applicable to the primary cause of fire. Evacuate personnel to a safe area removed and upwind of the fire. Fire or e.xcessi.ve heat might cause production of hazardous decomposition products. SECTION V - REACTIVITY DATA STABILITY: This product is stable. INCOMPATIBILITY: Strong bases or acids. HAZARDOUS DECOMPOSITION OR BYPRODUCTS: Ammonia (bases) . sulfur dioxide (acids) . HAZARDOUS POLYMERIZATION: Will not occur, .cat Sim . icy- Pyd 1 SECTION VI -- HEALTH HAZARD DATA ROUTES OF ENTRY: Inhalation. Skin or eye contact. Ingestion. HEALTH HAZARDS (Acute and Chronic) : Cause eye 'and skin irritation. Inhalat.ion of mist or dried residue can irritate the respiratory tract . Ingestion can cause gastrointestinal irritation, nausea, headache and/or weakness. CARCINOGENICITY: None of the components in this product is listed by NTP, IARC, or OSHA as a carcinogen. SIGNS AND SYMPTOMS OF OVEREXPOSURE: Irritation of eyes, skin , respiratory tract , or mucous membrane. Dermatitis. Coughing. Nausea. Dizziness. Headache. Emergency and First Aid Procedures a. Inhalation. If inhaled remove to fresh air. I.f not breathing , give artificial respiration. Give Oxygen if breathing is difficult Call a physician. . b. Sk-in � contact. Flush skin with copious amount of water.. c. Eye contact. Flush eyes immediately with plenty of water .for at lust 15 minutes. Call a physician. d. Ingestion. If swallowed , do not induce vomiting. Give large quantities of water. Never- give anything by mouth to an �. unconscious person. Call a physician. Refer all cases of ingestio�,to a poison-control center or a physician. Vomiting should normally be- initiated only on their advice and by the means they specify. SECTION VII - PRECAUTIONS FOR SAFE HANDLING AND USE STEPS TO BE TAKEN IN CASE MATERIAL IS RELEASED OR SPILLED. Contain the spill . Neutralize with sodium bicarbonate. If local effluent laws permit , flush to- sewer with large amounts of water. WASTE DISPOSAL METHOD. If permitted , flush to - sewer with large amounts of water. Pretreatment might be required. Or , dispose of in an approved and permitted biological treatment system or an . approved and permitted deepwelI or- landfill . PRECAUTIONS TO BE TAKEN IN HANDLING AND STORAGE. i-."eep container tightly closed when not in use. Do not store or consume food , drinks, or tobacco in areas where they might be contaminated by this product. Avoid storage or contact with strong bases or acids. SECTION VII - CONTROL MEASURES VENTILATION: Good general ventilation ( 10 room volumes per flour) should be sufficient. PROTECTIVE GLOVES: Use rubber or plastic gloves. EYE/FACE PROTECTION: Chemical splash goggle. MATERIAL- SAFETY. DATA SHEET 11 J I IDENTITY Name 2201 DEVELOPER Number . 535-40 Formula : Aqueous mixture SECTION I MANUFACTURER Solutelf Corporation 94 Shirley Street Boston , MA 02119 TELEPHONE - .emergency or product information (617) 445-5t35 DATE PREPARED: 11/1e/88 Prepared ,by: 'Director of Research SECTION II - HAZARDOUS INGREDIENTS / IDENTITY INFORMATION HAZARDOUS COMPONENT CAS # OSHA PEL ACGIH TLV % Hydroquinone 123-31-9. 2 mg/M3 2 mg/M3 <10 Potassium hydroxide 1310-5e-3„ 2 mg/M3 2 mg/M3 <5 SECTION III - PHYSICAL / CHEMICAL CHARACTERISTICS Boiling- point: Over 1,00-C Specific gravity (H,0=1 ) : ' 1. 1 Solubility in. water: 1007 pH: 10-.5 Form: Clear liquid Color: Straw Odor: None SECTION IV - FIRE AND EXPLOSION HAZARD DATA FLASH POINT: None FLAMMABLE LIMITS: None FIRE FIGHTING PROCEDURES:. This product is non-combustible. Use extinguishing media applicable to. the primary cause of fire. Evacuate personnel to a safe area removed and upwind of the fire. Fire or e:.cessive heat, might cause production of hazardous decomposition products. 'SECTION V - REACTIVITY DATA STABILITY: This product is 'stable. INCOMPATIBILITY: Strong acids. HAZARDOUS DECOMPOSITION OR BYPRODUCTS: Sulfur dioxide. HAZARDOUS POLYMERIZATION: Will not occur. l SECTION VI - HEALTH HAZARD DATA ROUTES OF ENTRY: Inhalation. Skin or eye contact. Ingestion. HEALTH HAZARDS (Acute and Chronic) : Causes eye and sl::in irritation. Inhalation of mist or, dried residue can irritate the respiratory tract. Ingestion can cause gastrointestinal irritation`, nausea, headache and/or weakness. Hydroquinone, in high. concentrations, can cause stein disease, and discoloration and corneal opacity of the eyes. However , ' none of these latter systemic effects has been associated with the use of this product. CARCINOGENICITY: None of the components in this product is listed by NTP, IARC, or OSHA as a carcinogen. SIGNS AND SYMPTOMS OF OVEREXPOSURE: Irritation of eyes, skin , respiratory tract , or mucous membrane. Dermatitis. Coughing . Nausea. Dizziness. Headache. ,EMERGENCY AND FIRST AID PROCEDURES a. Inhalation. If inhaled remove to fresh air. If not breathing , give artificial respiration. Give oxygen if breathing is difficult. Call a physician. b. Skin contact '. Flush skin with copious amount of water. c. Eye contact. Flush eyes immediately with plenty of water for at least 15 minutes. Call a physician. d. Ingestion. If swallowed, do not induce vomiting. Give large quantities of water. Never give anything by mouth to an unconscious . person. Call a physician. Refer all cases of ingestion to a poison-control center or a physician. Vomiting should normally be initiated only on their advice and by the means they specify. SECTION VI.I - PRECAUTIONS FOR SAFE HANDLING AND USE STEPS TO BE TAKEN IN CASE MATERIAL IS RELEASED OR SPILLED. Contain the spill.. Neutralize with sodium bicarbonate. If local Effluent laws permit , flush to sewer with large amounts of water. WASTE DISPOSAL METHOD. If permitted , flush to sewer with large amounts of water . Pretreatment might be required. Or , dispose of in an approved and per-mitted' biological treatment system. or an approved and permitted deepwell or landfill . PRECAUTIONS TO BE TAk;EN IN HANDLING AND STORAGE. f::eep container tightly closed 'when not in use. Do not store or consume food , drinks, or tobacco in areas where they might be contaminated by this product. Avoid storage or contact with strong acids. SECTION VII - CONTROL MEASURES ! VENTILATION: Good general ventilation ( 10 room volumes per hour) should be sufficient. PROTECTIVE GLOVES: Use rubber or plastic gloves. EYE/FACE PROTECTION: Chemical splash goggle, LOCATION SEWAGE PE IT NO, VILLAGE A & B CESSPOOL SERVICE 128 BISHOPS TERRACE, HYANNIS, MA 02601 BUILDER OR OWNER i' DATE PERMIT ISSUED DATE COMPLIANCE ISSUED r _. _ 31. r� i