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HomeMy WebLinkAbout0041 BODICK ROAD UNIT UNIT 41A - Health 41 BODICK RD., HYANNIS A= 344.080 A I - TOWN OF BARN LSE 53 CLju�o LOCATION 0 ��� �, SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL3 �� U�U A INSTALLER'S ME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) LEACHING BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on < . site or within 200 feet of leaching facility) Feet. Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY ate, ed cow 41-/ TOWN OF BARNSTABLE LOCATION </� D� SEWAGE# VL:v,LAGE t4IC/ ASSESSOR'S MAP&PAR CEL3y�'y OR A INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1 LEACHING FACILITY.(type) (size) NO.OF BEDROOMS OWNER S. G ..I� �8� (-767wa" PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY Town of Barnstable Inspectional Services Public Health Division MASS. $ Thomas McKean,Director 039• 6. 200 Main Street Ep MA'S Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Advanced Body Science Notice Date: June 18, 2020 41 D Bodick Road Hyannis, MA 02601 Re: Hazardous Materials Permit According to our records, you do not have a current Hazardous Materials Permit. In accordance with the Town of Barnstable general ordinance, Chapter 108, Hazardous Materials, all businesses that handle or store hazardous materials greater than household quantities are required to obtain an annual permit. The permit runs from July Is'to June 301h. Your permit expired on July 1, 2019 (almost one year ago). There is a $150.00 Hazardous Materials, Category III, Fee.. In addition, there would be a$10 late fee assessed, however, this fee is waived due to the COVID-19 emergency. You have a PAST DUE balance (Permit for Year 2019-2020) of$150.00. Please submit a check, payable to "Town of Barnstable,"to 200 Main Street, Hyannis, MA 02601, along with the application. FOR HAZARDOUS MATERIALS APPLICATION ONLINE: Go to the website, llttps://townotbarnstable.us/. Click on Departments> Inspectional Services > Health Division> Application & Forms> Hazardous Materials Application. If you have any questions or concerns, please contact the Public Health Division at 508-862- 4644. Thank you. PER ORDER OF THE BOARD OF HEALTH c eah, S., Agent of the Board of Health Q:\Hazmat\2020-TL\Advanced Body Science Notice June 18 2020.docx YOU W 1SH TO OPEN A BUSINESS? ForYourh=n atbn.: Bushess certiC ates (cost$40 00 fDr4 years).A business certfcate ONLY REGNTERS YOUR NAM E ii town (ahishWu mustdobyM G L.-:Ldoesnotgieyoupern issisntnoperate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: 1 cal a Feria phase: APPLI ANT'S YOUR NAM E/S: t BUSNESS YO R OM EADDRESS: I TELEPH ON E # H om e Tehphone N um ber NAM E OF COR PO RATDN _--------�P.�t_--------— -------= - - - -- -------- --—----------- ---- ------ --- --...--- -- - -- --- --- TYPE OF BUSNESS_--� N AM E O F N EW BUS IN ES S_Fl_�, VZ -�A-----= ------------------------------ 11------- n IS THIS A HOM E OCCUPATDN? YES NO _- M AP/PARCELNUM BER J v -U�/T k%ssesshg) ADDRESS OFBUSNESSAt When start iag anew business there are setieralthhgs you m ustdo is order tD be is com p3hnce w 1h the nzhs and reguht:bns of the Town of Bamstabh. This form is mended to assistyou h obtaiahq the hforn atbn you m ayneed. You M UST GO TO 2 0 0 M ah St.- (comer ofYarm ouch Rd.& M ah Street) to m ake sure you have the appropriate perm its and Icenses requked to hga]Voperate yourbushess is this town. 1 . BUILD.NG COM M ISSDNERIS OFFICE This hdirhualhas been hfbrn ed ofanypern is re ents thatpertaia to finis type ofbusiaess. Authored Si3nature* COM M EN TS: r 2 . BOARD OF HEALTH MUST�,UMPLY WITH ALL This hdirdualhas be ed of pern isrequaem ents thatpertaia to this type ofbusiaess. 7ARDOUS MATERIALS REGUL.A i0`� Authored S#iature* COM M ENTS: 3 . CONSUMER AFFAIR,$ ([,ICENSNG AUTHOR=) ,, This iadirdua7has been inform ed of the 1hensiag requ>rem enL�thatpertah this type ofbusiaess. Authorrl nd Signature* 5 COM M EN TS II i. I t" Date: �� / AO/ � TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: AB �PRulC2S BUSINESS LOCATION: 'yl cg— Q-&9 _ (mil"d]r INVENTORY MAILING ADDRESS: (G LA �A id Tech CIV ry-1 1 TOTAL AMOUNT: TELEPHONE NUMBER: 60 3 3 CONTACT PERSON: Q r�id '� 5 }ps EMERGENCY CONTACT TELEPHONE NUMBER:-:: Ba-13B06 MSDS ON SITE? TYPE OF BUSINESS: C cx C INFORMATION / RECOMMENDATION : 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) Refrigerants Motor 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 'v (including bleach) Cleo r-�;(lam rnck k)t � Spot removers&cleaning fluids (dry cleaners) Uj 1, v bk L�(je Other cleaning solvents p Bug and tar removers ' Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS App cant's Signat re Staff's Initials Town of Barnstable oFTHe tph► Regulatory Services 'Lo Thomas F. Geiler,Director Public Health Division * BaRNSTAsLE, Thomas McKean,Director 9 MAC'q 200 Main Street, Hyannis,MA 02601 j i639• �� Phone: 508-862-4644 Email: health@town.bamstable.ma.us Fax: 508-790-6304 Office Hours: M-F 8:00—4:30 July xx 2011 Mr. Michael Hatfield RE: Vehicle Washing Waste Water Discharge, Advanced Body Science Units A-D, 41 Bodick Road,Hyannis 41 Bodick Road,Units A-D, Hyannis, MA 02601 Dear Mr. Hatfield, On July 19,2011 vehicle washing activity was observed at the address above.A vehicle was being hand washed with Trans-Mate Hi Foam Type S detergent in the drive way and the waste wash water was running down the drive onto Bodick Road where it formed a puddle. Town of Barnstable Ordinance Chapter 108 Hazardous Materials, Section 9,Prohibitions, states in relevant part that,"The release of any hazardous materials...,upon the ground within the Town of Barnstable is prohibited.".Therefore,your are hereby notified to immediately cease the use of any cleaning solvents including but not limited to,chemical's,soaps, degreasers or detergents in the use of the vehicle washing activity. See the enclosed"Vehicle Washing Policy"for guidance. A waste water collection system meeting the requirements of 314 CMR Department of Environmental Protection,Division of Water Pollution Control Regulations, 18.00: Industrial Wastewater Holding Tank and Container Construction,Operation,and Record Keeping Requirements and Town of Barnstable Code, Chapter 108: Hazardous Materials is required for the future use of any cleaning solvents as noted above. You may request a hearing provided that a written petition requesting same is receive by the Board of Health with in ten(10)days after this Order is served. T s A.McKean,RS,CHO u ector of Public Health MATERIAL SAFETY DATA SHEET Page 1 TM004— HI-FOAM TYPE"S" Page 2 EFFECTIVE DATE:05/04/05 SUPERCEDES: 01/21/03 ------------------------------------------ -- ------- -- - --- - - SECTION 3A: SARA TITLE III INFORMATION COMPANY: TRANS-MATE PRODUCTS INC. 13 STERLING ROAD EHS RQ(LBS) EHS TPQ(LBS) SEC 313 313 CATEGORY 311/312 CATEGORIES N.BILLERICA,MA 01862 1* 2* 3* 4* 5* (978)667-0100 CHEMTREC: 1-800-424-9300 —------ —-- -- -- --- — ————--- --— — -- ——-- — --- - - — — — — —---------------------------------------------- —-- -------- — — 1. N/A N/A N/A N/A H-1 2. N/A N/A N/A N/A H-1 SECTION 1:GENERAL INFORMATION PRODUCT:HI-FOAM TYPE"S" *1=Reportable Quantity of Extremely Hazardous Substance. Sec 302. PRODUCT NO:TM004 *2=Threshold Planning Quantity,Extremely Hazardous Substance, Sec 302. Shipping Name:NOT REGULATED *3=Toxic Chemical.Sec 313. NFPA 701 *4=Required by Sec.313(40 CFR 372.42)used on Toxic Release Inventory Form HAZARD RATING Hazard Class: NA *5=Hazard Category for SARA Sec.311/312 Reporting. 4—Severe H=2 UN/NA: N/A 3=Serious F=1 Packaging Group: N/A HEALTH HAZARD: PHYSICAL HAZARD: _ 2=Moderate R=0 1=Slight H-1=Immediate(acute) P-3=Fire 0=Minimal NOTE: N/A or NA=NOT APPLICABLE,OR NOT AVAILABLE H-2=Delayed(chronic) P-4=Sudden Release of Pressure P-5=Reactive ----------------------------------------------------------------------------------- EMERGENCY OVERVIEW: SECTION 313: CERCLA INFORMATION WARNING: Causes eye irritation. May cause skin irritation with prolonged contact. Vapors or mist may cause EPA-Comprehensive Environmental Response,Compensation and Liability Act.Under EPA-CERCLA(Superfund) respiratory tract irritation. Avoid contact with eyes and skin. Avoid breathing vapor or mist. Wash thoroughly after releases to air,land or water which exceed the reportable quantity must be reported to the National Response Center,1- handling. 800424-8802 REPORTABLE QUANTITY FOR RELEASE(RQ)=No.1=1000 lbs which means that a minimum of 7470 pounds of finished product would need to be released before reporting requirements are triggered for this component. SECTION 2: HAZARDOUS INGREDIENT SECTION 3C: RCRA INFORMATION OSHA PEL ACGIH TLV EPA-RCRA Hazardous waste as specified in 40 CFR 261?No INGREDIENT(CAS#) (ppm or*mg/M3) WT% +=skin, c=ceiling — — —-- —— —-- --- — —— --— — — — -------— — — — — — SECTION 4: PHYSICAL/CHEMICAL DATA 1.Sodium dodecylbenzene sulfonate(25155-30-0) N/A N/A 10-30 BOILING POINT: >212F @ IATM 2.Cocoamide DEA(68603-42-9) N/A N/A 1-20 %VOLATILE: 85 VAPOR DENSITY:Approximately that of water WT/GALLON:8.502 lbs SPECIFIC GRAVITY:1.020 SOLUBILITY:Complete EVAPORATION RATE:Approximately that of water C pH:9.5 to 10.0 APPEARANCE&ODOR: Clear green,slightly viscous foamy liquid with mild odor. �t r� TMO04-HI-FOAM TYPE"S" Page 3 TM004-- HI-FOAM TYPE"S" Page 4 SECTION 5: FIRE AND EXPLOSION DATA SECTION 9: PERSONAL PROTECTIVE MEASURES FLASH POINT: >200E--> TEST: SETAFLASH(ASTM D3278) EYE PROTECTION: If eye contact is possible,wear eye protection. Contact lenses should not be wom. EXPLOSIVE LIMITS: LEL: N/A UEL: N/A PROTECTIVE GLOVES: When prolonged or repeated contact is possible,chemical resistant clothing(e.g.gloves)is EXTINGUISHING MEDIA: Use water spray,dry chemical,CO2 or"alcohol'foam. recommended. UNUSUAL FIRE AND EXPLOSION HAZARDS: Combustion may produce noxious and irritating gases which will RESPIRATORY PROTECTION: Where exposure through inhalation may occur from use,NIOSH/MSHA approved require fresh air source in fire fighting. respiratory protection equipment is recommended. SPECIAL FIRE FIGHTING PROCEDURES: Firefighters should be equipped with self-contained breathing apparatus VENTILATION: Either local exhaust or general room ventilation is recommended. and turnout gear as a general precaution. OTHER PROTECTIVE EQUIPMENT: Emergency eye wash station is recommended. SECTION 6: REACTIVITY DATA r � SECTION 10: SPECIAL PRECAUTIONS { STABILITY: Stable j HAZARDOUS POLYMERIZATION: Does not occur. L / HANDLING AND STORAGE: Handle according to good manufacturing and warehousing practices. Wash hands INCOMPATIBILITY(MATERIALS TO AVOID): Strong acids,oxidizing agents and excessive heat. before eating,drinking,smoking or using toilet facilities. Promptly remove,contaminated clothing and wash before reuse. Store in original containers. - HAZARDOUS DECOMPOSITION PRODUCTS: Oxides of Carbon,Nitrogen, Sulfur and other toxic gases. SPILLS AND LEAKS: CAUTION: Floor may become slippery. Sweep/soak up small spills using inert material. For large spills,limit access to area. Dike and contain spill with inert material,if necessary,and transfer the material to SECTION 7: HEALTH HAZARD(ACUTE/CHRONIC) containers suitable for recovery/disposal. Keep large spills out of sewers and open bodies of water. CARCINOGENICITY: NTP: N IARC: N OSHA: N WASTE DISPOSAL: Dispose of in accordance with all Federal,State and Local Environmental Laws in effect at the time. EFFECTS OF OVEREXPOSURE: —— — ---- —-- — —-----———-- —— — — -- —— --—----------- Neither this data sheet nor any statement contained herein grants or extends any license,expressed or implied,in EYES: Causes eye irritation. connection with patents issued or pending which maybe the property of the manufacturer or others. The information in this data sheet has been assembled by the manufacturer or his agent based on its own studies and on the work of others. SKIN: Prolonged contact may cause skin irritation.Symptoms may include redness,drying,defnting and crackin of the Neither the manufacturer nor his agent makes any warranty,expressed or implied,as to the accuracy,completeness,or skin. adequacy of the information contained herein.Neither the manufacturer nor his agent shall be held liable(regardless of fault)to the vendee,the vendee's employees or anyone for any direct,special or consequential damages arising out of or INHALATION: Vapors or mist may cause irritation to mucous membranes and respiratory tract. in connection with the accuracy,completeness,adequacy or furnishing of such information. INGESTION: Ingestions of large amounts may produce gastrointestinal disturbances including irritation,nausea, Data is supplied for use only in connection with occupational safety and health. vomiting and diarrhea. CHRONIC EFFECTS AND MEDICAL CONDITIONS: May aggravate pre-existing skin and respiratory illnesses. SECTION 8: EMERGENCY AND FIRST AID EYES: Flush with water for 15 minutes. If irritation develops or persists,get medical attention at once. SKIN: Thoroughly wash exposed area with water. Remove contaminated clothing and launder before reuse. Get medical advice if imitation develops. INHALATION: Remove to fresh air. If breathing is difficult,get medical attention at once. INGESTION:Do not induce vomiting: possible aspiration hazard. If possible,do not leave victim unattended. Do not give anything by mouth to an unconscious or convulsing person.Get medical attention at once. °FtHE r Town of Barnstable - ��- °� Regulatory Services ♦ r * MMWABLE. ` MASS. $ Thomas F. Geiler, Director Building Division Thomas Perry, CBO Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: .508-790-6230 October 3, 2008 Ms. Susan M. Hatfield 48 Hitching Post Lane Centerville, MA 02632 RE: 41 Bodick Road(units A-D) Advanced Body Science, Inc. . Dear Ms. Hatfield: This letter is in response to your correspondence of September 19, 2008 regarding your business known as Advanced Body Science which occupies units A-D of 41 Bodick Road Hyannis-7This business which presently occupies these units under the zoning ordinance as presently written would be allowed. However, as part of the Zoning Ordinance there is the Groundwater Protection Overlay provisions, section 240-35,which were first enacted in 1987. It is this aspect of your business which you area pre- existing non conforming use, the storing and application of Hazardous Materials. This office works in conjunction with the Board of Health Department and Fire Department to monitor the amounts of materials and also_the manner which these materials are applied and stored. Presently this business has a Board of Health license to store more than 111 gallons of Hazardous Materials. On February 19, 2008, it was noted that on the premises there was various materials amounting to 1,396 gallons. There appeared to be no problems with the manner in which these materials were being stored or used. It is important not to exceed this amount because this is the amount of materials which with which you are limited to: This amount applies to units A-D only;'it does not apply to other bays or units on the property.. If you should have nay questions regarding this please feel free to write this office with your inquiry. Respectfully, Th my, Perry, CBO Building Commissioner Jul 02 09 03:09p RICHARD HATFIELD 5087780829 p.1 �i A D V A rC--E-D B O--D'Y--S-C_I_E N C E 41 Bodick Rd. Hyanni.s,_MA 026.01--.-. -) (508)778-5541 FAX(508)778-0829 Complete Collision Repair&Restoration FACSIMILE TRANSMITTAL SHEET TO: ( FROM: d�tC..c,e of ?Oci �C i ill Y COMPANY: DATE: Q FAX NUMBER: SOY— 7c16 - 30 y TOTAL NO.OF PAGES INCLUDING COVER: PHONE NUMBER: SENDER'S REFERENCE NUMBER: RE: YOUR REFERENCE NUMBER: ❑ URGENT ❑FOR REVIEW ❑PLEASE COMMENT ❑PLEASE REPLY ❑ PLEASE RECYCLE NOTESICOMMENTS: Jul 02 09 03:09p RICHARD HATFIELD 5087780829 p.2 y 73 Town of Barnstable - Barnstable ylo Regulatory Services Department Public Health Division � I. 9 200 Main Street,Hyannis MA 02601 2007 Office: 508-862-464' Thomas F.Gei ler.Direct Jr FAX: 508-790-6304 Thomas A.McKean,CF10 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE l O 1 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT �, ��t� Y)r\• t's � Q� NAME OF ESTABLISHMENT M y -�-'ALEJ C�drJ*`y S L-;e we- ADDRESS OF ESTABLISHMENT i-) I and, (A. MA Oa01 TELEPHONE NUMBER Soar -J-7 SS' Lf { SOLE OWNER: ✓ x s' NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 01�3�-39�5 ,20 STATE OF INCORPORATION /l7/9�C.fiW 7 TS FULL NAME AND HOME ADDRESS OF: PRESIDENT Aj�A' 2&A4r4iF/-D TREASURER CLERK y '� SIG f R APPLICANT RESTRICTIONS: HOME ADDRESS./,i r ^ HOME TELEPHONE# „:Fz?e �6'yf Oo'6cT/ Q'VHa:;rr.1-0.Haz.Mat Appl:cation2008-DOC I d N 00 r- ADVANCED BODY SCIENCE a0 41 Bodick Rd_ 0 Hyannis,.AFU 02601 (508) 778-554t FAX(508)778-0829 Complete Collision Rep*air&Restoration SPELL CONTINGENCY PLAN Contact person:` Richard Hatfield 508-778-5541 Spill cleanup materials located in shop. Emergencies dial 911 o Hyannis fire department: 508-775-2323 or 911 w a H annis olice department: 508-775-0387 or 911 a Local Ambulance: 508-775-2323 or 911 FFif National response center: 800-424-8802 Clean harbors: 617-849-1800 or 617-935-9066 a o ri 0 rn 0 N O Town of Barnstable °FINE r Regulatory Services Thomas F. Geiler,Director MASS. ` Public Health Division Arf1639.NIA' 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. OW OO DATE APPLICATION FOR PERMIT TO S T ORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT I C 2 ttiti�\ ►�1 �i r.)c— NAME OF ESTABLISHMENT AD01piaLe 'R�4 S ADDRESS OF ESTABLISHMENT TELEPHONE NUMB Jr' O 15 7 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. 0 t I _3 0 STATE OF INCORPORATION A FULL NAME AND HOME ADDRESS OF: nn PRESIDENT 1 C�n,A lZt� �4 i��Z CY <6 l'r cL.%-C� PO _ V d PQ y t f� TREASURER rf CLERK SIGNATURYOF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE # 5 9 6 y a D 14 0 Haz.doc/wp/q i TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1. Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops c unsatisfactory- 4.Manufacturers COMPANY c ���� O (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS ( Class: 7.Miscellaneous }�ir)ntS/t 44 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: c� waste motor oil (C) new motor oil(C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: IV 44C �91 4-T W)6�,- DISPOSAL/RECLAMATION REMARKS: 1. Sanitary Sewage 9,,Yater Supply O Town Sewer ublic � On-site OPrivate 60 3. Indoor Floor Drains YES NOIX O Holding tank:MDC O Catch basin/Dry well t/(A) Irk O On-site system j 4. Outdoor Surface drains:YES �NO� O Holding tank:MDC ! Avc( -t `` O Catch basin/Dry well St O On-site system 5.Waste Transporter k IN Narne of Hauler Destination Waste Product Licensed?! �G NO 2. n( r Interviewed Inspector Uate Town of Barnstable Regulatory Services Thomas F. Geiler,Director > AS& ' Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 00 i -t ASSESSORS MAP AND PARCEL No..39LI- 61F6 A-.D DATE l d APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT �t C d� t"i (t C NAME OF ESTABLISHMENT NC, ADDRESS OF ESTABLISHMENT %C, QA�5 h&a 0 9 1&0 TELEPHONE NUM13E � / 7? SOLE OWNER: V YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS O�ALL _ PARTNERS: w° .► 3> IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. `-0 3'20 STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: p PRESIDENT SZ►c A �41 �; I �25 H A k 1 ya4 fos4 L o&c , rOce o I 1 e, tAA TREASURER I CLERK h��11 Z" StaATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# D i =� C,J 4 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 00 G ' Map , Q .,6.• Parcel Permit# 499? 7/10 Health Division J6 - 'U WN OF BARF4STg9LE _ Date Issued o Conservation Division Z005 APR 2$ PM ; 2$ Application Fee Tax Collector 0 4 a d Permit Fee g Treasurer Planning Dept. _ EXISTING SEPTIC SYSTEM Date Definitive Plan Approved by Planning Board LIMITED . Historic-OKH Preservation/Hyannis Project Street Address �� (�( /�,/�: Village h4pn h.! 5 Owner Address Telephone Permit Request �'3"y/C.O IN Square feet: 1st floor: existing proposed (�L Z 2nd floor:existing proposed Total new Z Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type W 6Z�17 Lot Size Grandfathered: ❑Yes ❑No If yes,attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other W N^-Ar Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new _ Half:existing new Number of Bedrooms: existing_ new Total Room Count(not including baths): existing new- First Floor Room Count A Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size___T _Barn:❑existing ❑new size 1I Attached garage:El existing ❑new size Shed:❑existingAnew sizei�b Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded O Commercial KYes ❑No If yes,site plan.review# Current Use N 0- Proposed Use e BUILDER INFORMATION Name NE Telephone Number 0 --2-Bab Address NBC IVJ . License# M $(a S Home Improvement Contractor# _ 1329 3 S Worker's Compensation# W L^ 7(P ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO lDi,�E �V�'�5 071 Cv 7- SIGNATURE r DATE /6,�_ ..o' Town of Barnstable-Health Department Page 1 HAZARDOUS MATERIALS INVENTORY SITE VISITS DBA: Advanced Body Science Fax: Corp Name: Mailing Address ......... Location: 41 D Bodick Rd.,Hyannis Street: 41 D Bodick Road ......... ............. mappar: 344-080 OOA-000 City: Hyannis Contact: 'Richard Hatfield State: Ma Telephone: '508-778-5541 Zip: 02601 Emergency: 508-778-5541 Person Interviewed: Michael Hatfield ... ............... Business Contact Letter Date: 6/2/2005 .............. ......._........ ....... Category: VehicleMaintenance Inventory Site Visit Date: 6/21/2005 ............... Type: :Auto Body Follow Up/Inspection Date: ......... ............. public water ❑ indoor floor drains ❑ outdoor surface drains W license required ❑ private water ❑ indoor holding tank mdc ❑ outdoor holding tank mdc d❑ currently licensed ❑ town sewage ❑ indoor catch basin/drywell ❑ outdoor catch basin/drywell expir ---- date: 6/30/2006 ❑ on-site sewage El on-sites ste -- --- ---- g y outdoor onsite system Spray Booth. Manifests in office. DEP#MAV000016198. Buy Oil From compliance: Bailey's in N.H. A/C certification. 3/93. must have MSDS sheets on Satisfactory site. Need Secondary Containment for Above ground tanks. Waste oil burner. Water solvent parts washer. Spray guns HVLP. Lube on location. Burn their oil PPE available. MSDS available. Violations: ground paint thinner drum. 4/20104 Need to follow up with HazMat inventory. They never acquired a license. 4/28104 Paint thinner drum above ground. MSDS onsite/in shop. They still burn their oil for heat. Get their oil from"Clerio Auto Repair"next door. Clerio is being investigated for not having a car selling license or an auto body registration license. Advanced Body Science keeps all manifests onsite,has a spill control plan,and wastes are in proper container. Rags are in covered container. Questionable if they should be practicing auto maintanence at their location-it's on a wellhead and Building says there should be no auto repair going on there at all. 6/21/05 alp-very clean areas,contingency plan in place,msds on site, ppe available to all staff,used oil filters are drained and lube on location takes them away.RECOMMENDATIONS: place lid on shop rags can,close parts cleaner lid.ORDER:label all waste that is hazardous qq 1 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 gty's 111 gals or more escn dn ti unit of rrieasure� antifreeze(for gasoline or coolant systems) 180gallons motor oil552gallons diesel fuel,kerosene,#2 heating oil 165gallons ..___..._.._._..._.._...........__................._...............____........__.........................._.................._.____....._._........_.._._.:n._.._....__.__._...___ .__..._.._..._.._............... .........._,............_. car waxes and polishes. 22�gallons ___._.___._._......_...._.__.__....__.._......._._._.____ __. __ ___ _._ ....._____.._.....___.........._...-._------------- ._.___ waste oil 180 gallons paint,varnishes,stains,dyes 111 gallons ._._..W._._W._. Windshield Wash 200 gallons Misc.Combustible 2 gallons Misc.Flammable 18 gallons waste antifreeze 55 gallons _........_._....._:...................__._...._._.._.._...___._..____... __-_. caulk/grout 1 gallons Waste Transporter: Cyn Oil Fire District: ;Hyannis Last HW Shipment Date: 5/3/2005 Waste Hauler Licensed: Yes .„:� - +.4ar.• '•..,•vi+..`s::..C;sFv-y.: .,c: .::.. k,.`as• � .,e +.zv3+,e7.Rc'n'.Y Y+' a.*f>.•.,�.�M.. ..i ,...aft-.^--� +�fis"•s�'.fit x:,;i TOWN OF BARNSTABLE UNDERGRUUND FUEL AND CHEMICAL STORAGE REGISTRATION MAP NO. L PARCEL NO. Q�Q TAG NO. CLA ADDRESS OF TANK:_ - 'l 1 ( (C lk fl VILLAGE: MAILING ADDRESS ( IF DIFFERENT FROM ABOVE ) OWNER NAME: y.�c �/� v/�Cj 0,1111 PHONE S-a�S ® 2 0 / INSTALLATION DATE: / �J/0/ BY: INSTALLER ADDRESS: -CERT.NO. STANK LOCATLON rOV BELOW (D.COOW Z om .TANK LOCAT Z ON W 2 TH "amm"CT TO au Z l—D 2 N0) CAPACITY /�/Q / TYPE OF TANK _A AGE 3R,55- YRS. FUEL/CHEMICAL !h• / q ' TESTING CERTIFICATION [ ] PASS [ ] FAIL DATE LEAK DETECTION [ ] CHECK IF N/A TYPE/BRAND . ZONE OF CONTRIBUTION [ ] YES [ ] NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED [ ] YES [ ] NO DATE CONSERVATION [ ] CHECK IF N/A DATE BOARD OF. HEALTH TAG NO. [ / j ] DATE 0 1) PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD .�+o-in..irr+"'°"^"9'd `�i.+7�tt�+P.+ii.x7�ntt�.+rir.+R.vy�:,or,;^'�,'"s"�...�t� _ .. ""1^1y'ft�Y4„a�t r �.�I�r,„+,""•+��a`t.. TOWN OF BARNST$ABLE - UNDERGRUUND FUEL AND CHEMICAL STORAGE REGISTRATION MAP NO S- PARCEL NO. DRO TAG NO. IQA ADDRESS ,OF TAN.Ki:-''-----1- "___ rC'.. VILLAGE "' � 1.... fvumb�r •tr��'t MAILING k ADDRESS ( IF DIFFERENT FROM ABOVE ) : / X 2. 2 OWNER NAME: �`�-:X-- t/l� �Q�47'� PHONE:' �w}� �©p, �� 1 INSTALLATION DATE: �5�4� BY: /-P,417 � INSTALLER ADDRESS:' 'CERT .NO. *TANK LOCATION: ABOVE BELOW (DCQCR Z DG TANK LOCATION W S TH /�QOPQCT TO aU IrL7D I NO) CAPACITY �/`D � TYPE OF, TANK S� AGE ��a5 Y R S. FUEL/CHEM 1 CAL f TESTING CERTIFICATION - [ ] PASS [ ] FAIL DATE LEAK DETECTION [ I CHECK IF N/A TYPE/BRAND ZONE10F CONTRIBUTION [ ) YES [ ] NO `, DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED [ ) YES [ ] NO DATE CONSERVATION [ ] CHECK IF N/A DATE .BOARD OF HEALTH TAG NO. [ / / a ) DATE 3)._�©zb f # PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION 'ON THE BACK' OF THIS CARD 1 �� 1 ��'- � . `\W\ /'\ 1�. • 1 1 ,� �t{\ I 1 {��}�� �J � t � i t I � i } � 1 I \, ! �, j i __ � (t Date: : 1*0/ TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: �'� "'e 6y) BUSINESS LOCATION: l MAILINGADDRESS: PO 95 rS Mail To: Board of Health TELEPHONE NUMBER: Town of Barnstable CONTACT PERSON: �� ' ��ra P.O. Box 534 EMERGENCY CONTACT TELEPHONE NU BER: ?67 3 ZV Hyannis, MA 02601 TYPEOFBUSINESS: Does your firm store y of 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: ?7� 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. 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 Z Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants 300 Motor oils Pesticides Y2- NEWS USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED IT-? 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) Batteryacid (electrolyte) Swimming pool chlorine ( Yt ) 9 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): Spot removers & cleaning fluids �qjf (dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS ���^' �� � �. G�� i ,s — :K. 36Y`lflw .�5". `n.aJWb4G�r"•'^'TRL.^Ci K'f![PE '?T'A•.e.'Y°'f:''F'—i'•,w,'.?'R1j.. TOWN OF BARRNSTABLE - UNDERGRUUND FUEL AND CHEMICAL STORAGE REGISTRATION MAP NO. PARCEL NO. .Xe . flo t TAG NO. ADDRESS OF TANK: 6jitl7k f VILLAGE' lt1�I! Number •tr�bt - � r%' MAILING ADDRESS ( IF DIFFERENT F OM ABOVE ) : Potqox [ v Jf CA' !/�/� � f�^ PHONE: OWNER NAME: O INSTALLATION DATE: `b ' I CJ ' BY: N Y (7Vl tmot INSTALLER ADDRESS: 'CERT.NO. *TANK .LOCATION: ABOVE BELOW (ow s as TANK LOOAT Z ON W 2 TH IlQQPQCT TO 1u 2 LD I N0) CAPACITY_ 006 TYPE OF TANK �G�S�TG AGE 0 YRS. FUEL/CHE ICA_ TESTING CERTIFICATION [ ] PASS [ ] FAIL DATE LEAK DETECTION [ ] CHECK IF N/A TYPE/BRAND ZONE OF CONTRIBUTION [ ) YES [ ] NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED [ ] YES [ ] NO DATE CONSERVATLON [ ) CHECK IF N/A DATE 4 HOARD ,OF HEALTH TAG NO. [ ] DATE # PLEASE PROVIDE A SKETCH . SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD TOWN OF BARNSTABLE - UNDERGRUUUUND FUEL AND CHEMICAL STORAGE REGISTRATION MAP NO. �►! � PARCEL NO-. N0. ADDRESS OF TANK: k r V I LLAGE: N�m b�r •t r y•-t ' MAILING ADDRESS ( IF DIFFEREN ABOVE ) : ' po OWNER NAME: y Je L /Vcw/;A . 0 �! INSTALLATION DATE: `fi ' ' 'D BY: INSTALLER ADDRESS: -CERT.NO. *TANK LOCATION: ABOVE BELOW . c DQoow I,mK TANK LOCATION,_W I TM._/LQQPQCT ^`TOU I LD I NO) CAPACITY TYPE OF TANK ��SG AGE 0 YRS. FUEL/C�iE"I�I I CAL TESTING CERTIFICATION [ ] PASS [ ] FAIL DATE LEAK DETECTION [ ] CHECK` IF N/A TYPE/BRAND _\. ZONE OF CONTRIBUTION [ ] YES [ ] NO DATE TO BEwREMOVED FIRE DEPT. PERMIT ISSUED [ ] YES [ ] NO DATE CONSERVATION [ ] CHECK IF N/A DATE BOARD ,OF HEALTH TAG NO. [ ,,� , . . ] DATE PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON%' THE BACK OF THIS CARD �� -� �. �. J ...,.y�y,A""„-,r.,.,,c...,r.:,.;.,,.-.�.-y.,..^,r--••"---'...e._.. �a:.,.-....-v..-„.y,.,:=.--r -s'; .,,;-�.vw;n,-c...,,.-^w:�,,,..,�"n,..: ,-,F�-..�,;,,.v.�. ,.u!r`. ':x,r-rc ;.`-'wcr-��fi'aj.'.r•erkj,�7.e-+'='... , TOWN OF BARNSTABLE - UNDERSRUUND FUEL AND CHEMICAL STORAGE REGISTRATION MAP NO. -57 LA_ PARCEL NO. TAG N0.!'�/" �_. ADDRESS OF TANK. _ _ 4 ( IK�C !� VILLAGE: /- MAILING ADDRESS ( IF DISFFERENT FROM ABOVE ) : U 73Gh` 1 OWNER NAME: lLk- 6AIn !Z"Q4; PHONE: INSTALLATION DATE: fS~ BY: INSTALLER ADDRESS: -CERT.NO. *TANK LOCATION: , .BOVED BELOW DCpCRQ I pG TANK LOCATION W 2 T1-1 Imp pPpCT TO - pU I LD I NO) CAPACITY TYPE OF TANK - AGE YRS. FUEL/CHEMICAL TESTING CERTIFICATION [ ] PASS [ ] FAIL DATE LEAK DETECTION [ ] CHECK IF N/A TYPE/BRAND ZONE OF CONTRIBUTION [ ZYES: [ ] NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED [ ] YES [ ] NO DATE CONSERVATION [ ] CHECK IF N/A DATE r BOARD OF HEALTH TAG NO. [ s ] DATE �� 1171 /P ' f PLEASE PROVIDE A SKETCH. SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD ,. ., r.�;�*..'�+-:*^'•w`t'�5'"+�w�,c.,r'R*.r";�•aac^..., tr+u.n..^:.. Y",�"'#` .,.. s .. , TOWN OF BARNSTABLE - UNDERGRUUND FUEL AND CHEMICAL STORAGE REGISTRATION MAP NO. PARCEL NO. r TAG NO -t� E ADDRESS OF TANK: q. l 4 VILLAGE: % Number Ytrwfw�t _ f MAILING ADDRESS ( IF DIFFERENT FROM ABOVE ) : 1 OWNER NAME: GF/-4 G11'n IA- 4�A PHONE: C ' INSTALLATION DATE: �� BY: /1f SCd'JG" �� ''rPl INSTALLER ADDRESS: -CERT.NO./ STANK LOCATION: `A OVE BELOW (ow=cmI K TANK LOCATION W i TM RGOP�CT TO al.J I 1�D I N0) CAPACITY TYPE OF TANK Se.c�( AGE Q YRS. FUEL/CHEMICAL �/-/` TESTING CERTIFICATION [ ] PASS [ ] FAIL DATE LEAK DETECTION C ] CHECK IF N/A TYPE/BRAND ZONE OF CONTRIBUTION `'[ U'YES [ ] NO DATE TO BE REMOVED FIRE DEPT. PERMIT S I S UE D C J YES [ ] NO .,. DATE CONSERVATION [ ] CHECK IF N/A DATE 1 BOARD OF HEALTH TAG N0. ;[ 1� ] DATE PLEASE PROVIDE A SK,E'TCHySHOWING THE TANK LOCATION ON THE BACK OF THIS CARD Health Complaints 21-Feb-06 Time: 1:10:00 PM Date: 2/13/2006 Complaint Number: 18655 Referred To: DAVID STANTON Taken By: SHARON CROCKER Complaint Type: BUILDING PERMIT Article X Detail: ILLEGAL OPERATIONS Business Name: ADVANCED BODY SCIENCE Number: 41 Street: BODICK RD Village: HYANNIS Assessors Map_Parcel: 344-080-OOC Complaint Description: THEY ARE LOOKING FOR A SIGN PERMIT AT SAID LOCATION. CONCERN THAT THE USE OF THE"12'X 16' STORAGE BUILDING" MAY NOT BE FOR"PAPER STORAGE"AS ORIGINALLY PERMITTED FOR, AND THAT THE PROPERTY MAY BE GOING TO BE USED AS AN OFFICE, WITHOUT PLUMBING. Actions Taken/Results: DS WENT TO SAID LOCATION AND SPOKE WITH AN EMPLOYEE THE OWNER, RICHARD HATFIELD (AKA MIKE)WAS NOT THERE AND WILL BE OUT UNTIL WEDNESDAY. THE EMPLOYEE SAID HE WAS NOT SURE WHAT THE PLANS FOR THE BUILDING WERE, AND THAT I WOULD NEED TO SPEAK WITH THE OWNER. LOOKING THROUGH THE WINDOW OF THE "STORAGE BUILDING" IT APPEARS THAT IT IS ONLY BEING USED AS STORAGE, AS THERE WERE JUST BOXES OBSERVED INSIDE. THE EMPLOYEE STATED THEY DO HAVE A BATHROOM INSIDE THE BUILDING. DS WILL CALL THE OWNER LATER ON AND SEE WHAT THE PLANS ARE FOR THE ; "STORAGE BUILDING" ON 2/15/06 DS WENT Health Complaints 21-Feb-06 BACK TO SAID LOCATION. OWNER HAD JUST STEPPED OUT, SO DS LEFT TO CONDUCT OTHER INSPECTIONS. ON 2/15/06, THE OWNER CAME IN TO THE FRONT COUNTER. DS EXPLAINED EVERYTHING TO HIM. HE CLAIMS HE HAS BATHROOMS IN THE MAIN BUILDING. HE SAID THEY ARE NOT GOING TO USE THE SHED FOR AN OFFICE. THEY HAVE PERSONAL STORAGE IN THE SHED NOW. HE SAID THE SPRAY BOOTH HAS BEEN IN THERE FOR EVER, AND THAT RALPH CROSSING APPROVED IT. NO HEALTH VIOLATIONS, NO FURTHER ACTION REQUIRED. Investigation Date: 2/13/2006 Investigation Time: 1:30:00 PM 2 V � V Q Q' h eY: 4 J wr r. ill p� Y 16,Y 1 I x t.. t �.,,,«iLc���ltTlVJ'W7CiNAYP.DOC L Lr C A T111 O N S E W A GE P E R C'I 1 T 130. J VILLAGE IDSTA LLER'S 93ALIE 8 ADDRESS .arn:E-a�....- ®R MCI ER DATE PENC31T ISSUED M DATE C0PAPLIANCE ISSUE® i ' o v� Ch T� . f e _ tNo..___g -G --� Fa$......... _a. ... —•-_- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH d . ... ......­1............ ...................... -0q , , - , App irFation for Uhipoii al Works Tonotrnrtion ramit Application is hereby made for a Permit to Construct ( i") or Repair ( ) an Individual Sewage Disposal System at: _ _Q ................_••.....................•...-•-•---••-----•---•---_......---------------._....... ........ .... •--- •o- tion- --s or Lot o. .........`...� .. _.. _n .._ out!. _...... - c. � .. ............... 7 er Address W ---•----••.......................•----•-•----.._....----•-----• Installer Address Type of Building Size Lot_-Z � a�_-----Sq. feet Dwelling—No. of Bedrooms......_.....................................Expansion Attic ( ) Garbage Grinder ( ) PLO Other—Type of Building _.......... No. of persons....... ............ Showers ( ) — Cafeteria ( ) P� Other fixtures ----------------------------•-•• - Design Flow...................../_-............gallons per person per dal. Total daily flow............................................7__�____.______._.:_-gallons. WSeptic Tank—Liquid capac y�_cQ0-gallons Length...�.�..._ Width.-' .__Zc._ Diameter................ Depth- -_�_ Disposal Trench—No ____________________ Width..... - -_-._ Total Length.._-_:2�-__-__ Total leaching area_.�._6-:4- q. ft. x s Seepage Pit No..........:.......... Diameter.................... Depth below inlet.................... Total leaching area......_...........sq. ft. Other Distribution box Dosing tank-(--r �l43 Percolation Test Results Performed by---------------- -------•-•••--••-••---••------•---- Date........................................ Test Pit No. 1................minutes per inch Depth—& Test Pit------_._____.__--_. Depth to ground water........................ (% Test Pit No. 2.................minutes per inch ,Depth of Test Pit.................... Depth to ground water........................ a ----•-•--•-----------------------------------------•-------•----------------•---•------------------•......................................................... ODescription of Soil--------------- r-�---•- ✓ •------------------ ---------------------------------............................................ x V ---•------ ----------------------------•--•----------------•---•---------------______....._....-----••--••---------- ----------------------------------------------------- -----•------•----------------- W -•-•--------------•------------••••---------•--------•. ---------------••-••••-•-•-----------•-•---••-----•---------•...•---•----------•-•-•-•-•-----•-•----•-•-----•---•------•---•--------•------- VNature of Repairs or Alterations—Answer when applicable................................................................................................ -----------=----------------•-------•---•-•----------------•---•--------•-----------•-------------•-----•---••----------...---------------------------------------•-••-------•-•------•_._......-•••---• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of L I HE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. 'Z......... ................................ Date Application Approved BY --�- = ........... Date Application Disapproved for the following reasons:----____•---___•---•___••__•____________••____________________•_•-•_--________-_•___-___._..___________._......_ .....................•-----...------------•--•--......---•---...-----•---------------------•--------.._...---•-------------------•---------------------------------- Date PermitNo......................................................... Issued_--•--•---•---•-----•------•---•--•-•---._..._•-----f• _ r • - ---• THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7..... ............OF.....�..n.211/S 7`F))s3L e'................... Appfiration for Disposal Works Ton,strur#ion rrmi# Application is hereby made for a Permit to Construct (tl or Repair ( ) an Individual Sewage Disposal System at jDJ5c) /tic ,� c - /��,nn'fs......... ...._......._...--••-• ............. .........- ....................................................... Location-Address or Lot No. •--•---•--•----.-•......................•----^-.•---•--•--••--•---......••._..................... ..........-•...................................__................................................. W Owner Address Installer Address Type of Building Size Lot..2 � ?. Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a Other—Type of Building . No. of persons......Z�.� ......... Showers — ( ) Cafeteria ( ) Otherfixtures -----•-----------•---------------•-----------•---------•...--•--•-•-------••-......... w Design Flow.....................ls............gallons per person per day. Total daily flow............ . .............--..gallons; WSeptic Tank—Liquid capacity/°O�.gallons Length.. �_G.�. Width._......._..o-• Diameter................ Deptli.�..... x Disposal Trench—No........!.........=. Width...../.!2 Total Length.....2�-..... Total leaching area..2,.A5r.4:..sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet....:............... Total leaching area..................sq. ft. Z Other Distribution box ( ✓ , Dosing tank,.(--)- p,S43 a Percolation Test Results Performed by................ ... ��.. -•.•--------.-----.----------.--•--. Date..... Test Pit No. 1................minutes per inch Dep of Test Pit__......__._......_. Depth to ground water........................ rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water----------.............. 9 •-•----••••-••-•-•---------•------•-------••-•••...--•-••--•-••-•--...•--.........•-----•--••------......................................................... Description of Soil............... ....................................... W U ------••-•••-••--••--•-•-----•-------••--•--••------••-•----•-•--•...••--•-•----•---•...................•-•-••-----••--•--------••--•------•------•--•••••-••-••---•--••-••---•---•----••-•-...._....•. w U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ..------••----------------------------------•-•-------------------------------••----........---------......--•-------------------•----------------------------------•--•-------------•----------•-.----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage,Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Sined-X--------••--•--•--......-•----•---••-•.............•-•--...-••---•-••-•........ � Date Application Approved By. �.. 3 --/a,��''z'� - Date Application Disapproved for the following reasons----------------•---------------•----•--•--------------•-----------....----------•----------•-•......--•------••- ----•---------------------------••-•---------------•--------------------•---------•----------- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH T© VV,-V......................OF..... �GZ/V S.!..`-:�'-.4-47 (5rdifirtt#.e of ToutpliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) by--.--------•----------------•-----•--------------------•--------------------•----------•---------- ---•-----------------.-------------•-------------.-------.------------------------------------- Installer has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No...d'� -_ �................ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONS UE® AS A GUARANTEE THAT THE SYSTEM WI FU TION SATISFACTORY. DATE..... .................................................. Inspector.. .... ................................................... THE COMMONWEALTH OF,MA CHUSETTS I BOARD OF HEALTH a✓I/i✓T' .........oF.... �: :SZ- 7-�,0 .........................---.......L.....C.--•-- ..................No.. ... . ..�....- FEE ...... Disposal Work5 %onstra ion rrani# Permissionis hereby granted............................................................................................................................................... to Construct (✓) or_Repair ) an Individual Sewage Disposal System at No_- -. .:T..---3..1......Imo- © �`k - -0 __)/S_e ✓1/%-s...... .`?.:...._..... as shown on the application for Disposal Works Construction Per 't No..................... Dated...._..................................... f. ••. ...........� ...----/. ------------------------------------------- Boa o e;i tC - DATE-------•--------•---.......................................................... FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS r f, ♦ P-ermit Number: ` Da-te: CompTeted by , • - 1Z -.. S1�4 10127- ' � H1,GH GROUND-WATER LEVEL COMPUTATION - Lot No.:. Site Loca t i.on: Owner: Address: ` �' Q,r- raeA�`!"„� _ � Contractor: vrk to Address , Notes: - IV' STEP 1 Measure depth to water table to--nearest1.110 ft. . ... . . . ... ._ date. r-kii Using ,(at. r-Lever Range-Zone ' `and bnJaex Wel1..'Nap locate s-i t&�aifddet i ermermn.e: �� R i w-zoo - A) AppOpa:te.:index well ft vel range, zone Eiv" Usinot lyreport"Current ak. " ..Water tesx Ices Cored i:'t cores" 4 Fde#errn"axre current depth to Z� _ ' � Ater eror foriri hale cmwel Tm .. 3 / 1 , . t -' SZEP !t "11s y n al le of lJa'ter.t eme] STDA ; .�curr.ent d.epthto. b jwateriv�elfor i nd.exwel:l - � = ' , ($TEP;. ) an dwater revel; ��zoneSTEP2B) deterrn•inet � 9 M .waterieladja�stment�a • -STEP S Est mate de-tk to h r.gh�water ,. '' ,�.-n. 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