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0142 CORPORATION STREET - Health
142.Corporation Street fi :� Sewer'Acct # 4247 r Hyannis - - - - - - - - — —---- A - 293 e Q o a o r Haz rdo s aterials Inventory Sheet Checklist Z� b 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-no blanks) 1y//� Storage Information - location of storage, how long is storage for? If none, note that. Allk Disposal Information -where and who? If none, note that. t1 Applicant Signature - understand what is listed and noted Staff Initial -any questions, know who to ask Vehicle Washing/Rinsing? -give a vehicle washing policy and explain it Attach the Business Certificate with your sign off and comments **The inventory form should explain what the business consists of and the'procedures they are doing. Notes need to be left to explain what you discussed with them. YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) usiness Certificates are available at the Town.Clerk's Office, 1"FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) DATE: a I5� Fill in please: APPLICANT'S YOUR NAME/S: o /3 GV J771i1�.i17!�G7:'1� �I7Y$n h /✓ . fiE BUSINESS YOUR HOME ADDRESS: l`7�0 /�L/iw/ s T '�T@pi' yS"'I r� i3 ��::�. { r:ii '' .�• S0 6 6�s= `16a 6 IN, d'v-�STr?-ac � � • 5+_, a ilk IR?fiP TELEPHONE # Home Telephone Number So NAME OF CORPORATION: D/o-- - aP NAME OF NEW BUSINESS TYPE OF BUSINESS v u,u 3r►irf/�,aG IS THIS A HOME OCCUPATION? YES NO ADDRESS OF BUSINESS /'Z/ alz• 0 7JaZ 6 M4 MAP/PARCEL NUMBER �/3 vZ (Assessing) 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 TQ2IIO-mairiSt. - (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your usiness in this town. 1. BUILDING CO MISSIO ER'S OFFI. This individ al h' e 4-n for d f ny p rmi re uiremen that pertain to this Ope of-business. Au horized Gignature* MENDS: WLf G 2. BOARD OF HEALT This individual h n inf m f the p �Mit eeq ements that pertain to this type of business. Authorized i nature** SNtU M 163H S'M H31%M Sf10QaMZ11M COMMENTS: 17MRMA :WWO3 ISM. 3. CONSUMER.AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS- oil Date: �( / TOWN OF BARNSTABLE / TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: rr-eAr eerp g%z Oij<7' 7w S BUSINESS LOCATION: l 'y�- CoR _Ti�.,�� RaQ INVENTORY MAILING ADDRESS: lclo t'l- S i— t3,r,zvq6rr�B �/I j-1iP otaT TOTAL AMOUNT: TELEPHONE NUMBER: Sob 6 9 s-- 5'6o 15' CONTACT PERSON: EMERGENCY CONTACT TELEPH NE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: yn1 Srh 1 ThlI•v 6- INFORMATION Fire District: �` lJS F- Si n•1 pl� GGt�2n1 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 re uires 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) f lubricants, gear oil ❑ NEW ❑ USED - Degreasers for engines and metal Printing ink y 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 .r Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, i 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 o Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials � fir _ t de ��cS `�" YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $40.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in the Town (WHICH YOU MUST DO according to M.G.L. - it does not give you permission to operate). You must first obtain the necessary signatures on this form.at 200. Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st FI., 367 Main St., Hyannis, MA 02601(Town Hall) and get the_.Business Certificate that is required bylaw. Fill in please: DATE (v — 3AA /� �� APPLICANT'S YOUR NAME/CORPORATE NAME_ -Donn - Md e i ros BUSINESS TYPE: ScrAp r1c¢a /,- BUSINESS YOUR HOME ADDRESS: Z. o TELEPHONE # Home Telephone umber In — a e�$ Ce(( ,to8 Y6 y- y NAME OF NEW BUSINESS , e S Have you been given approval from the building division? YES NO _ ``Oo�' p ADDRESS OF BUSINESS I'�{2, Car op�q o., Sci—fi ,4 -� OU'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 m This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 2. BOARD OF HEALTH m This individual has be n inf rm of a per require ents that pertain to this type of business. " Authorized nature** COMMENTS: 3. CONSUMER AFFAIRS (LIC NSING U HORITY) This individual has benfor t licensing requirements that pertain to this type of business. ,Ay/thonzgd S' nature** COMMENTS: Ha3er5lous Materials Inventory Sheet Checklist . y Date Physical Street Address-Check database to ensure it.exists lam, Working Phone Number Actual Amounts -( ie. gas being used to fuel machines, thinner to clean brushes all count as hazardous materials-no blanks) 1,_�Storage Information -location of storage, how long is storage for? If none, note that. 1----Disposal Information -where and who? If none, note that. _Applicant Signature -understand what is listed and noted i Staff Initial -any questions, know who to ask Vehicle Washing/Rinsing? -give a vehicle washing policy and explain it " ttach.the Business Certificate with your.sign off and comments � "The tory.form should explain what the business:eonsists of and:the procedures they are doing.: Notes need to be left to explain what you:discussed with them. Date: TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE NAME OF BUSINESS: 7.cYli. kki c 4-A /,r BUSINESS LOCATION: IY ;L �01-�oor,g-�t: X4, INVENTORY MAILING ADDRESS: o a 6 o t TOTAL AMOUNT: TELEPHONE NUMBER: (51a2 77,s'� D S X8 CONTACT PERSON: Tjo W-tct c I,'ro.f— Ls68) 36y-�y�q �fo8� �89- j'y0s EMERGENCY CONTACT TELEPHONE NUMBER: Kt✓►; T. 141 t1 eo r-x— MSDS ON SITE? TYPE OF BUSINESS: Jtf&p INFORMATION/RECOMMENDATIONS: Fire District: OIVN� 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 r (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which ,you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) . Other cleaning solvents ~ Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials Town of Barnstable oFt t z s4 Regulatory Services Thomas F. Geiler,Director rI Public Health Division 141 *NBARNSTABI:E;<` * Thomas McKean,Director 200 Main Street Hyannis,MA 02601 X Phone: 508-862-4644 Email: health(a�town.barnstable.ma.us Fax: 508-790-6304 Office Hours: M-F 8:00—4:30 May 1, 2006 Mr. J. Craig Medeiros J._Craig Medeiros 142 Corporation Road Hyannis,MA 02601 Dear Mt. Medeiros: Thank you for your time and cooperation during the hazardous materials inventory and site visit at J. Craig Medeiros on April 20,2006. This letter contains information from that visit that will help you become compliant with Chapter 108 of the Town of Barnstable Ordinance: Hazardous Materials. Enclosed are copies of Chapter 108: Hazardous Materials ordinance,the Toxic and Hazardous Materials On-Site Inventory form from the site visit, a sample Contingency Plan, and sample MSDS for you to view and obtain more for the products used at your facility. Please note the .problems identified at your place of business during the hazardous materials inspection and their corresponding orders or recommendations listed below. PROBLEM: • Drum of waste oil was not properly labeled. ORDER: • Please label your 55 gallon drum of waste oil with"Waste Oil"or"Used Oil". PROBLEM: • Cylinders of acetylene and oxygen are located in traffic areas and are not protected from tipping. ORDER: • Please chain all cylinders to a wall or cart to ensure they are not tipped over. These cylinders are highly dangerous in these situations. PROBLEM: • Large quantities of grease and lubricants are not being utilized and are adding to the hazardous materials inventory. RECOMMENDATION: • Dispose of all hazardous materials in accordance with the Massachusetts Hazardous Waste Management Act., Ch. 704 of the Acts 1979. See 108-5(C) Storage Controls. • Disposal of these unused products will keep you below the minimum requirement to obtain a hazardous materials permit, which is 111 gallons or more of storage,usage and disposal. PROBLEM: • Contingency plan not posted in areas throughout the facility. ORDER: • Please refer to the Town of Barnstable General Ordinance: Chapter 108: Hazardous Materials, Section 6(A-H). • Post contingency plan near all phones. On Site Inventory Total The Toxic and Hazardous Materials On-Site Inventory from April 20, 2006 shows that you have approximately.106 gallons of toxic and hazardous materials being used, stored, generated and disposed of at J. Craig Medeiros, 142 Corporation Road,Hyannis,MA (Please see enclosed Toxic and Hazardous Materials On Site Inventory sheet). Why are these recommendations being made for J. Craig Medeiros? • This information is intended to educate you, a business'owner/operator in the Town of Barnstable, in order to keep your business operations in compliance with local, state and federal toxic and hazardous materials laws so that you can avoid future regulatory problems, • Complying with the Town of Barnstable General Ordinance: Chapter 108:Hazardous Materials can prevent contamination of Barnstable's existing and future drinking water supply,prevent environmental contamination which can' bankrupt site owners, lower or destroy land values,drive out residents and industry, depress local economies and endanger public health. A representative from the Public Health Division will re-visit your business during the next 30 days as a follow up to further advise you on your compliance. If you have any questions about these problems,the orders and recommendations, or you need further information, guidance or assistance,please do not hesitate to contact the Public Health Division. S' cerely, Alisha L. Parker Hazardous Materials Specialist All orders to correct vio ations of Chapter 108 of the Town of Barnstable Ordinance: Hazardous Materials 11 be comp eted upon receipt of this letter. o as . McKean,RS, CHO Director of Public Health Enc. On-Site Inventory(copy) Chapter 108 (copy) Contingency Plan(sample) MSDS (sample) Date: TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: 0/mccl e- BUSINESS LOCATION: INVENTORY MAILING ADDRESS: C TOTAL AMOUNT- TELEPHONE NUMBER: ii 629 --7_79— 09,19 CONTACT PERSON:SeL�l 14_APGl!P1 151 EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: M S _ A It) IN ORMATI N/RECOMMENDATI NS: Fire District: T I� muv 6 a e UFj S CA/ rz &t 21V C. av aAAi�� WasteYr-ap tAon: Last hipment of azardo us.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 5 NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants /01 Motor Oils Pesticides NEW 66 USED (insecticides, herbicides, rodenticides) o 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 19 ' 17 (including bleach) AP Spot removers &cleaning fluids ` (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash ' WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS _ Town of Barnstable-Health Department Page 1 HAZARDOUS MATERIALS INVENTORY SITE VISITS . ...._............................_.... ............_....................................._........................ DBA: J.Craig Medeiros Fax: — _........... ... ...................................._._.._..- ...........................-- ...._ Corp Name: Mailing Address .,._�< i _................................ ...._......_........................................................................_._..... _--_._.._._.............................._................._........ _................................. Location: 142 Corporation Road,Hyannis Street: 78 Linden Street ..................._........................._...__..__.............................._ ........ ._....._......_........................__....._.._........._....................................................._............................. mappar. City: Hyannis Contact: `J.Craig Medeiros State: Ma Telephone: (508)775-0828 Zip: 02601 Emergency: (508)775-0828 Person Interviewed: ...-.................................---......_..........................._.._.... Business Contact Letter Date: :........_............. ............_..................._......__........_........................................ _--.._._.............._.._._........_._...._.............................._... ... . Category: Miscellaneous Inventory Site Visit Date: 4/20/2006 Type: Follow Up/Inspection Date: public water ❑ indoor floor drains 91 outdoor surface drains ❑ license required ❑ private water ❑ indoor holding tank mdc ❑ outdoor holding tank mdc ❑ currently licensed ❑ town sewage ❑ indoor catch basin/drywell outdoor catch basin/drywell expir -........................-..-....- - ---... 91 on-site sewage ❑ indoor on-site syste ❑ outdoor onsite system date: .................................................................... Remarks:4/18/97 I/2 steel wall-fuel oil tank,rags for spill-take to col't'lpliange: Hyannis brake&oil filters. Satisfactory REMARKS:4/14/98-W.O.raken to Hyannis Brake-Junk Dealer keeps for recycling -Brass.Copper.Leach.Aluminium,etc. ORDERS: Obtain MSDS Material Safety Data Sheets obtain receipts from Hyannis Brake upon delivery of w.o. 4/20/2006 alp-Waste Oil taken to Hyannis Brake and Auto for heating fuel(obtain receipt for transfer),Label waste oil drum with"Waste or Used Oil",Obtain MSDS for products used on site,Service all fire extinguishers,chain all cylinders,and dispose of grease/lubricant in order to keep quantities of hazardous materials below II I gallons. t( •;Page 2 Town of Barnstable-Health Department HAZARDOUS MATERIALS INVENTORY �. Chemicals: ❑ -ZeroToxic Waste Materials • d❑ t ''s.>25 lbs�q y dry or 50 gals liquid but less than 111 gals ❑ gty's 111 gals or more ' gasoline 10 gallons diesel fuel,kerosene,#2 heating oil 2 gallons diesel fuel,kerosene,#2 heating oil 275 gallons . �waste oil Y55 gallons---w__�__. motor oiler 6 gallons automatic transmission fluid 1 gallons Windshield Wash' 1 gallons z misc.petroleum products:grease,lubricants 22 gallons antifreeze(for gasoline or coolant systems) 5 gallons ' paint,varnishes,stains,dyes 1 gallons Waste Transporter: Fire District: 'Hyannis . LastHW Shipment Date: i Waste Hauler Licensed: No ............_..............:.::...:................._.......... r • J -• Est. 1957 y(508)775-0828 G G MEDFj, O ; Y s 40+Years Business• Same Good Name Sewerage Work•All Types J.C.M. METALS Copper•Brass •Alum. •Etc. Shop: Mail: 142 Corporation Rd- _ 78.Unden St: 02 Next to Cape Cod Mall Hyannis,MA 6011 `` 1.i �� �O V" ��( Ill/ , \ . (✓.�"- r v(/I..VW�" "J 1 • v cam- 5 . �a�.� --7 g L��� fit—, H��,,s ►M�o��®d � OIL WASTE OIL OIL FILTERS ANTIFREEZE WASTE / � � ANITFREEZE .� ILIV/ 275 y A GASOLINE WASTE GAS DIESEL FUEL W/W FLUID ATF / t HYDRAULIC/ MISC. MISC. MISC. MISC. BR#KE FLUID COMMBUSTIBLE FLAMMABLE CORROSIVE PETROLEUM (GEAR OIL/GREASE/ LUBRICANTS) lag FREON ACETYLENE CAR WASH CAR WASH PAINTS/ WAX DETERGENTS THINNERS vx SEALANT CLEANING BATTERIES/ POISION/TOXIC CAULK/GROUT SOLVENTS BATTERY ACID FERTALIZERS WASTE SOLVENT a MSDS rb 3 Y AO1�. a � 9 . MANIFESTS Li ft- NA V)Lo 6 .AtAY I.Ce� :. r 0� i TOWN"OF.BARNSTABLE Date .r�... ..: 0 New App ication LICENSE . * BAxNsrABLE • Renewal tHass. .200 Man-Street �b39:. .0 0 Transfer '°lEn ,t A Hyannis,MA 02601 508-862-4674 .0 Other ► NO. BUS Sfs Q E VALID LICENSE' UN :Z`fIE PREMISES Name of applicant/co orafio� o �r: _' ` p Home hone# 'Address of applicant/corporation. Business D/B/A Business phone# .Business location: '- w ca ,�(J� Business mailing.address: Local business address: Xz:O Local mailing address: .� / -&Y6 0 L LICENSE TYPE;' �l:....�/U•� ............................. •� iN Aririval Seasonal HOURS OF OPER. .... y'F-ID# s " t1.s " �k Namd magagec�---�: Email• f.tJ i.� . Local mailing address 1.. ! :'.' 11 ....fly....... .... :. Manager.'s Permanent mailing address r , r rU$IJIe$S�phOF1' -4 Q��""fir° p Manager's home phone.#: ° _ _ _ SSA of'manager' Name of property owner. ASSESSOR'S MAP/PARCEL#: MAP . PARCEL Q�.......................:.....:. Lisf.any#lammable substance or hazardouswaste used`fi business(specify)': Applicants .must ..contact ` Building ;Com�niasioner'.s :.off"ice, (508) 'the Board of .Health- .; 508) .862-4644, and the .appropriate 'ire.. District office. to schedule i ape t�ions Signature of.applicant ;.. :. ovyn-use o REAL ESTATE TAXES PA41.ID IN FULL PAYMENT AGREEMENT IN EF T ON A J, r'�`~ tWv £ - ) /�r•wJ� j /y �r IS THIS USE PERMI ; WI HIN TFNINY DISRICT /� /� f' N.0 'O INSPECTORS APPROVAL �`__ .:.Capacity set by Building Division No Inspection St�r-. Building/Zoning.______._,__-___:__ Date". ` _ Board of Health Dafe'_ Wire ------==•-'--�`-- Date-__:_.:_�_-------= Plumbing :_:_____ Date -- -- ' s r. .Gas -_ Date ____—__ ,Fire Distract — }q_+ Date Comments: White=Licensing Authority Canary:Health Division Gold=Building Commissioner Pink-Fire Department•. ' YOU WISH TO OPEN A BUSINESS? Er Information Business certificates (cost$30.00 for 4.years). A business certificate ONLY REGISTERS YOUR NAME in town (which t el by M.G.L.-it doesnot dive you permissiontoope.rate.) Business Certificates are available at the Town Clerk's Office, 1' FL., 367 reet, Hyannis, MA.02601 (Town Hall) tysu TS,S MtlIN64uS9�4$$ '- � 04TE: - � >�� Fill in please: • ..s�-say-..... _ , . , , 1 APPLIGANT'S YOUR NAME: �� �� ���lJrffGQ g ' BUSINESS YOU HOME ADD ESS: w TELEPHONE # Home Telephone Number,4T it 7 Cad I NAME OF NEVI/ B11 'FNE�uS �' %/JG=?� 5 Tl(PE O.F BUSINESS: IS THIS A•HOME OCC JPATION?' YES IVO Have you been given:approval-f'bin Fie b NO ADDRESS'OF BUSINESS ��,,�j� Mgp/pARCL NUMBER When starting a new business there are several things you must do in order.to be in compliance with the rules and regulations bf the Town of Barnstable. This form is intended to assist you in obtaining the information you ay need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street m ).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 e I orm.ed ny permit requirements that pertain to•this type of business. Authprized Signature* , COMMENTS: Y +- s - _ I f• . 2. BOARD O EALTH This individual h s inform th �rzeqlilir ments that pertain to this type of business. Authorized ig ure** - STGONlPl.YWITHALL COMMENTS: . .._<._... REGULATIONS 3: CONSUMER AFFAIRS (LICENSING AUTHORITY) . -This individual has.been informed of the licensing requirements that pertain to this type of business. Authorized Signature.** s COMMENTS: j '► : Date:,,./ TOWN OF BARNSTABLE TOXIC AND HA2;.A.RDQLJS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: /YZ 40i BUSINESS LOCATION: / S INVENTORY MAILING ADDRESS: �h S � 01S 47S Ml TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: EMERGENCYCONTACTTEE EP ON U BER: S�� - j7-5 MSDS ON SITE? TYPE OF BUSINESS: T/y tp 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. j 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 j Antifreeze (for gasoline or coolant systems) Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels -Paint-&varnish removers, deglossers (including.chloroform, formaldehyde.,_._ Misc. Flammables hydrochloric acid, other acids) Floor &furniture strippers Other products not Ped which you feel Metal polishes y be ncoaz rdous (please list): Laundry soil & stain removers (including bleach) Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS TOWN OF BARNSTABLEf(s, MPLIANCE: CLASS: 1.Marine,Gas Stations,Repair tisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops 41- satisfactory- 4.Manufacturers COMPANY •� �� 93�1? e"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS Class: 7.Miscellaneous QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Undertp-ound 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: <c i i DISPOSALIRECLAMATION REMARKS: 1.&itaxy Sewage 2.W ter Supply % •� i Town Sewer Public 0 On-site OPnvate J ri 3. Indoor Floor Drains YES NO 0 Holding tank:MDC 0 Catch basin/Dry well 0 On-site system 4. Outdoor Surface drains:YES NO ORDERS: O Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler 1Product YES NO 1• 2. Person(s) Interviewe Inspector Date , TOWN OF BARNSTABLT)r COMP NCE: CzasS: 1.Marine,Gas Stations,Rep r satisfactory 2•Printers BOARD OF HEALTH3.Auto Body Shops c unsatisfactory- 4.Manufacturers tores COMPANY ° �Y� (see"Orders") 5.RetaFuel Suppliers 6.Fuel Suppliers ADDRESS r - rrn.lass• �•Miscellaneous QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MAT]EIALS Case lots Drums IN OUT IN OUT IN OUT #&gallons Age Test Fuels: l (A) n nlT��, #2 (B) Q. 7 Heavy Oils: t waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: DISPOSAI✓RECLAMATION REMARKS: 1. Sanitary Sewage 2. W ter Supply O Town Sewer ublic kon-site OPrivate 01 3. Indoor Floor Drains YES N0_jf-� O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES_NO� ORDERS: O Holding tank:MDC atch basin/Dry well /d On-site system 5.Waste Transporter DestinationName of Hauler 2. n (s) Interviewed Inspector Dat««e._,_ TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair 2. nters BOARD OF HEALTH O satisfactory 3.Auto Body Shops jK unsatisfactory- 4.Manufacturers COMPANY_,)C/tAVA� (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS &I Class: z b 7.Miscellaneous W-lam� � QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Undez-6n-ound IN OUT IN OUT IN OUT #&gallons Age Test Fuels: z"25 Gasoline Jet Fuel (A) C,cwS Diesel, Kerosene f� Heavy Oils: -s " wastemotor oil (C) new motor oil (C) transmission/hydraulic r L,f N Synthetic Organics: degreasers Miscellaneous: DISPOSALIR.ECLAMATION REMARKS: L Sanitary Sewage 2.Water Supply LD ' *Lke v4 �)3''-e k- k O Town Sewer AOublic _ I(On-site OPrivate re c -c�SI l e�� vU-,w, k 3. Indoor Floor Drains YES N0_A_ O Holding tank:MDC O Catch basin/Dry`well O On-site system 4. Outdoor Surface drains:YES_,X—NO ORDERS: O Holding tank: MDC 0Gtat� Mi-Oftil��,aJ r f J O Catch basin/Dry well ® Re GQ(,' dq 01." �y v�o �� 1VOn-site system 5.Waste Transporter Name of Hauler Destination Waste Product YES NO er d . ` 2. �111VA4 ow _,0 son(s) Interviewed nspe for Date TOXIC AND HAZARDOUS MATERIA S REGISTRATdION FORM NAME OF BUSINESS: - �*_-0 1C0 Aed e"'` l A'l g�/s Qe eye-1 r h q Mail To: BUSINESS LOCATION: /5,1 6 ��.ao�-ot, o,., ��1 /��,,,,,,S Ala dy6pl Board of Health MAILING ADDRESS: 'P1114^ a6+� S't t�H-��w�S '� OL6 u� Town of Barnstable P.O. Box 534 TELEPHONE NUMBER: •7 >s"— © ��"� Hyannis, MA 02601 CONTACT PERSON: �� • G�o� /y4ec�E'VO.,S EMERGENCY CONTACT TELEPHONE NUMBER: --� Does your firm store any of the'toxic or hazardous materials listed below, either for sale or for your own use, in quantities to ailing, 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 Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) 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 a1 ..No. .�..�'�� FRs........5............... THE COMMONWEALTH OF MASSACHUS�ETTS BOARD c3� %-.-..�``'......................OF..... ..v...a..`.... ._ ........a.J.. ........... .......... Appliration.for liiipau al Workii Tonstrur#ion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sy, tem at: C ` �4..' L_- ......�tvLOL�Z� tv�o { l �. ��5 1�� �0 t:a /^A ,, -.-: �( Locati - ddress o c� .. _. � c �°t }� .` .............. �1}yry�r ��AA --.. 1 I -Address � M Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of.persons............................ Showers a Other—Type g ......:....................• p ( ) — Cafeteria ( ) d fixtures ----------------------------------•---------------......•---•------.................-•-------•----•-•-.---------•----------------••-•-••-••--•--•-•-- g Other W Desi n Flow............................................gallons per person per day. Total daily flow.......................... ..................gallons. WSeptic Tank—Liquid'capacity_...___.....gallons Length................ Width_.............. Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total.leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.....................Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by..•-•••••-••••-••••-••-••--•••••-•••-••.....................:............. Date........................................ a Test Pit No. 1.:.........:....minutes per inch Depth of Test Pit.....................,Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.................... ODescription of Soil................ -�---�-:f--•----------------•---------------------•----------------------- ---•---•-------- - --- - W x �_` -------......••... U Nature a airs Alterations—Answer when aPPlivable___________ .. l -�V��......1... A emnt: e� -- ------------ 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 Co pliance has been issue y the_board of health. Sign, --•-• •--•---- .....-•----. / ... ate Application Approved By.............. -•-••- _-- . .......................... ....--•� -•-- Date Application Disapproved for the f lowing reasons-................................................................................................................ C ate Permit No.... �?. � .......--•------ - Issued..... -- .V.. . Date FEs....�.J�®O ........._ c THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF................................ ... ......................................... .�pnlirFatinn for Disposal Works Tonstrurtion rrrmi# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ................_.. __......... •'U' ......................... .......... ------46.- --......._...... --------..._....... .........------... � • Locatio ddressor .. . -•-Address Installer Address Type of Building Size Lot............................Sq. feet I—. Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—Type of Building g ............................ No. of persons..........,'.,..,.' ............. Showers ( ) — Cafeteria ( ) 04 Other fixtures ---- -------------•--------------------- ------------------ •••••-••----......... ------ Design Flow............................................gallons per person per day. Total daily flow_...........-.:_.._................._......_gallons. W Septic Tank—Liquid'capacity...._._._...gallons Length................ Width.................Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 1.4 Percolation Test Results Performed by........................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ DDescription of Soil-------------- ..................f................................................................................................................... V ......_......•--••-••--•----•-----•-•-••----------------•-----•-----------••••----•---..........---•--•----•-----••-••-----------•••-•-•--------•--------••-••---------•---------...__-••---......_...... � ---•--------r----"-1----.---.-�--�--•---------•--••--•------•--------------•------------•----•---------•--•V•----••------- --.---.-•....;.;-:-.-.-.-f.,.:.�...-.-._.__--- U Nature epairs Alterations—Ans ,when applicable..............11 I �,- . ........�._.__.�._...v._._.�..r .... ............................... A Bement: y 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 C pliance has been `issu by the board of health. Sign __`._ ._.... .._.... /I.- ......... - Dat Application Approved By............. :... _ . ---------........._-------- --_ 1-f-]Date ._ ....... Application Disapproved for the flowing reasons-----------------------•-------------•---.....---•-----------------------------------....._...._•-----........--- .....................................................-••-----••-•••-----••--•••------.......------.....-.----------•-•---•••---=•-•-•••---------...------••-•--•--------••---••-------•-•--•-----._...._ Permit No.._�..1_---- ��` _-..... - ----•------------------- Issued.... --- -•---..._..au------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARDS OF HEALTH ..........OF.....1.... :.. ......:"::'�+........................................... C9rdif irtt#r of ToutpliFanrr THg IS TQ-L-ERTIFY, T]��Ahe I ividual Sewage Disposal System constructed ( ) or Repaired bye............. ...f _________......_____'____-__ °�'-..-_-_•-_ ___ _._.._1 ..........________._.........__.___........._... 1....".. / nstall/s/` /. f....... Lo ..........2 ..has been installed in accordance w tli the provisions of TITLE 5 of Thetz Sanitary Code as escribed in the application for Disposal Works Construction Permit No........ ;. =!I�,............. dated........�-_ _.�. ...g--------------_.-• . THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GU A EE THAT THE SYSTEM WILL FUN TION SATISFACTORY. e DATE........... ...J.. ._- g- ......................................... Inspector............... -- -•- I J THE COMMONWEALTH OF MASSACHUSETTS .-- � BOAR? D O HEALTH a /.�....."��" " ......OF..... I No..._ �"�..... - FEE.-- ............ Disposal Vorjw7 Tunstrud n rrntil- Permission is hereby granted-- •--J ."--- ..............-•- . ... •-- .............................. to Construct ( ) or>,Rep t .r an -Sew 1 posa�l. ystem at No. ... ..... ..........:!p`"....... ........ . St as shown on the application for Disposal Works Construction Per it No85_:A;�k_ Da d1-'�.�__"$ .................... f rd of Health f DATE---------�-----•-�•----- FORM 1255 A. M. SULKIN, INC., BOSTON LOC&.TIOt-,I 5EWoCE PERMIT $T&: VILLAGE IKISTQLLER*S W&ME ADD `-Z 7>h n 11' /W_ s S 15UIL R 5 Q [IMF- ADDRESS �hwk$ /eta — Dt.\TE PER"VT 155UED I IS.. COKAPLI &&ICE ISSUED : - - — r , i I I d r o � . QP d l3 THE COMMONWEALTH OF MASSACHUSETTS BOARD F HE TH ra� ` Ii(............OF...... .... ...... 4....... . pplirFation -fair Bigivii al Works Tonstrurtion Vrrmft Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at tar�`�-----,��'PQO,P.I T'ia.� �4�------------ --------------------------= --------------------------------------------------------------------- �+ oc on-Address ,f�ilAl �a-- ..----------------------------------- ......... 44- oe-:- a= a srr�.�ra�r s............................... Address . ........ ...-------•............................... Installer Address d Type of Building � Ad Le Size Lot_f.?S. __� ._,__Sq. feet U Dwelling—No. of Bedrooms..l�SEo__C_A�__ +��___Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building -_-- No. of persons.- ( ) — ( ) pi _____________________ _ .�_.__.____.._._.__._-_. Showers Cafeteria a Other fixtures ...................................................... W Design Flow.....-.....................................gallons per person per day. Total daily flow--------------------------------------------gallons. W x Septic Tank—Liquid caacity 99 aons Length________________ Width--____.................... Diameter................ Depth........ ._... Disposal Trench�N .................... Vidti...:..::.... . hotalLength.-::.:.......:_. Totalliach .. a1 q Seepage Pit No--- -d �-------- Diameter. Dept belo 1 Total eaciit are:.....,... .._.sc. it. Z Other Distribution box Dosing tank D Total " 4!�'-, 7 6 aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit...................: Depth to ground water........................ 4, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_-.__-_-___-___-____- - ---------------------------------------------------------------•-•----•-•---•-••--------------------......................................................... 0 Description of Soil----------------------------------------•--------------------------- ----------------------------...-•---...------------------------------------------------------------ x - U •-••-•••-•---------•-•••................•••--•••-••----••••-••--••--•-••-------•-•--••••••-------------------•-----------------------------------------••••--•-••-•-............••••......-•-----•---... ----------•-------------------------------------------------------------------------------------------------------------------------••------------------------------------------------------------•----. 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 Article \I of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has Vqn issued by the bo rd of health. Signe .. ... ---. .......................... ----•.................•------------------- Vf Date Application Approved By..... - - ------ ------- - >----------•-. •tl� i�J � ice f. Application Disapproved for the following reasons:........................... .................................................................................. ....................................•-----------------------..............---------..._..------•-•-----.....--• .......r...........------------------.................--- .& DTC_ ate ----- . 'I��ss Permit No......................................................... ued........................................................ MSC . ,trJn -------------- - -- - ----------------- Date •------------------- 10- - No.--•/I- ...... F>aa.... ..................... THE COMMONWEALTH OF MASSACHUSETTS SOAR® - :JH� ........ ...(1�l............OF. ........................ Applirtt#iun -for 4%ipoiial Works Totu#rnr#inn Fermi# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: o. �- l/n� !__'- _ ocaon:Address ... t'Z �� � Q 1....�U �or Lot N�1/I, S < / .— q Owner Address Ch'IEJEv/OS Instal Ier Address Type of Building �� E Size feet Dwelling—No. of Bedrooms... ..'....................................I Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............---------------- No. of persons.-.—">-------.-------------- Showers ( ) — Cafeteria ( ) d Other fixtures ------------------------------------------------------ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacitv.l.uut/ gallons Length................ Width................ Diameter................ Depth.........--..... x Disposal Trench—No. .................... Width.................... Total Length-------............. Total leaching area....................sq. ft. Seepage Pit No..!_61(jo........ Diameter.................... Depth below)• .-nlet........ ......._. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) O4 , 1✓e'4�t — G— /7 — 7 J" Percolation Test Results Performed bY.......................................................................... Date........................................ W Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ W -•------------------•--------••-•---......-•-••----------------•--•-•------••--------•-•••....•-•---....................................... ODescription of Soil............................................................................................................................................... ........................ x U -----------•-----••...-----•-----------------•-----•--•----------------••••-•-•-••---•-•---------•---•----••--•----•-•-••---•-----•------•------•-----•--•------•----......----•--•----....----•-------. W x -•--••-----------------------------------•-----•---•---••---------------•---••---•-••-------•-•---•------------•----......------•----•----•-•-----------•-•--••--•-------......-•---------------•---.... U Nature of Repairs of Alterations—Answer when applicable............................................_.._.....•........_................................. ------------------------------------------------------------------------------------------ Agreement: - The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has Peg issued by the boardof Signe .:• ................ ..... • •--•--•--•-•-•-•-••-•------.. DS!•' - 7 ..- /' Date _ Application Approved By.... : t•.. ' �/' �- -- �' Date Application Disapproved for the following reasons:----------- ---------------------------------------------------------------------•--•-•--••-- --------------------------------------------------------------------------------------•-•----------------••---------•-------•-•--•••---....------•-••---•---•-------•--------------•--••--•-•--------••-- Date PermitNo......................................................... Issued......................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..... 7iI )........OF............. Gv ........ der#ifirtt#.e of Oomplittnre � I b IIbS TO CERTI Y, Thf the Individual Sewage Disposal S,+stem constructed ( or Repaired ( ) ------�/--=•.1�//,O./i�!�" 1.7-.�...1_ /c!!......(�- � - .. -•-- , has been installed in accordance with the provisions of Ayr�tsc e XI of The State Sanitary Cof e 'de c� r-Ued in the application for Disposal Works Construction Permit No.e ...../ L. ..._........... dated...../11----_--- l_!_'..... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A G ARANTEE THAT TIME SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... ---------------------------------... ._ i THE COMMONWEALTH OF MASSACHUSETTS 7S BOARD OlEr HEALTH ............• FEE... Permis;o is hbf . . .G _ranted._.. --' G j ------------- --------- ------�-------- -..!_rim...,�-----------•--•;�"-----•-------- to Cat on�t>r ct_ / , or R pr ( ) an Indauid 1 Se ' e Disposal System �" street - as shown on the application for Disposal Works Construction P I No.....-_..-S'?-. . ed.... 7.s �- Board of 19ealth ......•- DATE...... ----•••------•------............................................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS TOWN OF BARNSTABLE LOCATION �aZ -l2loa4d"-Gc..r�L TzCP SEWAGE # VILLAGE y ASSESSOR'S MAP & LOTgO-9.3 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS /7 BUILDER OR OWNER Lit GL/ PERMITDATE: COMP LANCE 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 Wedand and Leaching Facility(If any wetlands exist within 300 feet of leaching facility)' Feet Furnished by TOWN OF BARNSTABLE 11-7 LOCATION "/` C,��o�-�..y T1GP SEWAGE # VILLAGE ASSESSOR'S MAP & LOTA-5^OJJ- O. cS�_�D�b �app���•�v Cy cD-�iA SEPTIC TANK CAPACITY 14zpde-L 1�6 0-- LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER 6a.4 . PERMTTDATE: 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 0/a LOCATION 6C4,00VZO R CP SEWAGE # VILLAGE � � � ASSESSOR'S MAP & LOT-! ✓ _�ao� .I�1E�S-AI•AA�F ���i���^v. -1F ...P SEPTIC TANK CAPACITY Atr Q— LEACHNG FACILITY: (type) (size NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: COYIPLI.ANCE 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 110142 LOCATION l a -25Z SEWAGE # VILLAGEseax,� SSESSOR'S MAP & LOT SEPTIC TANK CAPACITY G —�v LEACHING FACILITY: (type) (size) NO.OF BEDROOMS— BUILDER BUILDER OR OWNER L.�.(6L4 PERMITDATE: 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 BA.RNSTA.BLE LOCATION �7� �o' � �L� SEWAGE # VILLAGE. SSESSOR'S MAP & LOTa2-93' 10ao1 SEPTIC TANK CAPACITY LEACHING FACIL=: (type) (size NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: 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 ��y7 LOCATION lla r�16*7ac 17CP SEWAGE # VILLAGE ASSESSOR'S MAP & LOT SEPTIC TANK CAPACITY C��t-e•o �-S B- LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BUILDER OR OWNER ��14., PERMITDATE: 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 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EE Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System.at, loclion A or Lot No. Address Installer Address Type of Building Size Lot.... feet Z Other Distribution box Dosing tank '---'-------------------'--'--------------------------------------- Agcoeoent: - The undersigned agrees to install the uforedeucribcd Individual Sewage,Disposal System in accordance with 9peration until a Certificate of Compliance has been issued by the board of health. the provisions of Article XI of the State Sanitary Code—The undersigned f urther agrees not to place'the system in Date Dag Date � �� j4 No..11S5.............. Fm�.. ........................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........OF....... .. ......................... Aptiration -for IN-wiial lVarks Tontitrurtion Urrutit, Application is hereby made for a Permit to Construct or Repair an lndi,vidual Sewage Disposal System at: i 1,3 ................................... ............................................................ ......................... ............. .......(? ...... Location-Address or Lot No. ...................... ..............................f!............. .......................... .................................................................................................. wner Address ....... ...................................................................................... ................................................................................................ Installer Address S,,," L 6' Type of Building Size Lot----------:...........1..........Sq. feet U Dwelling—No. of Bedrooms,,..........................................Expansion Attic G,.Aage Grinder Other—Type of Building .... No. of persons.....---------------------- Showers �.Cafeteria Otherfixtures ------------------------------------------------- .................................................................................................... 7 0 / .t_ 0 Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. 1:4 Septic Tank—Liquid capacity"`--'-_gallons Length------------_-- Width................ Diameter---------------- Depth................ Disposal Trench No..................... Width.................... Total Length------- ----------- Total leaching area... ----------------sq. f t. > Seepage Pit No.-,-------------------- Diameter�.O_"__:-------- Depth betfow' 'fnlef!�.................... Total leaching area------- ----------sq. f t. Z Other Distribution box Dosing tank Percolation Test.Results Performed by.......................................................................... Date-------------------------------------- Test Pit No. I................minutes per inch- Depth of Test Pit.................... Depth to ground water------------------------ �14 Test Pit No'. 2................minutes per inch Depth of Test Pit------------------ Depth �o ground Water------------------------ P4 ----- --------------------------------------------------------------------------------*.............*--------------------------------------------------- 0 Description of Soil------------ .............. ....................................................................................................................I............ U ............................................... ................................................................................................................................................... ------------- -------------------------------------------------------------------------------------------------------------.................................------------------------------------- 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 Article X I of the, State Sanitary Code—The undersigned f urther agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. S, &;L'_; -?=t.� ..................��n----............................. ------ ------ Date ........................ Application Approved By.: Date Application Disapproved for the follb7bing -reasons:--------------------/---------------------------------------------------.............................. .............................................................I..................................................................... ----------- �a ....... ... ... ...7 Permit No......................................................... a Iss_U4 I ie THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................ .... ................ F . :'0 .... .. Tntifirate of 001'amphaurr 0-- T(H,�IS,- TO, CERTIFY That ,the Individual Sewage Disposal System constructed or Repaired .1 .4aA..........-21. A b- V 7' il--------InsUler-------------- �4_10_;................. 7"_ ;4 ......... ........ ........ e.K. .112.......... at crib d ' the ici, has been instal i accortance with the provisions of Ar icle XI of, T e State Sanit?ryy Code as des 1 1 > application for Disposal Works Construction Permit No------------ 10 .................. dated... --------�4............. ............ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM*WILL FUNCTION SATISFACTORY. DATE.............................................................................. Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD ODJ HEALT�' ...... PV1................................ N0.... OF....... _0 ................. FEE...2, ........ ..................... trA It qVrrmit a-, Dispagal rkii TTanfi _t, V Permission* is hereby granted-,—V aw e;-,, o"Y' ........................................... I S t, �a ys`_4 - --------------------- --------------------- - ,to Construct or Repair, aVIndivid ZSewpke sp * -- -1 - .A, - - , ----------------------- at 1,�o.............F....7......................I...17.... ...-.0...-------- F ..Xk. 4��Jw,L"2", Strce as shown on the application for Disposal Works Construction P,,dfltnit Np,_- Dated /I --------------- ---------- --- ------- ------ _W�........ 4a_e .................................. Board'of Heait DATE ................ 3 ------------------------ �OR�_,1 255 HOBBS & WARREN. INC.. PUBLISHERS- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliration -for Dhipmal lVarkii Cnomitrurtion Vrrnift Application is hereby made for a Permit to Construct (v) or Repair ( ) an individual Sewage Disposal ; System at -40.1 -- ---- c t' -Qd es or N. t - - e ...------•---••..... -•---••-- '�"/� --.•• fner N Address Installer Address U Type of Building Size Lot.........._-----------------Sq. feet Dwelling—No. of Bedroom t ��. �'%�E_ at � ) Garbage GrinderOther—T e of Buildi� .a yp Gs'L� .? __ . No. S_______________ Showers ( ) — Cafeteria ( ) Otherfixtures ......................................................----------------------------------- .... -- �v .....�-------•-•-•------- W Design Flow__ ___________ �.__..._. -_ allons per person per day. Total daily flow___----- /. .--_-__________-.__-....gallons. 1:4 Septic "1':lrtk L'quid capacityl allons Length----------------- Width................ Diameter------ ------ D pth....••-------... W Disposal Trench—No_ _______________---- Width.................... Total Length.................... Total leaching area-��_....sq. ft. x Seepage Pit No--------------------- Diameter.................... Depth below inlet...... ....._..... Tota eaching area.-___-_-__-______-sq. ft. Z Other Distribution box ( ) Dosing tank ( ) t Percolation Test Results Performed by______________________ � ---•.......... .................................... Date.................................... Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water_-.__________.---_.__--- Gi, Test Pit No. 2................minutes per inch epth of 'I st Pit.......... ........ Depth to gro nd water........................ 9 -------------------------------- -------------------- ----- -•--••• -•••-••.. . .........._..__....... O Description of Soil____________ ________________ .............. ................................................ 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 Article \I of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. g 1L 11 Signed -----.- G=t--—---r-------•---------------- Date Application Approved By.----- ------ ------ - ----• ---- ---• . Date Application Disappr6ved for the following reasons:--••---•--•----••--•------------- ............................•-.......'.:........_.__.....•-•-----••--•-----------------•---------- -------------------------------------------------------------.------_--.-----------_--_--------- Date Permit No...... �7..4L� Issued. =----------------------•---••-- Date X THE"COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........... ...`........... .� slirtttion -for i� usttf park C��tt rtgitil�tt �rr�ti� Application is hereby made for a Permit to Construct (v) or Repair ( ) an Individual Sewage Disposal System at ` � c't' Qd e.. � or No. 1 A � ---------- •- -•• . .................... ner . Address Installer Address Type of Building Size Lot----------------------------Sq, feet U Dwelling—No. of Bedroo -------------------- E a% ) Garbage Grinder ( ) aOther f—/Type of Buildi / No. �� `� Showers Cafeteria ( ) QOther fixtures : ----------------•-•---••-•-•---------- ........................................./.•.�•y �{----r--------•-----_---- W Design blow.. ..........: ....::�._ __ allons per person perfday. Total daily flow.....____..___-___ ._________._-_._._-.....gallons. WSeptic Tank t L•quid capacity/Mallons Length................ Width.............•.. Diameter---•- D p,th---------------- x Disposal Trench/—No. .................... Width.................... Total Length.................... Total leaching area__�j_�40.'�_.._.sq. ft. Seepage Pit No..................... Diameter-------------------- Depth below inlet------ Tota eaching area_=__...._..__....sq. ft. z Other Distribution box ( ) Dosing tank Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. 1----------------minutes per inch Depth of "Pest Pit...________-____-_-- Depth to ground water........................ (� Test Pit No. 2----------------minutes per inch Aepth of T st Pit---------- -------- Depth to gro d water------------------------ -------------•--........----...... _....._....-- !........... .----- -• ............. • • -- - ---•••--------------------•------------- ODescription of Soil ............ .............................................. .x _ U --•--------------------•--•----...........-----------....._..........----------•--•------......---•--•-------...._---•-------------•------...._...------•-•--•........-- ......------------ w x ... --------••---------------------------------------------------------------•-...••••.....-•-•----------•--------.......--------....----------------••---------------------------•..._.---.......------ V Nature of P.epairs or Alterations—Answer when applicable............................................_...._._............___._...__.._...__-___..._...... .. . .........................•--•------..........-----------------------...----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I 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. Signed --• �,. r�,,., --------- D l ' , -• --•-• -••--- / a e Application Approved By... �.............. .. •-• . =•- ---------- ..... ... ................... Date...._.. Application Disapproved for tlt.e following reasons:. ___ ........................................_..............------.........---........--••-------------•-----• ..------..........._..------_.._.._...... Date PermitNo.-----.................................................. Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........OF........ ./ �. (Irr#if iri#p of Tamlifiattre 7jF IS TO,CERT� Y, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) (/ -- - --�-�-�-- - -- ----�----- - - - •- T�J/ • 4 I taller leas been installed in accordance with the provisions of Article XI The State Sanitary Code as described in the application for Disposal Works Construction Permit No-----------------------------............ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE ' SYSTEM WILL FUNCTION SATISFACTORY. DATE.......... ............................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH2�-- ....... .....OF....:�................ .. ..... ....--•--•..... No.._ --��._.._... _.._•. FEE.- .......... Bisils al orkii C rttrti t ,�Vrrmit � . . Permission is h eby granted:__ .. £f`.�. .._ ..,.. ��1.....:............................. to Construct ( or pair ( ari In ' .idual iSewa Disposal S st ... sir t _ as shown on the application for Dispo7Woonstruction Permit ........... .....v Da -- ...----•---- „ / Board of Health DATE... _./.. ...f'- - FORM 125.5. HOBBS & WARREN. INC.. PUBLISHERS r r 10 OD All U Sr ly t i r � N t t L cxz u5 r^