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HomeMy WebLinkAbout0104 ENTERPRISE ROAD - Health I04-Enterprise Road Hyannis A = 294-0 WER-s Transmissions o l e e i e c e i Message Pagel of 1 Lavelle, Timothy From: Lavelle, Timothy Sent: Wednesday, February 15, 2017 9:26 AM To: Roma,'Paul Cc: Anderson, Robin Subject: 24 Plant Road, Rhino Lining Here are my notes from review of the package sent by Pizzuti & Mazzeo: 1) Both of the liquid component parts of the process (isocyanate and resin) meet the town's definition of hazardous material under 108-3 B.(1). Cleaning solvents including acetone and/or isopropyl alcohol would also be kept on site. 2) The attorney is"splitting hairs" by saying that the pre-mixed components are not considered "waste" and therefore are not subject to the zoning bylaws-the zoning bylaws were written based on the Massachusetts Contingency Plan that only uses "waste" in its language. 3) It's true that a conventional spraybooth and permit would not be required, but all discussion of an enclosed application room with mechanical ventilation and particulate filters matches what I was told by MassDEP -this was not discussed by the proponent when they initiated this process. This is what I would require if this project moves forward. Timothy Lavelle Hazardous Materials Specialist Town of Barnstable Public Health Division 200 Main St, Hyannis, MA 02601 508-862-4645 tim.lavellena town.barnstable.ma.us 2/15/2017 r., PIZZUTI & "` Steven J. Pizzuti, Esq. FAAMAZZE0 steven@pizzutimazzeo.com P:508-771-1911 A T T O R N E Y S Anthony J. Mazzeo, Esq. F: 508-790-0800 anthony@pizzutimazzeo.com 336 South Street, Hyannis, MA 02601 www.pizzutimazzeo.com 'Via email to robin.anderson@town.Barnstable,ma.us and first class mail February 7, 2017 Robin Anderson, ZEO Town of Barnstable 200 Main Street Hyannis, MA 02601 RE: Rhino Lining Application at 24 Plant Road, Units 4 & 5 Hyannis Dear Ms. Anderson: Cape Custom Coatings desires to apply Rhino Lining spray protective finings at the commercial condominium located at 24 Plant Road Units 4 & 5 Hyannis, Massachusetts. The condominium is identified as Map 312/Block017/Lot00D and is in the Town of Barnstable Groundwater Protection Overlay District. Cape Custom Coatings submits this letter in support of its proposed use and to answer any safety questions at the request of Barnstable Zoning Enforcement Officer Robin Anderson. Cape Custom Coatings is owned by Christopher and Courtney Van Gelder. Christopher and Courtney are respected business owners who own and operate Hyannis'Transmission II located at 104 Enterprise Road Hyannis, Massachusetts. They intend to purchase the unit located at 24 Plant Road and operate Cape Custom Coatings,as a family business. Cape Custom Coatings would apply Rhino Lining coating to vehicle bed liners and undersides in order to provide corrosion resistance. Two component systems are mixed resulting in an inert polymer coating that is sprayed onto the vehicle and dries within 5-8 seconds. The two components will ✓not affect groundwater or air quality when properly handled, and any waste material is not ti v considered hazardous. b QUESTIONS After a telephone conversation between myself and Robin Anderson, Ms. Anderson asked that specific questions regarding material safety and application be addressed. _ 4 I have contacted representatives from Rhino Linings, and attached the following supporting documentation: Email from Rhino Linings (Exhibit"A"); Fire & Safety Report (Exhibit"B"); Rhino Hybrid Data Sheet(Exhibit-"C"); Requirements Spray Equipment Transfer Efficiently Test(Exhibit"D"); and Letter from Rhino Linings (Exhibit"E"). The questions addressed are as follows: 1) What is the impact on air quality? What is impact on HVAC? Why is a spray booth not needed? If a spray booth was used would the filters eventually become clogged? "There is no impact on air quality refer to fire marshal letter. As far as a spray booth goes there is no need to have a conventional spray booth with a sprinkler system due to the fact that the material is 100% solids with no voc's or solventslthere should be an application enclosure with a fan and filters for catching oversprayll particles because the 2 part material when it comes together in a dual application gun the procluct turns inert. The filters would have to be changed on a regular basis." (See Exhibit"A) 2) Are any of the substances flammable? Neither substance is fire combustible. (See Exhibit"B") 3) Are any of the substances petroleum based? No. (See Exhibit"C") 4) What is the specific substances being used? Isocynanate and Resin. (See Exhibit"C") 5) How much of each pre-mixed substances would we like to store on site? Ideally, a maximum of 55 gallons of each substance would be stored on site. See (Exhibit"A") ZONING IN GROUNDWATER PROTECTION OVERLAY DISTRICT The Condominium is located in the Groundwater.Protection Overlay District as defined by The Town of Barnstable By-Laws §240-35. Ms. Anderson was concerned that since the condominium was located in the groundwater protection overlay district, the property would be preempted from housing a Rhino Lining application system because prohibited uses of By-Law §240-35 (F)2(p). After further investigation, outlined above and in the attached exhibits, it is clear that the Rhino Lining application would not be categorized as a prohibited use because the pre mixed substances are not"hazardous waste that are subject to MGL Ch 21C and 310 MCR 30.00" and as noted by Rhino Linings"Our waste material from masking has been thoroughly tested for disposal by standard means and is not considered hazardous." (See Exhibit E) CONCLUSION Since the proposed use would not be prohibited in the groundwater protection overlay district, Cape Custom Coatings would like to schedule a time as soon as possible to meet with Town of Barnstable Officials in order to expedite approval of its proposed Rhino Lining application use. Very truly yours, AnJhy rzzeo AJM/bb Enclosures CC: Christopher and Courtney Van Gelder f EXHIBIT A Anthony Mazzeo From: Dan Gamba <dgamba@rhinolinings.com> Sent: Wednesday, February 01, 2017 1:37 PM To: Anthony Mazzeo Subject: RE:Cape Custom Coatings Attachments: Fire Marshall Letter.doc; Rhino_Hybrid_HP_11-50_TDS.pdf Hello Anthony, Question 1 There is no impact on air quality refer to fire marshal letter. As far as a spray booth goes there is no need to have a conventional spray booth with a sprinkler system due to the fact that the material is 100% solids with no voc's or solventsthere should be an application enclosure with a fan and filters for catching overspray particles,because the 2 part material when it comes together in a dual application gun the product turns inert.The filters would have to be changed on a regular basis. Question 2 answered in the fire marshal letter. Question 3 please see Hybrid TDS sheet Question4 please see Hybrid TDS sheet Question5 The product doesn't come pre-mixed it is shipped in 55 gallon containers a product A& B and is mixed through a plural component heated system. Normally you would have 1 container of each on site. Hopefully this will help. From: Anthony Mazzeo [mailto:anthony@pizzutimazzeo.com] Sent: Wednesday, February 01, 2017 9:31 AM To: Dan Gamba Subject: Cape Custom Coatings Dan: The Town of Barnstable Board of Health has some specific safety and health questions it would like addressed for Cape Custom Coatings proposed business to apply the Rhino Linings product. I would like to present the answers to these questions: 1) What is the impact on air quality? What is impact on HVAC? Why is a spraybooth not needed? If a spraybooth was used would the filters eventually become clogged? 2) Are any of the substances flammable? 3) Are any of the substances petroleum based? 4) What is the specific substances being used? 5) How much of each pre-mixed substances would we like to store on site? If you have any evidence/research that I can support the answers to these question in a letter to the town it would be greatly appreciated. Anthony J. Mazzeo, Esq. Pizzuti &Mazzeo, LLC 336 South Street Hyannis, MA 02601 i h Ph. (508) 771-1911 Cell (774)238-0255 Fax (508) 790-0800 anthony@pizzutimazzeo.com PIZZUTI MAZZEG CONFIDENTIALITY STATEMENT The information transmitted by this e-mail is intended only for the addresses and may contain confidential and/or privileged material. Any interception,review,transmission,dissemination,or other use of,or taking of any action upon this information by persons or entities other than the intended recipient is prohibited. If you receive this communication in error,please contact the Sender immediately at(508)771-1911 and delete the communication from any computer or network system. Although this email and any attachments are believed to be free of any virus or other defect that might negatively affect any computer system into which it is received and opened,it is the responsibility of the recipient to ensure that it is virus free and no responsibility is accepted by the Sender for any loss or damage arising in any way in the event that such a virus or defect exits. 2 EXHIBIT B 11YINIRhino Linings February 7, 2017 Re: Fire & Life Safety Requirements Dear Fire Marshall or Inspector, This letter is intended to assist you in understanding the Rhino Linings spray-on protective linings process and answer any questions regarding the flammability of the Rhino Linings products. Also, we are providing information on relevant fire codes pertaining to the Rhino process. This includes the appropriate sections of the 2003 Uniform Fire Code (UFC), and the National Fire Protection Association (NFPA). Rhino Linings (RLUSA) polyurethane linings are 100% solids and do not contain any solvents or volatile organic compounds (VOCs). The lining is created by the reaction of two liquid components - an isocyanate and a resin. Once the two Liquid raw materials are properly mixed and applied, they react completely to form an inert polymer that is completely harmless. The flashpoint for the isocyanate is 427 OF and the resin is 3920F making both components non-flammable and non-combustible by the standard definitions. The NFPA uses the Underwriters Laboratories UL340 standard for testing and comparing the flammability of liquids. Based on this standard, The Rhino Linings iso (A) and resin (B) components meet the UL 10-20 rating. For your reference, an in-shop Rhino Linings spray-on lining process has the following basic steps: 1. Cleaning the surface — blowing and wiping it down with a rag dampened with acetone as necessary. Technician wears a cartridge respirator when wiping with acetone. 2. Masking the area with tape and paper. 3. Roughening the surface with the appropriate tools, i.e. cup-brush sander or by hand. 4. Final wipe down with acetone (using a dampened rag) to pick up dust and dirt. 5. Ap I i t of et ane 'ni usin the proper ersonal rotective a ui ment PE) in a ventilated application room. 6. 1 a cus om color is required, then a solvent-based UV topcoat polyurethane paint is use onto t e fining. 7. Final un-masking and trimming. The Rhino process will use small quantities of acetone in order to clean the surface. A rag dampened with acetone is used to wipe the surface clean of any dirt, oil or grease residue. A plunger can is used to dampen the rag and to avoid spilling excess acetone. For this cleaning, the shop will not need more than 1-2 gallons of acetone on site at any given time. At no point in our process is a flammable material sprayed or atomized. 1 The lining is applied in an application room that is curtained to contain any overspray and the ica vapors that may be generated. A fire retardant polyethylene curtain is used because the polyurethane overspray easily peels off the plastic curtain. This allows the shop to keep the application room clean and free from excessive overspray build-up on the walls. The application room also has an exhaust fan to clear the air of any overspray and c emical vapors. The exhaust an uses situp a particle arrestor alters i e urnace filters) to capture any small polyurethane particles. The materials involved in this operation are two part materials classified as Class III-B combustibles and irritants. A complete list of all materials being stored or used and their quantities is attached. Quantities will be maintained below the exempt amounts allowed in Table 3-D of the UBC, Tables 7902.1-A (container type and size), 7902.5-A and 7903.2-13 of the UFC for Class III-B combustible liquids. Also, quantities will be maintained below the exempt amounts allowed for materials classified as irritants (Table 8001.13-13 of the UFC.) Therefore, a flammable or combustible liquids permit, or a permit for material classified as an irritant, will not be required. A spray booth permit should not be required since the material being applied is not flammable. Also, since the material is being applied with low temperature, low pressure equipment, it is not atomized or finely divided. The application process does not present the hazards usually associated with spray applications of Class I flammable liquids, such as lacquer base paints and varnishes. NFPA 33, Chapter 14 (2003 Edition) Miscellaneous Spray Operations This product and application is an automotive body lining operation as discussed in NFPA 33, Chapter 14. If adequate natural or mechanical ventilation is provided,this operation is exempt from the spray booth provisions of the UFC for spray finishing operations. RHINO LININGS TRANSFER EFFICIENCY TEST Attached to this letter is a Spray Equipment Transfer Efficiency Test Report, provided by Rhino . Linings USA, Inc. On March 15, 1994, Rhino Linings USA, Inc., and Rhino Linings of Glendale, performed a transfer efficiency test of the Rhino Linings Application system. As the high performance coatings are applied,the Rhino product will hardener i�econds r s . The 1% of lost product is not fugitive and is found on masking paper, floor and walls of application area. However, mechanical ventilation will be provided for adequate air changes to comply with Chapter 12, ection -1 of NFP an ar o. PRODUCT INFORMATION New Rhino Linings Dealers offer the same service and utilize the same processes and materials used by all 800 + Dealers currently in operation throughout the United States and other Countries. The following materials are used at Rhino Linings Dealerships. " 2 Tuff Stuff 85-15, a polyol resin Blend, is a Class III-B combustible liquid with a flash point of 392°F. Tuff Stuff A323 (MDI Isocyanate) is a Class III-B combustible liquid with a flash point of 427°F. Quantities in open and closed use do not exceed the exempt amounts of allowable Class III-B combustible liquids for storage, use and handling,_per the 2003 edition of the Uniform Fire Code. Rhino Linings Authorized Dealers will also use minimal amounts of Class I flammable liquids such as Acetone and Denatured Alcohol, for cleaning and wiping when necessary. The Uniform Fire Code also exempts the use of 30 gal IIons of Class I-A flammable liquids for storage and use in approved safety containers, with not more than an aggregate amount of five to ten gallons in use. Each container shall not be larger than an approved one-gallon "safety can" meeting the minimum requirements of the fire code. Sincerely, Bharat Naik Director of Technical Services I 3 EXHIBIT C ti ��lff1'110- f A . Part A- Rhino Hybrid" HP 11-50 Iso - Part # 60216-1 } Part B- Rhino Hybrid" HP 11-50 Resin - Part # 60250-1 DESCRIPTION: Rhino Hybrid"HP 11-50 is a one to one volume ratio,two-component, 100% solids(no VOCs,no solvents), exothermic,rapid curing, elastomeric hybrid polyurea lining system.The lining thickness varies based on application,typically minimum of 1/16" (62.5 mils; 1.6mm)up to unlimited thickness. It can be sprayed up to 98% humidity and a dew point temperature difference of 15'or more with no blistering. Rhino Hybrid HP is easy on spray equipment with no fast gelling at the spray gun tip. TYPICAL USES • Excellent general purpose industrial lining for •Spray-on application creates a monolithic,seamless lining applications such as: that conforms to any shape and size -Material delivery systems where a • Bonds to virtually all substrates of any dimension, including seamless flexible system is-essential metals,wood,concrete and fiberglass -Floor and wall protection in industries such •Can withstand vehicle forklift traffic and heavy loads with as food processing,food storage, proper thickness build veterinary,production area and laboratories •Stable from-40OF(-40°C)to 1750F(79.4°C) -Secondary containment as a monolithic, •Elastomeric properties allow for application to surfaces impermeable lining for industrial plant, subject to:vibration,expansion, contraction, agriculture,and petrochemical applications movement,flexing,abrasion and impact. • Reduces noise from vibration and impact FEATURES&BENEFITS: • Robust application window with ability to spray at •Good chemical resistance low temperatures and high humidity • Excellent corrosion resistance • High tensile strength and tear strength properties •Good noise reduction •Very good abrasion and impact resistance • Easy to texture CHEMICAL PROPERTIES_*: Standard Test Isocya_nate_(A) Resin(B) Specific Gravity(grams/cc)— _ _ASTM D-792 1.09—1.12 -- 1.13—1.02 Viscosity,cps 550 850 _Solids by Volume/Weight __ ---- 100% —__ 100% —_ - Volatile Organic Compounds,calculated —0 Ibs/gal — 0 Ibs/gal — —Mix Ratio, parts per volume— ---__ 1 1 Mix Ratio, parts per weight 109 100 _Gel Time,seconds 3 Tack Free,seconds -- 4 —_— — — BcOat, max _ ----- 4 hrs ---_------------_—.—_ I 95—99% Cure Time 24 hrs Theoretical Coverage 1600 sqft/gal 0 1 mil -- — Odor _mild amine Freezing Point — 40*F n/a -- Base Color _ amber/brown_ _ amber/brown_ _ _ _Shelf Life-Unopened Containers — 12 months — 12 months — — -- •Properties were tested at 77T(25*Q. TYPICAL PHYSICAL PROPERTIES: Test Result Hardness(Shore D) ASTM D-2240 50±5 —__ -- ----- --- ---- -----Tensile Strength Strength(psi)** ASTM D-412 2250 Secant Modulus @ 100% elongation ASTM D-412 1250 Secant Modulus @ 200% elongation --- --- ASTM D-412 1850 _-- Tear Resistance(pli)**Die C ASTM D-624— 375 — Elongation(%)** ASTM D-412 _250 — Impact Resistance,ibs ---_ ASTM D-2256 _ 160 (continued) ensi m�m5 RHINO HYBRID"HP 11-50(continued) TYPICAL PHYSICAL PROPERTIES: Test Result Density(lb/ft3) ASTM D-1622 69-70 Compressive Strength(psi) ASTM D-695 800 Taber Abrasion Resistance(mg of loss/1000 cycles) ASTM D-4060 140 H18 Wheel; 1000 grams weight Mandrel Bend, 180°, 1 inch mandrel ASTM D-522 Pass Coefficient of Friction on Steel: -Static ASTM D-1894 .6 -Kinetic ASTM D-1894 _.55 Water Absorption(%) ASTM D-570 _s1.6 Dielectric Strength(volts/mil) _ _ ASTM D-149 300 Volume Resistancy(ohm/inches) _ _ ASTM_D-257 6 X 10(12) —---__ Dielectric Constant(MHz) _ _ ASTM D-150 _5.4 �___' Dissipation Factor(MHz) V `^ ASTM 0-150��~ 0.058 _ Cathodic Disbonding _ ASTM G-8 Pass "Properties were checked of Rhino Hybrid-lining,lh.'(62 mils),(1.6 mm)thick stock. PROCESSING CHARACTERISTICS:The system settings required to achieve quality spray application will vary depending on environmental and substrate conditions.The following recommended parameters will help ensure optimum quality. Equipment Spray Gun Process Pressure,psi(static) Graco Reactor E-XP1; E-XP2 Fusion-Air Purge or Mechanical Purge 2000-2500 Process Temperatures Iso Com onent Resin Component Hoses P _ P 1500-160°F 1400-150°F DRY FILM THICKNESS RANGE:Varies based on application,typically a minimum of 1/16" (62.5 mils; 1.5mm)up to unlimited thickness. NOT RECOMMENDED FOR: • Sustained temperatures below-40°F(-40°C)or above 250°F(121°C) •Application to high-density polyethylene or thermo plastics CHEMICAL RESISTANCE:Rhino Hybrid HP 11-50 provides good resistance to many commercial and industrial chemicals such as acids,alkalis,oils and cleaning chemicals. For specific applications and information,please consult a Rhino®representative. SUBSTRATES: Metals,wood,concrete,fiberglass, most epoxy or polyurethane painted substrates and geotextiles COLOR OPTIONS:Standard colors-black.Custom colors are available by special order. HOW SUPPLIED: Net weight per set is 910 pounds(412.7 kg).A set of Rhino Hybrid HP 11-50 consists of one(1)55 gallon (208 L)drum of'A'component and one(1)55 gallon(208 L)drum of'B' component. SAFETY PRECAUTIONS:Health Considerations:Consult the Rhino Linings®Safety Data Sheets(SDS) This chemical system requires the use of proper safety equipment and procedures. Please follow the Rhino Linings®product SDS and Safety Manual for detailed information and handling guidelines. For Your Protection:The information and recommendations in this publication are,to the best of our knowledge,reliable. Suggestions made concerning the products and their uses, applications,storage and handling are only the opinion of Rhino Linings Corporation.Users should conduct their own tests to determine the suitability of these products for their own particular purposes and of the storage and handling methods herein suggested.The toxicity and risk characteristics of products made by Rhino Linings Corporation will necessarily differ from the toxicity and risk characteristics developed when such products are used with other materials during a manufacturing process.The resulting risk characteristics should be determined and made known to ultimate end-users and processors. Because of numerous factors affecting results, Rhino Linings Corporation makes no warranty of any kind,express or implied,other than that the material conforms to its applicable current Standard Specifications. Rhino Linings Corporation hereby disclaims any and all other warranties, including but not limited to those of merchantability or fitness for a particular purpose. No statements made herein may be construed as a representation or warranty.The liability of Rhino Linings Corporation for any claims arising from or sounding in breach of warranty,negligence,strict liability,or otherwise shall be limited to the purchase price of the material. ©2015 Rhino Linings Corporation.All rights reserved. Rhino Linings Corporation ings• 9747 Businesspark Avenue,San Diego,CA 92131 Rhino Lin PROTECTION NEVER LOOKED SO GOOD- 1-8 0-422-26 •Fax 858 450 6881 1-800-422-2603 www.rhinolinings.com EXHIBIT D Rhino Unings7 SPRAY EQUIPMENT TRANSFER EFFICIENCY TEST REPORT On March 15, 1994 Rhino Linings USA, Inc., performed a transfer efficiency test of the MK- 14 application system. The MK-14 system is manufactured by, Rhino Linings USA, Inc., 9151 Rehco Road, San Diego, California 92121. It is designed to proportion, mix, spray and apply Rhino Linings high performance coatings. The test method was that contained in South Coast Air Quality Management District- Spray Equipment Transfer.Efficiency Test Procedure for Equipment User, May 24, 1989. The protocol was that submitted by Rhino Linings USA, Inc., in November 1993 (addendum A)with revised section F (addendum B) per AQMD meeting of March 8, 1994. The test procedure (addendum C) followed that submitted to AQMD on March 11 via facsimile transmission. Following the above submitted format, a typical pick-up truck bed was prepared and coated with Rhino Linings on March 15, 1994 at Rhino Linings of Glendale, Inc., 1819 Dana Street, Glendale, California 91201. Representing this firm and performing the spray application was Mr. Valerio De Guevara, President. Representing the AQMD and witnessing the test in order to validate the result was Mr. Jerry Ebersole, Air Quality Engineer. Based on the data obtained from the test and recorded on a handwritten work sheet (addendum D), which was witnessed and initialed by Mr. Ebersole, the following figures were developed and used to compute the transfer efficiency percentage. 1) Total weight of material produced 20,240gm 2) Weight of material delivered to test surface (21,021gm less 1063gm tare) 19,950gm 19,950gm = 99% 20,240gm By this test, transfer efficiency 'of the MK-14 spray equipment is shown to be 99%. Variations in the shapes/sizes of pick-up truck beds can be expected to alter the figure by a small amount not significant to the pass/fail requirement figure of 65%transfer efficiency. Submitted by: Rhino Linings USA, Inc. Mr. Richard Oglesbee March 18, 1994. 4 'I EXHIBIT E I LMW December 8, 2016 City of Barnstable Barnstable, Massachusetts Re: Operations at Cape Custom Coatings To whom it may concern, This letter is meant to address environmental and health concerns the City of Barnstable may have regarding the Rhino Linings product offering at Cape Custom Coatings. Rhino Linings has been offering our products through independent applicators for 29 years. We pride ourselves on offering a coating for vehicles that is not only highly functional but environmentally friendly and safe to apply. Our products contain no VOC's and are not flammable. They are a two component system applied through proprietary equipment that is designed to precisely mix the components resulting in an inert polymer coating that dries in 5-8 seconds. As such, our products do not adversely affect groundwater or air quality when properly handled. Our waste material from masking has been thoroughly tested for disposal by standard means and is not considered hazardous. Rhino has over 450 shops nationwide safely applying our products in every state in the USA and in many countries worldwide. We are confident that Cape Custom Coatings will represent us well in the City or Barnstable. Should you have any additional concerns please feel free to contact me directly. My mobile phone number is (858) 205-5188. Sincerely, An6 196cfan RHINO LININGS CORPORATION Director of Technical Services Office: 800.747.6966 1 Fax: 858.450.5078 http://rhinolinings.com Rhino Linings Corporation 9747 Businesspark Avenue • San Diego,CA 92131 USA, PROTECTION 50°°012°°' NEVER LOOKED SO GOOD. www.rhinolinings.com•Tel 858.450.0441 9Fax 858.450.6881 iAA6'� U.S. Environmental Protection Agency April 2011 Methylene Diphenyl Diisocyanate (MDI) And Related Compounds Action Plan [RIN 2070-ZA151 I. Overview This Action Plan addresses the use of methylene diphenyl diisocyanate (MDI) and related compounds (See Appendix 1) in products that may result in consumer and general population exposures, particularly in or around buildings, including homes and schools. Diisocyanates are well known dermal and inhalation sensitizers in the workplace and have been documented to cause asthma, lung damage, and in severe cases, fatal reactions. This Action Plan focuses on the potential health effects that may result from exposures to the consumer or self-employed worker while using products containing uncured (unreacted) diisocyanates (e.g., spray applied foam sealants, adhesives, and coatings) or incidental exposures to the general population while such products are used in or around buildings including homes or schools. In conducting this review of MDI compounds, EPA considered a number of potential actions, including regulatory actions under TSCA sections 4, 5, 6, and 8; cooperative actions with other federal agencies; and voluntary actions. II. Introduction As part of EPA's efforts to enhance the existing chemicals program under the Toxic Substances Control Act (TSCA)',the Agency identified an initial list of widely recognized chemicals, including MDI, for action plan development based on their presence in human blood; persistent, bioaccumulative, and toxic (PBT)Z characteristics; use in consumer products; production volume; and other similar factors. This Action Plan is based on EPA's initial review of readily available use, exposure, and hazard information 3 on MDI. EPA considered which of the various authorities provided under TSCA and other statutes might be appropriate to address potential concerns with MDI in developing the Action Plan. The Action Plan is intended to describe the courses of action the Agency plans to pursue in the near term to address its concerns and does not constitute a final Agency determination or other final Agency action. Regulatory proceedings indicated by the Action Plan will include appropriate opportunities for public and stakeholder input, including through notice and comment rulemaking processes. In a concurrent action, a separate Action Plan is under development for Toluene Diisocyanate (TDI), a substance chemically related to MDI with similar hazard and exposure concerns. 15 U.S.0 §2601 et seq. 2 Information on PBT chemicals can be found on the EPA web site at http://www.epa.gov/pbt/. ' Sources initially consulted for basic background information for all the action plan chemicals,including MDI, include Inventory Update Report(IUR)submissions;Toxic Release Inventory(TRI)reporting;data submitted to the HPV Challenge Program;existing hazard and risk assessments performed by domestic and international authorities including but not limited to U.S.Federal government agencies,the Organization for Economic Cooperation and Development,the Stockholm Convention on Persistent Organic Pollutants,Health and Environment Canada,the European Union;and others. Details about the specific sources used for this Action Plan can be found in the reference list in Section XI.of this document. 1 .. U.S. Environmental Protection Agency April 2011 III. Scope of Review Diisocyanates (also commonly known as isocyanates) are highly reactive and versatile chemicals with widespread commercial and consumer use. Over 90%of the diisocyanates' market is dominated by1wo diisocyanates and their related polyisocyanates: MDI and toluene diisocyanate(TDI) (Allport et al., 2003). They have unique properties and functional versatility, and contain free isocyanate functional groups (-N=C=O). When isocyanates are combined with other compounds that contain free hydroxyl functional groups (i.e. —OH)they react and begin to form polyurethane polymers. This chemical reaction is completed when all of the initially free— N=C=O groups are bound within the polymer network. This process is commonly referred to as "curing." Products that contain free N=C=O groups are intended to react and undergo "curing" in the process of use. An example would be an adhesive, which is sold to be initially applied in an uncured form and as it cures(hardens), bonds two pieces of wood together. Other polyurethane products, such as mattresses, pillows, and bowling balls, are considered completely cured products before they are sold. Completely cured products are fully reacted and therefore are considered to be inert and non-toxic (Krone & Klinger, 2005). This Action Plan focuses on concerns for unreacted uncured products. Because of their reactivity and the diversity of uses, MDI and its related polyisocyanates (see Appendix 1) are generally supplied by their manufacturers as raw materials to formulators who take advantage of the diisocyanates' chemistry to combine them with other chemicals to create different polyurethanes with a wide diversity of applications. This diversity of applications also means that exposures to diisocyanates can occur in a broad range of production facilities from small workshops to automated production lines. Diisocyanates are potent dermal and lung sensitizers and a major cause of work-related asthma worldwide (NIOSH, 2006). Diisocyanates are also commonly available in unreacted forms as part of product mixtures widely used in construction, automotive, and other similar applications that require an end-use reaction as part of the functional performance of these products. Such applications occurring beyond the confines of a controlled production facility could result in exposures unless there is careful observance of best practices and controls to prevent exposures, including the use of protective equipment, containment,ventilation,proper clean-up practices, and medical surveillance of anyone who may be exposed. In the past, consumer exposures have not been a focus of concern with respect to diisocyanates, because it has been assumed that consumers were generally exposed to products containing cured polyurethanes, which have been generally considered to be inert and non-toxic (Krone & Klinger, 2005). However, an increase in the consumer availability of polyurethane products intended to further react and undergo "curing"has occurred in the marketplace (see additional discussion in section on Consumer/General Population Exposure). For example, installation of spray polyurethane foam insulation in homes, schools and other public buildings is a source of potential exposure to uncured isocyanates by building occupants, as well as in do-it- yourself(DIY) consumer projects. Readily available consumer products, such as adhesives (including glues) and sealants also contain diisocyanates that are not completely reacted when applied and can provide potential exposures (Krone, 2004; Bello et al., 2007). In addition, certain workers (e.g., self-employed) are not subject to the applicable OSHA exposure limits, and are not legally required to receive health and safety training and chemical hazard 2 U.S. Environmental Protection Agency April 2011 information, or wear personal protective equipment(PPE)or undergo medical surveillance and therefore could potentially be overexposed to uncured polyurethane products. EPA is concerned about the presence of uncured MDI in products used by or around consumers, as well as other unprotected building occupants, and the lack of guidance or regulations to protect them, this action plan focuses on the potential health effects that may result from exposures to the consumer or self-employed worker while using products containing uncured MDI, or incidental exposures to the general population while such products are used in or around buildings,including homes or schools. IV. Uses and Substitutes Summary MDI and TDI are the largest volume aromatic diisocyanates, are high production volume chemicals, and are predominantly used in the production of polyurethanes. In 2008, the U.S. demand for pure MDI was 192.1 million pounds and for polymeric MDI was 1,418 million pounds (ACC, 2009). There are many types of polyurethane products in the marketplace, with foams representing the largest sector of the polyurethane industry. Non-foam polyurethane use sectors of MDI and polymeric MDI include coatings, adhesives, binders, and sealants. However, these products comprise a small amount of the total production volume. Polyurethane foams take two forms: flexible and rigid. Flexible foam is primarily used for cushioning, while rigid foam is used mainly for insulation. The majority of polyurethane products undergo curing prior to reaching the consumer. However, other polyurethane products such as spray foams, coatings, sealants and adhesives may be sold and used, most often in a mixture of formulated product, in an uncured form. Researchers looking at workplace exposures to diisocyanates have noted an increase in the number of isocyanate-containing products used by consumers. These researchers also noted that community exposures to isocyanates could potentially result from industrial exposures as well as the use of consumer products containing isocyanates (Redlich, et al, 2006). The 2006 Inventory Update Reporting(IUR) database indicates that MDI chemicals are used in the following consumer/commercial categories: adhesives and sealants; paints and coatings;transportation products; rubber and plastic products; and lubricants, greases and fuel additives (EPA, 2010). The vast majority of these products contain forms of MDI as the diisocyanate components. To reduce vapor hazards, polyisocyanates and pre-polymer forms of isocyanates were developed;however, many products contain a mixture of MDI monomer and a MDI-based polyisocyanate. The use of polyurethane foam for insulation is greatly expanding as many federal and state government programs create incentives for their use in increasing energy efficiency. In addition to their traditional uses by commercial applicators to insulate roofs and walls of buildings, pour-in-place foam, spray polyurethane foam(SPF) and one-component foam(OCF) have a variety of other uses. Pour-in-place, SPF, and OCF cans are all used in the arts arena for sculpture, mold making, and designing movie and theater sets. They are similarly used in theme parks, shopping malls, and parade floats (ACC, 2009). In addition, these types of foams are popularly used by arts and crafts hobbyists. Other major types of non-foam polyurethane products sold for use in an uncured form include coatings and adhesives. The terms "coatings", "sealants", "binders", and "adhesives" are 3 U.S. Environmental Protection Agency April 2011 sometimes used interchangeably when referring to various polyurethane products and some industry sectors use some or all of those four types of products. In particular, the auto refinishing and repair, the marine leisure craft maintenance and repair (ACC, 2009), and the floor and deck maintenance and repair (Jarand et al., 2002; ACC, 2009) sectors have all had a variety of uncured polyurethane products available to both the professional applicator as well as the DIY consumer. Additionally, the synthetic recreational surfacing industry uses a variety of for both indoor and outdoor surfaces c m orients in formulating its products o b t polyurethaneo p g (Advanced Polymer Technology Corporation, 2010). Polyurethane coatings are available for use by industry and consumers to seal concrete, waterproof walls and refinish floors. Polyurethane sealants have a variety of uses in the automotive sector, the largest being glass installation of windshields and side windows. Polyurethane adhesives are used in numerous industrial and consumer applications. Some of these products are specifically marketed to DIY consumers for general multi-purpose applications as well as for specialty uses in woodworking, bookbinding and other hobbies. Consumer use of adhesives and sealants is a growth sector as noted by an industry overview of this sector in late 2009. This growth reflects increasing numbers of DIY energy-conscious homeowners doing more of their own home renovation and repair work in order to save money, as well as from craftsmen and consumers generally continuing to use adhesives (Pianoforte, 2009). The spray foam industry, recognizing the growing use of these products by DIYers, recently developed a website on the use of spray foam with guidance directed specifically to DIYers, in addition to homeowners and professionals (ACC, 2010). Replacement of diisocyanates in an environmentally and economically friendly manner presents a significant challenge. However, a new class of non-isocyanate polyurethanes that offers potentially safer alternatives to conventional polyurethanes has been reported by two research groups(Figovsky & Shapovalov, 2006; Javni et al., 2008). Other reported technologies include an isocyanates-free expanding foam product (Soudal, 2010) and a faster curing "isocyanates-free" flexible food packaging adhesive that reportedly prevents potential migration of isocyanates into non-dry food. Of note, a soy-based adhesive intended to replace formaldehyde-urea adhesives received a Presidential Green Chemistry Award (EPA, 2009), but more research is needed to determine if soy-based adhesives would be an adequate substitute for polyurethane adhesives. While research and development of appropriate alternatives is underway with a goal of direct product substitutions, it is important to focus on the safe use of existing polyurethane products through hazard communication and educating product users. V. Hazard Identification Summary The toxicity studies discussed in this summary were carried out on MDI chemicals with unreacted (uncured) isocyanate functional groups. Environmental and Ecological Hazards. Although there is a moderate acute ecotoxicity profile for MDI, the hazards associated with exposures to MDI chemicals have centered on human health effects not ecological effects. Experimental ecotoxico logical data for MDI and its degradation products indicate moderate to low toxicity to aquatic organisms (Bayer, 1992; Bayer, 2000a; Bayer, 2000b;Bayer, 2000c; Bayer, 2009). Other toxicity data suggest low likelihood of effects to terrestrial biota such as plants and earthworms (Van der Hoeven et al., 1992a; Van der Hoeven et al., 1992b). 4 U.S. Environmental Protection Agency April 2011 Toxicity in Humans. Most of the data on human health hazards resulting from diisocyanate exposures are based on occupational populations. These data indicate that exposure to diisocyanates can cause contact dermatitis, skin and respiratory tract irritation,immune sensitization, and asthma (NIOSH, 2006). It is well documented that isocyanate exposure is the leading cause of work-related asthma, and prevalence in the exposed workforce is estimated at 1- 20% (Ott et al., 2003; Bello et al., 2004). Both inhalation and dermal exposures to diisocyanates are thought to contribute to the development of isocyanate asthma(Bello et al., 2007; Liljelind et al., 2010). Once a worker is sensitized to diisocyanates, subsequent exposures can trigger severe asthma attacks. Higher incidences of asthma are typically associated with processes that generate higher exposures, such as spray application or heated processes that generate airborne vapors and mists that can expose workers via respiratory and dermal routes. For example, the UK Health and Safety Executive reported that vehicle refinishers who spray coatings containing isocyanates have an 80 times higher risk of getting asthma compared with the UK working population. (HSE 2009) [http://www.hse.gov.uk/mvr/priorities/isocyanates.htm/]. Fewer cases of diisocyanate asthma have been reported in work settings with lower isocyanate airborne exposures, and most workers who developed diisocyanate asthma have experienced long periods of exposure (months or longer). However, the minimum exposure to isocyanates that can elicit sensitization responses or asthma is not known. In addition, immune response and subsequent disease in humans can be quite variable (Redlich et al., 2006). Fatalities linked to diisocyanate exposures in sensitized persons have been reported (NIOSH, 1996; ACC, 2005). There are very few reports of non-occupational exposures to diisocyanates available; however, some incidents have been reported where diisocyanates in products are suspected of causing asthma reactions in humans (D ietemann-Mo lard et al., 1991;NIOSH, 1996; Jan et al., 2008). Toxicity in Laboratory Animals. MDI has low acute toxicity via the oral and dermal routes, but is considered toxic via the inhalation route in animals (Collins, 2002; ECB,.2005). Dermal absorption of MDI has been experimentally demonstrated, and MDI is uniformly distributed throughout the body, following inhalation exposure (Collins, 2002; ECB, 2005) (Gledhill et al., 2005). MDI causes skin, eye, and lung irritation, progressive impairment of lung function with long-term inhalation exposure and is a respiratory sensitizer via both the dermal and inhalation routes of exposure in animals (Collins, 2002; ECB, 2005). Cross-sensitization has been observed between MDI, TDI,hexamethylene diisocyanate (HDI) and dicyclohexylmethane diisocyanate (HMDI) in mice, and between MDI, TDI and HDI in humans (O'Brien et al., 1979). MDI is negative in gene mutation assays in vitro and in chromosomal aberration assays in vitro and in vivo (ECB, 2005). Animal data indicate that MDI may be carcinogenic;however, a consistent association has not been reported in epidemiologic studies (IARC, 1987b; IARC, 1987a; ECB, 2005). VI. Fate Characterization Summary. Hydrolysis is the dominant process in determining the overall environmental fate, transport, and bioaccumulation potential of diisocyanates. Commercially, diisocyanates react at room temperature with other chemicals (i.e. polyols)to form various polymers. Data shows that water from humidity in air can hydrolyze MDI thus forming the amine, methylene diphenyl diamine/toluene diamine (MDA), which also has hazards associated with it. Although their rapid 5 U.S. Environmental Protection Agency April 2011 hydrolysis in surface water will reduce persistence and bioaccumulation in the environment (Yakabe et al., 1999),under conditions of low humidity, diisocyanates may be stable long enough to be transported some distances and inhaled. Data from the Toxics Release Inventory shows releases to all media (EPA, 2008b). Despite their apparent rapid reaction time, there is uncertainty regarding diisocyanate vapors and MDA in ambient air as a function of humidity (Dyson &Hermann, 1971). Air releases are of particular concern, because the hydrolysis products formed are irritants and there is a potential for inhalation exposure. VII. Exposure Characterization Summary Occupational Exposure. Approximately 280,000 U.S. workers were estimated to be potentially exposed to diisocyanates in 1996 (NIOSH, 1996) but given industry growth and new applications (Bello et al., 2007),this estimate is expected to be higher today. OSHA regulates workplace exposures to MDI through its permissible exposure limits (PELs) (see Appendix 2). To reduce worker exposures when exposure levels exceed its PELs, OSHA requires use of PPE when engineering controls (e.g., ventilation) or administrative controls are infeasible or fail to reduce levels adequately. Airborne MDI concentrations during manufacturing processes.are influenced by whether the material is heated or sprayed, how the diisocyanate is reacted or cured, whether the process is conducted in an open or closed system, and the types of sampling methods used (Booth et al., 2009). Exposures to MDI during SPF insulation and binder, coating, adhesive and sealant operations were found to be greater than MDI exposures from the production of other types of polyurethane products (e.g, mattresses) which reach consumers in a cured form(Booth et al., 2009). Notably high MDI airborne exposures have been documented among workers during spray-on applications of truck bed liners and rigid foams for insulation (SPF) (Crespo & Galan, 1999; Lofgren et al., 2003; Bonauto et al., 2005;NIOSH, 2006; Lesage et al., 2007). Certain NIOSH and OSHA evaluations have shown that worker exposures levels can be above OSHA PELs when spray applying MDI (NIOSH, 2004; Fairfax&Brooks, 2006) Airborne concentrations of MDI can also occur above established exposure limits in pour-in-place applications during process upsets (Booth et al., 2009). Occupational skin exposures in workers exposed to MDI are of concern because isocyanate sensitization and/or asthma has occurred in cases where the potential for skin exposure is substantial but measured airborne MDI monomer levels are below Occupational Exposure Levels (OELs) or below the limits of detection with the methods used, or where similar MDI levels would be expected but MDI air monitoring data is not available (Bernstein et al., 1993; Ulvestad et al., 1999; Petsonk et al., 2000; Sommer et al., 2000; Donnelly et al., 2003). Skin exposure to MDI at work can occur even with use of personal protective equipment (Bello et al., 2004). In 13.2 OSHA inspections conducted between February 2004 and March 2005, approximately 46% of MDI samples collected during MDI-based spray-on urethane use in truck- bed lining exceeded OSHA's PEL (Fairfax &Brooks, 2006). The truck bed lining industry is primarily composed of small employers (six or fewer workers)with an estimated total of 10,000 workers (Lofgren et al., 2003; Fairfax &Brooks, 2006). Since polyurethane coatings and sealants are marketed and used for truck trailers, house decks, walls, foundations and sports 6 U.S. Environmental Protection Agency April 2011 flooring and these applications use the same or similar chemicals, spray techniques, and equipment as the spray-on truck bed lining process and SPF insulation, excessive exposure to MDI may occur during these related applications, resulting in risk to spray gun users and other nearby workers (NIOSH, 2006). However, non-OSHA covered self-employed workers and small firms, may not have access to or be aware of the hazard information and appropriate precautions to take when using uncured polyurethane products (Krone, 2004). Also, non- occupational exposures of workers, self-employed or otherwise,that have been sensitized to diisocyanates at work deserve special attention (ECB, 2005). EPA is aware that there is uncertainty about curing time of various products under different situations and that additional data are needed to address certain concerns, such as re- entry time, which are important for improving communication to prevent exposure. Additionally, while OSHA and NIOSH have developed methods to estimate air concentrations within workplaces, current methods underestimate air concentrations and may warrant the use of a compensation factor and/or development of improved analytical methods. Methods for detection of dermal exposure are in the early stages of development and will be key to estimating dermal exposures. There are several data gaps associated with dermal exposure, sensitization, and the availability of uncured isocyanate groups (Stretcher et al., 1998; Bello et al., 2007). In the U.S., only isocyanate monomers (e.g., TDI and MDI) are regulated, although similar polyisocyanates that are widely used in commercial and consumer products contain the same reactive isocyanates. EPA is concerned that there does not appear to be sufficient recognition that potential exposures of consumers and non-OSHA regulated workers to MDI and its related polyisocyanates may need to be addressed with similar recommendations for use of engineering controls, PPE, and hazard communication as those required for OSHA-regulated occupational settings. Consumer/General Population Ezposure: The highe"r,exposure operations identified in ,_. . . k,r .z ._., ...... oc!pational=settings,`(Booth'.et al:,=-2009)-use polyurethane products;which'are most commonly used by consumers (e�g' spray foam, adhesives);Thus-;consumers, bystanders, build g y �occupa is(including children), hobbyists and DIY applicators m y be exp e"d t u cured MDr`"� � . _ r - - Fwhen using similar productssUnlike workers who are protected by workplace regulations and, in most cases ha 66'access to hazard information and training for working with diisocyanates,most consumers are unaware of the potential hazards of consumer products containing uncured MDI. Consequently, incorrect use because of insufficient and inadequate hazard communication may lead to increased consumer exposure. Even if consumers are aware of the hazards,they may not take appropriate precautions. The European Union assumed that"the systematic use of PPE by the consumer will be unlikely." (ECB, 2005). Concerns for potential consumer exposure to MDI-containing products ultimately resulted in a regulation requiring the inclusion of appropriate gloves and precautionary statements in consumer products containing MDI (European Union, 2009). Consumer use of uncured polyurethane products that contain MDI has increased rapidly as the market for consumer products has expanded (Krone, 2004; Redlich et al., 2006).., In 2004, the National Institutes of Health Household Products database, which represents a random sampling of brand name products, listed 16 products containing MDI (Krone, 2004). In 2010, a search of the same database resulted in 43 products containing MDI (NIH, 2010). In addition, there is a growing availability of products,both consumer products and those labeled as 7 �y;2 U.S. Environmental Protection Agency April 2011 "professional grade," that contain uncured MDI in retail and home improvement stores, as well as for purchase over the Internet that are available to the consumer (MPK Enterprises, 2010; NIH, 2010). Some professional art organizations have noted the common use of uncured polyurethane products by their members and warn their members of the potential hazards associated with these products in their safety library(United Scenic Artists, 2010). However, it is unclear whether amateur and school arts groups are similarly aware of the potential hazards resulting from the use of these same products. Rigid foam products containing MDI are predominantly used to make spray foam insulation by a variety of systems. Exposures to consumers are not well characterized. The exposure potential varies with the method and quantity used, particle size distribution, and end- product curing time. With two-component high pressure spray polyurethane foam systems, chemical migration between floors was noted with certain conditions. Area samples show that occupants and bystanders, including sensitive populations, may be exposed at levels above the workplace exposure limits (Crespo & Galan, 1999;Lesage et al., 2007; Bayer, 2009; IRSST, 2009). This is of special concern because exposure limits for the general population's exposure to hazardous chemicals are lower than workplace exposure limits, primarily because the general population also includes the sick, the disabled, sensitive and immuno-compromised individuals, and children (Redlich, et al, 2006). Several researchers have recommended establishing a work zone to minimize exposure of unprotected individuals during application. This is supported by data that show reduction of MDI (Lesage et al., 2007) concentration with distance from the application site (Lesage et al., 2007). Until polyurethane products fully cure, there may be the potential for inhalation and dermal exposure. However, limited information on the impact of such factors as product composition, temperature, humidity, and application technique on curing times affects determination of safe re-entry time after application. Children exposed to the same airborne concentrations of MDI as adults may receive a larger dose because they breathe more per pound body weight and per unit respiratory surface area. Additionally, children may be more highly exposed to environmental toxicants through dermal routes than adults. For instance, children may crawl, roll or sit on surfaces treated with chemicals (i.e., carpets and floors) and play with objects such as toys where residues may settle. Similarly, children have a higher surface area relative to body weight,which would result in a greater dose relative to body weight for a child than for an adult with equivalent skin exposure (EPA, 2008a), and children are more likely to crawl, lay, or spend time on the floor. Children may have a greater potential for exposure if they use or are bystanders to the use of uncured MDI products, because they may not have fully developed judgment for following labeling instructions and safety precautions and may not cease activity even when they are experiencing symptoms of exposure. An accidental acute exposure of children to high levels of MDI in a polyurethane sealant used on a school athletic track was associated with asthma-like symptoms, including among children with no prior history of respiratory dysfunction (Jan et al., 2008). This observation is consistent with MDI being a well known source of occupational asthma. Children with asthma are an especially vulnerable population for exposure; they are more susceptible to inflammatory narrowing of the airways, which results in a proportionally greater obstruction of their smaller respiratory system (NIH, 2011; Trasande &Thurston, 2005). In contrast to the large amount of exposure data available for professional workers who work with diisocyanates, there is limited exposure data available characterizing the use and 8 U.S. Environmental Protection Agency April 2011 exposure scenarios of consumer and commercial products containing uncured MDI. Additional data characterizing the concentration of MDI in the air is needed. It is unknown to what extent factors such as application techniques, product composition, and method of measurement influence the availability of uncured MDI. In addition, comparing concentrations to existing workplace exposure limits is not appropriate because the worker PEL is not sufficiently protective for the consumer (Redlich, et al, 2006). IX. Risk Management Considerations Similar quantities of uncured products are available for purchase by either professionals or consumers. Numerous authors have noted the versatility of polyurethane as well as its increasing uses. EPA is concerned that the potential exists for similar exposures in non-OSHA- regulated situations. Both primary users and bystanders should be made aware of the potential risks and appropriate precautions to take when uncured MDI is being used. In addition, personal and health care products, such as bandages and orthopedic casts could contain uncured MDI but are beyond the scope of this action plan. However, exposures from use of such products could contribute to cumulative diisocyanate exposures (Sommer et al., 2000; Donnelly et al., 2003). The factors described above suggest that a heightened concern for potential risks of diisocyanate exposure to children should be addressed during actions taken to manage these chemicals. Current and Ongoing Regulatory and Related Activities MDI and its related polyisocyanates are the subjects of a variety of regulatory and related activities, some of which are summarized below. Additional details, including numerical values, are provided in Appendix 2. EPA Regulatory Activities. MDI is regulated under the Clean Air Act as a hazardous air pollutant and under RCRA and CERCLA as a hazardous waste. Diisocyanates as a category are subject to Toxics Release Inventory reporting. Under TSCA, EPA has previously used its authority under TSCA sections 8(a) and 8(d)to request information from industry(see 40 CFR parts 712 and 716). EPA has also received submissions regarding diisocyanates under TSCA section 8(c) and TSCA section 8(e). Diisocyanates are a TSCA New Chemicals Program Chemical Category and any new chemical substance falling in that category may be further regulated after a TSCA section 5 premanufacture notice has been submitted (EPA, 2002). Spray Polyurethane Foam (SPF) Federal Partnership Promoting Stewardship & Research. In 2009, EPA convened a multi-agency partnership with OSHA,NIOSH, and the Consumer Product Safety Commission(CPSC)to evaluate and address potential exposures to isocyanates and other chemicals during installation of spray polyurethane foam(SPF) insulation and air sealants in homes and schools. Commercial and DIY applicators, as well as building occupants are often unaware of inhalation and dermal hazards. Applicators and others at the work site may not wear adequate PPE. Building occupants, who remain on the premises during the operations or re-enter the site before the product is fully cured may be at risk. The federal agencies are working with the polyurethanes industry to ensure accessible hazard communication, applicator training, and best workplace practices to prevent exposure to isocyanates and other SPF chemicals. In addition, the federal group has identified critical research needs to assess and measure exposures to total reactive isocyanate groups (TRIG) 9 U.S. Environmental Protection Agency April 2011 during use and curing of SPF products. EPA will continue to work with its federal partners, the polyurethanes industry, and others to ensure improved labeling and product safety information for polyurethane products containing unreacted isocyanates, especially products targeted to consumers. EPA is also considering a green chemistry challenge to encourage the development of safer alternative chemicals. European Union. Following publication of an.MDI risk assessment which identified risks to human health for consumers,the European Union(EU) amended its REACH regulation to include restrictions on certain consumer uses of MDI. Effective December 27, 2010, all consumer products manufactured and imported into the EU containing concentrations of 0.1 percent or more MDI must include specific types of protective gloves and specific warnings and use instructions (European Union, 2009). X. Next Steps In conducting this review, EPA considered a number of potential actions, including regulatory actions under TSCA sections 4, 5, 6, and 8; cooperative actions with other federal agencies; and voluntary actions as described above. Based on EPA's screening level review of MDI and its related polyisocyanates(Appendix 1),EPA intends to: 1. Issue a data call-in for uncured MDI under TSCA section 8(c)to determine if there are allegations of significant adverse effects and initiate a TSCA section 8(d) rulemaking for one- time reporting of relevant unpublished health and safety studies for uncured MDI. 2. Consider initiating a TSCA section 4 test rule to require exposure monitoring studies on uncured MDI and its related polyisocyanates in consumer products and exposure monitoring studies in representative locations where commercial products with uncured MDI and its related polyisocyanates would be used. 3. Consider initiating rulemaking under TSCA section 6 for a. Consumer products containing uncured MDI, and b. Commercial uses of uncured MDI products in locations where the general population could be exposed. 4. Consider identifying additional diisocyanates and their related polyisocyanates that may be present in an uncured form in consumer products that should be evaluated for regulatory and/or voluntary action. XI. 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OSHA Compliance Issues -- Isocyanate Exposure in an Autobody Repair and Collision Center.Journal of Occupational and Environmental Hygiene 3, 24 - 27. Figovsky, O., and Shapovalov, L. (2006). Cyclocarbonate based polymers including Non- isocyanate polyurethane adhesives and coatings. In Encyclopedia of Surface and Colloid Science, pp. 1633-1652. Taylor&Francis. Gledhill, A., Wake, A., Hext, P., Leibold, E., and Shiotsuka, R. (2005). Absorption, distribution, metabolism and excretion of an inhalation dose of 14 C 4,4' -methylenediphenyl diisocyanate in the male rat.Xenobiotica 35, 273-292. IARC (1987). International Agency for Research on Cancer. 4,4'-Methylenediphenyl diisocyanate and polymeric 4,4'-Methylenediphenyl diisocyanate May 3 2010. <http•//monog_raphs iarc fr/ENG/monographs/vo171/mono7l-47 pdf> IRSST (2009). Occupational Health and Safety Research Institute. 4,4'-Diphenylmethane diisocyanate(MDI)safety practices and concentration during polyurethane foam spraying. R-929. (IRSST, Ed.). Jan, R. L., Chen, S. H., Chang, H. Y., Yeh, H. J., Shieh, C. C., and Wang, J. Y. (2008). Asthma- like syndrome in school children after accidental exposure to xylene and methylene diphenyl diisocyanate. JMicrobiol Immunol Infect 41, 337-341. Jarand, C. W., Akapo, S. O., Swenson, L. J., and Kelman, B. J. (2002). Diisocyanate emission from a paint product:a preliminary analysis.Appl Occup Environ Hyg 17, 491-494. Javni, I., Hong, D. P., and Petrovic, Z. S. (2008): Soy-based polyurethanes by nonisocyanates route Journal of Applied Polymer Science 108, 3867-3875. Krone, C., and Klinger, T. (2005). Isocyanates, polyurethane and childhood asthma. Pediatric Allergy and Immunology 16, 378-379. Krone, C. A. (2004). Diisocyanates and Nonoccupational Disease: A Review.Archives of Environmental Health 59, 306-316. Lesage, J., Stanley, J., Karoly, W. J., and Lichtenberg, F. W. (2007). Airborne methylene diphenyl diisocyanate (MDI) concentrations associated with the application of polyurethane spray foam in residential construction. J Occup Environ Hyg 4, 145-155. Liljelind, I.,Norberg, C., Egelrud, L., Westberg, H., Eriksson, K., and Nylander-French, L. A. (2010). Dermal and Inhalation Exposure to Methylene Bisphenyl Isocyanate (MDI) in Iron Foundry Workers.Ann Occup Hyg 54, 31-40. Lofgren, D., Walley, T., Peters, P., and Weis, M. (2003), MDI Exposure for Spray-on Truck Bed Lining Appl Occup Environ Hyg 18, 772-779. 12 U.S. Environmental Protection Agency April 2011 MPK Enterprises (2010). Professional Grade Moldmaking Silicone and Polyurethane Casting Resin systems being offered for both master moldmaker and hobbyist alike June 17 2010 httl2://www.moldmakinjzsiticone.com. NIH (2010).National Institute of Heath. Household Products Database. June 9 2010 <http://householdproducts.nIm.nih.gov/cgi-bin/househo Id/brands?tbl=chem&id=1949>. NIH (2011). Asthma in Children. Medline Plus. January 21, 2011. http://www.nim.nih.gov/medlineplus/asthmainchildren.html NIOSH (1996).National Institute for Occupational Safety and Health. Preventing asthma and death from diisocyanate exposure: NIOSH Alert. (DHHS, Ed.). NIOSH(2004). National Institute for Occupational Safety and Health. A Summary of Health Hazard Evaluations: Issues Related to Occupational Exposure to Isocyanates 1989-2002. (D. o. H. a. H. Services, Ed.),pp. 1-42, Cincinnati, OH. NIOSH(2006). National Institute for Occupational Safety and Health. Preventing Asthma and Death from MDI Exposure During Spray-on Truck Bed Liner and Related Applications: NIOSH Alert <http://www.cdc.gov/niosh/docs/2006-149/default.html>. O'Brien, I. M., Harries, M. G., Burge,P. S., and Pepys, J. (1979). Toluene d i-iso cyanate-induced asthma I. Reactions to TDI, MDI,HDI and histamine. Clinical &Experimental Allergy 9, 1-6. Ott, M. G., Diller, W. F., and Jolly, A. T. (2003). Respiratory effects of toluene diisocyanate in the workplace: a discussion of exposure-response relationships. Crit Rev Toxicol 33, 1- 59. Petsonk, E., Wang, M., Lewis, D., Siegel, P., and Husberg, B. (2000). Asthma-like symptoms in wood product plant workers exposed to methylene diphenyl diisocyanate. Chest 118, 1183-1193. Pianoforte, K. (2009). Adhesives and sealants market update, November 2009. In Coatings World, accessed at http://www.coatingsworld.com/contents/view/19735. Redlich, C. A., Bello, D., and Wisnewski, A. (2006). Isocyanate exposures and health effects. In Environmental and Occupational Medicine (W. Rom, and S. Markowitz, Eds.), pp. 502- 516. Lippincott Willimas& Wilkins Philadelphia, PA. . Sommer, B. G., Sherson, D. L., Kjoller, H., Hansen, I., Clausen, G., and Jepsen, J. R. (2000). Asthma caused by methylene-diphenyl-diisocyanate cast in a nurse. Ugeskr Laeger 162, 505-506. Soudal,N. (2010).New from Soudal: Isocyanate Free Foam. http://www.infrasite.tiet/products/productnews article php?IDeproductnews=304&langu age=en. Strcicher, R. P., Reh, C., and Key-Schwartz, R. (1998). Determination of airborne isocyanate exposure. NIOSH Manual of Analytical Methods. (NIOSH, Ed.), pp. 115-140. Trasande, L., and Thurston, G. (2005). The role of air pollution in asthma and other pediatric morbidities.JAllergy Clin Immunol 115, 689 - 699. . Ulvestad, B., Melbostad, E., and Fuglerud, P. (1999). Asthma in tunnel workers exposed to synthetic resins. Scand J Work Environ Health 25, 335-341. United Scenic Artists (2010). Health& Safety: Urethane Resin Systems June 2010. http://www.usa829.org/index.php?option=com content&task=view&id=40&Itemid=157. Van der Hoeven,N., Roza, P., and Henzen, L. (1992a). Determination of the effect of TDI, TDA,MDI, and MIDA on the emergence and growth of the plant species Avena sativa and Lactuca sativa according to OECD Guideline No. 208. British Library Document Supply Centre, Boston Spa, Wetherby, West Yorks. 13 U.S. Environmental Protection Agency April 2011 Van der Hoeven,N.,Roza, P., and Henzen, L. (1992b). Determination of the LC50 (14 days) of TDi, TDA, MDI, and MDA to the earthworm Eisenia fetida according to OECD guideline no. 207. British Library Document Supply Centre, Boston Spa, Wetherby, West Yorks. Yakabe, Y., Henderson, K. M., Thompson, W. C., Pemberton, D., Tury, B., and Bailey, R. E. (1999). Fate of Methylenediphenyl Diisocyanate and Toluene Diisocyanate in the Aquatic Environment. Environmental Science & Technology 33, 2579-2583. Appendix 1 Tier 1: MDI monomers and related isomers and polymers No CASRN CA Index Name Acronym. Common Name 1 101-68-8 Benzene, 1,1'-methylenebis[4- 4 4'-MDI 4,4'-Methylenediphenyl isoc anato- diisocyante 2 5873-54-1 Benzene, 1-isocyanato-2-[(4- 24'-MDI 2,4'-Methylenediphenyl , isocyanato hen 1)methyl]- diisocyante Benzene, 1,1'-methylenebis[2- 2,2 isocyanato- 3 2536-05-2 2,2 -MDI Methylenediphenyl diisoc ante 4 26447-40-5 Benzene, 1,1'- MDI Methylenebis(phenyl meth lenebis isoc anato- isoc anate) 5 9016-87-9 Isocyanic acid, Polymeric Poly(Methylenebis(phe of meth lene of hen lene ester MDI n 1 isoc anate Tier 2: MDI dimers, trimers and polymers No CASRN CA Index Name Acronym Common Name 1,3-Diazetidine-2,4-dione, 1,3- 4,4'-MDI 4,4'-Methylenediphenyl 6 17589-24-1 bis[4-[(4-isocyanatophenyl) dimer diisocyante dimer meth 1] hen 1 - 1,3-Diazetidin-2-one, 1,3-bis[4-[(4- 4,4'-Methylene isocyanatophenyl)methyl]phenyl]-4- 4,4'-MDI diphenyl diisocyante 7 31107-36-5 trimer [[4-[(4-isocyanatophenyl)methyl] trimer (or Uretonimine of 4,4'- phenyl]imino]- MDI) Benzene, 1,1'-methylenebis[4- 4,4'-MDI 4,4'-Diphenyl 8 25686-28-6 isocyanato-, homopolymer homo- methanediisocyanate polymer homo of mer Appendix 2 —Regulatory and Exposure Limits for MDI EPA. The EPA's Integrated Risk Information System(IRIS)program has developed a reference concentration(RfC) for MDI of 6 x 10-4 mg/m3 using histopatho logical changes in the upper respiratory system in animals as the critical effect (EPA, 1998). 14 U.S. Environmental Protection Agency April 2011 OSHA. Diisocyanate hazards are addressed by OSHA in specific standards for the general industry, shipyard employment, and the construction industry, including PELs for workplace exposure. OSHA's PEL for the MDI monomer is 0.2 mg/m3 (0.02 ppm) as a ceiling limit (29 CFR § 1910.1000). OSHA also requires the use of PPE to reduce worker exposure to hazards when engineering and administrative controls are not feasible or effective in reducing exposure below its PELs. NIOSH. In 1996 and 2006,NIOSH issued Alerts to prevent asthma and death from diisocyanate exposure to workers in certain situations (NIOSH, 1996;NIOSH, 2006). NIOSH considers SPF insulation application to present hazards similar to other spray polyurethane applications and recommends use of the same safety procedures and PPE. NIOSH's Recommended Exposure Limit (REL) for the MDI monomer is a Time Weighted Average (TWA) of 0.05 mg/m3 (0.005 ppm) for up to a 10-hour workday during a 40- hour workweek with a ceiling limit of 0.2 mg/m3 (0.02 ppm) for any 10-minute period (NIOSH, 2005). The NIOSH REL is intended to prevent acute and chronic irritation and sensitization of workers but not to prevent health effects in workers who are already sensitized. Per NIOSH, available data do not indicate a concentration at which MDI fails to produce adverse reactions in sensitized persons (NIOSH, 2006). ACGIH. American Conference of Governmental Industrial Hygienists. Threshold Limit Values (TLVs) for MDI address respiratory sensitivity but not dermal sensitivity. It has been suggested that there is now sufficient information to recommend the addition of a"skin notation" to the TLVs for MDI to bring attention to the potential for absorption of diisocyanates through the skin. ACGIH has assigned the MDI monomer a TLV of 0.05 mg/m3 (0.005 ppm) as a Time- Weighted Average (TWA) for a normal 8-hour workday and a 40-hour workweek. The ACGIH TLV for MDI is based, among other things, upon the potential for sensitization and meant to protect workers from induction of this effect (ACGIH, 2009). California, OEHHA. In April 2010, California's Office of Environmental Health Hazard Assessment (OEHHA) released "for comment"draft documents describing proposed Reference Exposure Levels (RELs) for MDI which have been revised to include consideration of possible differential effects on the health of infants, children and other sensitive subpopulations (California EPA, 2010). EU. Following publication of an MDI risk assessment which identified risks to human health for consumers, the EU amended its REACH regulation to include restrictions on certain consumer uses of MDI. Effective December 27, 2010, all consumer products manufactured and ' imported into the EU containing concentrations of 0.1 percent or more MDI must include specific types of protective gloves and specific warnings and use instructions (European Union, 2009). 15 Rhino Linings° SAFETY DATA SHEET Part No.: 60250 Released:August 3,2016 PRODUCT NAME(S): Rhino Hybrid TM HP 11-50 Resin SECTION 1 —IDENTIFICATION Manufacturer's Info: Product name: Rhino Hybrid TM HP 11-50 Resin Rhino Linings Corporation Chemical Name: Polyol/Polyamine Blend 9747 Businesspark Avenue Chemical Family: Polyurethane/Polyurea Hybrid Resin San Diego, CA 92131 Product Category: Component of Polyurethane/Polyurea Hybrid Information phone: (858)450 0441 System Emergency contact: CHEMTREC(800)424 9300 Recommended use: Spray Elastomer SECTION 2—HAZARD(S)IDENTIFICATION OSHA Hazard Communication Standard: This product is a"Hazardous Chemical"as defined by the OSHA Hazard Communication Standard, 29 CFR 1910.1200. GHS-Label Elements: Signal Word: Pictogram(s): WARNING < > < > < > �r GHS 08 GHS 07 GHS 09 Classification of the substance or mixture:_ Hazard Class Cate o Hazard Statement Codes Hazard Statements Acute Toxicity, Oral 4 H302 Harmful if swallowed Acute Toxici , Dermal 5 H313 May be harmful in contact with skin Skin corrosion/irritation 3 H316 Causes mild skin irritation. Serious eye damage/Eye irritation 2A H319 Causes serious eye irritation Skin Sensitization 1B H317 May cause an allergic skin reaction May cause damage to kidney, liver and pancreas Specific target organ toxicity, 2 H373 through prolonged or repeated exposure repeated exposure May cause damage to respiratory system/lungs through prolonged or repeated exposure by inhalation Aquatic Hazard,Acute _ 1 H400 Very toxic to aquatic life Aquatic Hazard, Chronic 1 H410 Very toxic to aquatic life with long lastin effects Precautionary Statements: Prevention: P260 Do not breathe mist,vapors, spray. P270 Do not eat,drink, and smoke when using this product. P280 Wear protective gloves/protective clothing/eye protection/face protection. P264 Wash exposed area with plenty of water and soap thoroughly after handling. P272 Contaminated work clothing should not be allowed out of the workplace. P273 Avoid release to the environment. Response: P301 +P312+P330 IF SWALLOWED: Call a POISON CENTER or doctor/physician. Rinse mouth. P302+P352 IF ON SKIN:Wash with plenty of soap and water. P333+ P313 If skin irritation or rash occurs: Get medical advice/attention. P363 Wash contaminated clothing before reuse. P305+ P351 +.P338 IF IN EYES: Rinse cautiously with water for several minutes. Remove contact lenses, if present and easy to do. Continue rinsing. P337+ P313 If eye irritation persists: Get medical advice/attention. P314 Get medical advice/attention if you feel unwell. P391 Collect spillage. Storage: None Disposal: P501 Dispose of contents/container to hazardous or special waste collection point in accordance with local/regional/national/international regulations. Hazards not otherwise classified: Not known. Page 1 of 8 5 a Rhino Linings° SAFETY DATA SHEET Part No.: 60250 Released:August 3,2016 SECTION 3-COMPOSITION I INFORMATION ON INGREDIENTS i Components CAS# i EC# Concentration,% -- - —-- -- - -_ - - ... . Polyether Polyol 9082 00 2 618 655 1 60 80 Diethyltoluenediamine 68479 98-1 270-877-4 20 30 ...........-- ... .... ........... Confidential Component 1 Trade Secret Trade Secret 1 -10 Diethylene Glycol 111-46-6 203-872-2 1 -10 -. . _ ..... ......._. _ ......... Zeolites 1318-02-1 930-915-9 1 -5 Confidential Component 2 Trade Secret Trade Secret 0 1 0.5 --- - -- ---- -- _ ..... Confidential Component 3 Trade Secret Trade Secret 0.1 0.5 SECTION 4-FIRST-AID MEASURES Description of First Aid measures: Inhalation: Move to fresh air and keep at rest in a position comfortable for breathing. If experiencing respiratory problems, seek medical attention. Skin: Wash material off of the skin with plenty of soap and water for at least 15 minutes. Remove contaminated clothing and shoes immediately and wash them before reuse. Get medical advice/attention if irritation or rash occurs. Eye: Rinse cautiously with water for several minutes,especially under the eyelids. Remove contact lenses, if present and easy to do. Continue rinsing for at least 15 minutes. Do not rub eyes in order to prevent corneal injury. Get medical advice/attention if eye irritation persists. Ingestion: Immediate medical attention required. Call a poison center or physician. Remove exposed person to fresh air and keep at rest in a position comfortable for breathing. Remove dentures if any. If the exposed person is conscious, rinse mouth with water and then give plenty of water to drink. Stop if the exposed person feels sick as vomiting may be dangerous. If vomiting occurs,the head should be kept low so that vomit does not enter the lungs. Do not induce vomiting unless directed to do so by medical personnel. If unconscious, place in recovery position and get medical attention immediately. Maintain an open airway. Loosen tight clothing such as a collar,tie, belt or waistband. Never induce vomiting or give anything by mouth if the victim is unconscious or having convulsions. Most important symptoms/effects,acute and delayed: See Section 11 for more details. General advice for First Aid responders: No action should be taken involving any personal risk or without suitable training. If potential for exposure exist refer to Section 8 for specific personal protective equipment. Show this SDS to physician. Note to physician:Treatment should be supportive and based on the judgment of the physician in response to the reaction of the patient. Recommended medical monitoring for at least 24 hours. Certain ingredient of this product may cause methemoglobin formation resulting in a reduced ability of the blood to carry oxygen; a symptom may include cyanosis. Immediately give oxygen if victim turns blue(lips,ears, fingernails). Since reversion of methemoglobin to hemoglobin occurs spontaneously after termination of exposure, moderate degrees of cyanosis need to be treated only by supportive measures. SECTION 5-FIRE-FIGHTING MEASURES Suitable extinguishing media: Water fog or fine spray, alcohol-resistant foam,dry chemical or carbon dioxide fire extinguishers. Unsuitable extinguishing media: Direct water stream may cause frothing,splattering of burning material and spreading of fire. Specific hazards arising from the chemical: Material may be ignited only if preheated to high temperatures(such in fire conditions). Fire in vicinity poses risk of pressure build-up and rupture. Containers at risk from fire should be cooled with water and, if possible, removed from the danger area. Hazardous combustion products: carbon and nitrogen oxides, amines, hydrogen cyanide, lower molecular weight organic molecules. Special Protective Equipment and Precautions for fire-fighters: Wear NIOSH or OSHA approved self-contained breathing apparatus in positive pressure mode with full face piece and full protective gear. Isolate the scene by removing all persons from the incident area. No action should betaken involving any personal risk or without suitable training. Spilled product will cause very slippery walking surfaces. SECTION 6-ACCIDENTAL RELEASE MEASURES Personal precautions,protective equipment and emergency procedures: Keep unnecessary and unprotected personnel from entering. Ensure adequate ventilation/exhaust extraction.Avoid breathing vapors or mist during clean up. Use protective equipment as described in Section 8. Do not touch or walk through spilled material;spilled material may cause a slipping hazard. Environmental precautions: Prevent from entering into soil, ditches, sewers,waterways and/or groundwater. Inform the relevant authorities if the product has caused environmental pollution.Water polluting material. May be harmful to the environment if released in large quantities. See Section 12. Page 2 of 8 J Rhino Linings° SAFETY DATA SHEET Part No.: 60250 Released:August 3,2016 Methods and materials for containment and cleaning up: Remove mechanically; cover the remainder with non-combustible absorbent material(e.g.sand,earth, vermiculite or diatomaceous earth). Following absorption,transfer into properly labeled chemical waste containers. If necessary, repeat application of absorbent material until all liquid has been removed from the surface.Wash the spill site with soap and water. Cover container and remove from work to a well ventilated area.,Properly dispose of the waste material and any contaminated equipment(i.e., broom or brush)in accordance with existing federal,state and local regulations. For major spills: Stop leak if without risk. Move containers from spill area.Approach release from upwind. Wash spillages into an effluent treatment plant or contain and collect with an absorbent material as described in the previous paragraph. For minor spills:Wipe up with absorbent material(e.g. cloth,fleece). Clean surface thoroughly with soap and water to remove residual contamination. Never return spills to original containers for re-use. Residues from spill cleanup may continue to be regulated under provisions of RCRA and require storage and disposal as hazardous waste. For major spills, see Section 1 for the Emergency contact; for further disposal measures, see Section 13. SECTION 7—HANDLING AND STORAGE Precautions for safe handling: Protect chemical from atmospheric moisture.Avoid prolonged exposure to heat and air. Keep away from sources of ignition.Do not reseal if contamination is suspected. Use adequate ventilation to keep airborne levels below the exposure limits. Do not breathe vapors and mists.Wear respiratory protection if material is heated,mixed, sprayed or used in a confined space.Avoid contact with skin and eyes.Wear appropriate eye and skin protection.Wash hands thoroughly after handling. Hands and/or face should be washed before eating,drinking and smoking and at the end of the shift. Remove contaminated clothing and protective equipment before entering eating areas. Conditions for safe storage,including any incompatibilities: Store in original or approved alternative container protected from direct sunlight in a dry, cool and well-ventilated area,away from incompatible materials(see Section 10)and food and drink. Keep container tightly closed and sealed until ready for use. Containers that have been opened must be carefully resealed and kept upright to prevent leakage. Protect it against physical damage and moisture. Normal temperature and pressures do not affect the material. Keep liquid away from heat, sparks and flame. Do not cut, drill, grind,weld or perform similar operations on or near containers. Use appropriate containment to avoid environmental contamination. Segregate from acids and acid forming substances. Storage stability: Stable under normal conditions. Storage temperature:60-90°F(16—32°C) Employee education and training in the safe use and handling of this product are required under the OSHA Hazard Communication Standard 29 CFR 1910.1200. Employees and consumers should be warned of health risks associated with product use. See Section 8 for additional information on hygiene measures. SECTION 8—EXPOSURE CONTROLS/PERSONAL PROTECTION Control Parameters/Occupational exposure limit values: Not available for mixture. Results for components are listed in Section 15. Appropriate engineering controls: Good local and general ventilation should be sufficient to control worker exposure to airborne contaminants below recommended exposure limits. Local exhaust may be required in some areas. Personal protective equipment: Eye/face protection: When directly handling liquid product,eye protection is required. Examples of eye protection include safety glasses and goggles or full face shield when there is a greater risk of splash. Contact lenses should not be worn when working with chemicals. Skin/body protection: Impervious gloves(nitrile butyl rubber, neoprene and PVC)should be worn always when working with this product. Body should be covered with appropriate clothing(apron, arm covers or full body suit)depending on the task being performed and the risks involved. Protective clothing should be selected and used in accordance with"Guidelines for the Selection of Chemical Protective Clothing"published by ACGIH.Wash contaminated clothing before reuse. Store work clothing separately. Appropriate footwear should be also selected based on the task being performed and the risks involved. Respiratory protection: Use local or general ventilation to control exposures below applicable exposure limits.When ventilation is inadequate, use either an atmosphere supplying respirator or NIOSH or OSHA approved air-purifying respirator for organic vapors. Respirator must be properly fitted and its selection must be based on known or anticipated exposure levels, the hazards of the product and the safe working limits of the selected respirator. Additional Protective Measures: Educate and train employees in safe handling of this product. Follow all label instructions. As a general hygiene practice,wash hands and face after use. Clean water should always be readily available for emergency skin and eye washing. Emergency eyewash fountains and safety shower are recommended in close proximity as a matter of good work practice. SECTION 9—PHYSICAL AND CHEMICAL PROPERTIES Appearance: Yellow to Amber Liquid I. Odor: Slightly ammonia-like Odor threshold: Not available Page 3 of 8 Rhino Linings° SAFETY DATA SHEET Part No.: 60250 Released:August 3,2016 pH: 8—10 Melting point/freezing point: Not available Initial boiling point and boiling range: >200°C Flash point: >200°C _ Evaporation rate: Not a licable Flammability solid, as): Not applicable Upper/lower flammability or explosive limits: Notapplicable Vapor pressure: Negligible Vapor density: Not available Relative density: 1.00-1.05 @ 25°C(77°F) Solubility(water): Ve slightly soluble Partition coefficient n-octanol/water: Not available Auto-ignition temperature: >250°C Decomposition temperature: Not available Viscosity: Not available SECTION 10—STABILITY AND REACTIVITY Reactivity: Product will not undergo hazardous polymerization. Corrosive effects to metal are not anticipated. Based on its structural properties the product is not classified as oxidizing. Does not form flammable gases in the presence of water. Chemical stability: Stable under recommended storage conditions. Product is hygroscopic; contamination with moisture will negatively affect product performance. Avoid unintended contact with isocyanates;the reaction will generate heat. Conditions to avoid: Unintentional contact with moisture,excessive heat, open flame and sparks.Avoid mist formation. Incompatible materials: Strong oxidizing agents.Water,alcohols, amines,bases, acids, copper,aluminum and zinc alloys. Hazardous decomposition products: Depend upon temperature, air supply and presence of other materials. Can include, but are not limited to carbon and nitrogen oxides, amines, hydrogen cyanide, lower molecular weight organic molecules. SECTION 11 —TOXICOLOGICAL INFORMATION Likely Routes of Exposure: Skin and Eye Contact, Inhalation and Ingestion. Symptoms of exposure: Acute toxicity: Oral: Harmful if swallowed. May cause burns to mouth,throat and stomach. Adverse symptoms may include abdominal pain, nausea,vomiting,and diarrhea. Dermal: May be harmful in contact with skin.Adverse symptoms may include irritation and redness. Inhalation: Inhalation is unlikely due to the low vapor pressure. However, if handled at elevated temperatures, it may give off-gas, vapor or mist that is very irritating to the respiratory system.Adverse symptoms may include nausea, headache,difficulties with breathing. o DETDA,CAS#:68479-98-1:Inhalation,skin absorption or ingestion may cause methemoglobin formation resulting in a reduced ability of the blood to carry oxygen;a symptom may include cyanosis(purplish-blue coloring of the skin,fingernails,and lips). Skin corrosion/irritation: Causes skin irritation if not washed off accordingly. Adverse symptoms may include irritation and redness. Serious eye damage/eye irritation: May cause serious eye irritation.Adverse symptoms may include tearing and redness. Specific target organ toxicity,single exposure: Not expected. Aspiration hazard: Not an aspiration hazard. Chronic toxicity: Respiratory and Skin Sensitizer: This product contains a component that is reported to be a skin or respiratory sensitizer. o Confidential Component 2,CAS#:Trade secret:skin sensitizer. o Confidential Component 3,CAS#:Trade secret:skin sensitizer. Germ cell mutagenicity: Risk to humans is not expected from exposure to this product: Carcinogenicity: This product does not contain components reported to be possibly carcinogenic to humans by IARC. o Zeolites,CAS#: 1318-02-1: IARC:Group 3(Not Classifiable as to its Carcinogenicity to Humans) Reproductive toxicity: Risk to humans is not expected from exposure to this product. Specific target organ toxicity, repeated exposure: Liver, kidney, pancreas, respiratory system/lungs. Page 4 of 8 _ Rhino Linings' SAFETY DATA SHEET Part No.: 60250 Released:August 3,2016 Medical conditions aggravated by overexposure: Liver, kidney, pancreas, respiratory system/lungs and skin disorders if product is handled without adequate protection. Toxicity test results: Not available for mixture. Results for components: Components Test Results Non-hazardous Acute Toxicity Oral LD50(Rat):>5,000 mg/kg;may cause mild gastrointestinal effects including nausea and diarrhea. Dermal LD50(Rabbit):>2,000 mg/kg Inhalation LC50(Rat),1 hr:>200 mg/L;not expected to cause any significant respiratory tract effects. Skin corrosion/irritation(Rabbit):may cause slight irritation,but not expected to cause serious damage. Serious eye damage/eye irritation(Rabbit):may cause irritation(redness),but not expected to cause serious damage. Polyether Polyol, STOT,SE:risk to humans is not expected from exposure to this product. CAS#:9082-00-2 Aspiration hazard:No Chronic toxicity Sensitization,skin and respiratory:Not sensitizer Germ cell mutagenicity:Risk to humans is not expected from exposure to this product. Carcinogenicity:No component of this product present at levels greater than or equal to 0.1%is identified as probable,possible or confirmed human carcinogen by IARC,NTP,OSHA and ACGIH. Reproductive toxicity:Risk to humans is not expected from exposure to this product. STOT,RE:No known or re ortp ed target organs from repeated exposure. Acute Toxicity Oral LD50(Rat):738 mg/kg(OECD Test Guideline 401) j Dermal LD50(Rat):>2,000 mg/kg(OECD Test Guideline 402) Skin corrosion/irritation(Rabbit):Non-irritating(OECD Test Guideline 404) " Eye Irritation(Rabbit):Irritating(US-EPA) i Chronic toxicity Diethyltoluenediamine Skin Sensitization(guinea pig):Negative(intracutaneous test) DA), Germ cell mutagenicity:Positive and negative results were seen in various in Vitro and in Vivo studies. (DET CAS 68479-98-1 Reproductive toxicity:Oral(Rat,females),Dose:0,50.150,500 mg/kg General Toxicity Maternal:No observed adverse effect level:50 mg/kg body weight Teratogenicity:No observed adverse effect level:500 mg/kg body weight Embryo-fetal toxicity:No observed adverse effect level:150 mg/kg body weight j Embryotoxic effects and adverse effects on the offspring were detected only at high maternally toxic doses(OECD Test Guideline 414) STOT,RE:Oral(Rat),90 days,Dose:50-125-320ppm,NOEL:28 mg/kg;LOEL:221 mg/kg; Dermal(Rabbit),21 day,Dose:1-10-100mg/kg,NOEL:210 mg/kg Chronic ingestion ma Y cause liver damage_Pancreas damage. Acute Toxicity Oral LD50(Rat):1,000-2,000 mg/kg;Harmful if swallowed.May cause gastrointestinal effects including nausea,lethargy and diarrhea. Dermal LD50(Rabbit):>2,000 mg/kg Inhalation LC50(Rat),1hr:No data available. Skin corrosion/irritation(Rabbit):may cause slight irritation,but not expected to cause serious damage. Serious eye damage/eye irritation(Rabbit):may cause irritation(redness),but not expected to cause serious damage. I Confidential Component 1, STOT,SE:risk to humans is not expected from exposure to this product. CAS#:Trade secret Aspiration hazard:No Chronic toxicity Sensitization,skin and respiratory:Not sensitizer Germ cell mutagenicity:Risk to humans is not expected from exposure to this product. Carcinogenicity:No component of this product present at levels greater than or equal to 0.1%is identified as probable,possible or confirmed human carcinogen by IARC,NTP,OSHA and ACGIH. Reproductive toxicity:Risk to humans is not expected from exposure to this product. P Y P P STOT,RE:No known or reported target organs from repeated ex osp ure• Acute Toxicity Oral LD50(Rat):1,120 mg/kg;moderately toxic after single ingestion Dermal LD50(Rabbit):11,890 mg/kg Inhalation LC50(Rat),4hr:>4.6 mg/L;not expected to cause any significant respiratory tract effects. Skin corrosion/irritation(Human),24hrs:not irritating(Patch test) Serious eye damage/eye irritation(Rabbit):not irritating I STOT,SE:No data available. Diethylene Glycol, Aspiration hazard:No CAS#:111-46-6 Chronic toxicity Sensitization,skin and respiratory(Guinea pig):Not skin sensitizer(GPMT) Germ cell mutagenicity:negative in vitro and in vivo test Carcinogenicity(Rat,Oral),108 weeks:NOAEL:1,210 mg/kg bwt;No evidence of carcinogenicity. Reproductive toxicity:Fertility(Rat,Oral)two generation study:NOAEL:2,200 mg/kg bwt;Fetal Development(Rabit,Oral),30days:NOAEL: 1,000 mg/kg bwt;No reproductive effects.Has caused toxicity to the fetus and some birth defects at maternally toxic,high doses in animals. I Other animal studies have not reproduced birth defects even at much higher doses that caused severe maternal toxicity. STOT,RE Rat,OralL4weeks/daiINOAEL:10,000 mglkg-Kidneydamage:Cat�ory Acute Toxicity Oral LD50(Rat):>5,110 mg/kg(OECD Guideline 401);May cause gastrointestinal tract irritation. Dermal LD50(Rabbit):Not data available i Inhalation LC50(Rat)(dust/aerosol),4hrs:>5.3 mg/L.Slightly irritant. Skin corrosion/irritation(Rabbit):Slightly irritant.May cause dehydration. Zeolites, Serious eye damage/eye irritation(Rabbit):Slightly irritant.May cause abrasion or mechanical irritation. CAS#:1318-02-1 STOT,SE:risk to humans is not expected from exposure to this product. I Aspiration hazard:No Chronic toxicity Sensitization,skin and respiratory:Not sensitizer(Guinea pig maximization test) Germ cell mutagenicity:Risk to humans is not expected from exposure to this product. Carcinogenicity:IARC:Group 3(Not Classifiable as to its Carcinogenicity to Humans) Reproductive toxicity:No adverse effects in rats and rabbits or their offspring following administration in the drinking water during re nanc . Page 5 of 8 Rhino Linings' SAFETY DATA SHEET Part No.: 60250 Released:August 3,2016 STOT,RE:Effects on kidney were observed in rats and dogs administered high dose levels in their feed for one month.Effect on blood, chronic pneumonitis and acute bronchopneumonia were observed in dogs. Long-term inhalation by rats and dogs produced inflammation in the lungs associated with accumulation of particulate. ' Acute Toxicity Oral LD50(Rat):>5,000 mg/kg(OECD Guideline 401) Symptoms:drowsiness,gastrointestinal disturbance,liver and kidney disorders,muscle weakness. Dermal LD50(Rat):>2,000 mg/kg(OECD Guideline 402) Inhalation LC50(Rat),4hrs:>5.0 mg/L(OECD Guideline 403).No mortality was observed. Skin corrosion/irritation(Rabbit):not irritating(OECD Test Guideline 404) Serious eye damage/eye irritation(Rabbit):not irritating(OECD Test Guideline 405) Confidential Component 2, STOT,SE:no specific target organ toxicity to be expected after a single exposure. CAS#:Trade secret Chronic toxicity Respiratory or skin sensitization(Guinea pig):skin sensitizer(OECD Guideline 406) Germ cell mutagenicity:Not mutagenic in bacteria,mammalian cell culture and mammals. Carcinogenicity:No data available. Reproductive toxicity:The results of animal studies gave no indication of a fertility impairing effect and a developmental toxic effect at doses that were not toxic to the parental animals;Teratogenicity:did not cause malformations. STOT,RE:May cause damage to the liver after repeated ingestion.Effect found in rodents only.The relevance to humans is questionable. Due to the sReecies specific mode of action,the effects are not expected to occur in humans. —-... - — ------ — — --- . ..._.._ . —.... .__-__... .. . . .... ......... ............ .------...-.. ..........._—..... ......---.. _.._ ..-.... ..............._ Acute Toxicity Oral LD50(Rat):2,000-5,000 mg/kg(OECD Guideline 401) Confidential Component 3, Skin corrosion/irritation(Rabbit):not irritating(OECD Test Guideline 404) i CAS#:Trade secret Serious eye damage/eye irritation(Rabbit):not irritating(OECD Test Guideline 405) STOT,SE:no specific target organ toxicity to be expected after a single exposure. Chronic toxicity Respiratory or skin sensitization(Guinea pig):skin sensitizing(OECD Guideline 406) SECTION 12—ECOLOGICAL INFORMATION Ecotoxicity:Acutely and chronically hazardous for aquatic organisms. Do not release into natural waters. Persistence and degradability: Not readily biodegradable by OECD criteria. In contact with water the substance will hydrolyze slowly. Bioaccumulative potential: No significant accumulation in organisms is expected. Mobility in soil: Not known. Other adverse effects: Not known. Ecotoxicity test results: Not available for the mixture. Results for components: Components Test Results Polyether Polyol, Acute Toxicity: CAS#:9082-00-2 Fish:LC 50,96hrs:>100 m /L based on available data and comparison to similar compounds) Aquatic toxicity:Very toxic to aquatic organisms;may cause long-term adverse effects in the aquatic environment. Acute Toxicity Diethyltoluenediamine Fish:LC50(Fathead minnow),96hrs:>106 mg/L(OECD Guideline 203) (DETDA), Aquatic Invertebrates:EC50(Daphnia magna),48hrs:5.8 mg/L(OECD Guideline 202) Algae:ErC50(Green algae),72hrs:104 mg/L(OECD Guideline 201) CAS#:68479-98-1 Ecological Data Microorganisms,EC50(bacterium),24hrs:>170 mg/L(DIN 38412 Part 8) biodegradation,28da s:<1% OECD Guideline 301D;COD:2.370 m /g Aquatic toxicity:High probability that the product is not acutely harmful to aquatic organisms.The inhibition of the degradation activity of activated sludge is not anticipated when introduced to biological treatment plants in appropriate low concentrations.Product not tested;The statement has been derived from substances/products of a similar structure or composition. Acute Toxicity: Fish(zebra fish),96hrs:LC50:>100 mg/L Confidential Component 1, Aquatic Invertebrates(Daphnia magna),48hrs:EC50:>100 mg/L CAS#:Trade secret Aquatic Plants(algae),72hrs:EC50:>100 mg/L(Guideline 92/69/EEC,C.3) Microorganisms(activated sludge),0.5hrs:EC20:>1,000 mg/L Ecological Data: Biodegradation:Not readily biodegradable. Bioaccumulative potential:Does not significantly accumulate in organisms. Mobility in soil:Not expected. Product does not contain organically bound halogen. Acute Toxicity Fish:LC50(fathead minnow),96hrs:75,200mg/L(flow-through test) i Aquatic invertebrates:EC50(Daphnia magna),24hrs:>10,000 mg/L(static test) Diethylene Glycol, Aquatic plants:EC50(green algae),96hrs:6,500-13,000 mg/L(growth rate inhibition)(similar substance) CAS#:111-46-6 Ecological Data j Biodegradability(Activated sludge,aerobic),28days:90-100%-Readily biodegradable(OECD Test Guideline 301 B) Bioaccumulative potential:log Pow:-1.98 Mobility in soil:No data available. Acute Toxicity: Fish(fathead minnow),96hrs:LC50:>680 mg/L(EPA 72-1,static).The details of the toxic effect relate to the nominal concentration.The LC50 is higher than the solubility limit. Zeolites, Aquatic invertebrates(Daphnia magna),24hrs:EC50:2,808 mg/L(OECD Test Guideline 202,part 1,static) CAS#:1318-02-1 Aquatic plants(Green algae),96hrs:EC50:>328 mg/L(OECD Test Guideline 201,static).The details of the toxic effect relate to the nominal ! concentration.Tested above maximum solubility.The product has low solubility in the test medium.An eluate has been tested. Microorganisms(Bacteria),16hrs:EC50:950 mg/L(Growth inhibition)(DIN 38412,Part 8).The product has not been tested.The statement has been derived from substances/products of a similar structure or composition.The details of the toxic effect relate to the nominal Page 6 of 8 Rhino Linings SAFETY DATA SHEET Part No.: 60250 Released:August 3,2016 concentration.The product has low solubility in the test medium.An eluate has been tested. Chronic toxicity: Fish(fathead minnow),30days:NOEC:z86.7 mg/L(OPP 72-5,EPA-Guideline,Flow through).The statement of the toxic effect relates to the analytically determined concentration. Aquatic invertebrates(Daphnia magna),21days:NOEC:32 mg/L(OECD Test Guideline 211,semistatic).The details of the toxic effect relate to the nominal concentration.The product has low solubility in the test medium.An eluate has been tested. Ecological Data: Biodegradability:Not readily biodegradable.The product is virtually insoluble in water and can thus be separated from water mechanically in suitable effluent treatment plants.It cannot be eliminated from water by biological purification processes. Mobility in soil:Transport between environmental compartments:Study scientifically not justified. Aquatic toxicity:Very toxic to aquatic organisms;may cause long-term adverse effects in the aquatic environment.The inhibition of the degradation activity of activated sludge is not anticipated when introduced to biological treatment plants in appropriate low concentrations. Acute Toxicity Fish:LC50(Rainbow trout),96hrs:1-10 mg/L(OECD 203,static) Aquatic invertebrates:EC50(Daphnia magna),24hrs:1-10 mg/L Aquatic Plants:EC50(algae),72hrs:>100 mg/L(growth rate),(OECD Guideline 201,static) Confidential Component 2, EC10(algae),72hrs:10 mg/L(growth rate)(OECD Guideline 201,static) CAS#:Trade secret Chronic toxicity:NOEL-No observed effect level Aquatic invertebrates(Daphnia magna),21 days:NOEL:51 mg/L(OECD Guideline 202,part 2,semistatic) Soil living organisms LCO,(redworm)14 days:NOEL:>1,000 mg/kg,(OECD Guideline 207,artificial soil) LCO,(redworm)56 days:NOEL:>100 mg/kg,(OECD Guideline 222,artificial soil) Ecological Data Activated sludge,ECO,3hrs:1,000 mg/L(OECD Guideline 209,static) Bioaccumulative potential(golden orfe):Does not significantly accumulate in organisms. Mobili in soil:expected adsorption to solid soil phase. Aquatic toxicity:Very toxic to aquatic organisms;may cause long-term adverse effects in the aquatic environment.The inhibition of the degradation activity of activated sludge is not anticipated when introduced to biological treatment plants in appropriate low concentrations. Acute Toxicity Fish:LC50(Rainbow trout),96hrs:1-10 mg/L(OECD 203,static) LC50(Zebrafish),96hrs:51 mg/L(OECD 203,semistatic) LC50(Bluegill),96hrs::51 mg/L(OECD 203,static) Aquatic invertebrates:EC50(Daphnia magna),24hrs:10-100 mg/L Confidential Component 3, Aquatic Plants:EC50(algae),72hrs:1-10 mg/L(growth rate),(OECD Guideline 201,static) CAS#:Trade secret Chronic toxicity:NOEL-No observed effect level Aquatic invertebrates(Daphnia magna),21 days:NOEL:1.0 mg/L(OECD Guideline 211,semistatic) Ecological Data Activated sludge,ECO,3hrs:>100 mg/L(OECD Guideline 209,static) j Bioaccumulative potential:Not expected Mobility in soil:expected adsorption to solid soil phase. Not readily biodegradable. Elimination info:38%DOC reduction,28da s SECTION 13—DISPOSAL CONSIDERATIONS Product Disposal:The generation of waste should be avoided or minimized wherever possible. If product becomes a waste, it does not meet criteria of hazardous waste as defined in 40 CFR 261, Subpart C and D. Do not.discharge into sewer system. Spill cleanup residues may still be subject to RCRA storage and disposal requirements. Dispose waste in compliance with local,state and federal regulations via licensed waste disposal contractor. Container disposal: Even after emptying, container may retain residues. Empty containers should be completely drained and safely stored until appropriately reconditioned or disposed through licensed contractor in accordance with government regulation. This material and its container must be disposed of in a safe way. SECTION 14—TRANSPORT INFORMATION Land transport,U.S. DOT: Non-regulated Sea transport,IMDG: Non-regulated Air transport,IATA/ICAO: Non-regulated SECTION 15—REGULATORY INFORMATION U.S. Regulations: OSHA HCS:This product is a"Hazardous Chemical'as defined by the OSHA Hazard Communication Standard, 29CFR 1910.1200. TSCA Regulations: All components of this product are listed or are exempt from TSCA Inventory requirements under 40 CFR 720.30. EPCRA Section 302(40 CFR Part 355)(Emergency Response Planning, Extremely Hazardous Substance): No components are subject to the reporting. EPCRA Section 304(40 CFR Part 355)(Emergency Release Notification Requirements): No components are subject to the reporting. EPCRA Sections 311 &312(Hazardous Chemical Inventory Reporting, Hazard Categories): Acute Health Hazard, Chronic Health Hazard EPCRA Section 313(40 CFR Part 372)(Toxic Chemical Release Inventory Reporting): No components are subject to the reporting. CERCLA Sections 102-103(40 CFR Part 302)(Hazardous Substances Release Notification): No components are subject to the reporting. Page 7 of 8 Rhino Linings' SAFETY DATA SHEET Part No.: 60250 Released:August 3,2016 Clean Air Act: • Ozone Depleting Substances(ODS): This product does not contain and is not manufactured with ozone depleting substances. • Hazardous Air Pollutants, OSHA, Section 112 U,Table Z-1: The followin component is listed: 9 P _.......... - -- -— mRenigulatory� Lim 8 dai/0S A;m L NIOSH REL mmmended Limits TWA,m/m Substance � OSHA PEL Cal/OSHA PEL _ NIOSH REL ACGIH 2015-TL� -hour __ t pP-- g .._..... g }.. P ...... g g CAS#Hydrate1 312-58 7m Silicate(Kaolin), Repprtable fraction ust 15 2' 15 2 ppm-parts per million;'-no asbestos and<1%Crystalline Silica; Occupational Exposure Limits o Diethylene glycol,CAS#: 111-46-6: AIHA WEEL:TWA: 10 mg/m' Clean Water Act: • Section 307(a)(Toxic pollutants): No components are listed. • Section 311(b)(2):Table 116.4A(Hazardous chemicals)/Table 117.3(RQ): No components are listed. NFPA rating: Health: 2 Fire: 1 Reactivity: 1 Special: 0 HMIS rating: Health: 2* Flammability: 1 Physical hazard: 1 State Regulations: California Prop.65 Components: This product does not contain components known to State of California to cause cancer,birth defects, or any other reproductive harm. Instruction:for regulatory information on components of this mixture, check the appropriate state websites. International Regulations/Inventories: Canada:All ingredients of this product are listed or are exempt from the DSL. WHMIS Classification(Controlled Products Regulations): Class D26: Material causing other toxic effects WHMIS Label Information: O • SECTION 16—OTHER INFORMATION LEGEND GHS Globally Harmonized System CAS Chemical Abstracts Services EC European Community EPA Environmental Protection Agency OSHA Occupational Safety and Health Administration ACGIH American Conference of Governmental Industrial Hygienists NIOSH National Institute of Occupational Safety and Health PEL Permissible Exposure Limits TLV Threshold Limit Value REL Recommended Exposure Limit TWA Time-Weighted Average STEL Short-term exposure limit IARC International Agency for Research on Cancer NTP National Toxicology Program COD/BOD Chemical Oxygen Demand/Biological Oxygen Demand STOT,SE Specific Target Organ Toxicity following Single Exposure STOT,RE Specific Target Organ Toxicity following Repeated Exposure DOT Department of Transportation IMDG International maritime dangerous goods code IATA,ICAO International Air Transport Association,International Civil Aviation Organization TSCA Toxic Substances Control Act EPCRA Emergency Planning and Community Right-to-Know Act CERCLA Comprehensive Environmental Response,Compensation and Liability Act CFR Code of Federal Regulations RQ Reportable Quantity EHS Extremely Hazardous Substances DSL Domestic Substance List WHMIS Workplace Hazardous Materials Information System Latest revision date: August 3, 2016 Date of the previous revision: May 20, 2015—Preparation of SDS in accordance to the GHS requirements Disclaimer:The data set forth in this sheet are based on information provided by the suppliers of the raw materials and chemicals used in the manufacture of the aforementioned product. Rhino Linings Corporation makes no warranty with respect to the accuracy of the information provided by their suppliers,and disclaims all liability of reliance thereof. Page 8 of 8 1Z4►�s� lawk b� Iq ► a, Rhino Linings' SAFETY DATA SHEET Part No.: 60216 Released: May 13,2016 PRODUCT NAME(S): Rhino Hybrid TM HP 11-50 Isocyanate SECTION 1 —IDENTIFICATION Manufacturer's Info: Product name: Rhino Hybrid'""HP 11-50 Isocyanate Rhino Linings Corporation Chemical Name: MIDI Prepolymer 9747 Businesspark Avenue Chemical Family: Aromatic Isocyanate San Diego, CA, 92131 Information phone: (858)450 0441 Emergency contact: CHEMTREC(800)424 9300 SECTION 2—HAZARD(S)IDENTIFICATION OSHA Hazard Communication Standard: This product is a"Hazardous Chemical"as defined by the OSHA Hazard Communication Standard, 29 CFR 1910.1200. GHS-Label Elements: Signal Word: Pictogram(s): DANGER < > 1r GHS 08 GHS 07 CONTAINS ISOCYANATES.INHALATION OF ISOCYANATE MISTS OR VAPORS MAY CAUSE RESPIRATORY IRRITATION,BREATHLESSNESS, CHEST DISCOMFORT AND REDUCED PULMONARY FUNCTION.OVEREXPOSURE WELL ABOVE THE PEL MAY RESULT IN BRONCHITIS, BRONCHIAL SPASMS AND PULMONARY EDEMA.LONG-TERM EXPOSURE TO ISOCYANATES HAS BEEN REPORTED TO CAUSE LUNG DAMAGE, INCLUDING REDUCED LUNG FUNCTION WHICH MAY BE PERMANENT.ACUTE OR CHRONIC OVEREXPOSURE TO ISOCYANATES MAY CAUSE SENSITIZATION IN SOME INDIVIDUALS,RESULTING IN ALLERGIC RESPIRATORY REACTIONS INCLUDING WHEEZING, SHORTNESS OF BREATH AND DIFFICULTY BREATHING.ANIMAL TESTS AND OTHER RESEARCH INDICATE THAT SKIN CONTACT WITH MIDI MAY PLAYA ROLE IN CAUSING RESPIRATORY SENSITIZATION. Classification of the substance or mixture: I Hazard Class Cata eq9ry Hazard Statement Codes Hazard Statements_ Acute Toxicity, Inhalation(mist) 4 H332 Harmful if inhaled Skin corrosion/Irritation 2 H315 Causes skin irritation _ ...-, _ _... _._..- _ .-----. - .. . __.... --..... ... ._-_ ... ..... ... - Serious eye damage/E e irritation 2A _ _H319_ Causes serious�e irritation j Respiratory Sensitization 1 H334 May cause allergy or asthma symptoms or breathing difficulties if inhaled Skin Sensitization 1 B H317 May cause an allergic skin reaction Carcinogenicity 2 H351 Suspected of causing cancer j Specific target organ toxicity, 3 H335 May cause respiratory irritation Specific target organ toxicity, 2 H373 May cause damage to olfactory organs through repeated exposure prolonged or repeated exposure by inhalation Precautionary Statements: F ` Prevention: P201 Obtain special instructions before use. P202 Do not handle until all safety precautions have been read and understood. P281 Use personal protective equipment as required. P285 In case of inadequate ventilation wear respiratory protection. P260 Do not breathe mist,vapors, spray. P271 Use only outdoors or in a well-ventilated area. P264 Wash exposed area with plenty of water and soap thoroughly after handling. P272 Contaminated work clothing should not be allowed out of the workplace. Response: P304+ P341 IF INHALED: If breathing is difficult, remove victim to fresh air and keep at rest in a position comfortable for breathing. P342+ P311 If experiencing respiratory symptoms: Call a POISON CENTER or doctor/physician. P302+P352 IF ON SKIN:Wash with plenty of soap and water. P333+ P313 If skin irritation.or rash occurs: Get medical advice/attention. P362 Take off contaminated clothing and wash before reuse. P305+ P351 +P338 IF IN EYES: Rinse cautiously with water for several minutes. Remove contact lenses, if present and easy to do. Continue rinsing. P337+P313 If eye irritation persists: Get medical advice/attention. P308+P313 IF exposed or concerned: Get medical advice/attention. Page 1 of 9 a Rhino Linings SAFETY DATA SHEET Part No.: 60216 Released: May 13,2016 Storage: P403+ P233 Store in a well-ventilated place. Keep container tightly closed. P405 Store locked up. Disposal: P501 Dispose of contents/container to hazardous or special waste collection point in accordance with local/regional/national/intemational regulations. Hazards not otherwise classified: No specific dangers known. SECTION 3—COMPOSITION/INFORMATION ON INGREDIENTS Components CAS# EC# Concentration,% 4,4'-Di hen (methane Diisoc anate(MDI) 101-68-8 202-966-0 30—50 2,4'-Di hen (methane Diisoc anate(MDI) 5873-54-1 227-534-9 5-15 4,4'-Diphenylmethane Diisocyanate,oligomers 25686-28-6 500-040-3 1 -5 4,4'-Diphenylmethane Diisocyanate, oligomeric reaction products with butane-1,3-diol,2,4'- 123714-19-2 500-312-1 1 -5 diisocyanatodiphenylmethane, [(methylethylene) . bis oxy di ro anol and ro ahe-1,2-diol SECTION 4—FIRST-AID MEASURES Description of First Aid measures: Inhalation: Immediate medical attention required. Call a poison center or physician. Remove victim to fresh air and keep at rest in a position comfortable for breathing. If it is suspected that fumes are still present,the rescuer should wear an appropriate mask or self-contained breathing apparatus. If not breathing, if breathing is irregular or if respiratory arrest occurs, provide artificial respiration or oxygen by trained personnel. It'may be dangerous to the person providing aid to give mouth-to-mouth resuscitation. If unconscious, place in recovery position and maintain an open airway. Loosen tight clothing such as a collar,tie, belt or waistband. In case of inhalation of decomposition products in a fire, symptoms may be delayed. Asthmatic symptoms may develop and may be immediate or delayed up to several hours. Extreme asthmatic reactions can be life threatening. Skin: Wash material off of the skin with plenty of soap and water for at least 15 minutes. Remove contaminated clothing and shoes immediately and wash them before reuse. Continue to rinse for at least 10 minutes.An MDI study has demonstrated that a polyglycol-based skin cleanser(such as D-TamTM, PEG-400)or corn oil may be more effective than soap and water. For severe exposures, immediately get under safety shower and begin rinsing. If irritation develops,consult a physician or dermatologist. Eye: Rinse cautiously with water for several minutes,especially under the eyelids. Remove contact lenses, if present and easy to do. Continue rinsing for at least 15 minutes. Do not rub eyes in order to prevent cornea injury. Immediate medical attention required. Ingestion: Immediate medical attention required. Remove victim to fresh air and keep at rest in a position comfortable for breathing. Remove dentures if any. If the exposed person is conscious, rinse mouth with water and then give plenty of water to drink. Stop if the exposed person feels sick as vomiting may be dangerous. If vomiting occurs,the head should be kept low so that vomit does not enter the lungs. Do not induce vomiting unless directed to do so by medical personnel. If unconscious, place in recovery position and get medical attention immediately.Maintain an open airway. Loosen tight clothing such as a collar,tie, belt or waistband. Never induce vomiting or give anything by mouth if the victim is unconscious or having convulsions. Most important symptoms/effects,acute and delayed: Eye irritation,skin irritation, allergic symptoms. Symptoms can appear later. See Section 11 for more details. General advice for First Aid responders: No action should be taken involving any personal risk or without suitable training. If potential for exposure exist refer to Section 8 for specific personal protective equipment. Show this SDS to physician. Note to physician: Specific antidotes or neutralizers do not exist.Treatment should be supportive and based on the judgment of the physician in response to the reaction of the patient. Recommended medical monitoring for at least 48 hours. o Inhalation:Treatment is essentially symptomatic.An individual having a dermal or pulmonary sensitization reaction to this material should be removed from further exposure to any diisocyanate. o Eyes: Stain for evidence of corneal injury. If cornea is burned, instill antibiotic/steroid preparation as needed.Workplace vapors could produce reversible corneal epithelial edema impairing vision. o Skin: This compound is a skin sensitizer.Treat symptomatically as for contact dermatitis or thermal burn. o Ingestion:Treat symptomatically. There is no specific antidote. Inducing vomiting is contraindicated because of the irritating nature of the compound. Page 2 of 9 Rhino Linings SAFETY DATA SHEET Part No.: 60216 Released: May 13,2016 SECTION 5—FIRE-FIGHTING MEASURES Suitable extinguishing media: Water fog or fine spray, alcohol-resistant foam,dry chemical or carbon dioxide fire extinguishers. Unsuitable extinguishing media: Direct water stream may cause frothing, splattering of burning material and spreading of fire. Specific hazards arising from the chemical: Material may be ignited only if preheated to high temperatures(such in fire conditions). Fire in vicinity poses risk of pressure build-up and rupture. Containers at risk from fire should be cooled with water and, if possible, removed from the danger area. Exposure to heated diisocyanate can be extremely dangerous. Reaction between water and hot isocyanate may be vigorous. Hazardous Combustion products: carbon dioxide, carbon'monoxide, nitrogen oxides, amines, hydrogen cyanide, lower molecular weight organic molecules. Special Protective Equipment and Precautions for fire-fighters: Wear NIOSH or OSHA approved self-contained breathing apparatus in positive pressure mode with full face piece and full protective gear. Isolate the scene by removing all persons from the incident area. No action should be taken involving any personal risk or without suitable training. Dispose of fire debris and contaminated extinguishing water in accordance with official regulations. SECTION 6—ACCIDENTAL RELEASE MEASURES Personal precautions,protective equipment and emergency procedures: Keep unnecessary and unprotected personnel from entering. Ensure adequate ventilation/exhaust extraction.Avoid breathing vapors or mist during clean up. Use protective equipment as described in Section 8. Do not touch or walk through spilled material. Environmental precautions: Prevent from entering into soil,ditches, sewers,waterways and/or groundwater. Inform the relevant authorities if the product has caused environmental pollution. Methods and materials for containment and cleaning up: Remove mechanically; cover the remainder with non-combustible absorbent material(e.g. sawdust, sand,earth,vermiculite or diatomaceous earth).After approximately one hour,transfer into properly labeled and approved chemical waste containers. Do not fill the container more than 2/3 full to allow for expansion. Cover container, but do not seal, and remove from work area. Keep in a well ventilated area. If necessary, repeat application of absorbent material until all liquid has been removed from the surface. Decontaminate the spill surface area using a neutralization solution. Scrubbing the surface with a broom or brush helps the decontamination solution to penetrate into porous surfaces.Wait at least 15 minutes after first application of the neutralization solution. Cover the area again with absorbent material and shovel this into chemical waste container. Apply lid loosely to the waste container(do not tighten the lid because carbon dioxide gas and heat can be generated from the neutralization process).With the lid still loosely in place, move the container to an isolated,well-ventilated area to allow release of carbon dioxide.After 72 hours,seal the container,and properly dispose of the waste material and any contaminated equipment(i.e., broom or brush)in accordance with existing federal, state and local regulations. Spill cleaning solutions: Products or product mixtures that have been shown to be effective neutralization solutions for decontaminating surfaces,tools, or equipment that have been in contact with an isocyanate includes: Products available through industrial suppliers: • Spartan Chemical Company: 1-800-537-8990: • Spartan@ ShineLine Emulsifier Plus • Spartan@ SC-200 Heavy Duty Cleaner Products available through retail outlets: • ZEP@ Commercial Heavy-Duty Floor Stripper • Greased Lightning@ Super Strength Cleaner and Degreaser • EASY OFF@ Grill and Oven Cleaner or EASY OFF@ Fume Free Oven Cleaner • A mixture of 50%Simple Green@ Pro HD Heavy-Duty Cleaner and 50%household ammonia • A mixture of 90%Fantastic@ Heavy Duty All Purpose Cleaner and 10%household ammonia. Note:Always wear proper PPE when cleaning up an isocyanate spill and using a neutralization solution. It may take two or more applications of the neutralization solution to decontaminate the surface. Check for residual surface contamination using a surface wipe method such as the CLI Swype@ pad. For major spills: Stop leak if without risk. Move containers from spill area. Remove ignition sources. Approach release from upwind. Prevent entry into sewers,water courses; basements or confined areas.Wash spillages into an effluent treatment plant or contain and collect with an absorbent material as described in the previous paragraph. Residues from spill cleanup may continue to be regulated under provisions of RCRA and require storage and disposal as hazardous waste. For major spills, see Section 1 for the Emergency contact; for further disposal measures, see Section 13. SECTION 7—HANDLING AND STORAGE Precautions for safe handling: Protect chemical from atmospheric moisture. Avoid prolonged exposure to heat and air. Keep away III from sources of ignition.Do not reseal if contamination is suspected. Use adequate ventilation to keep airborne levels below the exposure limits. Do not inhale vapors and mists.Wear respiratory protection if material is heated, mixed,sprayed or used in a confined space.Avoid contact with skin and eyes.Wear appropriate eye and skin protection.Wash hands thoroughly after handling. Hands and/or face should be washed before eating,drinking and smoking and at the end of the shift. Remove contaminated clothing and protective equipment before entering eating areas. Page 3 of 9 Rhino Linings° SAFETY DATA SHEET Part No.: 60216 Released: May 13,2016 This material can produce asthmatic sensitization upon either single inhalation exposure to a relatively high concentration or upon repeated inhalation exposures to lower concentrations. Individuals with asthma, chronic respiratory disease or prior allergic reactions to isocyanates and those with a history of skin sensitization problems should not be employed in any process in which this product is used. Do not handle until all safety precautions have been read and understood. Conditions for safe storage, including any incompatibilities:Store in original or approved alternative container protected from direct sunlight in a dry, cool and well-ventilated area, away from incompatible materials(see Section 10)and food and drink. Suitable containers: Carbon steel (Iron), High density polyethylene(HDPE), Low density polyethylene(LDPE), Stainless steel 1.4301 (V2). Unsuitable containers: Containers made of copper, copper alloys or galvanized surfaces. Store locked up. Keep container tightly closed and sealed until ready for use. Containers that have been opened must be carefully resealed and kept upright to prevent leakage. Protect it against physical damage and moisture. Normal temperature and pressures do not affect the material. Keep liquid away from heat, sparks and flame. Do not cut,drill,grind,weld or perform similar operations on or near containers. Use appropriate containment to avoid environmental contamination. Segregate from acids and acid forming substances. Protect from freezing. Storage stability: Stable under normal conditions. Storage temperature:60-90°F(16-32°C) Employee education and training in the safe use and handling of this product are required under the OSHA Hazard Communication Standard 29 CFR 1910.1200. Employees and consumers should be warned of health risks associated with product use. See Section 8 for additional information on hygiene measures. SECTION 8—EXPOSURE CONTROLS/PERSONAL PROTECTION Control Parameters/Occupational exposure limit values: Not available for mixture. Results for components are listed in Section 15. Advice on system design: Provide process enclosures, local exhaust ventilation or other engineering controls to maintain recommended PEL. Appropriate engineering controls: Use only with adequate ventilation. Diisocyanates can only be smelled if the occupational exposure limit has been exceeded considerably. Emissions from ventilation or process equipment should be checked to ensure they comply with the requirements of environmental protection legislation. In some cases,fume scrubbers,filters or engineering modifications to the process equipment will be necessary to reduce emissions to acceptable levels. Personal protective equipment: Eye/face protection: When directly handling liquid product,eye protection is required. Examples of eye protection include safety glasses and goggles or full face shield when there is a greater risk of splash. Contact lenses should not be worn when working with chemicals. Skin/body protection: Avoid contact with skin. Impervious gloves(nitrile butyl rubber, neoprene and PVC)should be worn always when working with this product. Use proper glove removal technique(without touching glove's outer surface)to avoid skin contact. Dispose contaminated gloves after use in accordance with good laboratory practices. Body should be covered with appropriate clothing (apron,arm covers or full body suit)depending on the task being performed and the risks involved. Protective clothing should be selected and used in accordance with"Guidelines for the Selection of Chemical Protective Clothing"published by ACGIH. Wash contaminated clothing before reuse. Store work clothing separately.Appropriate footwear should be also selected based on the task being performed and the risks involved. Respiratory protection: Use local or general ventilation to control exposures below applicable exposure limits. When ventilation is inadequate, use either an atmosphere supplying respirator or NIOSH or OSHA approved air-purifying respirator for organic vapors. Respirator must be properly fitted and its selection must be based on known or anticipated exposure levels,the hazards of the product and the safe working limits of the selected respirator. Additional Protective Measures: Educate and train employees in safe handling of this product. Follow all label instructions. As a general hygiene practice,wash hands and face after use. Emergency eyewash fountains and safety shower should be in close proximity as a matter of good practice. Medical Surveillance: All applicants who are assigned to an isocyanate work area should undergo a pre-placement medical evaluation. A history of eczema or respiratory allergies such as hay fever, are possible reasons for medical exclusion from isocyanate areas. Applicants who have a history of adult asthma should be restricted from work with isocyanates.Applicants with a history of prior isocyanate sensitization should be excluded from further work with isocyanates.A comprehensive annual medical surveillance program should be instituted for all employees who are potentially exposed to diisocyanates. Once a worker has been diagnosed as sensitized to any isocyanate,further exposure cannot be permitted.The Occupational Exposure Limits listed do not apply to previously sensitized individuals. Sensitized individuals should be removed from any further exposure. Page 4 of 9 Rhino Linings® SAFETY DATA SHEET Part No.: 60216 Released: May 13,2016 SECTION 9-PHYSICAL AND CHEMICAL PROPERTIES Appearance: Light yellow Liquid Odor: Must Odor threshold: Not applicable pH: Not applicable Melting point/freezing point: Not available Initial boiling point and boiling range: >200°C_ _— Flash point: >200°Coen cup) Evaporation rate: Ne ligible Flammability(solid,gas): Not flammable Upper/lower flammability or explosive limits: Not relevant Vapor pressure: -0.00001 mmH 25°C 77°F Vapor density: Not applicable Relative density: Not available Solubility water): Insoluble Partition coefficient n-octanol/water: Not applicable Auto-i nition temperature: Not available Decomposition temperature: Not available Viscosity: Not available SECTION 10-STABILITY AND REACTIVITY Reactivity: MDI is insoluble in and heavier than water and sinks to the bottom but reacts slowly at the interface. A solid water-insoluble layer of polyurea is formed at the interface accompanied by carbon dioxide release. This can lead to container bursting, if tightly closed. There is a risk of exothermic reaction with materials containing active hydrogen groups. The reaction becomes progressively more vigorous and can be violent at higher temperatures if the miscibility of the reaction partners is good or is supported by stirring or by the presence of solvents. Contact with certain rubbers and plastics can cause brittleness of the product with subsequent loss in strength. Hazardous Polymerization: Contact with moisture, alcohols, amines, bases and acids or temperatures above 350°F(177°C). Chemical stability: Stable under recommended storage conditions. Product is hygroscopic; contamination with moisture will negatively affect product performance.Avoid unintended contact with incompatible chemicals;the reaction will generate heat. Conditions to avoid: Unintentional contact with moisture,excessive heat, open flame and sparks. Avoid mist formation. Incompatible materials: Strong oxidizing agents.Water,alcohols, amines, bases, acids, copper, aluminum and zinc alloys. Hazardous decomposition products: Depend upon temperature, air supply and presence of other materials. Can include, but are not limited to carbon dioxide, carbon monoxide, nitrogen oxides,amines, hydrogen cyanide, lower molecular weight organic molecules. Creates dense black smoke in fire conditions. SECTION 11 -TOXICOLOGICAL INFORMATION Likely Routes of Exposure: Inhalation, Skin and Eye Contact, Ingestion. Symptoms of exposure: Acute toxicity: Oral: May be harmful if swallowed.Adverse symptoms may include abdominal pain, nausea,vomiting, and diarrhea. Dermal: May be harmful in contact with skin.Adverse symptoms may include irritation and redness. Inhalation: Irritating to respiratory system. Inhalation of vapors may cause irritation of the mucous membranes of the nose, throat or trachea, breathlessness, chest discomfort, difficult breathing and reduced pulmonary function. Inhalation exposure well above the PEL may result additionally in eye irritation, headache, chemical bronchitis, asthma-like findings or pulmonary edema. Isocyanates have also been reported to cause hypersensitivity pneumonitis, which is characterized by flu-like symptoms,the onset of which may be delayed. Skin corrosion/irritation: Irritating to skin. Skin contact may result in dermatitis, either irritative or allergic. Serious eye damage/eye irritation: Irritating to eyes.Adverse symptoms may include tearing, redness and itching. Specific target organ toxicity,single exposure: Causes temporary irritation of the respiratory tract. Aspiration hazard: Based on physical properties, not likely to be an aspiration hazard. Chronic toxicity: Respiratory and Skin Sensitizer: This product is a skin and respiratory sensitizer. 0 4,4'-Di phenyl methane Diisocyanate(MDI),CAS#: 1014-8:skin and respiratory sensitizer. 0 2,4'-Diphenylmethane Diisocyanate(MIDI),CAS#:5873-54-1:skin and respiratory sensitizer. Page 5 of 9 Rhino Linings SAFETY DATA SHEET Part No.: 60216 Released: May 13,2016 o Diphenylmethane Diisocyanate,oligomers,CAS#:25686-28-6:skin and respiratory sensitizer. 0 4,4'-Di phenyl methane Diisocyanate,oligomeric reaction products with butane-1,3-diol,2,4'-diisocyanatodiphenylmethane, [(methylethylene)bis(oxy)jdipropanol and propane-1,2-diol,CAS#: 123714-19-2:skin and respiratory sensitizer. Sensitization possible after skin contact.The substance may cause sensitization of the respiratory tract.As a result of previous repeated overexposures or a single large dose,certain individuals will develop isocyanate sensitization(chemical asthma)which will cause them to react to a later exposure to isocyanate at levels well below the PEUTLV.These symptoms,which include chest tightness,wheezing,cough,shortness of breath,or asthmatic attack,could be immediate or delayed up to several hours after exposure.Similar to many non-specific asthmatic responses,there are reports that once sensitized individual can experience these symptoms upon exposure to dust,cold air,or other irritants.This increased lung sensitivity can persist for weeks and in severe cases for several years.Chronic overexposure to isocyanates has also been reported to cause lung damage,including a decrease in lung function,which may be permanent.Prolonged contact can cause reddening,swelling,rash,scaling,or blistering. In those who have developed a skin sensitization,these symptoms can develop as a result of contact with very small amounts of liquid material,or even as a result of vapor-only exposure.Animal tests indicate that skin contact may play a role in causing respiratory sensitization.However,the relevance of this result for humans is-unclear. Germ cell mutagenicity: Risk to humans is not expected from exposure to this product. 0 4,4'-Di phenyl methane Diisocyanate(MDI),CAS#:101-68-8:The substance was mutagenic in various bacterial test systems; however,these results could not be confirmed in tests with mammals. Carcinogenicity: I This product contains component suspected to be carcinogenic by IARC. 0 4,4'-Di phenyl methane Diisocyanate(MDI),CAS#:101-68-8:IARC:Group 3(Not classifiable as to its carcinogenicity to humans).A carcinogenic potential cannot be excluded after prolonged exposure to severely irritating concentrations.These effects are not relevant to humans at occupational levels of exposure. Reproductive toxicity: Risk to humans is not expected from exposure to this product: 0 Repeated inhalative uptake of the substance did not cause damage to the reproductive organs. Birth defects were not seen in two independant animal(rat)studies.Fetotoxicity was observed at doses that were extremely toxic (including lethal)to the mother.Fetotoxicity was not observed at doses that were not maternally toxic.The doses used in these studies were maximal,respirable. Specific target organ toxicity, repeated exposure: Respiratory system, lungs, olfactory epithelium after repeated inhalation. Medical conditions aggravated by overexposure: The isocyanate component is a respiratory sensitizer. Respiratory sensitization may result in allergic(asthma-like)signs in the lower respiratory tract including wheezing, shortness of breath and difficulty breathing,the onset of which may be delayed. Repeated inhalation of high concentrations may cause lung damage, including reduced lung function,which may be permanent. Medical supervision of all employees who handle or come into contact with isocyanates is recommended. Persons with history of respiratory disease or hypersensitivity should not be exposed to this product. Persons with asthmatic conditions,chronic bronchitis,other chronic respiratory diseases, recurrent eczema or pulmonary sensitization should be excluded from working with isocyanates. Once a person is diagnosed as having pulmonary sensitization(allergic asthma)to isocyanates,further exposure is not recommended. Pre-employment and periodic medical examinations with respiratory function tests(FEV, FVC as a minimum)are suggested. Toxicity test results: Not available for mixture. Results for components: Components Test Results Acute Toxicity I i Oral LD50(Rat):>2,000 mg/kg(Directive 84/449/EEC,B.1) I Dermal L050(Rabbit):>9,400 mg/kg Inhalation LC50(Rat),1hr:2.0 mg/L(OECD Guideline 403)An aerosol was tested. Skin corrosion/irritation(Rabbit):irritating(Draize test) ' Serious eye damage/eye irritation(Rabbit):irritating(Draize test) 4,4'-Di phenyl methane Sensitization(guinea pig):sensitizing(Buehler test) Diisocyanate(MDI), (mouse):Can cause skin sensitization(Mouse Local Lymph Node Assay) CAS#:101-68-8. Chronic Toxicity Repeated dose toxicity:Experimental/calculated data:(rat,inhalation)2 yrs,6 hr/day at 0,0.2,1,6 mg/m':olfactory epithelium;NOAEL:0.2 mg/m', LOAEL:1 mg/m' Genetic toxicity:in vitro(Salmonella typhimurium):with and without metabolic activation ambiguous(OECD Guideline 471 Ames-test)/in vivo(rat): i Inhalation negative(OECD Guideline 474 Micronucleus assay) Carcinogenicity:Experimental/calculated data(rat,inhalation)at 0,0.2,1,6 mg/m':Lung tumors(OECD Guideline 453) Teratogenicity:(rat,inhalation)at 0,1,4,12 mg/m':NOAEL Mat.;4 mg/m',NOAEL Teratog.:4 mg/m'(OECD Guideline 414)-The substance did not cause malformations in animal studies;however,toxicity to development was observed at high doses that were toxic to the parental animals. SECTION 12—ECOLOGICAL INFORMATION Ecotoxicity: By considering the production and use of the substance, it is unlikely that product is harmful to aquatic organisms, neither acutely nor chronically. Immiscible with water, but will react with water to produce inert and non-biodegradable solids. Conversion to soluble products, including diamino-diphenylmethane(MDA), is very low under the optimal laboratory conditions of good dispersion and low concentration. In air,the predominant degradation process is predicted to be a relatively rapid OH radical attack, based on calculation and analogy with related diisocyanates. Page 6 of 9 Rhino Linings SAFETY DATA SHEET Part No.: 60216 Released:May 13,2016 Persistence and degradability: Poorly biodegradable by OECD criteria. In contact with water the substance will hydrolyze slowly. After evaporation or exposure to the air,the product will be rapidly degraded by photochemical processes. Bioaccumulative potential: No significant accumulation in organisms is expected. Mobility in soil: Not expected. Other adverse effects: No known significant effects or critical hazards. Ecotoxicity test results: Not available for the mixture. Results for components: Components Test Results Acute Toxicity Fish:LC50,96hrs:>1,000 mg/L(OECD Guideline 203,static) LC50,96hrs:772.14mg/L(OECD Guideline 203,static) Aquatic invertebrates:EC50,24hrs:>1,000 mg/L(OECD Guideline 202,part 1,static) 4,4'-Diphenylmethane Aquatic plants:EC50,72hrs:1,640 mg/L(growth rate)(OECD Guideline 201,static) Diisocyanate(MDI) Ecological Data CAS#:101-68-8 Activated sludge(EC50 aerobic bacteria from a domestic water treatment plant),3hrs:>100 mg/L(OECD Guideline 209) Elimination data Aerobic,activated sludge,28days:0%BOD of the ThOD;Poorly biodegradable(OECD Guideline 302 C); Stability in Water(Hydrolysis):t1rz:20 hours(25°C) Bioconcentration factor(common carp) 28days:200(OECD Guideline 305 E) SECTION 13—DISPOSAL CONSIDERATIONS Product Disposal:The generation of waste should be avoided or minimized wherever possible. If product becomes a waste, it does not meet criteria of hazardous waste as defined in 40 CFR 261, Subpart C and D. Do not discharge into sewer system. Spill cleanup residues may still be subject to RCRA storage and disposal requirements. Dispose waste in compliance with local, state and federal regulations via licensed waste disposal contractor. Container disposal: Even after emptying, container may retain residues. Empty containers should be completely drained and safely stored until appropriately reconditioned or disposed through licensed contractor in accordance with government regulations. This material and its container must be disposed of in a safe way. SECTION 14—TRANSPORT INFORMATION Non-bulk: _.....-. --- _.......... _- _ 1 Land transport, U.S. DOT: Non-regulated Sea transport, IMDG: Non-regulated Air transport, IATA/ICAO: Non-regulated Bulk: This product is regulated if the-amount in an individual container exceeds the Product Reportable Quantity.4,4'-Diphenylmethane Diisocyanate(MDI), RQ: 5,000 Ibs; Product RQ: >5,000 Ibs UN number: UN 3082 ....... UN proper shipping name: Other regulated substances, liquid, n.o s (contains 4,4' Diphenylmethane Diisocyanate(MDI)) Transport hazard classes: 9 _ _ ....... - ---------- .. Packing group III Hazard Label ! i 1 SECTION 15—REGULATORY INFORMATION U.S. Regulations: OSHA HCS:This product is a"Hazardous Chemical"as defined by the OSHA Hazard Communication Standard, 29CFR 1910.1200. TSCA Regulations: All components of this product are listed or are exempt from TSCA Inventory requirements under 40 CFR 720.30. EPCRA Section 302(40 CFR Part 355)(Emergency Response Planning, Extremely Hazardous Substance): No components are subject to the reporting. EPCRA Section 304(40 CFR Part 355)(Emergency Release Notification Requirements): No components are subject to the reporting. EPCRA Sections 311 &312(Hazardous Chemical Inventory Reporting, Hazard Categories): Acute Health Hazard, Chronic Health Hazard EPCRA Section 313(40 CFR Part 372)(Toxic Chemical Release Inventory Reporting): The following components are subject to the reporting: o 4,4'-Diphenylmethane Diisocyanate(MDI), CAS#: 101-68-8: in Product: 30-50%; De Minimis: 1.0% CERCLA Sections 102-103(40 CFR Part 302) (Hazardous Substances Release Notification): The following components are subject to the reporting: 0 4,4'-Diphenylmethane Diisocyanate (MDI): RQ: 5,000 Ibs/Product RQ: >5,000 Ibs Page 7 of 9 Rhino Linings• SAFETY DATA SHEET Part No.: 60216 Released:May 13,2016 Clean Air Act: ` • Ozone Depleting Substances(ODS): This product does not contain and is not manufactured with ozone depleting substances. Hazardous Air Pollutants, OSHA, Section 112(b) Table Z-1: I_ ppm � Regulatory Limits Recomm8-hour TWA,mg/m_ _Up to 10-hourTWA mg/mended Li its Substance 8 hourTWA mg/m OSHA PEL Cal/OSHA PEL NIOSH REL ACGIH 2O15 TLd° 4,4'-Diphenylmethane Diisocyanate, 0.05 mg/m3 I (C)0.02 (C)0.2 1 0.005 ppm 0.005 ppm CAS#:101-68-8 � (C)0.2 mg/m [10-min] (C)Ceiling,(ST)STEL,ppm-parts per milion Clean Water Act: • Section 307(a): (Priority Toxic Pollutants 40 CFR 401.15): No components are listed. • Section 311(b)(2):Table 116.4A(Hazardous chemicals)/Table 117.3(RQ): No components are listed. NFPA rating: Health: 2 Fire: 1 Reactivity: 1 Special:W HMIS rating: Health: 2 Flammability: 1 Physical hazard: 1 State Regulations: California Prop.65 Components: This product does not contain chemicals known to State of California to cause cancer, birth defects, or any other reproductive harm. Instruction:for regulatory information on components of this mixture, check the appropriate state websites. International Regulations/Inventories: Canada:All components of this product are listed or are exempt from the DSL. WHMIS Classification(Controlled Products Regulations): Class D2A: Material causing other toxic effects(Very toxic). WHMIS Label Information: Class D26: Material causing other toxic effects(Toxic). T Europe, European Inventory of Existing Commercial Chemical Substances (EINECS):All components are listed or exempted. Australia inventory(AICS):All components are listed or exempted. China inventory(IECSC):All components are listed or exempted. Japan inventory:All components are listed or exempted. Korea inventory:All components are listed or exempted. Malaysia Inventory(EHS Register):All components are listed or exempted. New Zealand Inventory of Chemicals(NZIoC):All components are listed or exempted. Philippines inventory(PICCS):All components are listed or exempted. Taiwan inventory(CSNN):All components are listed or exempted Brazil Regulations Classification system used: Norma ABNT-NBR 14725-2:2012 SECTION 16—OTHER INFORMATION LEGEND GHS Globally Harmonized System CAS Chemical Abstracts Services EC European Community EPA Environmental Protection Agency OSHA Occupational Safety and Health Administration ACGIH American Conference of Governmental Industrial Hygienists NIOSH National Institute of Occupational Safety and Health PEL Permissible Exposure Limits TLV Threshold Limit Value REL Recommended Exposure Limit TWA Time-Weighted Average STEL Short-term exposure limit IARC International Agency for Research on Cancer NTP National Toxicology Program COD/SOD Chemical Oxygen Demand/Biological Oxygen Demand STOT,SE Specific Target Organ Toxicity following Single Exposure STOT,RE Specific Target Organ Toxicity following Repeated Exposure DOT Department of Transportation IMDG International maritime dangerous goods code IATA,ICAO International Air Transport Association,International Civil Aviation Organization TSCA Toxic Substances Control Act EPCRA Emergency Planning and Community Right-to-Know Act CERCLA Comprehensive Environmental Response,Compensation and Liability Act CFR Code of Federal Regulations RQ Reportable Quantity DSL Domestic Substance List WHMIS Workplace Hazardous Materials Information System Page 8 of 9 Rhino Linings SAFETY DATA SHEET Part No.: 60216 Released: May 13,2016 Latest revision date: May 13, 2016 Date of the previous revision: May 20, 2015—Preparation of SDS in accordance to the GHS requirements Disclaimer:The data set forth in this sheet are based on information provided by the suppliers of the raw materials and chemicals used in the manufacture of the aforementioned product. Rhino Linings Corporation makes no warranty with respect to the accuracy of the information provided by their suppliers, and disclaims all liability of reliance thereof. Page 9 of 9 F a r hY �o ' e - & + i �� � .. _ `"k- ' sk'T- y z Q h® ® Lin® s _-__ pat - � o aS-u heet s .. k ` Part A— Rhino Hybrid" HP 11-50 Iso — Part # 60216-1 Part B — Rhino Hybrid'" HP 11-50 Resin — Part # 60250-1 ' DESCRIPTION: r� Rhino Hybrid"HP 11-50 is a one to one volume ratio,two-component, 100% solids(no VOCs, no solvents), exothermic, rapid curing, elastomeric hybrid polyurea lining system.The lining thickness varies based on E` application,typically minimum of 1/16" (62.5 mils; 1.6mm) up to unlimited thickness. It can be sprayed up to 98% humidity and a dew point temperature difference of 150 or more with no blistering. Rhino Hybrid HP is easy on spray equipment with no fast gelling at the spray gun tip. h TYPICAL USES `' ,a'n; • Excellent general purpose industrial lining for • Spray-on application creates a monolithic, seamless lining � applications such as: that conforms to any shape and size -Material delivery systems where a • Bonds to virtually all substrates of any dimension, including seamless flexible system is essential metals, wood, concrete and fiberglass -Floor and wall protection in industries such • Can withstand vehicle forklift traffic and heavy loads with as food processing,food storage, proper thickness build veterinary, production area and laboratories • Stable from -40°F(-40°C)to 175°F(79.4°C) -Secondary containment as a monolithic, • Elastomeric properties allow for application to surfaces tA ' impermeable lining for industrial plant, subject to: vibration, expansion, contraction, agriculture, and petrochemical applications movement, flexing, abrasion and impact. • Reduces noise from vibration and impact FEATURES & BENEFITS: • Robust application window with ability to spray at • Good chemical resistance j. low temperatures and high humidity • Excellent corrosion resistance : ' • High tensile strength and tear strength properties • Good noise reduction •Very good abrasion and impact resistance • Easy to texture CHEMICAL PROPERTIES*: Standard Test Isocyanate(A) Resin (B) ' Specific Gravity(grams/cc) ASTM D-792 1.09- 1.12 1.13-1.02 a Viscosity, cps 550 850 ----- --- - — ..._...-- ------- - --- ---- .....-_ _—.._.._. -- -- `_ Solids by Volume/Weight mm100% 100% Volatile Organic Compounds, calculated 0 Ibs/gal 0 Ibs/gal _ Mix Ratio, parts per volume 1 1 F r Mix Ratio parts per weight 109 100 _ .......... -*� Gel Time, seconds 3 3 Tack Free, seconds 4 Recoat, max 4 hrs 3 95-99% Cure Time 24 hrs e3 �" .-...... __........-. -- ..... ............ .......... ................. _--_....... ...... .......... _..... -....... ................ Theoretical Coverage 1600 sqft/gal @ 1 mil Odor mild amine Freezing Point _40°F _- 6/a Base Color amber/brown amber/brown - - - __ ....- -- -- ...... .-. __.- -- - m. g Shelf Life-Unopened Containers 12 months 12 months .__ .......... __..__ _ _-._._ - _.. .-- .---..-_- ....... _ ....... -_..-...- ........_ ........ -: "Properties were tested at 77T(25°C). 'o TYPICAL PHYSICAL PROPERTIES: Test Result _ Hardness(Shore D) ASTM D-2240 50t5 Tensile D-412 2250 .. g Secant Moduglus(@s100/o elongation ASTM D-412 1250 o A ' _Secant Modulus @ 200% elongation ASTM D-412 1850 Tear Resistance(pli)** Die C ASTM D-624 375 40 Elongation (%o)** ASTM D-412 250 . _......... .-.__..._ .... .... Impact Resistance, Ibs ASTM D-256 160 - (continued) 10 rn5imn5 i RHINO HYBRID" HP 11-50(continued) TYPICAL PHYSICAL PROPERTIES: 'Test Result Density(lb/ft3) ASTM D-1622 69-70 Compressive Strength (psi) ASTM D-695 800 Taber Abrasion Resistance(mg of loss/1000 cycles) ASTM D-4060 140 H18 Wheel; 1000 grams weight Mandrel Bend, 180°, 1 inch mandrel ASTM D-522 Pass Coefficient of Friction on Steel: -Static ASTM D-1894 .6 -Kinetic ASTM D-1894 .55 Water Absorption (%) ASTM D-570 s1.6 Dielectric Strength (volts/mil) ASTM D-149 300 - ----- --.... -- _ ......... .... __ ......... Volume Resistancy(ohm/inches) ASTM D-257 6 X 10(12) Dielectric Constant(MHz) ASTM D-150_ 5.4 Dissipation Factor(MHz) ASTM D-150 0.058 Cathodic Disbonding ASTM G-8 Pass -- _ ..... ... ....... .. ...._. ............ .............. -Properties were checked of Rhino Hybrid-lining, /,F"(62 mils),(1.6 mm)thick stock. PROCESSING CHARACTERISTICS:The system settings required to achieve quality spray application will vary depending on environmental and substrate conditions.The following recommended parameters will help ensure optimum quality. Equipment Spray Gun j Process Pressure, psi (static) Graco Reactor E-XP1; E-XP2 Fusion -Air Purge or Mechanical Purge 2000-2500 Process Temperatures Iso Component Resin Component Hoses 1!ii -160°F 1400-150°F 1400-160°F DRY FILM THICKNESS RANGE:Varies based on application,typically a minimum of 1/16" (62.5 mils; 1.5mm) up to unlimited thickness. NOT RECOMMENDED FOR: • Sustained temperatures below-40oF(-40oC)or above 250°F(121°C) •Application to high-density polyethylene or thermo plastics CHEMICAL RESISTANCE: Rhino Hybrid HP 11-50 provides good resistance to many commercial and industrial chemicals such as acids, alkalis, oils and cleaning chemicals. For specific applications and information, please consult a Rhino®representative. SUBSTRATES: Metals, wood, concrete,fiberglass, most epoxy or polyurethane painted substrates and geotextiles COLOR OPTIONS: Standard colors- black.Custom colors are available by special order. HOW SUPPLIED: Net weight per set is 910 pounds(412.7 kg).A set of Rhino Hybrid HP 11-50 consists of one(1)55 gallon (208 L) drum of`A' component and one(1)55 gallon (208 L)drum of`B' component. ' SAFETY PRECAUTIONS:Health Considerations:Consult the Rhino Linings®Safety Data Sheets(SDS) This chemical system requires the use of proper safety equipment and procedures. Please follow the Rhino Linings®product SDS and Safety Manual for detailed information and handling guidelines. For Your Protection:The information and recommendations in this publication are,to the best of our knowledge, reliable. Suggestions made concerning the products and their uses, applications, storage and handling are only the opinion of Rhino Linings Corporation. Users should conduct their own tests to determine the suitability of these products for their own particular purposes and of the storage and handling methods herein suggested.The toxicity and risk characteristics of products made by Rhino Linings Corporation will necessarily differ from the toxicity and risk characteristics developed when such products are used with other materials during a manufacturing process.The resulting risk characteristics should be determined and made known to ultimate end-users and processors. Because of numerous factors affecting results, Rhino Linings Corporation makes no warranty of any kind,express or implied, other than that the material conforms to its applicable current Standard Specifications. Rhino Linings Corporation hereby disclaims any and all other warranties, including but not limited to those of merchantability or fitness for a particular purpose. No statements made herein may be construed as a representation or warranty.The liability of Rhino Linings Corporation for any claims arising from or sounding in breach of warranty, negligence, strict liability, or otherwise shall be limited to the purchase price of the material. 02015 Rhino Linings Corporation.All rights reserved. Rhino Linings Corporation Rhino Linings' 9747 Businesspark Avenue,San Diego,CA 92131 858-450-0441 •Fax 858-450-6881 PROTECTION NEVER LOOKED SO GOOD' 1-800-422-2603 www.rhinolinings.com con o22ou, MATERIAL SAFETY DATA SHEET NH OU NU OIL UNUERCURTINC SECTION I PRODUCT INFORMATION PRODUCT NAME: NH Oil Undercoating with RS 3000 Black/Clear WHMIS: Not a Controlled Product PRODUCT DESCRIPTION: A mixture of paraffinic oils and calcium base SUPPLIER: NH Oil Undercoating Company Phone (603)491-9012 263 R South Main st Fax (603) 529-8601 Concord,NH 03301 SECTION II REGULATED COMPONENTS The following components are defined in accordance with sub-paragraph 13(a) (i)to (iv) or paragraph 14(a) of the Hazardous Products Act No regulated components SECTION III PHYSICAL DATA Physical State: Viscous Liquid Evaporation Rate: >1 (1=n-butylacetate) Viscosity: 5-7,500 CPS @ 25'C @ 12 RPM Pour Point: N/A Density, kg/m3: 870 to .886 @ 15 C Appearance: Amber SECTION IV HEALTH HAZARD INFORMATION Nature of Hazard INHALATION: Negligible hazard at normal temperatures (up to 38 deg Q. Elevated temperatures or mechanical action may form vapours,mists or fumes, which may be irritating.to the eyes, nose,throat and lungs. Avoid breathing vapours or mists. EYE CONTACT: Slightly irritating but will not injure eye tissue. SKIN CONTACT: Low Toxicity. Frequent or prolonged contact may irritate the skin and cause a skin rash(dermatitis). INGESTION: Low Toxicity OCCUPATIONAL EXPOSURE LIMITS: For oil mists, 5 mg/m3 recommended based on the ACGIH TLV SECTION V FIRST AID MEASURES INHALATION: Vapour pressure of this material is low and as such inhalation under normal conditions is usually not a problem. If over exposed to oil mist, remove from further exposure. Administer artificial respiration if breathing has stopped. Keep at rest. Call for prompt medical attention. EYE CONTACT: Flush eyes with large amounts of water until irritation subsides. If irritation persists, get medical attention. SKIN CONTACT: Flush with large amounts of water. Use soap if it is available. Remove severely contaminated clothing(including shoes) and launder before reuse. If irritation persists, seek medical attention. INGESTION: If swallowed, DO NOT induce vomiting. Keep at rest. Get prompt medical attention. f '^ SECTION VI PREVENTATIVE AND CORRECTIVE MEASURES PERSONAL PROTECTION: The selection of personal protective equipment varies depending upon conditions of use. Where prolonged and/or repeated skin and eye contact is likely to occur, wear safety glasses with side shields, long sleeves, and chemical resistant gloves. Where eye contact is unlikely, but may occur as a result of short and/or periodic exposures,wear safety glasses with side shields. Where concentrations in air may exceed the occupational exposure limits given in Section 4 and where engineering work practices or other means of exposure reduction are not adequate, approved respirators may be necessary to prevent overexposure by inhalation. ENGINEERING CONTROLS: The use of local exhaust ventilation is recommended to control emissions near the source. Labratory samples should be handled in a fume-hood. Provide mechanical ventilation in a confined space. HANDLING STORAGE AND SHIPPING: Keep containers closed. Handle and open containers with care. Store in a cool, well-ventilated place away from incompatible materials. Do not handle or store near an open flame, sources of heat, or sources of ignition. LAND SPILL: Eliminate source of ignition. Keep public away. Prevent additional discharge of material; if possible do so without hazard. Prevent spills from entering sewers watercourses or low areas. Contain spilled liquid with sand or earth. Recover by pumping or using a suitable absorbant. Consult an expert on disposal of recovered material. Ensure disposal in compliance with government requirements and ensure conformity to local disposal regulations. Notify the appropriate authorities immediately. Take all additional action necessary to prevent and remedy the adverse affects of the spill. WATER SPILL: Remove from surface by skimming or with suitable absorbents. If allowed by local authorities and environmental agencies, sinking and/or suitable dispersants may be used in unconfined waters. Consult an expert on disposal of recovered material. Ensure disposal in compliance with government requirements and ensure conformity to local disposal regulations. Notify the appropriate authorities immediately. Take all action necessary to prevent and remedy the adverse affects of the spill. SECTION VII FIRE AND EXPLOSION HAZARD Flashpoint and method: 200 deg C COC D92 Autoignition: NA Flammable Limits: LEL NA UEL: NA GENERAL HAZARDS: Low hazard; liquids may burn upon heating to temperatures at or above the flash point. Decomposes; flammable/toxic gases will form at elevated temperatures (thermal decomposition). Toxic gases will form upon combustion. Empty product containers may contain product residue. Do not pressurize, cut, heat, weld, or expose containers to flame or other sources of ignition. FIRE FIGHTING: Use water spray to cool fire-exposed surfaces and to protect personnel. Shut off fuel to fire. Use foam, dry chemical or water spray to extinguish fire. Respiratory and eye protection required for fire fighting personnel. Avoid spraying water directly into storage containers due to danger of boilover. A self-contained breathing apparatus (SCBA) should be used for all indoor fires and any significant outdoor fires. For small outdoor fires, which may easily be extinguished with a portable fire extinguisher,use of an SCBA may not be required. HAZARDOUS COMBUSTIBLE PRODUCTS: Smoke, carbon monoxide and dioxide and traces of oxides of sul hur. SECTION VIII REACTIVITY DATA STABILITY: This product is stable. Hazardous polymerization will not occur. INCOMPATIBLE MATERIALS AND CONDITIONS TO AVOID: Strong oxidizing agents. HAZARDOUS DECOMPOSITION: Fumes, smoke, carbon monoxide, sulphur oxides if incomplete combustion. SECTION IX PREPARATION The Rust Stop pro Co. Date: March. 31, 2014 Concord,NH Prepared by: Operations The information presented herein has been compiled from sources considered to be dependable and is accurate to the best of The Rust Stop pro Company's knowledge;however,the The Rust Stop prol Company makes no warranty whatsoever,expressed or implied,and expressly disclaims all liability for reliance thereon.Such data are offered solely for your consideration,investigation and verification. ,f koo LOCATION SEWAGE PE IIIIT NO• a, 7� VILLAGE I INSTALLER'S NA E i ADDRESS 0 U I L D E R OR OWNER DATE PERMIT ISSUED DAT E COCIPLIAFICE ISSUED 3/z $�8y f T U`i --� � � � .: � �• �� i I �� No. d Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftplitation for MispOsal 6pstem Construction j3prmit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon lam) ❑Complete System ❑Individual Components Location Address or Lot No. 1 O L{ C N V c I�P f t 5lr Owner's Name,Address,and Tel.No. 0yc"J,-3L5 5�.��,� I�ro(�er�i�S/cG�eCcc)M,11 Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 13raw� lac sOS�y2D—YS3`/ Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) ey1 j—j e .5T4 ,-r _ 4 ljii�l��sNiy1,rrV�— Co ON my, r/-, VS9� . Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board o Ith. Signed - Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. , Date Issued 77 No. G I _I Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: I PUBLIC HEALTH DIVISION -TOWN-OF BARNSTABLE, MASSACHUSETTS( Yes application for Disposal *pstrm Construction Verrnit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon/❑Complete System ❑Individual Components Location Address or Lot No. 1 Q(-( C N t c r P r i g p Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Y o ' y Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. �ov5,�-S p1 13cuw� 1r�c SU�3-�/20`6/S3`/ Type of Building: ' Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date 1 Title Size of Septic Tank Type of S.A.S. a Description of Soil - Nature of Repairs or Alterations(Answer when applicable) 65 X1 L Date last inspected: Agreement: _ The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board o alth. Signed Date 'Z-- Application Approved by Date Application Disapproved by Date for the following reasons Permit No. !�D a Q Date Issued "? ----------------------- -- - . .. . ..,... ---------=- ------------------ Wr P y�c THE COMMONWEALTH OF MASSACHUSETTS c v�r f`Y� " U BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS I TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) i Abandoned(V)by J a T-N c- at t-j has been constructed in accordance l with the provisions of Title 5 and the for Disposal System Construction Permit No. 01 Z--3 q i dated I Installer f, Designer #bedrooms ,NI . Approved design flow god The issuance of this ermit shall not be construed as a guarantee that the system 11 func,'i n as desiign ed. >c Date I ! 7 ��- Inspector .L C No. ] ) �- ` _ Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction 3permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abando System located at ICN�'P /�d F.✓ �V/� G/ll M and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be lomplet'd within three years of the date of this permit. i Date .- Approved bye. i Malkus, Karen , j From: Ifein@simon.com Sent: Wednesday, January 18, 2012 11:08 AMO To: Malkus, Karen Subject: Fw: Hyannis Transmission Septic Hi Karen, please let me know if you received this Leo J. Fein General Manager Cape Cod Mall #4919 Phone: 508.771. 0201 Fax: 508.771.2588 ----- Forwarded by Leo Fein/Simon on 01/18/2012 11:06 AM ----- From: Leo Fein/Simon To: karenmalkus@town.barnstable.ma.us Date: 01/18/2012 10:06 AM Subject: Hyannis Transmission Septic Hi Karen,. Mall's understanding has been that as long as Hyannis Transmission was still a tenant, and the septic system had not failed, that the sewer hook up was not triggered. That said, could you get me scheduled on the next Board of health agenda to discuss a variance. As discussed early Feb is not good but March will be fine. Thanks for your Assistance. Leo J. Fein General Manager Cape Cod Mall #4919 Phone: 508.771. 0201 Fax: 508.771.2588 i c 1 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments µM ' 104 Enterprise Rd. Property Address Cape Cod Mail Owner Owners Name information is required for every Hyannis Ma 02601 1/19/2012 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:when filling out forms A. General Information :I on the computer, 1 use only the tab 1. Inspector: It key to move your cursor-do not Sean M Jones use the return Name of Inspector key. S M Jones Title V Septic Inspection Company Name 74 Beldan Ln. Company Address Centerville Ma 02632 City/Town State Zip Code LU rn 774-248-4850 smjonestitle5@gmail.com SI4522 ma's Telephone Number License Number ICU �z 0— clM' B. Certification o �G I certify that I have personally inspected the sewage disposal system at this address and that the informatioh reported below is true, accurate and complete as of the time of the inspection. The inspection CD was pearfformed based on my training and experience in the proper function and maintenance of on site °— `�' sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 1/19/2012 Inspectors Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. 4***This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use.. . . V � Ib � � I t5ins-09/08 i Title 5 Official'Inspection Form:Subsurface S age isposal System.Page il of 17 i Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 104 Enterprise Rd. Property Address Cape Cod Mall Owner Owner's Name 'information is Hyannis Ma 02601 1/19/2012 required for every y page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes","no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old"or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is Tess than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 104 Enterprise Rd. Property Address Cape Cod Mall Owner Owners Name information is required for every Hyannis Ma 02601 1/19/2012 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out orbigh static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed . ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 16.303(1)(b)that the system is not functioning in a-manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 104 Enterprise Rd. Property Address Cape Cod Mall -Owner Owner's Name information is required for every Hyannis Ma 02601 1/19/2012 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ Backup of sewage into facility or'system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool 0 ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than '/day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 104 Enterprise Rd. Property Address Cape Cod.Mall Owner Owner's Name information is Hyannis Ma 02601 1/19/2012 required for every y page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ' ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 104 Enterprise Rd. Property Address Cape Cod Mail Owner Owners Name information is required for every Hyannis Ma 02601 1/19/2012 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ Z Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)bn the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)1 D. System Information Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): t5ins•09/09 Title 5 Official Inspection.Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 104 Enterprise Rd. Property Address _Cape Cod Mall Owner Owners Name information is required for every Hyannis Ma 02601 1/19/2012 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ❑ No Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Auto mechanics Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ® Yes ❑ No Industrial waste holding tank present? ❑ Yes ® No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ® No ;Water meter readings, if available: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wM , 104 Enterprise Rd. Property Address Cape Cod Mall Owner Owner's Name information is required for every Hyannis Ma 02601 1/19/2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Current Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System:' ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (Yes or no) (if yes, attach previous inspection records, if any) Y ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest :inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. Other(describe): t5ins•09/08 Title 5 Official Inspection Fonn:'Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts U Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 104 Enterprise Rd. Property Address Cape Cod Mall Owner Owner's Name information is Hyannis Ma 02601 1/19/2012 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 20+years old Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 3 feet Material of construction: ® cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 2 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Gallons 3" Sludge depth: t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 104 Enterprise Rd. Property Address Cape Cod Mall Owner Owner's Name information is required for every Hyannis Ma 02601 1/19/2012 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top lof sludge to bottom of outlet tee or baffle 31 Scum thickness 2„ Distance from top of scum to top of outlet tee or baffle 611 Distance from bottom of scum to bottom of outlet tee or baffle 1011 How were dimensions determined? opened covers and took measurements Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Water level was at bottom of outlet invert, tank was structurally sound and not leaking. Tank should be cleaned soon. Inlet cover to grade with steel cover. Grease Trap(locate on site plan): Depth below grade: 2 feet Material of construction: ®concrete ❑ metal ❑ fiberglass -❑ polyethylene ❑ other(explain): J Dimensions: 1000 gallons 8r Scum thickness Distance from top of scum to top of outlet tee or baffle sDistance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 N Commonwealth of Massachusetts 7. Title 5 Official Inspection Form e Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 104 Enterprise Rd. Property Address Cape Cod Mall Owner Owner's Name information is required for every Hyannis Ma 02601 1/19/2012 � page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease trap should be cleaned soon, tank was structurally sound and not leaking. Inlet cover to grade with steel cover. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ,concrete ❑metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 104 Enterprise Rd. Property Address Cape Cod Mall Owner Owner's Name information is required for every Hyannis Ma 02601 1/19/2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS)(locate on site plan,excavation not required): If SAS not located, explain why: t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wM 104 Enterprise Rd. Property Address Cape Cod Mall Owner Owner's Name information is required for every Hyannis Ma 02601 1/19/2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: � 'leaching pits number: 4 1000 gallons ❑ 'leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: El leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): All 4 leach pits were found to be dry at time of inspection with no sign of past hydraulic overloading. All pits had covers to grade with steel covers. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer :Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 104 Enterprise Rd. Property Address Cape Cod Mall Owner Owner's Name information is required for every Hyannis Ma 02601 1/19/2012 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 104 Enterprise Rd. Property Address Cape Cod Mall Owner Owners Name information is required for every Hyannis Ma 02601 1/19/2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately tP-�ti`r D a 0 ° o V p�� �yueeS AP-';' 7D CMA-b07 t5ins•09/08 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 104 Enterprise Rd. Property Address Cape Cod Mall Owner Owner's Name information is required for every Hyannis Ma 02601 1/19/2012 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth,to high ground water: 12'+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database—explain: You must describe how you established the high ground water elevation: Groundwater elevation was determined by accessing Town of Barnstable groundwater contour maps. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts l Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 104 Enterprise Rd. Property Address Cape Cod Mall Owner Owner's Name information is required for every Hyannis Ma 02601 1/19/2012 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® inspection Summary D.(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09108 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Town of. Barnstable Barnstable SHE�p TAW . Regulatory Services Department jedcaCfty IRARNSTABLE 9 MASS. O 039. ,0 Public Health Division �ArfbM 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 y Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO March 22, 2013 Douglas Brown , PO Box 145 Centerville, MA 02632 Dear Doug: The Health Division has just reviewed sewer connection permits for the Stewart Creek area. Several properties are missing abandonment permits, which are needed for the project's completion and are required by the Health Division.This letter is a reminder to follow up with our Division for the following properties: 27 Keating Road, Hyannis (Map-Parcel 306-006) Sewer acct#4641 69 Studley Road,Hyannis (Map-Parcel 306-010) Sewer acct#4642 Our records also show missing abandonment permits from 2011-2012 for: 104 Enterprise Rd, Hyannis (Map-Parcel 294-019) Sewer acct#4629 149 Pleasant Street, Hyannis (Map-Parcel 326-053) Sewer acct#4581 Your prompt attention to this matter is greatly appreciated. Karen Malkus Coastal Health Resource Coordinator " Public Health Division 200 Main St.,Hyannis MA Email: Karen.malkus@town.barnstable.ma.us - 508-862-4641 Q:\SEWER connect\ABANDONMENT REMINDER LETTERS\Multi Prop Doug Brown Mar2013.doc Town of Barnstable Barnstable �p THE r0� Board of Health j a"a�j ■A MASS. 200 Main Street, Hyannis MA 02601 9 MASS. � �ArF1 39. a�� 2007 Office: 508-862-4644 -- Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff, D.M.D. Junichi Sawayanagi March 27, 2012 Michael Ford, Esquire PO Box 665 West Harwich, MA 02671 Dear Mr. Ford: You are granted an eight month extension, on behalf of your client, the Cape Cod Mall, to connect the building located at 104 Enterprise Road, Hyannis, to town sewer. This extension is granted until February 28, 2013. The applicant may continue to utilize the existing septic system. After that date, the building shall either be demolished or connected to town sewer. Attorney Michael Ford testified that it is the applicant's intent to connect the building to public sewer at that time. Sin rely yo , Way Miller, M.D. Chai erson Board of Health Town of Barnstable Q:\WPFILES\104 Enterprise Rd Cape Cod Mall Mar2012.DOC Malkus Karen From: Ifein@simon.com ' Sent: Wednesday, January,18, 2012 11:08 AM © �} To: Malkus, Karen Subject: Fw: Hyannis Transmission Septic Hi Karen, please let me know if you received this �K O Leo J. Fein General Manager Cape Cod Mall #4919 Phone: 508.771.0201 Fax: 508.771.2588 ----- Forwarded by Leo Fein/Simon on 01/18/2012 11:06 AM ----- From: Leo Fein/Simon To: karenmalkus@town.barnstable.ma.us 9b fin L Date: 01/18/2012 10:06 AM / C•. , Subject: Hyannis Transmission Septic Hi Karen, Mall' s understanding has been that as long as Hyannis Transmission was still a tenant, and the septic system had not failed, that the sewer hook up was not triggered. That said, could you get me scheduled on the next Board of health agenda to discuss a variance. As discussed early Feb is not good but March will be fine. Thanks for your Assistance. Leo J. Fein General Manager Cape Cod Mall #4919 Phone: 508.771.0201. Fax: 508.771.2588 t 1 ----- eo'rwarada ny Leo vean/J1mUi1 Vii Vi/.io/zuu z i ;: a --I ----- From: Leo Fein/Simon To: karenmalkus@town.barnstable.ma.us Date. 01/18/2012. 10:06 AM i Subject: Hyannis Transmission Septic Hi Karen, Mall's understanding has been that as long ,as Hyannis Transmission was still a tenant, and the septic system had not failed, that the sewer hook up was not triggered. That said, could you get me scheduled on the next Board of health agenda to discuss a - variance. As discussed early Feb is not good but March will be fine. Thanks for your Assistance. Leo J. Fein General Manager Cape Cod Mall #4919 Phone: 508.771.0201 Fax: 508 .771.2588 i 1 c. i t T Notes to the File l August 11, 2011 Scott's Auto Service 104 Enterprise Street Hyannis, MA Cynthia Martin, PHD Scott Bariteau, Owner, Scott's Auto Service Chris Van Gelder, Owner, Hyannis Transmission Scott's Auto Service utilizes the materials and space provided by Hyannis Transmission, a licensed Hazardous Materials business. Per Mr. Van Gelder, work is shared by the two businesses. Mr. Van Gelder performs only transmission repairs, all other work on the auto is performed by Mr. Bariteau. Based on this shared use, Scott's Auto Service is not subject to the Hazardous Materials licensing requirement of the Town of Barnstable. Hyannis Transmission was last inspected in 2008; the hazardous materials inventory amounted to four-hundred one gallons. n r THE FOLLOWING JS/ARE THE BEST - IMAGES FROM POOR QUALITY ORIGINALS) I M A kj L DA A L'Mt • • • • tl A Signature ,k�r' ;omplet' ems 1,2,and 3.Also complete ❑Agent e tem 4 i estncted Delivery is desired. X dell ❑Addressee 3rint your name and address on the reverse Mike ;o that we can return the card to you. B. Received by(Printed Name) C. Date ive attach this card to the back of the mailpiece, x on tt a front if space permits. D. is delivery address different from item 1? Yes postage S �(�`( 6n{� Pr s t krticie A�dtlressed to: If YES,enter delivery address below: : ❑No L / Certified Fee L, itum Receipt Fee 1� (p i;,>2 f dement Required) Here 1� ked Delivery Fee i 6 Z� dement Required) 3. S ice Type Postage&Fees �Z. 1 C } T ert ed Mail ❑Express Mail Z� ❑Registered ❑Return Receipt for Merchandise �T t ❑Insured Mail ❑C.O.D. l �_ Ot.L%c'� Cz p C �--LS— :: -------- C -- ------------------- 4, Restricted Delivery?(Extra Fee) ❑Yes vxNo. ( (� c� 2CS - ------------------ X 1e,Z/P+4 -- Article,Number. 7(]]�1 p 4 7 0 2 0 0 7, 4 5 2 5 6 2 3 2 i (transfer from service/aben Mil• r• ;',; —.- ��. �. - estic Return Receipt to2595-02-M-1540 55 TOWN, OF BARNSTABLE BAR-W Ordinance+ &k. Regulation WARNING XOTICE Name of Offender/Manager _ . Address of Offender t... ' • x .- a ; '.. a`� MV/MB .Reg.# Village/State/Zip k - 4 -' ;� Business Name am/pm, on ,. . 20 Business Address -Signature of .Enforcing Officer Village/State/Zip Location of Offense nfo i Dept/Division E ng rc ' Offense MPS' € Facts This' will serve only as a "warning. At this time no legal action has been taken. It is . go al oal of Town agencies to achieve voluntary compliance of Town warning Ordinances, Rules and Regulations. Education efforts and q notices are attempts to gain voluntary compliance.: Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING'OFFICER . 'GOLD ENFORCING DEPT. 9 • ., t—dfffprT&items 1,r2,d Also complete A. Signature le Barnstable item 4 if Restricted Delivery is desired. ❑Agent Print your name and address on the reverse XIOme McDaniel so that we can return-the card to you. 177 Addressee , A04medcaCtfy Attach this card to the back of the mailpiece, B. Rec In (Prinked N C. Dat f De ery 'rtment or on the front if space permits. Article Addressed to: D. Is delivery address different from Item 1? f If YES,enter delivery address below: ❑No j )a C Cad c_ 1 2007 i r—e _4 q L� 3. erviceType i Thomas F.Geiler,Director Thomas A.McKean,CHO 4 - rtMed Mail ❑Express Mail _ r v I n I 2k C_S ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. ( � 4. Restricted Delivery?(Extra Fee) ❑Yes uncle Number i I-ransfer from service iabeq 7006 0 810 0000 3525 5088 I =orm 3811,February 2004 Domestic Retum Receipt r o25s5 o2-M-154o — . Re: 104 Enterprise Road, Hyannis, MA. 02601 Map & Parcel: 294-019 Dear Property owner: According to our records, your property at 104 Enterprise Road, Hyannis, MA has a cesspool/septic system and is not connected to the public sewer system. Public sewer lines have been available in your neighborhood since 2000. The property owner was previously notified of the obligation to hook up and establish a sewer account with the town. This letter directs you to connect your building located at 104 Enterprise Road, Hyannis, MA. to public sewer on or before September 30, 2011. Sewer connection permits are available from DPW-Water Pollution Control Division, 617 Bearse's Way, Hyannis MA 02601 (508)790-6335. 1 like a hearing You may request a hearing before the Board of Health. If you would g please send a written petition requesting a hearing on this matter within seven (7) days of receipt of this letter. If you should have any questions, please call 508-862-4644. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health r% 'rF �+ K m F A L U S fU Postage $�, Er Certih6dFee � Retum':Reeipt Fee Postmark (Endorsement equired) i 4�1i Here O Restricted Delis ry OW p (Endorsement R uired) a ', 0 Total Postage&Fep� Q- Sent To �� t��Lfl?tt Street,Apt.No? ---- ............ `- 5 or PO Box No: /O d C3 ----------•--'j ----------- -------------- Clty,State,ZIP+4 ---=------------=-�=-=------ --•-----=-- �a�o� e 9 I ® Complete items 1,2,and 3.Also complete A. Signatur ^ Igggent item 4 if Restricted Delivery is desired. s ❑Addressee ® Print your name and address on the reverse so that we can return the card to you. B. Recei ed by(Printed Name C. Dat of Delivery a Attach this card to the back of the mailpiece, C ; /0 1 Lo- - 1 or on the front if space permits. D. Is d livery address different from item 1? ,�y Yes i 1. Article Addressed to: If YES,enter delivery address below: aN0 1+ All-Pro Transmission 1 104 Enterprise Road 3, Servi Type II Hyannis, MA 02601 ified Mail ❑ Express Mail Registered ❑Return Receipt for Merchandise - / ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) Yes 2. Article Number 7001 1940 0004 9042 1839 I (Transfer from service label) _— 102595-02-M-1540� — `— Domestic Return Receipt PS Form 3811,August 2001 Town of Barnstable CF E V Tp� P� o Regulatory Services Thomas F. Geiler,Director * &UMSPABLE, 9� ' Public Health Division ArfD MA'S� Thomas McKean,Director 200 Main St, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 March 6, 2003 All-Pro Transmission 104 Enterprise Road Hyannis, MA 02601 RE: Map & Parcel 294-047 Dear Sir: You are directed to connect your building located at 104 Enterprise Road, Hyannis, Massachusetts, to public sewer on or before September 6, 2003. The Department of Public Works, Engineering Division, has notified us that your property abutts town sewer lines. The lines were extended because of the density, and the size of the lots in the area, and the potential for serious health problems. Failure to comply with this order will result in a court complaint against you for failure to comply with a Board of Health Order. If you should have any questions, please telephone me at 862-4644. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S. CHO Health Agent for: Jt TOWN 'OF BARNSTABLE BOARD OF HEALTH Wayne Miller, M.D., Chairperson Susan G. Rask, RS. Sumner Kaufman, M.S.P.H. Return receipt requested Cc: Barbara Childs, Water Pollution Control 1 Q:Sewerorder.doc 1VVV11 V1 " 1U3LUV1V Regulatory Services oFt r Thomas F. Geiler, Director Public Health Division 9 BAM " LZ Thomas McKean,Director �pl i6;9' a`` 200 Main Street, Hyannis, MA 02601 fD MA'S Office: 508-862-4644 Fax: 508-790-6304 April 12, 2002 David L. McCarthy % Wellspark Group—Accounting One Wells Avenue Newton, MA 02459 RE: Map & Parcel 294-047 Dear Sir: You are directed to connect your building located at 104 Enterprise Road, Hyannis, MA., to public sewer on or before October 12, 2002. r The Superintendent of the Department of Public Works has notified us that your property abutts town sewer lines.. The lines were extended because of the density, and the size of the lots in the area, and the potential for serious health problems. Failure to comply with this order will result in a court complaint against you for failure to comply with a Board of Health Order. If you should have any questions, please telephone me at'862-4644. PER ORDER O THE BOARD OF HEALTH Thomas A. McKean, R.S. CHO Health Agent for TOWN OF BARNSTABLE BOARD OF HEALTH Susan G. Rask, RS., Chairperson copy: Peter Doyle Sumner Kaufman, M.S.P..H. Return receipt requested Wayne Miller, M.D. 7 sewe=2 TOWN OF BARNSTABLE bQ�pF'CH E T O�y� OFFICE OF 3AXISTAIM BOARD OF HEALTH y MAS 6. �° 1639' \gym 367 MAIN STREET �0 MAY h 1 HYANNIS, MASS.02601 May 4, 1999 Michael Ford, Esquire Box 665 West Harwich, MA 02671 Dear Mr. Ford: You are granted a.variance, on behalf of your client Cape Cod Mall Nominee Trust from the requirement to connect the building located at 104 Enterprise Road, Hyannis, to town sewer. The applicant may continue to utilize the existing septic system until May 30, 2002. After that date, the building shall either be demolished or connected to town sewer. This variance is granted because Attorney Michael Ford testified that it is the applicant's intent to demolish the building as soon as the tenant vacates the premises. The existing tenant, All-Pro Transmissions, has the right by lease agreement.to remain, in a portion of the building until May 2002. Sincerely yours, Susan G. Flask R.S. Chairperson Board of Health Town of Barnstable S G R/bcs ma113 EE: `Y antuasTnat,E, y MASS. •r �p 1639. EQ� Town of Barnstable r �S HE D. Board of Health A 367 Main Street, Hyannis MA 02601 'y Office: 508-790-6265 Susan G..Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,M.S.P.H. Ra[ph A.Murphy,M.D. _ VARIANCE REQUEST FORM LOCATION Property Address: 104 Enterprise Road , Hyannis Assessor's Map and Parcel Number: 2 9 4/ 12 Size of Lot: 23 , 962 Wetlands Within 300 Ft. Yes X Subdivision Name: N/A No Business Name: Cape C n d Mal l NnminPP T-rnct APPLICANT CONTACT PERSON Name: Cape Cod Mall Nominee Trust Name: Michael D . Ford , Esq . Addresse/o Michael D. Ford, Esq . Address: P. 0. Box 665 , W. Harwich,MA. Box 665 ,W.Harwich,MA. 02671 02671 Phone: 508-430-1900 Phone: 508-430-1900 FAX: 508-430-8662 FAX: 508-430-8662 VARIANCE FROM REGULATION(List Res.) REASON FOR VARIANCE(May attach if more space needed) _Variance from reg,,iremertt The Cape Cod Mall Nominee Trust . has acquired to tie in h„ i l d i n o t nn i b l i c the building on the site and is demnl i shi ng a portion sewer , thereof. A tenant, All—Pro Transmissions, has a right to remain in the remaining portion of the building up to May of 2002, It is the Mnll 's intent to demolish the rest of the building as soon as the tenant vacates the premises as the Mall 's approved erm' arking. Checklist(to be completed by office staff-person receiving variance request application) Four(4)copies of plan submitted(including septic system plans and/or restaurant floor plans) Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variances only) Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/leasee only],outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan G.Rask,R.S., Chairman NOT APPROVED Sumner Kaufman, M.S.P..H. REASON FOR DISAPPROVAL Ralph A. Murphy,M.D. Q:/WP/VARIREQ EXIST�NG 1 - 1y PARKI G AREA 8,72 3 S. Mgtt�r � ' 20 ACRE NCR�� 'i. �i O `4 A P R DPO S E`D �;� S�pR� V�,� pv ` PARKING go 0.31 ACRES ]1, LOT E0 :tom NO LEFT ONE TURN WAY ` 'r Y } 1717157{` J .1 0 y ALL—PRO PARKING 7070 SIr: PREPARATIoN PPLMvg ALTERNATIVE C 1 =4D A ND -NICIi0LS CAPE COD MALL R19NoV IOi�d` �r 1 . D2A1NNG REFUiENCE Dt" =yam II T -7 PHASE II ,J OWG L-1 k L—? ADMTMN a,�?q`' � + gnmeo r A St JAWS AWMWX X UFM ri73Ea7 DATE: OCT. 21.199E JL 1e"J ens - s.m r"jai}ess-=0 HYANWO, MA 04/27/19994 10:32 5084283115 SULLLIVAN ENG INC PAGE 02 Sullivan Engirmering Inc. 7 Parker Road Box 659 Osterville MA 02655 Peter Sullivan P.E.Mass. Registration No.29733 428-3344 fax 428-3115 e-mail:PSUIPEOaol.com April 26, 1999 Attorney Michael Ford 72 Main Street Box 665 W Harwich, MA 02671 RE: All Pro Transmission ' 104 Enterprise Road, Hyannis Map 294 Parcel 47 � Dear Attorney Ford, Per your request, I did a visual inspection of.the septic system at 104 Enterprise Road in Hyannis. Additionally, I reviewed the following: 1. Town of Barnstable GIS Map of the property 2. Town of Barnstable Board of Health "As Built" cards 3. Sewerage Treatment Plant pumping records. Summary: There are 2 (two) septic tank structures and 4 (tour) leaching pits. Two of the leach pits were dry, and two had very minimal grey water. Per GIS mapping, the bottom of the pits are about elevation 40 (forty). This places the bottom of the leach pits at least 4 (four)feet above ground water and approximately 200 feet of horizontal separation to the adjacent drainage ponds. The Sewerage'Treatment Plant had no record of pumping the system for the last 12 (twelve) months. Conclusion: Based on the above, it appears reasonable that the existing septic system will function adequately until the building is demolished. _ H you have any questions, please feel free to contact me. t cr.P`�4 AL � V trulyours, PMR {� Y SULLIVA" . J €� CIVI� Peter Sullivan PE , r Sullivan Engineering Inc. Members of American Society of Civil Engineers, Boston Society of Civil Engineers t Notes to the File August 11, 2011 Scott's Auto Service 104 Enterprise Street Hyannis, MA Cynthia Martin, PHD Scott Bariteau, Owner, Scott's Auto Service Chris Van Gelder, Owner, Hyannis Transmission Scott's Auto Service utilizes the materials and space provided by Hyannis Transmission, a licensed Hazardous Materials business. Per Mr. Van Gelder, work is shared by the two businesses. Mr. Van Gelder performs only transmission repairs, all other work on the auto is performed by Mr. Bariteau. Based on this shared use, Scott's Auto Service is not subject to the Hazardous Materials licensing requirement of the Town of Barnstable. Hyannis Transmission was last inspected in 2008; the hazardous materials inventory amounted to four-hundred one gallons. MPL.TE THIS SECTION ON DELIVERY: ® Completeitems 1,2,and 3.Also complete A. Signature item 4 if'riestricted Delivery is desired. ❑Agent X ■ Print your name and address on the reverse dell ❑Addressee so that we can return the card-to you. B. Received by(Printed Name) C. Date ive A Attach this card to the back of the mailpiece, or on the front if space permits. I it D. Is delivery address different from item 17 Ej Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No r �OLU2� CC7�QE j�� L LG ro C1 S Q_ IQ Cam" —r 3. Se ice Type Certified Mail ❑Express Mail — +q Zg ❑Registered ❑Return Receipt for Merchandise a ❑Insured Mail ❑C.O.D. 4, Restricted Delivery?(Extra Fee) ❑Yes 2. Article,Number Ib q: 61 0 0 d 1`: 4 5 2 5 6 2J 2 (transfer from service labeo I eStic Retum Receipt 102595-02-M-1540 f - � i UNITED STATES POSTAL SERVICE 1 First glass Mail Postage&Fees PaidUSPS i I Permit No.G-10 I I j • Sender: Please print your name, address, and ZIP+4 in this box • I i - Public 1-lcalth Division Town of Barnstable —� 200 Main Street Hyannis, MA 02601 I ti D �ftl �. e . . .- . .•. (rU —0 m OFFICIAL USE Iru Postage $ r Certified Fee 02661 p ostmark I C3 Retum Receipt Fee tI� Here p (Endorsement Required) Restricted Delivery 0 (Endorsement Required) II Q�I p Total Postage&Fees $ fit_ CC Lie i a em-To O Apt 1Vo.; - (-�--�-------------- c-------t--------------- orPOBoxNo. CNy Sitste,21P+4 ., ,� e-0 � (ro ^ i Ix Certified Mail Provides: - „ o Amailing receipt { o A unique identifier for your mailpiece c, o A record of delivery kept by the Postal Service for two years Important Reminders: n Certified Mail may ONLY be combined with First-Class Mails or Priority Mails. o Certified Mail is not available for any class of international mail. a NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the I fee.Endorse mailpiece'Return Receipt Requested'.To receive a fee waiver for a duplicate return receipt,a USPSs postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery" to If a postmark on the Certified Mail receipt is desired,please present the art!-, cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530.02-000.9047 :p'� '' _ gyp ' � •} �1 wY W �y�a 4L �, Al ,a tt7 ,o^ L•rF• . ; i rfQ .,� s`fr „L"7 .fr �"'u - Y t r f TOWRip, F BARNSTABLE " Bl�R-TnT 1 S v� } x ?4- �✓ L'+ f - -{J-F }"4 Qjii r. •.�v y ti. O n'an ori�(Re rdi c Nation � T s'I sWARNINP N0TIC J. , Name o€ .Offender/Manager ' ".t A ' ., 'd �-�.: . ��� ;���� . {. Y /MB Re 'Address of Offender_ :_ - .. r: - MV #' Village/State)Zip Q Business Name . am/,pnt. _ on j .P . �201 f _ - - -- Business. Addre-ss Kn , •� S ure rc is - S Y ignat of. Enfo in Off er Villa' e.,/State/Zi z3. g p - € Location of. Offense ., ` - - - -,�JnX , ca: -+ .ire . Y. � � �� , ,,r „+ = Enfo icing Dept/Division t ' ~ Offense + E. a �r�'' A N tr ._"J - .,r On. .F' Fa'ct�S ..r ' '` �r' Y r: ...v: �W�tiA'-G. � ;.1+.�i...�-n'tn:'�..�.r Y 57: ;t.�,�_� i .CK'6 P — ',; '•,�.�y� � �, _. '_,` This will serve only as- a warning. At;,t-his, timd- ho 1e.gal- action has been taken. It is the'"-goal of Town , agencies to achieve voluntary compliance of Town Ordinances, _ :Rules and. Regulations: Education .efforts and wa..rning notices are hattempts . to gain'', voluntary complance Subsequent',-viol'atons will result in y; appropriate legal action 'by the Town , °�hK = WHITE OFFENDER CANARY ORD; EG`P,ROG , PI K-ENFORCING�OFFICER!�y-..GOLD=ENFORCING;DEPT J LL F a -�.. o,.,n.�.. �.. � r'd'f4� ro-a�?t. y..c J�r, >�^�_.._ --�-..,`rrYrm••yy _.,,"yc`�? .°w'r3ap co D ra Cn o .. u-I . Ln ti PIF ILn ._ m Postage $ 5asn C3 Certifled Fee O • 0 Return Receipt Fee I P (Endorsement Required) ® � O Restricted Delivery Fee t rq (Endorsement Required) O to r3 Total Postage&Fees=$ pO Send^ -t `�� /��.p Cis Iti St 1%Ee�t, IApC No:-/ Fi r-/-s ��r, t.r��c r� C.sm M P�Q 1 G—.2 orPO Box,.................... ................ City State ZIR+4 V'lJit� `cA Certified Mail Provides:• A mailing receipt an fasaa)zooz eunt'0080:1 Sd • A unique identifier for your mailpiece - -•... b A record of delivery kept by the Postal Service for two years Important Reminders: n Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail& in Certified Mail is not available for any class of international mail. d NO INSURANCE COVERAGE IS PROVIDED with. Certified Mail. For valuables,please consider Insured or Registered Mail. •For an additional fee,a Retum Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailp,pe'Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"RestdctedDeiivery". a If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. 'IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. 0 COMPLETE •N COMPLETE THIS SECTIONON DELIVERY: FAttach te items 1,2,and .Also complete A. Signature Restricted Delivery is desired. X Tmme McDaniel ❑Agent ur name and address on the reverse Addressee we can return-the card to you. B. Rec d b Primed Name) C. Dat f De very his card to the back of the mailpiece, Me front if space permits. D. Is delivery address different from item 11 e 1..Article Addressed to: If YES,enter delivery address below: ❑No C/o i�r3�e m t C 4 r, C^cjrrmrn . I 12e-c, Sit S .r u t C I P U q Z 3. rvice Type t— PMWtified Mail ❑Express Mail -�' n ❑Registered ❑Return Receipt for Merchandise j `'r V I ��G S ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Numberfrom 7006 0810 0000 3525 5088 (IYansfer from service IabeQ M I I PS Form 3811,February 2004 , ;Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • SDC; Town of Barnstable 1 Health E)jvision I 200 Main Street I . Hyannis, MA 02601 cr THE T°�� Town of Barnstable Barnstable Regulatory Services Department CeC I BARNFUABLE, D "A9- Public Health Division prfD MAC A 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO 3/30/11 Mayflower Cape Cod, LLC c/o First American Comm Real Estate Services Irving, Texas 75016-7928 IMPORTANT NOTICE Re: 104 Enterprise Road, Hyannis, MA. 02601 Map & Parcel: 294-019 Dear Property owner: According to our records, your property at 104 Enterprise Road, Hyannis, MA has a cesspool/septic system and is not connected to the public sewer system. Public sewer lines have been available in your neighborhood since 2000. The property owner was previously notified of the obligation to hook up and establish a sewer account with the town. This letter directs you to connect your building located at 104 Enterprise Road, Hyannis, MA. to public sewer on or before September 30, 2011. Sewer connection permits are available from DPW-Water Pollution Control Division, 617 Bearse's Way, Hyannis MA 02601 (508) 790-6335. . You may request a hearing before the Board of Health. If you would like a hearing please send a written petition requesting a hearing on this matter within seven (7) days of receipt of this letter. If you should have any questions, please call 508-862-4644. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health Date: /0 /1b / off' TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: Py,4WMIS _�,e*A1Sq/55/QA/ BUSINESS LOCATION: /0 en17VePP4S A 1I*-n/WIJ INVENTORY MAILING ADDRESS: 45 ,490VE- TOTAL AMOUNT: TELEPHONE NUMBER: ojf Z{®/ 641-- CONTACT PERSON: ei-/'e/s EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: '7_0,4AJSN1Ss1oAJ 9EPAIS/c��/�✓� R ��R A10 INFORMATION/RECOMMENDATIONS: Au- w0iee. +W,& AMU. R/ FOR 4L Fire District: S-V9AAC- 15 hOKE on! Ce-Afg /> F"Ok r a10 Fthc)4 b A.WS o13,5&XWZ�. kvAl/Ab//K AhoyA113 of NAL /147 m&-Pr eAf Sim, /S ro 43med iwc�sc AAeb Ms b3 _ Com y Ai4Qu it P44A1 7v f3c GRe47Bb A06 O>Os rm VrZe Transportation: Last shipment of hazardous waste: y Name of Hauler: #4RBORS Destination: RP 11, Siev, of g_q- ` Waste Product: A-s�t�/1/' aNr,,e�z" Licensed? es° No M� ► NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum _ Antifreeze (for gasoline or coolant systems) Misc. Corrosive NEW SI' USED Cesspool cleaners t SS Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides S:'NEW 'IS" USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED r Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Q TWo �A� Degreasers for engines and metal 6us-AAj&re4 Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyt /Batteries Ac b 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 e���, vAiAr� y ) Floor &furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS ll ' r Town of Barnstable F� 2 Regulatory Services v, p's Thomas F.Geiler,Director Public Health Division U" Thomas McKean,Director ��� 1VIEk5� F `f V, 200 Main Street, Hyannis,MA 02601 Phone: 508-862-4644 Email: health(a,town.bamstable.ma.us Fax: 508-790-6304 co)- Office Hours: M-F 8:00—5:00 All Pro Transmission Attention:Wayne Colebrooke June 18,2004 104 Enterprise Drive Hyannis,MA 02601 RE: Hazardous Materials License Required and OVERDUE Dear Mr. Colebrooke: The Toxic and Hazardous Materials Inventory conducted on April 29,2004 shows that you have approximately 363.4 gallons of toxic and hazardous materials being used/stored/generated/disposed of at your place of business(Please refer to your copy of the i Toxic and Hazardous Materials Onsite Inventory). The Town of Barnstable Board of Health has determined that using,storing, generating and/or disposing of over 111 gallons of hazardous materials per month requires businesses in the Town of Barnstable to obtain an annual Hazardous Materials Permit. Please obtain your permit. You have 14 days to comply. After this time,you will receive written violations. If the violation warnings receive no response,you may be issued a non- criminal ticket citation in the amount of$75.00 for the first violation and$25.00 for each additional violation. Each day's failure to comply with an order shall constitute a separate violation. Please refer to Article 39: Control of Toxic and Hazardous Materials,Section 13, and Section 14-1, 14-2,14-3,and 14-4(copy enclosed). Passing your Hazardous Materials Inspection and obtaining your license will keep your business compliant,prevent contamination of Barnstable's existing and future drinking water supply, prevent environmental contamination which can bankrupt site owners,lead to future regulatory, and possibly,legal problems,lower or destroy land values,drive out residents and industry, depress local economies and endanger public health. You will receive your Hazardous Materials License certificate after you have passed your inspection and paid the license fee. Your continued cooperation is greatly appreciated. If you have any questions or need further information,please do not hesitate to contact the Public Health Division. Thank you, i Thomas A. McKean,RS, CHO Director of Public Health enc. Hamat license application Article 39,Sect.13,14 COPY & /� -oy Date: — o`�/ TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAMEOFBUSINESS: BUSINESS LOCATION: f O e- dD -ve-- INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: SO$ - -7 / /3 CONTACTPERSON: C g 363.yAa_1e(1077s EMERGENCY CONTACT TELEP ONE NUMBER: IFt�E p�5- 1�- TYPEOFBUSINESS: V e1i- ,'cam � cz•rti ys-� % Pr�Qiyl�2 OTHER INFORMATION: P�� � � M 505 or) . �T��e, •���-,�� ha wna�4- /;e�s�. ate► to -/�-®�/ �1 es Waste Transportation: `""" ' s h Ors Name of Hauler: ern C7i I Destination: Waste Product: _ wine o.-�J► Licensed? a No LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Observed (gallons): Ant ifr.Eeze(forgasolineor coolant systems) Drain cleaners 2 .NEW USED Cesspool cleaners . Automatic transmission fluid Disinfectants Engine and radiator flushes A I/v�ak Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils y�S Pesticides �- L NEW g*t USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED / Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car wares 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 Pai;`t brush cleaners Any other products with "poison" labels Floor &furniture strippers (including chloroform, formaldehyde, Metal polishes hydrochloric acid, other acids) Laundry soil &stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids Misc.: (dry cleaners) Other cleaning solvents Bug and tar removers i - Town of Barnstable-Health Department Page 1 HAZARDOUS MATERIALS INVENTORY SITE VISITS DBA: AIIPro Transmission Fax: - 1 Corp Name: JKL Assoc1aton Inc. Mailing Address Location: .104 Enterprise Road Street: 104 Enterprise Road mappar: .294-019-000-000 City: Hyannis Contact: 4 ,i a4*5_ V V OL7/t J2_ lam( e�te: Ma Telephone: !(508)771-9133 Zip: 02601 Emergency: (508)771-4041 Person Interviewed: Business Contact Letter Date: Category: 'VehicleMaintenance Inventory Site Visit Date: .......... Type: Follow Up/Inspection Date: .................. 66 public water ❑ indoor floor drains ❑ outdoor surface drains ❑d 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 - - - -on-site sewage ❑ indoor on-site syste Eloutdoor onsite 6/1 - 2004 s .......y stem date: - ./ --- Remarks: 6/24/97 6 lifts-Electric/Hydraulic,Spedi dry for spills,Rags- compliance: Acme. Orders: MSDS sheets. REMARKS: Satisfactory 10/19/98-MAD981066178. Material Safety Data Sheets in file. Unifirst does rags and uniform.6 electr.Lifts. Speedy dry on surface spills to solid waste. ORDER:Obtain Metal brocket w/lid for rags. Waste oil tank needs"Toxic"&"Hazardous Waste'labels. Obtain Material Safety Data Sheets from Retailers,Distrib.&Suppliers.Keep in file and in Shop. ORDERS: 1999 Need metal container for used rag storage.Recycle Speedy Dry. Used, rags keept in m tal container 4/20/04 Need to inventory to renew HazMat license due 6116/03). S ho clt/L Ji _7�7. — - r Pik-_ ate- i 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 _ description_ qty: unitof measure p �._. waste oil 275gallons .._..._........_......._.._...... 11.......,_._.._.... ----_.. ......... _._ _.._.____.._._....�_..._.�__. ___.-_....._ automatic transmission fluid 55gallons _*eases other cleaning solvents _ 20gallons Waste Transporter: 'Cyn Oil/ / Fire District: Last HW Shipment Date: / Waste Hauler Licensed: �nAo �e-- Town of Barnstable Regulatory Services • o� Thomas F. Geiler,Director 9B^M STABLE. Public Health Division 'A . 4iAleo +"�� Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT NAME OF ESTABLISHMENT _�A�(( Pra fi-FccW-S Ift' -551 c54` ADDRESS OF ESTABLISHMENT 10y 4t-f(-4At>S `I�Vi{4 O L(10O • TELEPHONE NUMBER SOLE OWNER: YES VNO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. d1 O e STATE OF INCORPORATION �c� FULL NAME AND HOME ADDRESS OF: PRESIDENT C Q\&nbzsc'2. dr ?I,i-,\�A dV h TREASURER c- ok �✓ SIGNATURk OF APPLICANT RESTRICTIONS: HOME ADDRESS • HOME TELEPHONE# Ae Hazdoc/wp/q MAIL-IN REQUESTS • Please mail the completed application form to the address below. Also include a copy of your contingency plan (to handle hazardous waste spills, etc). In addition, please include the required fee of$100. Make check payable to: Town of Barnstable. Allow five to seven (7) working days for in- house processing. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis,MA 02601 FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, please fax us a copy of your contingency plan (to handle hazardous waste spills, etc). In addition, please mail the required fee amount of$100.00. Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. Allow up to four days for in-house processing. r For further assistance on any item above, call(508) 862-4644 i r Date: `'( — o`/ TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAMEOFBUSINESS: /4"-iz?ir-. 2 � r°T5 07-". BUSINESS LOCATION: ( O y e- INVENTORY MAILING ADDRESS:1. TELEPHONE NUMBER: 509 — —7 71 TOTAL AMOUNT: CONTACTPERSON: C c ,J�3.y"wpws EMERGENCY CONTACT TELEP ONE NUMBER: 1=��� pl 57�ZICT TYPEOFBUSINESS: 'c-, ��a•� �: e-»R�ieA OTHER INFORMATION: P� )-l-Le- 64 L--t YD 64-w—, 4A a2 am tVa,!V� Or) 5if� 4 8,nA-0 Ll e s <� Waste Transportation: `'r' �'�- Name of Hauler: (�44 n E) 1 Destination: Waste Product: wine c-,-a Licensed? a No LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Observed (gallons): Ant ifreeze(for gasoline or coolant systems) Drain cleaners Z- ;NEW USED Cesspool cleaners /J0.c� Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils Zl- Pesticides Z 552 NEW �USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) .Diesel fuel, kerosene, #2 heating oil NEW USED l` Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil , NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car 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 Misc.: (dry cleaners) Other cleaning solvents Bug and tar removers TOWN OF BARNSTA.BLE COMPLIANCE: CLASS: 1. Marine,Gas Stations,Repair at�sfactory 2. Printers BOARD OF HEALTH � 3.Auto Body Shops Q unsatisfactory- 4.Manufacturers COMPANY Al Pry Z-OVS /�►-► 6.Fuel Suppliers (see"Orders") 5.Retail Stores / — ADDRESS b5v&f Se nn;-30ass: 7.Miscellaneous QU TITIES AND STORAGE (IN= indoors; OUT=outdoors) MAJOR MATERIALS . 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) I transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: DISPOSAVRECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply ca ATown Sewer 91Public O On-site OPrivate �' �ZD I pan 3. Indoor Floor Drains YES NO O Holding tank:MDC O Catch basin/Dry well S21l O 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 re yr, Narne of Haut YES NO 2. d� Person(s) nterviewed spector Date TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1. Marine,Gas Stations,Repair satisfactory 2. Printers BOARD OF HEALTH 3.Auto Body Shops �1 Q unsatisfactory- 4. Manufacturers COMPANY I �r^n fS�l(�' (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS r4p, Class: 7.Miscellaneous nniS QUANTITIES AND STORAGE (IN= indoors; OUT=outdoors) MAJOR MATRIALS Case lots Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: 7CN WE waste motor oil (C) new motor oil (C) i P_ I 15 - ansmissi raulic Synthetic Organics: degreasers Miscellaneous: DISPOSAIJRECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply L ' Lk_S��`- Town Sewer .Public �ltra� O On-site OPrivatebw t l nn ''__ b 3. Indoor Floor Drains YES NO O Holding tank:MDC _ O Catch basin/Dry well `�"" t. O On-site system 4. Outdoor Surface drains:YES NO _?jER,;;: O Holdin tank:MDC �-- g O Catch basin/Dry well �� +C> �v O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product Licensed? 1• YES N0 t1a 2. K �,... PA L . Person(s) Interviewed Inspector Date Town of Barnstable. °F114 i° Regulatory Services Thomas F. Geiler,Director IU MASS. Public Health Division qj 1639' ♦0 ATfD Ma's A Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR]PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT _ i 144 �- C� .1p4A NAME OF ESTABLISHMENT d J'�t ' G �'� 5WIS ILrA 5 ADDRESS OF ESTABLISHMENT / ( - k -s-z_�t�>�� TELEPHONE NUMBER �� SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS Z.S �U4efiK- L�T'��( HOME TELEPHONE# 23 7 a U-C P�,Tt- NS 6 Haz.doc/wp/q TOWN OF BARNSTABLE OMMANCE: CLASS: 1.Marine,Gas Stations,Repair J satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY ,&Z 6 w,4AV5Ar- (see"Orders") 5.Retail Stores c� 6.Fuel Suppliers ADDRESS /,0 . /�� r� � Class: � 7•Miscellaneous c�A,4UANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR ERIALS Drums IN OUT IN OUT IN OUT #&gallons Age Test Fuels: , Heavy Oils: Z �/ waste motor oil (C) new motor oil(C) transmission/hydraulic Synthetic Organics: degreasers .e s '2 Mi cell n ous: i j 1 DISPOSAUREC:LAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply z O Town Sewer Public OKOn-site OPrivate Y 3. Indoor Floor Drains YES NO—LI 0 Holding tank:MDC 0 Catch basin/Dry well 0 On-site system 4. Outdoor Surface drains:YES NO ORDERS: 0 Holding tank:MDC 0 Catch basin/Dry well 0 On-site system f 5.Waste Transporter Name of Hauler Destination Waste Product (� YES N0 2. 100, / '7 Y erson ( Interviewed Inspector Date ■ Complete items 1,2,and 3.Also complete A. Signatur item 4 if Restricted Delivery is desired. ^ '*Agent o Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. Recei ed by(Printed Name) C.gof Delivery ® Attach this card to the back of the mailpiece, �� O or on the front if space permits. D. Is d livery address different from item 1? Yes 1. Article Addressed to: If YES,enter delivery address below: allo ..All-Pro Transmission "104 Enterprise Road t��i � 3. Servi Type Hyannis MA 02601 ified Mail ❑ Express Mail 7 � P Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. LL, 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number i (Transfer from service label) 7 0 01 19 4 0 0004 9042 1839 PS Form 3811,August 2001 i-- Domestic Return Receipt 102595-02-M-1540 i t I 011 ll{ ( (1ii i i Ili i UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • Public Health Division Town of Barnstable 200 Main Street Hyannis, MA 02601 All ii fill 1333 3I111111133l311{{! !3{{{!3!{1l3Ilft!{i1133{{3idi{!P!1 BrA O / Map F F ru Po' M C"{ ea-F p 1. s Postmark Retum�Re Ip4 Fee b 0 (Endorsemgnt equired) 00 Here O Restricted Uet' ryl e_ p (Endorsement'R uired _ * C=31 Total Postage ti F RF -I- V -- Q-• Sent To Streef,A t.No,; to r .. .__ rq 414- M or PO Box No., Certified Mail Provides: o A mailing receipt o A unique identifier for your mailpiece o A signature upon delivery c A record of delivery kept by the Postal Service for two years 'Important Reminders: o Certified Mail may ONLY be combined with First-Class Mail or Priority Mail. o Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. r p For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT.Save this receipt and present it when making an inquiry. PS Form 3800,January 2001 (Reverse) 102595-M-01-2425 Ln a ru Ln Postage $ IL M Certified Fee ' CO Postmark Return Receipt Fee Here 0— (Endorsement Required) 1., 50 j C3 O Restricted Delivery Fee r3 (Endorsement Required) O Total Postage&Fees $ (3 'L7q O Name(PI Print CI arty)(t be mpleted y mailer) m �U. . ----- -=, /lCe. ------------------------------- St . Apt.No.; r PO Box No. M "„.......... •- - -•-- ----------- �a i Ci + �' ds Certified Mail Provides: o A mailing receipt r o A unique identifier for your mailpiece o A signature upon delivery A o A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Mail or Priority Mail. u Certified Mail is not available for any class of international mail. n NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to Provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece 'Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS postmark on your Certified Ma I receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mai. IMPORTANT.Save this receipt and present it when making an inquiry. PS Form 3800,July 1999(Reverse) 10259E-99-M-2087 f Town of Barnstable F THE Tp� o Regulatory Services Thomas F. Geiler,Director * BARNSTABLE, 94� 1639. .�� Public Health Division Thomas McKean, Director 200 Main St, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 March 6, 2003 All-Pro Transmission 104 Enterprise Road Hyannis, MA 02601 RE: Map & Parcel 294-047 Dear Sir: You are directed to connect your building located at 104 Enterprise Road, Hyannis, Massachusetts, to public sewer on or before September 6, 2003. f The Department of Public Works, Engineering Division, has notified us that �. your property abutts town sewer lines. The lines were extended because of the density, and the size of the lots in the area, and the potential for serious health problems. Failure to comply with this order will result in a court complaint against you for failure to comply with a Board of Health Order. If you should have any questions, please telephone me at 862-4644. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S. CHO Health Agent for: TOWN OF BARNSTABLE BOARD OF HEALTH Wayne Miller, M.D., Chairperson Susan G. Rask, RS. Sumner Kaufman, M.S.P.H. Return receipt requested Cc: Barbara Childs, Water Pollution Control Q:Sewerorder.doc 1 VVYIl V1 �Q111►�1.Q�llC Regulatory Services °FTHE r +� Thomas F. Geiler, Director Public Health Division M • w w 9&ARN„ "8 Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 En Mp'l Office: 508-862-4644 Fax: 508-790-6304 April 12, 2002 David L. McCarthy % Wellspark Group—Accounting One Wells Avenue Newton, MA 02459 RE: Map & Parcel 294-047 Dear Sir: You are directed to connect your building located at 104 Enterprise Road, Hyannis, MA; to public sewer on or before October 12, 2002. The Superintendent of the Department of Public Works has notified us that your property abutts town sewer lines. The lines were extended because of the density, and the size of the lots in the area, and the potential for serious health problems. Failure to comply with this order will result in a court complaint against you for failure to comply with a Board of Health Order. If you should have any questions, please telephone me at 862-4644. PER ORDER O THE BOARD OF HEALTH Thomas A. McKean, R.S. CHO Health Agent for TOWN OF BARNSTABLE BOARD OF HEALTH Susan G. Rask, RS., Chairperson copy: Peter Doyle Sumner Kaufman, M.S.P.H. Return receipt requested Wayne Miller, M.D. sewerco2 ' i 1Vrrll V1 "U1U3LaV1U Regulatory Services °FtH r Thomas F. Geiler,Director Public Health Division 9B'R'',r&W �" Thomas McKean,Director Q3,T 1639. Aim 200 Main Street, Hyannis, MA 02601 Ep Mp'l Office: 508-862-4644 Fax: 508-790-6304 April 12, 2002 David L. McCarthy % Wellspark Group—Accounting One Wells Avenue Newton, MA 02459 .RE: lrlap & Paroei 29 Dear Sir: You are directed to connect your building located at 104 Enterprise Road, Hyannis, MA., to public sewer on or before October 12, 2002. The Superintendent of the Department of Public Works has notified us that your property abutts town sewer lines. The lines were extended because of the density, and the size of the lots in the area, and the potential for serious health problems. Failure to comply with this order will result in a court complaint against you for failure to comply with a Board of Health Order. If you should have any questions,(please telephone me at 862-4644.. PER ORDER O THE BOARD OF HEALTH Thomas A. McKean, R.S. CHO Health Aaent for TOWN OF BARNSTABLE BOARD OF HEALTH Susan G. Rask, RS., Chairperson copy: Peter Doyle Sumner Kaufman, M.S.P.H. Return receipt requested Wayne Miller, M.D. sewerco2 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • Board of H020 Town of B 200 Main St Myann a M=_-dW=e0 am ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. ❑Agent a Print your name and address on the reverse X ❑Addressee so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery Is Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No Oxe--"_e _6"-"-Q— 1 Se/ice Typo Q O.Q 0 Certified Mail Dxpress Mail ❑ Registered Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (transfer from service label) ` O 9�' 3 f o o —6 04 9 omestic Return Receipt 102595-01-M-2509 jjjjj��M&'..77...,., Town of Barnstable u.s.1'Os-nrr:E tit Department of Health,Safety and Environmental SeMCI a Public Health Division,47 Main Street a ,,;, ' C 1 H MA 02601 , <, < ,4y � e {'�I �TC12 L,_ -„ 8026 5215 Can.1 ' Date p f of Deliven3ble AS_-~ l ��/n,�1 /1 _ Q_ -(( Unable To FoMWd O�t�jjtea't'j/ ❑insufficient Addresp �/} D(lo^ - 13 Moved,Left No Addms,6�i "�tfi& ` 13 Unclaimed 17 Refused 0 Attempted-Not 1CnoyyA ► ( ' J 13 No Such Street 13 Numbq CI Vacant ❑Illegible [I No Mail RecePtaao _ _ '4 -- 17 Box Closed'No rt_'��r V S i' _ 1� -_ i " ONO, 13 Returned For Bell*Addtea a P4ataga J)w I - i h I , I . I i I - �7 — oo (c3 oFTHEro TOWN OF BARNSTABLE OFFICE OF i BARISTOBL : BOARD OF HEALTH 7 MA64 p 039. \gym 367 MAIN STREET �D mo k' HYANNIS, MASS.02601 May 4, 1999 Michael Ford, Esquire Box 665 West Harwich, MA 02671 Dear Mr. Ford: You are granted a.variance, on behalf of your client Cape Cod Mail Nominee Trust from the requirement to connect the building located at 104 Enterprise Road, Hyannis, to town sewer. The applicant may continue to utilize the existing septic system until May 30, 2002. After that date, the building shall either be demolished or connected to town sewer. This variance is granted because Attorney Michael Ford testified that it is the applicant's intent to demolish the building as soon as the tenant vacates the premises. The existing tenant, All-Pro Transmissions, has the right by lease agreement to remain, in a portion of the building until May 2002. Sincerely yours, Susan G. Bask R.S. Chairperson Board of Health Town of Barnstable SGR/bcs ma113 pp 1HE Tp� TE: 40 J EE: snnrtsTner.E, y MASS. �p 1639. 10 E Town of Barnstable N HED� Board of Health A 367 Main Street, Hyannis MA 02601 g Z+ Office: 508-790-6265 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,M.S.P.H. r Ralph A.Murphy,M.D. VARIANCE REQUEST FORM LOCATION Property Address: 104 Enterprise Road, Hyannis Assessor's Map and Parcel Number: 2 9 4/12 Size of Lot: 23 , 962 Wetlands Within 300 Ft. Yes X Subdivision Name: N/A No Business Name:_CnP Cod Mall Nominee Trust APPLICANT CONTACT PERSON Name: Cape Cod Mall Nominee Trust Name: Michael D . Ford , Esq . Addressc/o Michael D. Ford , Esq . Address: P. 0. Box 665 , W. Harwich,MA. Box 665 ,W.Harwich,MA. 02671 02671 Phone: 508-430-1900 Phone: 508-430-1900 FAX: 508-430-8662 FAX: 508-430-8662 VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) Variance from rPruarement The Cape Cod . Mall Nomine Trus•1- has acquired to tie in h„i 1 d i n Q t op u b 1 i c the building on the site and is dem6l.i sh i no a portion sewer, thereof, A tenant, All—Pro Transmissions. has a right to remain in the remaining portion of the building up to May of 2002. Tt is Lbe Mall 's intent to demolish the rest of the building as soon as the tenant vacates the premises ns the Mnll 's approved permits arking. Checklist(to be completed by office staff-person receiving variance request application) Four(4)copies of plan submitted(including septic system plans and/or restaurant floor plans) Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variances only) Variance request application fee collected[no fee for lifeguard modification renewals,grease trap variance renewals[same owner/leasee only),outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed)) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan G. Rask,R.S., Chairman NOT APPROVED Sumner Kaufman, M.S.P.H. REASON FOR DISAPPROVAL Ralph A. Murphy,M.D. Q:/WP/VARIREQ E M ST�NG PARKI G � REA 8,723 S. i 'r ' g\t�r nt• 20 ACREE f PROPOSED a?, PARKINGAREA fJ2•fi� Q�EO..0 f�7'�� \_ �� '`f ,��ti/ / i �i �!• y :�`'�,�. •, V� i t �'� ,� ;` C `. 13,3 . _11 S,F. 1_i_ - � \L�: Ti• !` v�ti3� 1 >, "'O ,� 0.31 ACRES JV 01 I�� 1 � . Y y /' YY '✓ � Z i. op �-� N0 ' LLEFT TURN � `• WAY n ALL—PRO PARKING 707 ALTERNATIVE C ""' ANDFRgON—NICHOL sI�'FS PR 'AR,�TIf�1�F pI.g11'S o ,• CAPE COD MAIL, R]KNO V TrONE CRAWNG REFERENCE DPG P��E II T ADD=N PHASE If ,� DWG L-1 do L-2 owe A, tncraA nrwa r r rrr� DATc_: OCT. 21.099 JL renj as - 24M r"Im?)an- aura HYARNB, mA 04/27/1999 10:32 5084283115 SULLLIVAN ENG INC PAGE 02 Sullivan Engineering Inc. 7 Parker Road Box 659 Osterviile MA 02655 Peter Sullivan P.E.Mass. Registration No.29733 428-33" fax 428-3115 e-maii:PSUIPEOaol.com April 26, 1999 Attorney Michael Fond 72 Main Street Box 665 W Harwich, MA 02671 RE: All Pro Transmission 104 Enterprise Road, Hyannis Map 294 Parcel 47 Dear Attorney Ford, Per your request, i did a visual inspection of the septic system at 104 Enterprise Road in Hyannis. Additionally, I reviewed the following: 1. Town of Barnstable GIS Map of the property 2_ Town of Barnstable Board of Health"As Built" cards 3_ Sewerage Treatment Plant pumping records. Summary: There are 2 (two) septic tank structures and 4 (four) leaching pits. Two of the leach pits were dry, and two had very minimal grey water. Per GIS mapping, the bottom of the pits are about elevation 40 (forty). This places the bottom of the leach pits at least 4 (four)feet above ground water and approximately 200 feet of horizontal separation to the adjacent drainage ponds. The Sewerage Treatment Plant had no record of pumping the system for the last 12 (twelve) months. Conclusion: Based on the above, it appears reasonable that the existing septic system will function adequately until the building is demolished. 11 you have any questions, please feel free to contact me. t°A cr V truly yours. PM 80LL SA42-- IL Peter Sullivan PE Sullivan Engineering Inc. 9 9 Members of American Society of Gvii Engineers,Boston Society of Civil Engineers i;c- (50Y) ' q3o f ' � y j 04/27/1999 10:32 5084283115 SULLLIVAN ENG INC PAGE 01 Sullivan Engineering Inc. 7 Parker Road Box 6% Osterville MA 02856 Peter Sullivan PE Mass Registration No.29733 608-428-3344 fax 50 -428-3115 e-mail PSUIPECad.com Fax Transmittal Date: April 27, 1999 To: Tom McKean 508-790-6304 From: Sullivan Engineering Inc. RE: All Pro Septic Evaluation Dear Tom, Please find attached a septic report for the above referenced property. If you have any questions, please call. Ve truly yours, Peter Sullivan Pages including cover sheet 2 r • s%\ Conunonwealth of Massachusetts Executive Office of Envirolunental Affairs Dept. of Environmental Protection One winter Street Boston Ma. 02108 John Gj-nd ' D.E.P. Title V Septic Inspector P.O. Box 2119 Teaticket, MA 02536 WILLIAM F.WELD (508)564-6813 Governor ARGEO PAUL CELLUCCI Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION a 9 LA P. oLt 41 L 1 104 Enterprise Rd. Property Address: p� Hyannis � Address of Owner: Date of Inspection: 8115198 (If different) Name of Inspector: John Graci Dave McCarthy I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) Company Name,Address and Telephone Number: CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: x Passes This Inspection Is based on criteria dented In Title V Conditional) Passes code 310 CMR 16.303.My findings are of how the system is Y performing at the time of the Inspection.W inspection does _ Needs F th r Evaluation By the Local Approving Authority not Impyany warranty or guarantee orthelongevityarthe Fells septic system and any of Its components useful life. Inspector's Signature: Date: 8J18f98 -- —a The System Inspector shall submit a copy of this inspection report to the Approving Authority within thi 30), ays of completing tf is inspections. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspectof5and th systi n owner shall�s bmit the report to the appropriate regional office of the Department of Environmental Protection. FCE'V�0 The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving author1 y. AUG 1 1998 INSPECTION SUMMARY: + TOWN 11EOAL HADEPT., Check A, B.C,or D: � .A] SYSTEM PASSES: x 1 have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes, no, or not determined(Y, N,or ND). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of CoMpliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or the septic tank,whether or not metal, is cracked,structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04127)971 One Winter Street is Boston,Massachusetts 021108 is FAX(617)556-1049 is Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 104 Enterprise ad.Hyannis Owner: Dave McCarthy Date of Inspection:8115199 _ Sewaae backup or.breakout or hiah.static water level observed.in.the distribution box is due to a broken. or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced _The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed CJ FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other DJ SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No _ Backup of sewage in facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged ' cesspool. SAS is in hydraulic failure. (revised 04RA97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 104 Enterprise Rd.Hyannis Owner: Dave McCarthy Date of Inspection:8115198 D]SYSTEM FAILS(continued) Yes No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. pevleed 0427r97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST I Property Address: 104 Enterprise Rd.Hyannis Owner: Dave McCarthy Date of Inspection:9115198 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: ,c_ — Pumping information was requested of the owner,occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the and the system has been receiving normal — flow rates during that period. Large volumes of water have not been Introduced Into the system recently or as part of this inspection. x As built plans have been obtained and examined. Note if they are not available with N/A. x — The facility or dwelling was inspected for signs of sewage back-up. x — The system does not receive non-sanitary or industrial waste flow. _X— — The site was inspected for signs of breakout. x All system components, excluding the Soil Absorption System,have been located on the site. x The septic tank manholes were uncovered, opened,and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions,depth of liquid,depth of sludge,depth of scum. x _ The size and location of the Soil Absorption System on the site has been determined based on The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. x Existing information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part C is at issue, approximation of distance is unacceptable)[15.302(3)(b)) (revIsed t16R7)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 104 Enterprise Rd.Hyannis Owner: Dave McCarthy Date of Inspection:8115199 FLOW CONDITIONS RESIDENTIAL: Design flow: 0 g•P•d./bedroom for S.A.S. Number of bedrooms: 0 Number of current residents: 0 Garbage grinder(yes or no): No Laundry connected to system(yes or no): No Seasonal use(yes or no): No Water meter readings, if available.(last two(2)year usage(gpd): Na Sump Pump(yes or no): No Last date of occupancy: n1a COMMERCIAL/INDUSTRIAL: Type of establishment: Commercial Building 6000 Square Feet Design flow:0 gallons/day Grease trap present: (yes or no) Yee Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no)-No Water meter readings, if available: nia Last date of occupancy: n1a OTHER:(Describe) n1a Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: rda System pumped as part of inspection:(yes or no)No If yes,volume pumped:0 gallons Reason for pumping: nla TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes, attach previous inspection records,if any) VA Technology etc.Copy of up to date contract? Other APPROXIMATE AGE of all components,date Installed(if known)and source Information: 20.26 years old. Sewage odors detected when arriving at the site:(yes or no) No (reviesd 0412707) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 104 Enterprise Rd.Hyannis Owner: Dave McCarthy Date of Inspection:8115198 SEPTIC TANK: x (locate on site plan) Depth below grade: 2' Material of construction:x concreate metal FRP Polyethylene_other(explain) If tank is metal, list age nia . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: Le'6"H5'7••w4'10'- Sludge depth:6" Distance from top of sludge to bottom of outlet tee or baffle: 29" Scum thickness:3" Distance from top of scum to top of outlet tee or baffle:6" Distance form bottom of scum to bottom of outlet tee or baffle: 15" How dimensions were determined: Measured Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) Septic tank and all components are structurally sound and runclioning properly.Recommend pumping now and then malydained two years. GREASE TRAP: x (locate on site plan) Depth below grade: rda Material of construction:x concrete_metal_FRP_Polyethylene_other(explain) Dimensions: L8'6"H5'7'V4•lO" Scum thickness:1' Distance from lop of scum to top of outlet tee or baffle:6" Distance from bottom of scum to bottom of outlet tee or baffle:6" Date of last pumping;,, Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) Grease trap is structurally sound.Recommend pumping system. BUILDING SEWER: (Locate on site plan) Depth below grade: 2'6" Material of construction:_cast iron_40 PVC_other(explain) Distance from private water supply well or suction Iinetown Diameter: nla Comments: (conditions of joints,venting,evidence of leakage, etc.) (revised 04427)87) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 104 Enterprise Rd.Hyannis Owner: Dave McCarthy Date of Inspection:8/15198 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: rda Material of construction:_concrete_metal_FRP_Polyethylene—other(explain) Dimensions: We Capacity: nia gallons Design flow: rva gallons/day Alarm level:--Na Alarm in working order?_Yes_No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) rda DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: We Comments: (note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box etc.) rda PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)No Alarms in working order(yes or no) -yes Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) rda (revised 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 104 Enterprise Rd.Hyannis Owner: Dave McCarthy Date of Inspection:8115198 SOIL ABSORPTION SYSTEM (SAS):x (locate on site plan, if possible: excavation not required,but may be approximated by non-intrusive methods) If not determined to be present, explain: rda Type: leaching pits,number: 4-1000gallon leach pits leaching chambers, number:rda leaching galleries, number: rda leaching trenches, number, length: rda leaching fields, number, dimensions:rda overflow cesspool,nl-Imber:nla Alternate system: rVa Name of Technology:_rda Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.) The leach pits are structurally sound and functioning properly.They were all empty. CESSPOOLS:_ (locate on site plan) Number and configuration: rda Depth-top of liquid to inlet invert: rda Depth of solids layer: rda Depth of scum layer: nla Dimensions of cesspool: nla Materials of construction: rda Indication of groundwater: rda inflow(cesspool must be pumped as part of inspection) rda Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) rda PRIVY: (locate on site plan) Materials of construction: nla Dimensions: Na Depth of solids: rda Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) rda (revlaed 04l2T)9T) r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 104 Enterprise Rd.Hyannis Dave McCarthy 8115198 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) G Q i CG,P-�S (revised04)27197) Page >f OL 10 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 104 Enterprise Rd.Hyannis Dave McCarthy 8/15198 Depth of groundwater 12 Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. Observation of Site(Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers X Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS Maps and charts (revised WNW) page I0 of 10 TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH O satisfactory 3.Printers ody shops /� unsatisfactory- 4.Manufacturers COMPANY/III—Y 'ro -fir S d`1+.�1��'�hs O (see"Orders") 5.Retail Stores i '/ 6.Fuel Suppliers ADDRESS /&C/ FtA,!4,';S--P Rdj 14—Class: 7.Miscellaneous QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS IN OUT IN OUT IN OUT #&gallons IAge I Test Fuels: Gasoline,Jet Fuel(A) Diesel,Kerosene, #2 (B) Heavy Oils: 7_77 r waste motor oil(C) (� DC new motor oil (C) /4-7-F 2-3T K transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: p( Z ZS !s e ctc 4 -tie v q, CfM( Ct• CHuk G/+l• eaefti ' DISPOSAVRECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply O Town Sewer (Public Q (�14,�„s�-66—Go C/A� Y�_� . �e(`e c ,60n-site OPrivate R S4P014 C15-ev pa, 3. Indoor Floor Drains YES N0_jz O Holding tank:MDC_ S0 d GfC4 O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: _ 0 Holding tank:MDC 4 A", O Catch basin/Dry well *Wet O On-site system �� • /��� J S �� 5.Waste Transporter 4ky-f. Ku, pp !0 / YE NO 2 wferso nterviewed Inspector Datd A zqc( ov / Date: TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: jeL.. 0,1'05W*&1,,►6 BUSINESS LOCATION: MAILINGADDRESS: Mail To: Board of Health TELEPHONE NUMBER: ' '7 7/- 9L3-3 Town of Barnstable CONTACT PERSON:�Z /Y CC�AV V P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: Hyannis, MA 02601 TYPE OF BUSINESS: TAfts w5-r/o.o AIA Does your firm store any 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: 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 J:2-r f_ Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED AID QL. Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Paint brush cleaners Any other products with "poison" labels (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 (dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS 1 7 ? Ib 9/32jbofw TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas(8tations,Repair satisfactory 2.Printers BO"A�RD OF HEALTH 3.Auto Body Shops V W � '_ O unsatisfactory- 4.Manufacturers COMPANY (see"Orders") 5. l Stores 6.Fuel Suppliers ADDRESS Class' 7.Miscellaneous QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors) MAJOR MATERIALS 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 Miscellaneou 67 DISPOSAURECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply (J `LA dt_,Cder O Town Sewer Wublic V n-site OPrivate O e 3. Indoor Floor Drains YES N0_X FB� O Holding tank:MDC O-Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES_NO ORDERS: O olding tank:MDC Catch basin/Dry well On-site system 5.Waste Transporter YES NO 1. ' 2. ryry f �-. / Person(s) nterviewe Inspector l Date �i No. /q ^ "17 S— Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. ✓✓ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Rppfication for Mk4paal *pttem Construction Vermit Application for a Permit to Construct( )Repair( )Upgrade( Abandon( ❑Complete System ❑Individual Components Location Address or Lot No. O E o1 Owner's Name,Address and Tel.No. 7 �' phf N�VGI}(l /� I J3L 6) l[�/ �3�/A t /Q�L/�iv7 Assessors Map/PIX \l Z q y—0 LSa 3S-q ill - 9y� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. R Go(( Cv Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 1 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Bipsg of He th. l Signed C� Date/a Application Approved by Date 1) Application Disapproved for the WllowiRg reasons Permit No. - 7 7.5 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( )by at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer I The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector No. 7 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ Yes PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE., MASSACHUSETTS 25 Z[ppjtcation for ;Di_4po!5al *p5tem Cow6truction Permit Application for a Permit to Construct Repair Upgrade Abandon:( ) El Complete System El Individual Components Location Address or Lot No. O P I a Q— 'L Owner's Name,Address and Tel.No. 9 f��) 11 (r, //,, 13 IZ/A Ij + IV"r4-4"-'-T '-' f-,01ZPt—r Assessors Zap/Zer" A/_.5.9 :; :3 5--6i W 9,1 Y, Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. K;. Cc� C Type of Building: Dwelling No.of Bedrooms- Lot Size sq. ft. Garbage Grinder Other Type of Building No. of Persons Showers Cafeteria( Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank ----Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifir cate of Compliance has been issued by this Bip�a of He th. Signed Date/,) Application Approved by Date-1.) - 9 �f Application Disapproved for the Wflowing reasons Permit NO. Date Issued -- --------------------------—------- ------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed,(( Repaired Upgraded Abandoned by ,at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector No. 7 Fee THE COMMONWEALTKOF MASSACHUSETTS PUBLIC HEALTH"DIVISION - BARNSTABLE., MASSACHUSETTS f. 1=iqoal *g6tem Co MrItt-nanVermit Permission is hereby granted to Construct Repaif( Upgrade( �AbLan�don ) System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title'5 and the following local provisions or special conditions. Provided: Construction must be completed within three ybars of the date of this permit. Date: Approved by — TOWI+OF BARNSTAB��DINO PE&- A/`,�P OL�ATN Map aC U Parcel l Permit# Health Division Date Issued z Conservation Division Fee PIA Tax CollectoLIvl hvrJ oQ d1�q V � _ Vb'a Treasurer _ .. ='�L-' CC a �i�5 ww► liti �r►LL�D ►qd ' Planning Dept. 1N+TH TITLfr 5 AND Date Definitive Plan Approved by Planning Board F�lVI1r,NMrNTAL COP TV:4 F1t=rz1JL TaCNS Historic-OKH Preservation/Hyannis Project Street Address 9 3 7 =-Yay,voc76 M Village Owner Address Telephone _ Permit Request ��.��/�� J��l l/6��/�9f• �ili S� Square feet: 1st floor: existing proposed 2nd floor:existing proposed Total new Estimated Project Cost Zoning District Flood Plain Groundwater Overlay Construction Type 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: n Full ❑Crawl ❑Walkout ❑Other 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 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 Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use f (96' 012 BORTOLOTTI CONSTRUCTION, INC. 765 WAKEBY ROAD,MARSTONS MILLS, MA 02648 ". 508-771-9399 508428-8926 FAX: 508428-9399 Cy`� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION NORM PART A CERTIFICATION 9�/,qa��,O& Property Address: o� Date of Inspection: 7 Inspector's N me: Owner's Name and Address: a oa6 91 CERTIFICATION STATEMENT* I certify that I have personally inspected the sewage disposal system at this address and that the informa- tion reported below is true,accurate and complete as of the time of inspection. The inspection was per- formed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The System: Passes Conditionally Passes FAILED INSPECTION Needs Further Ev Lion y e Local Aproving Authority Fails alags Inspector's Signature: Date: The System Inspector shall submit a copy of this inspection report to the Approving authority within thir- ty(30)days of completing this inspection. if the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to Lite appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARYs A)SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B)SYSTEM CONDITIONALLY PASSES; One or more system components need to be replaced or repaired. The system, upon comple- tion of the replacement or repair, passes inspection. Indicate yes,nor,or not determined(Y,N,OR ND). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal,cracked, structurally unsound,shows,substantial infiltration or exftltration,or tank failure is imminent. The system will pass inspection if the existing sep- tic tank is replaced with a conforming septic tank as approved by The Board of Health. Sewage backkup or breakout or high static water.level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of The Board of Health): 's SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Broken pipe(s)replaced Obstruction is removed Distribution Box is levelled or replaced The System required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of The Board of Health): Broken pipe(s)are replaced Obstruction is removed C)FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by The Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1)SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 Feet of a surface water Cesspool or privy is within 50 Feet of a bordering vegetated wetland or a salt marsh. 2)SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTION- ING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVHRONMENT: The system has a septic tank and soil absorption system and is within 100 Feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is with a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 Feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 Feet but 50 Feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. D),OSTEM FAILS: vy I have determined that the system violates one or more of the following failure criteria as defined in 310 MR 15.303. The basis for this determination is identified below. The Board of Health shou be contacted to determine what will be tiecessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of efluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clog- ged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped -2- 'SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 Feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 Feet of a private'water supply well. Any portion of a cesspool or privy is less than 100 Feet but greater than 50 Feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: The following criteria apply to a large system in addition to the criteria above: The design flow of a system is 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist:' The system is within 460 Feet of a surface drinking water'supply The system is within 200 Feet of,a tributary to a surface drinking water supply The system is located in a nitrogen sensitive area Interim Wellhead Protection Area (IWPA)or a mapped Zone II of a public water supply well. The owner or operator of any such system shall bring the'system and facility into full compliance with the groundwater treatment program requireinenls of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST .A• Check if the following have been done: _Pumping information was requested of the owner,occupant,and Board of Health. _None of the system components have been pumped for atleast two weeks and the system has .been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. ✓ As-built plans have been obtained and examined. Note if they are not available with N/A. tThe facility or dwelling was inspected for signs of sewage back-up. �LThe system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. All system components,'excluding the Soil Absorption System;,have been located on site. The septic tank manholes were uncovered,opened,and the interior of the septic tank was in- spected for condition of baffles or tees,material of construction;dimensions,depth of liquid, depth of sludge,depth of scum. I _�Zfhe size and location of the Soil Absorption System on the site has been determined based on f existing information or approximated by non-intrusive methods. -3- r - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST(continued) _ j ne facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C`: SYSTEM INFORMATION FLOW CONDITIONS R Design Flow: gallons Number of Bedrooms: Number of Current Residents: Garbage Grinder: Laundry Connected To System: Seasonal Usd: Water Meter Readings,if available: Last Date of Occupancy: Type of Establishment: �kZ Design Flow: gallonstday Grease Trap Present: (yes or no) Industrial Waste Holding Tank Present: ,Ulm Non-Sanitary Waste Discharged To The Title V System: 1 j— Water Meter Readings,If Available: Last Date of Occupancy: OTHER: Describe) Last Date of Occupancy: GENE INFORMATION PUMPING RECORDS and source of information: System Pumped as part of inspection:A,)r) If yes,volyme umped: gallons Reason for pumping: TYPE OF SYSTEM: Septic Tank/Distribution Box/Soil Absorption System Single Cesspool Overflow Cesspool Privy Shared System(If yes,�,t,ach previous inspection records�i j any) Other(explain):. Q(T�i�n- � D Id alaz,it d o2z ao Ql�. AP RO TE AG of all components,date installed(if known)and source of information: f_ Sewage odors ected w en arriving a the site -4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . ' PART C GENERAL INFORMATION (continued) SEPTIC TANK: Depth below grade: Material of Construction: concrete metal FRP Other (explain) — Dimisions: Sludge Depth: Scum Thickness: Distance from top of sludge to bottom of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) GREASE TRAP: Depth Below Grade: Material of Construction: concrete metal FRP Other (explain) — — — — Dimensions: Scum'Thickness: Distance from top of scum to top of outlet tee or baffle: Comments: (recommendation for pumping,,condition of inlet and outlet tees or ba gs,.depth of liquid level in relation to outlet invert, stnicturul'integrity;evidence of learkige.'eic.) TIGHT OR HOLDING TANK: lA)D Depth Below Grade: Material of Construction: concrete__metal—FRP—Other(explain) Dimensions: Capacity:_ gallons Design Flo«: allons/day Alarm Level: Comments: (condition9(P..N of inlet tee. condition of alarm and Iloat swilc.hes, ctc ) . r as �i •a a..i,. .'. 9.. 4`1a • i ..3>bw-a .. ��' t+b,. .r.,Pr_ r .. DISTRIBUTION BOX: /00 Depth of liquid level above outlet invert: Comments:,(note if level and distribution is equal,evidence of solids carry-over, evidence of leakage into or out of box,etc.) _PUMP CHAMBER:, I� Pump'isin working order: Comments: (note condition of pump chamber;condition of pumps and alipimenances,etc.) • =S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) SOIL ABSORPTION SYSTEM(SAS):_X (Locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: Leaching pits,number: Leaching chambers, number: Leaching galleries,number: Leaching trenches,number, length: Leaching fields, number,dimensions: Overflow cesspool,nurr._ber: Comments: (note condition of soil,signs of hydraulic allure le I of ponding,conditioh of vegetation, _jWCESSPOOLS: ✓ �� Number and confi guration: -1 0g'"Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum laver: Dimensions of Cesspool: _Materials of construction: " 'A Wication of groundwater: Inflow(cesspool must be pumped as part of inspection) Comments:,(note condition of soilk,signs of h draulic failure, level of ponding,condition of vegetation, etc. ' PRIVY:A Materials of construction: Dimensions: Depth of Solids: Comments: (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.) -6 - 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to atleast two permanent references, landmarks or benchmarks. Locate all wells within 100 Feet. I 1➢I II I� DEPTH TO GROUNDWATER: > Depth to groundwater: FeetlO� Me od.o Determination or pprg9ximation: O i to or eez D Gl� i b uiQ fir'!' �laD.s � � . � l�. »e� � � \�\ ' ,:\�\\� » \>w . � �� �\�\f��7�; ��<\� _ ���». t � °r� © � 2� » < « � �® ~°�� � - \����\��������/\\���\/: a a > y J � >y�»£ «y»© � <m7�»2 » «�>m» � < : � � y.. «. y < <�\�/��y x w � : > §»\���2 m , . :: � y y��\% ° , . v ? � \ \/\ \ � ° ©Tw « � ?\�» � � . � \ . ?< 2 2��%�\\� �\\« ><�«» . : � �\\�\>/ . 2 � ^y«: . � . , \�\\\\����\�\�/������/ . � :s . , .« w. �y . . � � <«� « . : » . . av ,&Q�<w »< « a:�n . . . . . .�.r y, �< © ®^~©^\�2�??; .w \ee . ,. . . . . . . � � < °z . . »y�\�\�\\«, sue�d»: �y��. ^ ^ ���\§ /�\�\ ����\%< < . � . «» � � . �<. - . .m<«2 �. . «°\/�°�&�2w»y\ aƒ��2 . �a �.»va . . .. ..a �, .�_ ��. . . . . : .� _ ,. : , : ,�yye. � . aa. >w» , . . � � .:�«w»r � . \�� : �\ \ :����\, . . } ���d��� ` - ��\ �\ /� \ «�\,�\�� 2 », \ d» � ?:d®�> r . � _ . � a . «� y 2 y��/\����/��� , s . , � No. < s✓ d}�-, "✓ Fee s-' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION —TOWN OF BARNSTABLE, M SSACHUSETTS Yication for io o�aY *p�tein nttruction Permit Application for a Permit to Construct( )Repair( )Upgr e(• )Abandon( ❑Complete System ❑Individual Components Location Address or Lot No. L'. ���e� r1�'O✓ Owner's ame,Ad, ss and Tel.No. P /�I I lro -Firms-,s nn i ss t o n s Assessor's Map/Parcel �/(, 4 Y- Installer's_IDme,Address, d Tee No. D-)C Designer's Name,Address and Tel.No. "-4 r Type of Building: a5 Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank i Type of S.A.S. Description of Soil Nature of Repairs or Alt tions(Answer when applicable) k' ,o r_% M ery Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. Signed l�> . Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACH S BARNSTABLE, MASSA SETTS Cerfifirato omphance THIS I,S_TO CER the On-site a e Disposal System Constructed(, )Repaired ( )Upgraded( ) Abandoned( )by zopr at has been constructed in accordance with the provisions of Title 5 the for Disposal System Con structt0 t No - t�� 7 dated Installer Designer The issuance o s permit shall not be construed as a guarantee that the system will on as designed. Date Inspector +,,._ -..�...,..•„,..i+'. �,�..�frn».`y,. _ .+ r....'fF"".�' "� -"Y�.'tir.^.--*,.�'4Fv..svin.�.airy+^a-.y...is`}`9�..w'1Y�•..'t'h+�t..r'1. ..' "1FiY`i':f fr' tar°'`'yrr-....,..�frn�:,,�,�.�.r. No. ~G ` Fee . THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., M SSACHUSETTS 0[pphration for Migpogal *pgtem Con.5trurtton Vertnit Application for a Permit to Construct( \ )Repair( )Upgr e( )Abandon( ❑Complete System ❑Individual Components Location Address or Lot No. # k o 4 Owner's Name,Address and Tel.No. t P 1 rQ Trc� r,� nri e s 6 n Assessor'sMap/Parcel ()4- 5-- t,ve -- ;, Installer's Name,Address,and Te No. C Designer's Name,Address and Tel.No. 1 1 . CAL nj- Type of Building: y Dwelling No.of.Bedrooms Lot Size sq. ft. Garbage Grinder( ) f Other Type of Building No. of Persons Showers( ) Cafeteria( ) \ Other Fixtures 1 Design Flow °'`gallons per day: Calculated daily flow gallons. Plan Date 1 Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil �- .�� ���rr� �/-eF R+ Nature of Repairs or Alte ions(Answer when applicable) U f'l M 'C.(1 Date last inspected: 4'* Agreement: The undersigned agrees to ensure the constructioaand maintenance of the afore described on-site sewage disposal system,.. in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. Signed �,IPD Date. Application Approved by Date Application Disapproved foi�the following reasons % . f f , X% Permit No. Date Issued r THE COMMONWEALTH OF MASSACHUSETyTS - �� BARNSTABLE, MASSACHUSETTS Certif irate,of'Comp1tance ,.- ' THIS I O CER ;tat the On-site ewage Disposal System Constructed( )Repaired ( ) Upgraded( ) Abandoned( �y _ at 11-41 has been constructed in accordance with the provisions of Title 5 and-the for Disposal System Construction 'ermit No.Yff 77 dated Installer / Designer ,I, The issuance ofthis permit shall not be construed as a guarantee:that the system will fu cti n ate_ s designed. ? Date �� �. Inspector Fee THE,COMMONWEALTH OF MASSACHUSETTS r PUBLIC HEALTH DIVISIO,N`..BARNSTABLE,. MASSACHUSETTS i mtgogar pgtern (Congtrurtion Ve M. tt ,sPercussion is hereby granted to Construct( )Repair( )Upgrade( )A .a o ystem located at 4 j and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this 7� �--e rr r. t t. Date: -Approved b ice' 10 TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Station , epair BOARD OF HEALTH O satisfactory 2.Printers 3.Auto Body Shops o / unsatisfactory- 4.Manufacturers COMPANY (see"Orders") 5.Retail Stores n ��- 6.Fuel Suppliers � ��7`����!� Class: 7.Miscellaneous /bq D��i�{ W QUANTITIES AND STORAGE (IN= indoors; OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Unde4i, Virnk!M IN OUT IN OUT IN OUT #&gallons 777 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 �f Miscellaneous: DISPOSAIJRECLAMATION REM#RKS: 1. Sanitary Sewage 2. ater Supply u, 9J! Ve-9 V122 O Town Sewer public 0 1"`t tOn-site O Private >! 3. Indoor Floor Drains YES NO O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO . Q Holding tank:MDC O Catch basin/Dry well O On-site system 5 1 . Waste Transporter Name' of Hauler 1 Product YES NO 2. Person (s) Interviewed Inspecto 4ae r r � r 17 E , TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair r Q satisfactory 2.Printers BOARD OF HEALTH , , 3.Auto Body Shops �' ,.!. r-y ® unsatisfactory- 4.Manufacturers COMPANY� �� r��� �I` � �'� j (see"Orders") 5.Retail Stores �, 6.Fuel Suppliers ADDRESS : !7?) `,49(,C/�AL a l Class• 7.Miscellaneous QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Undiergrou"n' d IN I OUT IN I OUTI IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) L' 4 Heavy Oils: waste motor oil (Q) V.- new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers i lye Miscellaneous: DISPOSALlR.ECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply OTown Sewer ,6,Public �+ r+ `,i r� ® On-site OPrivate �^ 3. Indoor Floor Drains YES NO O Holding tank:MDC ! O Catch basin/Dry well On-sites stem 4. Outdoor Surface drains:YES NO ...ORDERS:' ,,>, O`Holding tank:MDC Q Catch.basin/Dry well O On-site system 5.Waste Transporter Name of Hauler I Destination Waste Product 1• YES INU 2, t - r i .. Person (s) Interviewed Inspector Date TOWN TOF BARNSTABLE l,�COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair Q satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops unsatisfacto 4.Manufacturers COMPANY, U" J I 'l I ' (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS G�-i���f�!��� � � Class: 7.Miscellaneous yy fi} QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground IN OUTI IN 10UT IN OUT #&gallons Age I Test Fuels: Gasoline,Jet Fuel (A) M' Diesel, Kerosene, #2 (B) Heavy Oils: N waste motor oil (C) C 1 new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers C'A0 I Miscellaneous: 01/ KI 21;,0 Zo, DISPOSAURECLAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply f' C /i. 1. - b)\ f Y O Town Sewer ®Public ( '&On-siteQPrivate 3. Indoor Floor Drains YES NO ��/ O Holding tank: MDC O Catch basin/Dry well i:z_(r vr/ O On-site system 4. Outdoor Surface drains:YES NO -ORDERS: Q Holding tank:MDC O Catch basin/Dry well O On-site system - 5. Waste Transporter DestinationName of Hauler 1 YES INO . 2. Person (s) Interviewed Inspector Date F ARNSTABLE LOCATION SEWAGE # VILLAGE tZLVAI� - ASSESSO 'S MAP & LOT 2-g Y. 0 -TA4106C7�X S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type /J (size) NO.OF BEDROOMS BUILDER O OWNE PERMTTDATE: COMPAILED I�� Ulm Separation Distance,Between the: PECTI �Y 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 /� r ., / h � _ � � �� _ � i = v . � TOWN OF BA(�R/N/STTA/BLE LOCATION SEWAGE # VILLAGE Rr ASSESSO 'S MAP &�L/OT NSPLZ_7MRS1 NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �b,,��J,/ 61) (size) /000 NO.OF BEDROOOOMS�:� BUILDER O OH WNER PERMPTDATE: gn IAI er?ATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 P . . i LOCATION SEWAGE PERMIT N0; + 13 x `JILLAGE/ A & B CESSPOOL SERVICE 128 BISHOPS TERRACE, HYANNIS, MA 02601 BUILDER OR OWNER fro��►�l �Ot1 r�C���2�5 DATE PERMIT ISSUED ,d ? q DATE COMPLIANCE ISSUED as,�� t �� '`�6 O �� � � � � /� � �� ai) 1 � , l '� t • i _ _� No...�3---- Q6 FEs..... ...10.00..... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .................. own...............OF.........Barris table -------------------------------------------- ------------------------- , ppliration for Disposal Works Tomitrurttnat Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (x ) an Individual Sewage Disposal System at: Hyannis, MA 02601 .---•--••-•••• -•----------------••------........-------------•-•--...----•------•-••-•-•-•••----..........-•--•- Locatio Doroth BOUT eO1Sn-Address 937A Route 132, Hyannis; MA 02601 ...... '- • ... ...... ............................................... --• -•---••-------------.-.------•--•---- a A & B Cess-pool Service, 128 Bishops Terra ce,dd yannis , MA 02601 ----•----•---------------------------------•-------------.-.-.-.------.---- Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms...................•........................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building No. of persons......................4... Showers — Cafeteria Q' Other fixtures ............................... d .. ------•-------------••---------..... W Design Flow............................................gallons per person per day. Total daily flow.._............................._...........gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No---_--------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by........................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water..................... fi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P+ -------------------------•--..............----...........-•--------.............------------.------------ -------------------- •-------- ----------. --- 0 Description of SoiBaiA..............................................................................•••--•-••--••••-•-•--••--•-•-•-•-•-•••••••••--••--•---••-•-----••---•••-......... x V W x ••-..................................................... ---_.... •----•-----------••••--••••--••••----•--•-----•---•------.....--•••-......•-•-----•-•• .............................................. U Nature of Repairs or Alterations—Answer when applicableinstallat ion of a 1,000 gall on, pre-cast, .........stone..pasrked..le.&ch..pi1._(overflow)t.....••••••-•••••...-•-•---•---••-••••-•••••••••••••••-•--•-----•-•-••••••••••••......•••••...........•..----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITA1L 5 of the State Sanitar Code—The undersigned further agrees not place the system in operation until a Certificate of Compliance s be i ued by the ar o Signe . ...,-....• •............... ... 9/27/83 Application Approved BY__.. ..._,/ 9/27. ------------------ Date Application Disapproved for the following re ons:................................................................................................................ -•---------------------------------------------------------------•--------•-•-----------•--••------------••----•------•••--•-•--•-••------••••-••••-------••••---•-••---•------------------•------------- Date Permit No.........83-........................................ Issued_........9/27..83_............................. Date No..--Q3-....i6�58 Fu$.....$... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................T own........................0 F.........Barns-table - - ----------------------------------------------- Appliratiou for Uhipoml Workii Tooitrortiou Vatnit Application is hereby made for a Permit to Construct ( ) or Repair (x ) an Individual Sewage Disposal System at: 937ARoute 132 , H ............................................ ....-•---•-••-----•-•-•-•----------••-----......_......__......_...•-•--•------------...........-- Dorothy Bourge19 Address 937A Route 132, Hyannik; PEA 026o1 ......................--.......................................................................... ..........-•--•-••••-•------•---......--•----••-•.........-•-•---•----------------.............--- a A & B Cesspool Service, 128 Bishops Terrace;dW%nnis , P?A 02601 Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type of Building No. of persons.......................4__- Showers — Cafeteria QI Other fixtures ------------------------•------•---------•----- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid*capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length..................... Total leaching area--------------------sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet......_............. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 1.4 Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water_-_-_-_______-_-__---._. G14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4r' --------•--------------•----•---•----------------•-•-------•---••---.........----•--•-•--•--•-•............................................................. O Description of SoiS4�..................... x U W VNature of Repairs or Alterations—Answer when applicableinstella,tion of- a 1,000_ gallon, pre-cast, stone packed leach__pit___(overflow) ._.__--_ ---------------------------------•-•-------•-------------------------•....----........_.._.._...•--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLL 5 of the State Sanitary_Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliances been issued by the board.of he_aal .". - 9/27/83 Application Approved BY.....:....... -• ---= . /81 / 9/27 •--•-•------•-------------------------- Date \ Application Disapproved for the following re ons:...-----•..................•-------------••---•--•-•--•-•-••--•-•------•-•--•--•----------------------•-------•. ---------------------------------------------------------------------------------------------------------•-----------------------•-----------------------------------------------------------------•---- ;l Date Permit No.........$3 ........................................ Issued-........9/27/83 Date \\ THE COMMONWEALTH OF MASSACHUSETTS ' BOARD OF HEALTH ...................Town...........0F............Bamstable .................................................................. (Irdifiratr of .f1�o �rli orr THIS IS TO CEgT��Y That th Ind idual S a e Dis o l S s m c str �L f or Re aired I. A .. .. Cesspool Service, 1�L.i Bishops e.96ceP �ya�n s, `�bvT ) P by ....-•-•------ .. --•----•-- ---•-•.-----•. ----- •. 937A Route 132, Hyannis, MA 02601 I°Ntothy Bourgeois at....................................................-................................................................................................................................................. has been installed in accordance with the provisions of TI93 5 The_ State Sanitary Cog? cribed in the application for Disposal Works Construction Permit No________________ —r- ---__._--__ dat THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU A GUARANTEE THAT THE SYSTEM WILL FU CTION SATISFACTORY. 9/127/83 DATE................................................................................ Inspector.......... ---•--••------•---------------..........._.........--•---.•-•-- THE COMMONWEALTH OF MAS AC USETTS BOARD OF HEALTH T own Barnstable 83_ 85 OF...... ................................... $ 10.00 No......................e FEE........................ Biginsal ork� C�o�a r ion rruti# A & B Cesspool Service Permission is hereby granted.............................................................................................................................................. to Construct or Ref ( Hy an f - iv Aual��0c Disp al Sty tyerrB g at No........ �oute 33 1 I oro Bourgeois Street as shown on the application for Disposal Works Construction it No 3 Dated_______________9 27/83 9/27/83 ------***......... Board of Health DATE ------------• FORM 1255 Hoees a WARREN. INC., PUBLISHERS t No...... .hle... - v FER..'��...--....... rE COMMONWEALTH OF MASSACHUSETTS --- B®AR® OF HEALTH Town-- ..----. ........... Appliratiou for Utipatial Mirkii Cnnnilrurtiun thrutit Application is hereby made for a Permit to Construct ( X) or Repair ( ) an Individual Sewage Disposal S stem at /�J Enter rise Road Hyannis Lot 12 .... prise ..................................... ................................................. Location-Address or Lot No. T.t T_�s.all��? •---•-------•.. ---� 7eiZ tl�?3,1:.f ........O er j Address Install r Address 23 ,962 Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building 0�ftc.e......... No. of persons......:..................... Showers — Cafeteria (no) Pa-� YP g ---- P �) ( Q' Other fixtures _________________________________ W Design Flow..75.Qal_,,J1QQQ,9_-f..gallons per person per day. Total daily flow---_-_,3QQ............................gallons. WSeptic Tank—Liquid capacity2QOQ-gallons Length ...... Diameter................ Depth.5.1.$1 x Disposal Trench—No..................... Width--_--------------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-------............. Diameter.__.10...._.._. Depth below inlet.._....6.......... Total leaching area......53J. ......sq. ft. Z Other Distribution box (X ) Dosing tank ( ) Percolation Test Results Performed bye'r_ap-e--_-God..3.urmey....CASLsult.antsDate........11/3.Q/7.g.......... Test Pit No. 1-------2_......minutes per inch Depth of Test Pit-___---1 r____- Depth to ground water---riOae---.------ Test Pit No. 2................minutes per inch Depth of Test Pit__.-_-._...._____-_ Depth to ground water........................ Description of Soil.•Q-4.•_3wQ9C�1Qr'litl....Q-3-m ....5---subso-i-L,-1-5-.7.5_._Sand&�r x layers.---•7...5,l3_.0..med-....c.oarse---&a-nd-.------------------------ -------------------------------------- o� cy� U --"REN SWIL'K"" m W -•------------------------------------------------------------------------------------------------------------------------------------------------------- ---•----------• -$•------•--- -•------- VNature of Rep •rs o Alte ions—A r when applicable.------------ ------------ _ ._._CHAP_MAN_.1S /� ���`�...... J L` ..... ....... No_27654 O Agreement: sj7 ��FF c/sTE����� The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in & the provisions of TT T�. ? p 5 of the State Sanitary Code—The undersigned further agrees not to place the sy in operation until a Certificate of Compliance has been issued by the board of health. Sig ,d Z ---- --- ------•--------------------------•------------------ •-------._..-... ------- ��� �G % ...' ate Application Approved BY r� 1� � � �K � �� Date Application Disapproved for the following reasons---------------•-•-••----•-----------------...---....------•---•------------------------•--•-•--••••--•-•---•--- ...........................................•------•-------•-•••••-••-••--------------.......••-••----------••-•--------•--•-•--•--------------•-•---------------•----•--•-----..........-•---••------- Date PermitNo......................................................... Issued---------_------------------------------------------- Dace--. No.....7.7vl... f F>s ...... THE COMMONWEALTH.,OF MASSACHUSETTS - BOARD OF HEALTH y Town.. .. --..........OF..........Barn table---------------------------------------------- y.. Appliratinn for DiSpilo al Works Towitrurtion thrmit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: .......Enterpr,se..Rma... �...Hyarz .LQt_. ..1 ..... .......... •--......---•--•-- - ocat' Add --•--------------•--__----•_--------•----.---Lot No. Address Installer Address22 3 i 9PQ 4 � d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a pa Other—Type of Building ..g.g1108......... No. of persons............................ Showers 05) — Cafeteria (no) aOther fixtures --------------------•----------- ------- ------------"'--------------------------------------..................................... W Design Flow..75. d ; Gaa1._._/�.QCQ-S..f..gallons per person per day. Total daily flow.......3C4............................gallons. 11 WSeptic Tank—Liquid capacity2QQQ.galions Length1.'11!'IM th.62 t.6."___. Diameter................ Depth_5.r Att _ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.....2------------- Diameter----ZQ......... Depth below inlet......6.......... Total leaching area....5.3.4------sq. ft. z Other Distribution box 9 ) Dosing tank ( ) a Percolation Test Results Performed byGape---Cod.. ur.VQjt...Consul.tantig:)ate.......11./3.01.7.9....... : a Test Pit No. I.......2.......minutes per inch Depth of Test Pit-------13...... Depth to ground water...n011e.......... Test Pit No. 2................minutes per inch Depth of Test Pit--...'-:-.._........ Depth to ground*water-----_----- -_ O ....... ••... 'F�l_Df A9gS ,Description of Soil.Q,�Q nQ-.-3.wood1 oath;_.-Q_.1-n 5_.-�Sll}� i"1 .1.¢---1Y-�5-�,5._ R IS $SAS` ______________ sq�, x r O y c.� ------ � �--�-.5--13.Q::mer�-�---Cc��rse--sand.---------------------------------- ------------------------------- �.... N W ---------------------------= ------- ----- B- �, ---------------------------------------------------------------------------- - c� 1d6A2785 00 PMAN V Nature of Rep irs Alte tions—A > when applicable.._______________ ---_-__--__-_._- „ f • �'- ' G /`- •---- ----- --•--••-- A�'p�i` /STEM Agreement: ' _ Z�r/7,9 FFss/ONAL EN�'\� The undersigned -agrees to install the aforedescribed Individual Sewage Disposal System in actor the provisions of TITLE, y g g p y 5 of the State Sanitary Code—The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has been issued by the board of health. Sig ,d --- --------------•---------- � ate Application Approved By.... �.- i.. ---- --- .............-... .w •-- Date Application Disapproved for the following reasons----------------=V.___.........__......................,.......__________.__.._._-_______. .............. ---------------------------------------------------•-------------•------••------------- Date Permit No el.` Issued - Date _ i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH v . i4 L? ' 1.....O F....' ... �........ l 1�4 Tntifirat d Tnntplianrr IS IS TO C RTI ' ` That the Individual Sewage Disposal System constructed ('" ) or Repaired ( ) by •-----•-•----- -- - ---------•------------ ----4C. e --.. .... -•------- w.r' �6 I-staller /'�� � at..... . -:_...l:L.- `'" ! _ ------------- has been installed in accordan e with the provisions of j of The State Sanitaras described in the application for Disposal Works Construction Permit N .:: ___._-77-_ ------------- dated---l-024►_4-_!t_7_5 ______________ THE IS OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT TIME SYSTEM WILL FUNCT1 N SATISFACTORY. DATE - ... ------•--•--------•....... Inspector--- l•y-pia yy . •-----••-•--•-------•----- THE COMMONWEALTH OF MASSACHUSETTS V BOARD O . HEALT No. FEE..................... Mops rkg y n y < inn Vrrmii s' Permission hereby grant d . -• ----- --- •----•• . ............... to Constr ct ( ) or air ) n vldual S age DI o Syst , Street as shown on the application for isposal Works Construction Eatili No. Dated...../;?—:'.'.G�............ �._.__. t i . b ............... H k4. DATE.... ------ oar of ealth FORM 1255 HOBBS & WARREN, INC., PUBLISHERS TOWN OF BARNS ABLE LC )N L6Aq &jg SEWAGE # V.1r LAGE ASSESSOR'S MAP & LOT2G y INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) — e ( (size) �WU NO.OF BEDROOMS C-ay) CJ BUILDER OR OWNER 1 , PERMITDATE: COMPLIANCE D 4.-_ Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 . _ ul i! c C4 n • � —_.�t'� .t,Asv"nx,rYh r, ... .,.v[y_v-:•_T�C��1La.� ' S 2�vt.s-7NE .O•M • ''�L 7 a- 4' DIST C. L �� , BOX J • i I� '2• YEN l • i ,� I �00 l __ i . o, 1000— GAL. I , GAL _-- - — •-( PRECAST OR f SEPTIC I 6 � ••. BLOCK TANK , . SEEPAGE PITS c • o V I1, •J n � o i,' r• ----- 20' MINIMUM 1, � FOUNDATION I I I % WASHED STONE I 1 ELEVATION SKETCH i0 SCAI-E I = 4 "r_. ,,,r•- -...m _ ,. __.-. .,,_•_ _._.. f ....�-_'' ..-• �,,,'' /',,.fin ./ ' ''� './ C�-' + rn If .� r Z- ey, ' 011r, r $l1/G A%Ny�s 2 ikz It 1 �/T R'J►..' `rip- I , 1 �. 1'.) ✓.F.. ...'.l i w J 1r ,..... ��i-/��� ..i-.�Nh� i 3c�ca �i r• G• % 0, # Zj rfi(4X X .�_�A c_ [�,r r FZ040 moo.. 7`/-// S,yr E,-7 i S117F'Yyt7CG.� ;'�� S,F Y Z.S• ��rrh"L'�S•F = 4�-7t? (jrP.lJ. � (! � ;'00 �- b ,BoTyc�/J? i �.`F, x /rD r�+,ry/S.F• �9 r"�i. Q G ,r 2- ^ �+ 'r0'Tf� 4 'F /Q r_ ! wQ, ."371 '�� in4a-v 11/t�"�`,�°. h?vi57/Gf9Qi..�• io '7N�.: �=r'" C� `•.1� ` F I ` SOIL LOG ' JTi-. - - ' STt 1r�`. .,�IT 'Ell eAvA L ELEVATION SCHEDULE � ` PROPOSED SITE PLAN , 1 — • `� I NV AT F 0UNDAT JN jp q SEWAGE SYSTEM DESIGN i 1lV 2 I NV INTO SEPT IC TANK - =' w N 67,4- 3 1 NV O.,T OF SEPTIC TANK = 4 INV '.T(' DISTRIBUTION BOX = a~ ? a - � V SCALE I"= Z'O* S INV OUT OF DISTRIBUTION BOX PERO. RATE � _ !�_G b INV INTO SEEPAGE PIT - CAPE COD SURVEY CONSULTANTS TEST BY : ROUTE 132 j TOWN INSPECTOR F'��•'•- /yh�.�.N - _ 7 BOTTOM OF PI' 4U NYANN15, MASS ! BACKHOE,OPERATOR — T[�iI hf1 .�+:.7Q • o v t r r [+o+ [ •v[r co�[u�r•Mr[, �c, C iESf MADE ON &IJAZI 7T 4. • 60TTOM OF STONE LAYER