HomeMy WebLinkAbout0045 FALMOUTH ROAD/RTE 28 - Health 45 Falmouth Road
Cape Tire
311 -053 Hyannis
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No. 60® . -1 v Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
�pphcation for Mi.5po!5a1 ,p!9tem Com6tructiou Permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandonk ❑ Complete System ❑Individual Components
Location Address or Lot No. �S N?Oz✓-t' , Owner's Name,Address,and Tel.No
�
Assessor's Map/Parcel _7?l ��
Installer's Name,AAA Ad . 0 Designer's Name,Address and Tel.No. c r`=•
350 Main.Street o
a �W. Yarmdut�i: MA 02673 -a S4
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garba Linder (�)
Other Type of Building No.of Persons Showe ) Cafeteria( '?)
Other Fixtures
Design Flow(min.required) gpd Design flow providedd
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 ecL t) ow-kl
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 E vironmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Boaid.of Hea
Signed t t 4 A-/ Date
Application Approved by c Date it, - ;- -0 r0
Application Disapproved by: Date
for the following reasons
Permit No. 2-00 `4 S Date Issued f 0 77 a 6
No. 2 - -t 5,b 1 Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered incomputer: ,
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,-MASSACHUSETTS -.Yes
Y
Application for Migpogar Opgtem' Congtruction Permit
'-Application for a Permit to Construct O Repair O Upgrade O Abandonx ❑ Complete System ❑Individual Components
Location Address or Lot No.1/S �f� I d y t� I I Owner's Name,Address,and Tel No
1.Assessor's Map/Parcel ( D 7?r/
Installera Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No'of,Bedrooms Lot Size sq.ft. Garbage`-Grinder (,
1
Other Type of Building No.of Persons Showeis( ) Cafeferia( )
Other Fixtures
r^ Pesgn Flow(min.required) gpd Design flow provided gPa
r = Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
y r
Nature of Repairs or Alterations(Answer when applicable) G I7/} 2 c
r - ,
Date last,inspected: t
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 of Hea h. ;; / L
Signed 1 Date I
Application Approved by ` Date
Application Disapproved by: Date
for the following reasons
Permit No. &0 fo Lf S Date Issued to - db
-------------
-————————————————————————————————— "— ————
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS 1
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( )
Abandoned( )by efzq�(U
at L/ �A/.,1 1 U✓-�A "' � // , has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. 9-0 o6- L1 S16 dated
Installer /-r Designer
#bedrooms Approved design flow gpd
The issuance of this permit hall of be construed as a guarantee that the system wall fu t o _as esigned.
Date ���lp � Inspector
---------------------------------------------
No. �L,5,0 6- 1�f 56 Fee C) J ^
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS
1=i5pogaf *pgtem Congtruction Permit
Permission is hereby granted to Construct ( ) Repair ( r pgrade ( Abandon
System located at �/-�� �t 1 leeJ VV.
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 errrit.
Date 10 �� `�� Approved by
v
r ,
Date: a2 /3 /moo
TOWN OF BARNSTABLE
TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY
NAME OF BUSINESS:
BUSINESS LOCATION: INVENTORY
MAILING ADDRESS: /570- 610X z5/i� 16.4AJAI/S TOTAL AMOUNT:
TELEPHONE NUMBER:
CONTACT PERSON:
EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE?
EP 1/2 NJl ,c1 Tz'-
TYPE OFBUSINESS: A�(r� � k /� �,4> /.+,vcc
INFORMATION/RECOMMENDATIONS: 5P6VP flf:�f IS AVAIL-A15C.._ 'F62- Fire District:
5FI 1S rI" Cx1-IN60e.5;r+Et5 uPTD Dk`iE Lye Vl4_5t! siA-nojtr /s /�yA-7VA83
,
l2tNc770A/A`L. STDRA-GG i6/666eS /5 e4 LoAjcn-&TE-
WAST o/L 77fAlk ours/��/si� eem7w-.W.,rwr AAIb uA/.bGw sNt9_,77_-W-
Q1'_,9 G/GE.i1SE JS Pik/0 A- P657W..
Waste Last shipment of hazardous wa te, "�a
Name of Hauler: -4 Destination: SSG AJS7a J
Waste Product: M,5r-r) 1L_ 1)x_4wE-D OIL Licensed? Yes No
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use,
storage and disposal of 111 gallons or more a month requires a license from the Public Health Division.
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health and the Public Health Division have determined that the following products exhibit toxic
or hazardous characteristics and must be registered regardless of volume.
Observed/Maximum Observed/Maximum
Antifreeze (for gasoline or coolant systems) _ Misc. Corrosive
NEW USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road Salts (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
3 Motor Oils Pesticides
/38" NEW P,6'USED (insecticides, herbicides, rodenticides)
Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers)
Diesel Fuel, kerosene, #2 heating oil NEW USED
Misc. petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil NEW USED
Degreasers for engines and metal Printing ink
Degreasers for driveways & garages Wood preservatives (creosote)
Caulk/Grout //co/2e-s Swimming pool chlorine
-� Battery acid (electrolyte)/Batteries o/,vim 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,
rspmy CAA15 or E.i-E-5WE /
-3 Misc. FlammablesILuGa+C*�rS• hydrochloric acid, other acids)
Floor&furniture strippers Other products not listed which you feel
Metal polishes �Oki may be toxic or hazardous (please list):
Laundry soil & stain remover '3 (f Z; , l
(including bleach) �v� v� -ndus'�posr � c LA-nl � �P"uE
Spot removers &cleaning fluid Pouc-, f I Rc :1,-(4 ftvv s TDPte c-0)jVV-r, s)Ir &-rl/ tc 1_65
(dry cleaners) mi- HoT L i 0 i5 g7r - 30 - -
L_XTIN61,WSura� /a-IJD SPIt,L GmS -7RyL M/ac7'EYL//kc..C�LAfQ�"L
Other cleaning solvents WASTE OIL,T*kj C A#jc t7 p_4-/►J 3u"FT5 h H-A2,+r?_nvvs W A-Srr/1
1 Bug and tar removers WA-STF 411,` LA66L fE-x aF L
Windshield wash vu4S1� ®D'3rX-/N t/A FU2 d/RUY f?A-G t3h(j +AJb X&xP e OS4D.
jraL Love-uP sNsa'�-r--f]ov u//`L j3
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS F-ler-OaM tV /A/ V—b i c0�" -
COPY ' /r'°�l '4 Date: 5�1l-0�/
TOXIC AND HAZARDOUS MATERIALS ON-SITE INVE O Y
NAMEOFBUSINESS: -C't
6-D
i
BUSINESS LOCATION: `� �• / f S INV 0R1��
.MAILING ADDRESS: TOTAL AMOUNT:
TELEPHONE NUMBER: - -7 7 -
CONTACT PERSON: ikA 4E•
EMERGENCY CONTACT TELEPHONE NUMBER:
TYPEOFBUSINESS: Auk '�_ Z.✓�P�® Fti�e 0
(57
OTHER INFORMATION: r
s
Waste Transportation:
Name of Hauler: _ L=`r� Chi( . Destination-
Waste Product: uu� t-� c') ( Licensed? es 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):
Q
f✓ Antifreeze(for gasoline or coolant systems) Drain cleaners CD
7:
ANEW USED Cesspool cleans
z�astAu%tomatic transmission fluid Disinfectants alko x
Engine and radiator flushes Road Salt (Haliie _
Hydraulic fluid (including brake fluid) Refrigerants w
Motor oils Pesticides P rn
,- NEW USED (insecticides, he icides, rodenticides)
Gasoline, Jet uel Photochemicals (Fixers)
Diesq!fuel, kerosene, #2 heating oil NEW USED
—L. Z_5:� �ther petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil • NEW USED
Degreasers for engines and metal Printing ink
Degreasers for driveways & garages Wood preservatives (creosote)
20 Battery acid•(electrolyte),1 •es Swimming pool chlorine
Rustproofers Lye or caustic soda
Car wash detergents Jewelry cleaners
Car waxes and polishes Leather dyes
Asphalt& roofing tar Fertilizers
Pai^ts, varnishes, stains, dyes PCB's
Lacquer thinners Other chlorinated hydrocarbons,
`®a�NEW USED
--- - (inc. carbon tetrachloride)-
Paint.&varnish.removers, deglossers An other products with "
Paint brush cleaners Y P 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.: We 2 -eAot lWce,jq, 4-1 ovex
(dry cleaners) e?U e, a42-t � �z t
Other cleaning solvents
Bug and tar removers
Flo
(;I J
pR50e 1 Date:
TOWN OF BARNSTABLE I �� .
TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY
NAME OF BUSINESS:
BUSINESS LOCATION: INVENTORY
MAILING ADDRESS: TOTAL AMOUNT:
TELEPHONE NUMBER: 6 9771 _ 1111
CONTACT PERSON:
EMERGENCY CONTACT TELEPHONE NUMBER MSDS ON SITE?
TYPE OF BUSINESS: ��I- L�il'� ��L�-QiLVAJ
INFORMATION/RECOMMENDATIONS: Fire.District:
- , r AA 8' ki
Al 14 ha awAtj
sl&�/ 6_kidoorA) �&&ja no &12ok-L kio U�W gal"141- pp PA 7
portation: Last shipment of hazardous -A t Wa�T
Name of Hauler- Destination:
Waste Product: _Licensed? er No
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use,
storage and disposal of 111 gallons or more a month requires a license from the Public Health Division.
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health and the Public Health Division have determined that the following products exhibit toxic
or hazardous characteristics and must be registered regardless of volume.
Observed/Maximum Observed/Maximum
Antifreeze (for gasoline or coolant systems) Misc. Corrosive
�A NEW USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road Salts (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor Oils Pesticides
b04NEW MCUSED (insecticides, herbicides, rodenticides)
Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers)
Diesel Fuel, kerosene, #2 heating oil NEW USED
Misc. petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil NEW USED
Degreasers for engines and metal Printing ink
Degreasers for driveways &garages Wood preservatives (creosote)
Caulk/Grout Swimming pool chlorine
Battery acid (electrolyte)/Batteries Lye or caustic soda
Rustproofers Misc. Combustible
Car wash detergents Leather dyes
Car waxes and polishes Fertilizers
Asphalt & roofing tar PCB's
Paints, varnishes, stains, dyes Other chlorinated hydrocarbons,
Lacquer thinners (inc. carbon tetrachloride)
NEW USED Any other products with "poison" labels
Paint &varnish removers, deglossers (including chloroform, formaldehyde,
Misc. Flammables hydrochloric acid, other acids)
Floor &furniture strippers Other products not listed which you feel
Metal polishes may be toxic or hazardous (please list):
Laundry soil & stain removers &(Yua
�QCJ
(including bleach) _
Spot removers &cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
Windshield wash
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
Town of Barnstable-Health Department Page 1
HAZARDOUS MATERIALS INVENTORY SITE VISITS
_.... _
DBA: Cape Tire Service Inc. Fax 508 775 5563
Corp Name: Mailing Address .,,
Location: 145 Falmouth Road,Hyannis Street: P.O.Box 248
.... _...
mappar: ,311-053-000-000 City: Hyannis
Contact: :Robert E.Wallace,Jr.(Bob) State: MA
Telephone: 508-771-1111 Zip: 02601
Emergency: :508-775-1312 Person Interviewed:
Business Contact Letter Date: 5/31/2005
Category: VehicleMaintenance Inventory Site Visit Date: 8/4/2005
............
Type: :Auto Repair Follow Up/Inspection.Date:
......._
public water ❑ indoor floor drains ❑ outdoor surface drains license required
❑ private water ❑ indoor holding tank mdc ❑ outdoor holding tank mdc currently licensed
❑ town sewage ❑ indoor catch basin/drywell ❑ outdoor catch basin/drywell expir -
❑ on-site sewage ❑ indoor on-site syste ❑ outdoor onsite system date: 6/30/2006
Remarks: 711/97 3 electric lifts,1 hydraulic lifts,spills-spedi dry& compliance:
rags,Laundry-Acme,Rags in can with cover,MSDS sheets on Satisfactory
site. 5/11/04 MSDS and manifests on site.
Waste oil tank in proper sheltered,secondary containment. Waste oil
pumped into outside waste oil storage tank. Staff has"Right to Know
Training"each year. Shop rags stored properly. Laundered by Unifirst
along with uniforms and fender covers. Knowledgeable and
compliant. 6/10/04 Sent license letter telling
them their license renewal is overdue for Hazmat. Sent letter on
6/11/04. They have purchased a license last year,so this letter is a
reminder. If no compliance in 30 days,send a WARNING. 8/4/2005 alp
ORDER: need 110%containment,currently at 50%containment. Sent
over calculations to correct via fax on 8/10/2005. Need to label
hazardous waste oil drum located outdoors.Need to remove all unused
55 gallon drums that are located outdoors.,Keep all lids and containers
closed and capped.
•s
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
v ' �d2SEnt10n xrOPP
�� Un10 measure f'motor oil ( 364 gallons
.___._.................._............................_.....____............,_.........
___.
Windshield Wash € 114 gallons
Batteries 2 gallons ✓
aste oil 275 gallons
..................................__.._._.___.........._.
Misc.Flammable 7,gallons✓
antifreeze(for gasoline or coolant systems) 114 gallons_ _
automatic transmission fluid _ E 57 gallons
misc.petroleum products:grease,lubricants 64 gallons
__._ ____._ ___._._..�.__.........�.._...� ._...........__....� _-_.._.. ._. _._._...__._.._.___..
laun_dry soil&stain removers,(including beach) _5 gallons
Waste solvent 60 gallonsi/
_.. _..__._..............m...........................__. __._.�__,.__._._
oil filters 110 gallons
._................
Waste Transporter: Cyn Oil Fire District: Hyannis
._.....
Last HW Shipment Date: 7/25/2005 Waste Hauler Licensed: Yes
I
Town of Barnstable
°FZ►+E roy� Regulatory Services
Thomas F. Geiler,Directork'e
S
'" '' "
M Public Health Division
v� 1639.
r
prFD 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
NAME OF ESTABLISHMENT
ADDRESS OF ESTABLISHMENT 145 FA I tr1oi 0\�l
TELEPHONE NUMBER
SOLE OWNER:-fYES NO
Of CaA7AO�e no7- rT-b'A; Id,ng
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 ADD SS OF:
PRESIDEN E
TREAS
CLERK
5
SIGNArTURE OF AP ICCANT
RESTRICTIONS: HOME ADDRESS NG✓ rl�G�l tS
HOME TELEPHONE# �Q —` —O Y
Haz.doc/wp/q
Length x width x depth x 7.48 =#gallons
Actual Measurements:
8' x 4' x .66' x 7.48 = 157.97 gallons
110% of 250 gallons=275 gallons
Recommendation: Add height of 6" for a total depth of 14"to contain 279.25 gallons at
110%.
Date: �r-(I-o V
TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY
NAMEOFBUSINESS:
BUSINESS LOCATION: C-f
.MAILING ADDRESS: "I INVENTORY• TOTAL AMOUNT:
TELEPHONE NUMBER: — 7 / r
CONTACTPERSON: P.r_k t=• .) �-f ZZ
EMERGENCY CONTACT TELEPHONE NUMBER:
TYPEOFBUSINESS: A - /,��,® ,./yy ;,, ,p�y��
OTHER INFORMATION: S
Waste Transportation:
Name of Hauler: Gc,i 1;j . Destination-
Waste Product: ��_ 7;t Licensed? es 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):
Ll Antifreeze(for gasoline or coolant systems) Drain cleaners
,ANEW USED Cesspool cleaners
�_aAAutomatic transmission fluid Disinfectants
Engine and radiator flushes Road Salt (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
cs Motor oils / Pesticides
5—a�O NEW�aatUSED (insecticides, herbicides, rodenticides)
Gasoline, Jet Fuel Photochemicals (Fixers)
.Diesel.fuel, kerosene, #2 heating oil NEW USED
-7,,�ther petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil NEW USED
Degreasers for engines and metal Printing ink
Degreasers for driveways & garages Wood preservatives (creosote)
20 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
Gad Paints, varnishes, stains, dyes PCB's
Lacquer thinners Other chlorinated hydrocarbons,
: A_atNNEW USED
- (inc. carbon tetrachloride)-
Paint &varnish removers, deglossers An other products with "
Paint brush cleaners Y p 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.: c-1 a,q�t
(dry cleaners) ,
� Other cleaning solvents �-
Bug and tar removers
LOCATION SEWAG PERMIT NO.
7�
VILLAGE
I N S T A LLER'S NAME i ADDRESS
B U it D E R OR OWNER
GATE PERMIT ISSUED
DAT E COMPLIANCE ISSUED
/1c - 71 --
eck
Y=.. Ar,
TOWN OF BARNSTABLE
a
-LOCATION �,-�e o�� �t a-7 ,SEWAGE #
VILLAGE nh ASSESSOR'S MAP .& LOT��
INSTALLER'S NAME & PHONE NO. �t� �i¢hGy %��f_-- O23'oo
SEPTIC TANK CAPACITY
- g
`LEACHING FACILITY:(type) 000 A • 02 � (Size) j�,eW
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER'
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: .Yes No �/
a
CJ
'V
v�
O
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1. Marine,Gas Stations,Repair
sat�sfacto 2.Printers
BOARD OF HEALTH O ry 3.Auto Body Shops
s n O unsatisfactory- 4.Manufacturers
COMPANY �E 7 1 PC (see"Orders") 5.Retail Stores
6.Fuel Suppliers
_
ADDRESS �' /tiro dot (2-0 Glass: 1 7.Miscellaneous
QUANTITIES AND STORAGE (IN= indoors; OUT=outdoors)
MAJOR MATERIALSUnderground
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels:
Gasoline,Jet Fuel (A)
Diesel, Kerosene, #2 (B)
Heavy Oils:
waste motor oil (C)
new motor oil (C)
transmission/hydraulic
Synthetic Organics:
degreasers
Miscellaneous:
DISPOSALIRECI AMATION REJMnARKS: L
1. S ry Sewage 2.�W�r Supply r 1"`�Q </1ck ^- r
Sewer,,,,� ®Public s _
On-site tr OPrivate
3. Indoor Floor Drains YES NO
O Holding tank: MDC
O Catch basin/Dry well ►/� �� >Z �1' '
O On-site system En n„ -
4. Outdoor Surface drains:YES NO ORDERS:
O Holding tank:MDC 6c
O Catch basin/Dry well
O On-site system
5.Waste Transporter
11 Name of"auler Des Waste Product Licensed?'
1. IV ,ram YES No
2.
Person (s) Interviewed Inspector Date
r�
N � T/...... Fmc.......... ...........
` THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
-------.-._--r !-....-.--...OF...-..-AA4-1l!!.'-•---......---------.......................................
Appliration, for Uiipoiial Workii Tomitrortion ramit ,
Application is hereby made for a Permit to Construct ( ) or,Repair ( ) an Individual Sewage Disposal
System at:
.. - ` -------- ... ----....
_: ..!1. - 1 ..............._..
}�;ocatiogt-Address or Lot No.
s
Own Address
G•�•F--•- E? :er.........--------- --------.......-- ------------------------------------------
Installer Address
Q Type'gf-Building Size Lot............................Sq. feet
D welling—No. of Bedroom Expansion Attic ( ) Garbage Grinder ( )
Qther Type of Building COA-A--5 . No. of persons............................ Showers ( ,) — Cafeteria ( )
Other fixtures ------------•-• •-•--•••-----•- - --•
W Design Flow.............3 S__.___.__._____._._._____gallons per person per day. Total daily flow.......1.v_u...........................gallons.
1 9 Septic Tank 4 Liquid'capacity/lll3-V-•gallons Length................ Width................ Diameter______________--:Depth................
W
x Disposal Trench—No_____________________ Width.................... Total Length................_... Total leaching area....................sq. ft.
Seepage Pit NO-------I............. Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Other Distribution box (✓- Dosing tank ( )
a; Percolation Test Results Performed by--------------------------------------------------------------•-•---•-•-- Date........................................
Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water........:__.,__________-
Ci, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...............:........
..................... -- - - -
t
O Description of Soil___________________ ..._. `.
x
U -••-•-••-•-----••--••--••-•••••••-•••••-•••-----••--•-•----••--•••••••---•---•-••-._.._..-•••••••••••-•-•••••---•-------•-••--•-•---•----------•-••-•---•--•----
W
VNature of Repairs or Alterations—Answer when applicable------------------------_......................................................................
.............-=-••------•--•----•--••--------------------•------------=-----------._......-•-•--------•----------------------------------------------------------------------------•••............----
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT1. 5 of the State Sanitary Code—*The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been iss�/L�byAlf and health.
Signed.------• -•---...... ��
7-��
-----=---------•- •-------------•------•-----•--
Date
Application Approved By............................................................ -•.......
Date
Application Disapproved for the following reasons:-.
lQ � _ y.___.. _.%_________________________
.._._._.....••_••-•-••--•--•-----------------------------------------------------•-----•••-••-•--•--•-•-----•-••-•-__7•-.--.---------------------------------------------------- ---------•---
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD ff HEALTH
y •
%TF. ertifirate of Tootlrliattre
I I CIFY at the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by...... .. ----------------••-----------•--
- e
Installer "_....._...__
atr' G?2 - - ' r ------------- -- •-------•-------------------------
has been installed in accordance h the provisions of T 5 of The State Sanitary Code as describ d in the
application for Disposal Works Construction Permit No ____��___7l______________ dated__..-�._:�= Z�________.__
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DA ...`..J�.. 7�........ Inspector..............
No 3 71 -- Fizz �.6 �� .....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..................._..................._OF......-.........-.....-......_-......... - ..._.-.-...---------..._-...-----------
Apphration for Uhip saf Works Tnnitrnriion Vantit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
(f.. ......../•. ---- ....................................0.......................
r -� c ion-Addre7§ l. G or Lot No.
......................----••---•----...........7............................._.... ---...----•--•--........._..................----•-
Owner Address
T� 'installer Address
dType of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms________________________________ _Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Buildin _ No. of persons____________________________ Showers — Cafeteria
dOther fixtures -------•••-• -----•-••••------•----•---•---••-----•••••---•-•-•••-----••-----------"-------•--�/
W Design Flow........... __5________________________..gallons per person per day. Total daily flow____.?_2_J__._........................gallons.
WSeptic Tank-� Liquid capacityolt�....gallons Length................ Width---------------- Diameter................ Depth................
x Disposal Trefich—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.....f.-------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box O Dosing tank ( ) -
'-� Percolation Test Results Performed by....................................................-...................... Date........................................
Test Pit" No. 1____.______'___minutes per inch Depth of Test Pit____________________ Depth to ground water-----------------_-____-
(i Test Pit No. 2........._......minutes per inch Depth of Test Pit.................... Depth to ground water........................
Descriptionof Soil .................: ---• •-•---.................._.....................................................
x
W ------------------------------------------------•-------------------------------------------------------------------------------...----•--------------------------•----------•-••-•-••••-•---------•-•--
U Nature of Repairs or Alterations—Answer when applicable------------------------------_................................................................
-------•-••-------------------------•------•----•-•---------------------------------._....._.._.....--•-----...---------------------------------.._--------------------------------------•-•---...•----•
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been�;isssud by thf& (6a/'health.
Signed.......` ............................................... - Date
ApplicationApproved By--••-----------------------------•-••.................................................. ........._..............__ -. ........................................
�� v�.. �•1�--- '1 i.............................................Date
Application Disapproved for the following reasons:-----_....;�__________________/._ -
._.__ . .
•-•------------------•---------------...-----•----------•----...-•---•-----------------•-•-•••-----•••-•---•-••---•-•/--•---•---•------•-••---•-••••-------------------••--••---------•-•-•-••----•-•---
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEALTH
j \ (9rdif iratr of Tuntlifiaurr �-
fI .,ISITO CE T FY That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
��
by.... • ...........�•------- ............--•-•-•••_:� ....••----•-•--..._--•••--• -- - .............. .... ---------------•••-•-•-••---••-
'u
Ut„ � �Installer�r ���'.�'��
at.................Y----...----- ---' !_......__...---- v
has been installed in accordance with the provisions of TTry of. The State Sanitary Ceo e gsco�e`d_in the
application for Disposal Works Construction Permit No.��......____ / dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.......9-.��-.. ................................................. Inspector........................•---•---•••------------•••-•---
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF'IMALTH
G-r--a.-.
No.......................... FEE........................
gisjlnsat ,, ork -_TvOtr , Uan lermii
h
Permission is hereb ranted_ __ '
Y � .. - =.....................................................................................
}� f r-
to Construct (_ ) o'r;Re ir� �`-)/an.Indivitele Se ge Disposal System
atNo.-------ff....-{-------�---.•=.=..-:....------•��•--•-•--•••----. r-'!� -------•------- -- --------------------------•-------•-
y -•-
Street -_ _-._7_________as shown on the application for Disposal Works Construction Permit AI `�G�� ._.._.
rye
............... -----•--•••-----•------ ----•-•------------------• '--•---••----•------
f Board of Health
DATE.................................................................................
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
TOXIC AND HAZARDOUS . ATERIALS REGISTRATION FORM
NAME OF BUSINESS: Mail To:
BUSINESS LOCATION: 'a"
Board of Health
MAILING ADDRESS: Town of Barnstable
P.O. Box 534
TELEPHONE NUMBER- f Hyannis, MA 02601
CONTACT PERSON:
EMERGENCY CONTACT' ELEPHO rNE NU R:
Does your firm store any of the toxic or hazardous materials listed below, either for sale or for
your own use, in quantities totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry
weight? YES NO
This form must be returned to the Board of Health regardless of a yes or no answer. Use the
enclosed envelope for your convenience.
If you answered YES above, please indicate if the materials are stored at a site other than your
mailing address:
ADDRESS:
TELEPHONE:
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health has determined that the following products exhibit toxic or hazardous character-
istics and must be registered regardless of volume. Please estimate the quantity beside the product that
you store:
Quantity/Case Quantity/Case
Antifreeze (for gasoline or coolant systems) Drain cleaners ,
Automatic transmission fluid Toilet cleaners
Engine and radiator flushes Cesspool cleaners
Hydraulic fluid (including brake fluid) Disinfectants
Motor oils/waste oils Road Salt (Halite)
Gasoline, Jet fuel Refrigerants
Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides,
Other petroleum products: grease, lubricants rodenticides)
Degreasers for engines and metal Photochemicals (fixers and developers)
Degreasers for driveways & garages Printing ink
Battery acid (electrolyte) Wood preservatives (creosote)
Rustproofers Swimming pool chlorine
Car wash detergents Lye or caustic soda
Car waxes and polishes Jewelry cleaners
Asphalt & roofing tar Leather dyes
Paints, varnishes, stains, dyes Fertilizers (if stored outdoors)
Paint & lacquer thinners PCB's
Paint & varnish removers, deglossers Other chlorinated hydrocarbons,
Paint brush cleaners (inc. carbon tetrachloride)
Floor & furniture strippers Any other products with "Poison" labels
Metal polishes (including chloroform, formaldehyde,
Laundry soil & stain removers hydrochloric acid, other acids)
(including bleach) Other products not listed which you feel may
Spot removers & cleaning fluids be toxic or hazardous (please list):
(dry cleaners)
Other cleaning solvents
Bug and tar removers
Household cleansers, oven cleaners
White Copy-Health Department/ Canary Copy-Business
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
BOARD OF HEALTH satisfactory 2.Printers
3.Auto Body Shops
unsatisfactory- 4.Manufacturers
COMPANY fZ'�1�� O (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS lass' 7.Miscellaneous
�2IY tAUANTITIES AND STORAGE (IN= indoors;OUT=outdoors)
MAJOR MATER S 1 ,• . , Tanks
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels:
Gasoline,Jet Fuel(A)
Diesel, Kerosene, #2 (B)
Heavy Oils: --
waste motor oil (C)
� A
new motor oil(C)
transmission/hydraulic f/1P
Synthetic Organics:
degreasers
D
Miscellaneous:
DISPOSAURECLAMATION REMARKS:
1. S nitary Sewage 2.Water Supply
Town Sewer ublic C
O On-site 0 rivate
J
3. Indoor Floor Drains YES NOX C
O Holding tank:MDC A-/(
O Catch basin/Dry well u �C C'! Y�L
O On-site system
4. Outdoor Surface drains:YES-NO N/ ORD :
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
5.Waste Transporter
Name of Hauler 1 • Pro i
2. ,
7-1 -592
Person (s nterviewed Inspec or Date
*AZAnooun mATsnwua nsomTnAnom pomw
*
� ooA: Cape Tire Service, Inc. fax:
corp name: Mail Addr
location: '45 Falmouth Road street :P.O. Box 248
mappar: mm Hyannis
contact: state: MA
telephone: zip: ouso
emergency: -1312
'--c�------------'^ o,aonintomiv"vod: |
Business:
inspection date l
omounrv: :Vehicle Maintenance
| | inspection date z
type: | | inspection date 3
nmmiowa� �� imuomfmv,umin 17 outdoor surface drain �7 nvonvumqumu
' private wmo indoor holding tank md outdoor holding tank md r7 currently licensed
to"vnsew"o �� indvv,omohuunin/u�wo| �� o�uuov,o,uo�uaoin/urvwm| vxpi,
__ -- | |
on-sitexo=ao indoor on-site ovote r7 outdoor onnhvvvste date:
notes:
oonm p.1i
Chemicals: 9ty/o > uamu dry mso gals liquid
automatic transmission fluid 16 gallons
hydraulic fluids(including break fluid) 13 gallons
motor oil 210 gallons
other petroleum products : grease, lubricants 30 gallons
degreasers for driveways and garages 10 gallons
printing ink
paint&varnish removers, deglossers 1 gallons
metal polishes
Household cleaners, oven cleaners 4 gallons
description: qty: unit of measure
0'`^ vX� �
waste transporter
waste transporter
����������
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF BUSINESS: CAPE TIRE SERVICE , INC . Mail To: F '
BUSINESS LOCATION: 45 FALMOUTH ROAD ROUTE 28 Board of Health
Town of Barnstable
MAILING ADDRESS: P .O . Box 248 , HYANNIS , MA 02601 P.O. Box 534
TELEPHONE NUMBER: ( 508) 771-1111 Hyannis, MA 02601
CONTACT PERSON: ROBERT E. WALLACE , JR . /MANUEL JASON
EMERGENCY CONTACT TELEPHONE NUMBER: 7 7 5-1312
Does your firm store any of the toxic or hazardous materials listed below, either for sale or for
your own use, i ,
YES X 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
9 g q Y
you store:
Quantity/Case Quantity/Case
j6 one gallonAntifreeze (for gasoline or coolant systems) Drain cleaners
16 U. S . gallaAautomatic transmission fluid Toilet cleaners
Engine and radiator flushes Cesspool cleaners
13 gallon Hydraulic fluid (including brake fluid) Disinfectants
210 gallons Motor oils/waste oils 10_9a11:ons__'Road Salt (Halite)
Gasoline, Jet fuel Refrigerants
55 gallons Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides,
3:0 gallons Other petroleum products: grease, lubricants rodenticides)
Degreasers for engines and metal Photochemicals (fixers and developers)
10 gallons Degreasers for driveways & garages Printing ink
Battery acid (electrolyte) Wood preservatives (creosote)
Rustproofers Swimming pool chlorine
Car wash detergents Lye or caustic soda
5 gallons Car waxes and polishes Jewelry cleaners
Asphalt & roofing tar sAf Leather dyes
15 gallons Paints, varnishes, stains, dyes V�Jp Fertilizers (if stored outdoors)
T
1 gallon Paint & lacquer thinners PCB,s
1 gallon Paint & varnish removers, deglossers 200 lbs .Other chlorinated hydrocarbons, calcium
1 gallon Paint brush cleaners chloride
g (inc. carbon tetrachloride)
5 gallons Floor & furniture strippers Any other products with "Poison" labels
10 gallons Metal polishes (including chloroform, formaldehyde,
Laundry soil & stain removers hydrochloric acid, other acids)
(including bleach) Other products not listed which you feel may
Spot removers & cleaning fluids be toxic or hazardous (please list):
(dry cleaners)
Other cleaning solvents
Bug and tar removers
4 gallons Household cleansers, oven cleaners
White Copy- Health Department/ Canary Copy Co -Business
..
i 3.Auto Body Shops
unsatisfactory 4.Manufacturers
(see"Orders") 5.Retail Stores
6.Fuel Suppliers
♦-
Miscellaneous
i
Case lots Drums Above Tanks Underground Tanks:`'
_®mu_®M_®=ew MENESEEMEMIN
motormmllellu� EMEM
MEMO 14 VA 6w
ONE rofflf RAIMMIM
MENINSIME
1 • 1 1
I A DI 0 V--1.0i i
Iff
off
2. 4
Name of Hauler Destination Waste Product Licensed?
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Statio s,Repair
satisfactory 2.Printers
BOARD OF HEALTH 3.Auto Body Shops
unsatisfactory- 4.Manufacturers
COMPANY 0 (see"Orders") 5.Retail Stores
p 6.Fuel Suppliers
ADDRESS class: � 7.Miscellaneous
QUANTITIES AND STORAGE (IN=indoors;OUT=ours)
MAJOR MAIALS Tanks
t oo/ Underground
jyyy IN OUT IN OUT IN OUT #&gallons Age T t
Fuels:
Heavy Oils:
waste motor oil (C)
new motor oil (C)
transmissio"ydraulic IC,,
Synthetic Organics:
degreasers
ellaneous:
h.
les
p t - 1
DISPOSAL/RECLAMATION REMARKS:
f
nitary Sewage 2.Water Supply .
Town SewerPublic .�
On-site OP4�NO
3. Indoor Floor Drains YES
O Holding tank:MDC
O Catch basin/Dry well
O On-site system 00
4. Outdoor Surface drains:YES NO 6�' ORDERS:
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
5.Waste Transporter fly
Name of Hauler Destination Waste Product •d
tr� (�-vLi � YES NO
2. .4VY :,P
�xoe ;
er n (s nterviewed Inspector Date
CAPE TIRE SERVICE, INC.
45 Falmouth Road
Hyannis,MA 02601
Goo
Independent Dealer
(508)771-1111
(508)771.-1112
49-2752
ROBERT E.WALLACE JR. (Bob) Fax:(508)775-5563
President/Treasurer Email:capetire®ibm.net
i
MON.-FRI.7:00 a.m.to 6:00 p.m.
SAT.7:30 a.m.to 2:00 p.m.
•Tire Sales and Service •Exhaust Service
Brake Service •Wheel Alignment
•Shocks and Struts •Steering and
-.Lube,Oil and Filter a Suspension Service
Custom Wheels __,.;...__:...
' TRUCK TIRE ROAD SERVICE
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Rep
satisfactory 2.Printers
BOARD. OF HEALTH 3.Auto Body Shops
Q unsatisfactory- 4.Manufacturers
COMP (see T (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS BU - Class: 7.Miscellaneous
J,,40-541��,QUANTITIESL AND STORAGE (IN=indoors;OUT=outdoors)
MAJOR MATESove Tanks
Case lots Drums""; Underground
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels:
Gasoline Jet Fuel (A) "s►..
Heavy Oils:
waste motor oil (C)
new motor oil (C)
transmission/hydraulic
Synthetic Organics:
degreasers
00,
Miscellaneous:
oy
DISPOSAUR.ECLAMATION REMARKS:
1. Sanitary Sewage 2.W ter Supply
�Town Sewer OPublic '
On-site OPrivate -
3. Indoor Floor Drains YES NO Y
O Holding tank:MDC
O Catch basin/Dry well f r1
O On-site system �,zii ; /yL�,s�
4. Outdoor Surface drains:YES NO ORDERS:
O Holding tank:MDC -
O Catch basin/Dry well i
O On-site system
5.Waste Transporter
Name of Hauler Destination Waste od
2. �...
r
Person(s) Interviewed In pector Date
MON.-FRI:7:00 a.m.to 6:00 P.m.
SAT.7:30 a.m.to 2:00 p.m.
•Tire Sales and Service •Exhaust Service
•Brake Service •Wheel Alignment
•Shocks and Struts
Steering and
Suspension Service
..:....... I
•Lube;Oil and Filter- .Custom Wheels
TRUCK TIRE ROAD SERVICE
4
CAPE TIRE SERVICE, INC.
45 Falmouth Road
Hyannis, MA 02601
Do
Independent Dealer
(508)771-1111
(508)771-1112
ROBERTE.WALLACE JR. (Bob) Fax1-800-675-2552
President/Treasurer ire@a 775-5563
Email:capetireC�attglobal.net`
y
jf I
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
p satisfactory 2• Printers
BOARD OF HEALTH 3.Auto Body Shops
{�� O unsatisfactory- 4.Manufacturers
COMPANYOa—I.—k R �(O (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS C18SS' 7.Miscellaneous
l S�Y%QUANTITIES AND STORAGE (IN= indoors; OUT=outdoors)
MAJOR MATERIALS Case lots Drunis Above Tanks Underground
i IN OUT IN OUT IN OUT #&gallons Age Test
Fuels:
Gasoline,Jet Fuel (A)
Diesel, Kerosene, #2 (B)
Heavy Oils:
waste motor oil (C)
5�
new motor oil(C)
r
transmission/hydraulic
Synthetic Organics:
degreasers
CLQ, Gu Q") IX
Miscellaneous:
DISPOSALIRECLAMATION REMARKS: ff
1. Sanitary Sewage 2.Water Supply I l _
O Town Sewer Public 0m . , o'(� '
XOn-site OPrivate
3. Indoor Floor Drains YES N0� 1 �b /
O Holding tank:MDC ���� V
O Catch basin/Dry well ULA i2a < i. lk� I A-! ��
O On-site system
4. Outdoor Surface drains:YES NO ERS:
O Holding tank:MDCf—
O Catch basin/Dry well
O On-site system
5.Waste Transporter
Name of Hauler Destination Waste Product
( `` ,
I I1 ` QI NO
2. ;� C'�1
allq
Person(s) Interview Inspector Date
Town of Barnstable
FtHE fn Regulatory Services /E®
Thomas F. Geiler,Director /�
9 A. Public Health Division F! EB 2 1 200Z
•i639
pTED 59 6 Thomas McKean,Director TOWN OF BARNSTABLE
200 Main Street, Hyannis, MA 02601 HEALTH DEPT.
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 C TI S?F()10-0- , aO C-1
ADDRESS OF ESTABLISHMENT 4! al w ne )+4-) 1 zd � +11-1 o 1 �
TELEPHONE NUMBER
SOLE OWNER:_X_YES NO
IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL
PARTNERS:
IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.C�3LI a o��� olCp
STATE OF INCORPORATION Mott 55
FULL NAME AND HOME ADDRESS OF:
PRESIDENT g E- tl aQ l a(v-,, J,`) Ond nq-u �d- �o
TREASURER ' '
CLERK �_c X IkOk C D
N
SIGNAT OF PLIC T
RESTRICTIONS: HOME ADDRESS
HOME TELEPHONE # �
Haz.doc/wp/q
� ///�o�/ ,Date:
TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY
NAMEOFBUSINESS:
BUSINESS LOCATION: S — of• / `s- � !li
INVENTORY
MAILINGADDRESS: TOTAL AMOUNT:
TELEPHONE NUMBER: — — /
CONTACT PERSON: k e7. .) LJ
EMERGENCY CONTACT TELEPHONE NUMBER: FIRE p(5- IC'
TYPEOFBUSINESS: �'�ir� `�¢_ ✓1?�,®��,c�,�i�G�.
OTHER INFORMATION:
t_/ t_-M s e_ M S LDS or)
Waste Transportation:
Name of Hauler: _ L44,.1 �;( . Destination-
Waste Product: Lv
c,�g� p;l Licensed? es 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):
Antifreeze(for gasoline or coolant systems) Drain cleaners
; ANEW USED Cesspool cleaners
2- 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-FueI Photochemicals Fixers
Diesel fuel, kerosene, #2 heating oil NEW USED
-7,2L5:� �ther petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil , NEW USED
Degreasers for engines and metal Printing ink
Degreasers for driveways& garages Wood preservatives (creosote)
2�Battery acid(electrolyte), fo u•, s Swimming pool chlorine
Rustproofers Lye or caustic soda
Car wash detergents Jewelry cleaners
Car wakes and polishes Leather dyes
Asphalt & roofing tar Fertilizers
Paints, varnishes, stains, dyes PCB's
Lacquer thinners Other chlorinated hydrocarbons,
�`®atNEW USED
- (inc. carbon tetrachloride)-
Paint &varnish.removers, deglossers An other products with "
Paint brush cleaners y p poison" labels
(including chloroform,formaldehyde,
Floor�&furniture strippers 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.: We1jA.24Uexo(Waal, e-1 oy
(dry cleaners) ,
Other cleaning solvents GT4a"L 1,
.Bug and tar removers
y
Town of Barnstable-Health Department Page 1
HAZARDOUS MATERIALS INVENTORY SITE VISITS
DBA: Cape Tire Service,Inc. Fax:
Corp Name: Mailing Address
Location: 45 Falmouth Road,Hyannis Street: P.O.Box 248
......... _ .. _. _
mappar: 311-053-000-000 City: Hyannis
Contact: Robert E.Wallace,Jr./Manuel Jason State: MA
Telephone: :771-1111 Zip: 02601
Emergency: '775-1312 Person Interviewed:
Business Contact Letter Date: 5/7/2004
Category: VehicleMaintenance Inventory Site Visit Date:
Type: Follow Up/Inspection Date:
public water ❑ indoor floor drains ❑ outdoor surface drains ❑d license required
❑ private water ❑ indoor holding tank mdc ❑ outdoor holding tank mdc 0 currently ' s—\
town sewage ❑ indoor catch basin/drywell ❑ outdoor catch basin/drywell expir . - -
❑ on-site sewage ❑ indoor on-site syste ❑ outdoor onsite system date: 6/11/2004
_...... .........
Remarks:7/1/97 3 electric lifts,1 hydraulic lifts,spits-spedi dry& compliance: l
rags,Laundry-Acme,Rags in can with cover,MSDS sheets on site. Satisfactory
0)491
2--7
s �QJ:
Lj
s
• 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
❑d gty's 111 gals or more
,7
tlescrrplion: qty.. uriit of_measure
N�
anti eze(for_gasoline or coolant systems) 55gallons
_..........__..........___._..._...____.__.._.._._.....___............................_._.._._.___._.__.._.......___... ........-........._....__._.._.__m...-._._........._.................._......._..._.._._.._.___._._..._.
autom tic transmission fluid _ 16;gallons
hydrauli fluids(including break fluid) - 13gallons
motor oil T _-� m 200;gallons mm
_...................._..__.._.__..__.....-_. _.........._..... _____._..........__...._.._......_......_........._.__.____.....d_._.__..__.._;._.___.___._..._...___.___._._...._........._........__..__.
diesel fuel,k rosene,#2 heating oil 55 gaIIons
misc.petroleu products:grease,lu ricants 30;gallons
degreasers ford'veways and gar es 10gallons ____._._.
car waxes and poli es _ 5;gallons _
_......___----------_.__.__..._._._...._._..._. ...-.---..._._._...__.........._...........__.............._.....__.___..__._._ _..........._._.__.._.....___...__.._..
paint,varnishes,star s,dyes 15gallons
acquer thinners 1gallons
printing ink
varnish removers,deglos rs _ 1;gallons
____........._..__.__...._.._. �.__-_ —__.. _..................._...._.._...._..._._....__....._................... ________..__.__...._............_.._............____....__.___._..__...
Misc.paint product i 1gallons
floor&furniture stri pers 5 allons
_..._..._.._..._. _.__._. _....._.. .. _ g__.__.____.._..... ---_.-__..__..
metal polishes 10;gallons
_...._._-..__....___.__...._._ .._..........._........._._......._....._._...............__._..............._.__...._......................._......_.._...__._,.......__._..._._..__._._._.._..._..._.._.._.._..____...._................._...
Household cl avers,oven clean s _ 4 gallons
road salt 10gallons
r ch rinated hydrocarbons 200;pounds
antifr ze(for gasoline or coolant syst ms) 3cases
._..._._.................._...._.........._.._._.....-_.._........._.................................._............................-..........._......__...__..,_... ._-. ._.. ._._...___...._..........._.._....._........
-.1
ge roil mm�16gallons
w ste oil 300gallons
Waste Transporter: ICyn Oil Fire District:
Last HW Shipment Date: Waste Hauler Licensed: No
�t
ice _
Hazardous Materials On-Site Inventory/Inspection
For ALL Shops and Businesses:
DBA:
Location: `'�7 Date: ��/.O c-f
Physical Features to Inspect:
1. Hazardous waste aeration sites (production/manufacturing areas):
2. Waste storage areas: 4�
3. Satellite accumulation points throughout:
4. HazMat stored outdoors — CHECK OUTSIDE:
5. Shipping and receiving,areas:
,A) 6
6. Run down of shop activities:
A
7. Housekeeping practices:
HazMat On-Site Inventory/Inspection:
Records to Review for SQGs and CESQGs
DBA:
Location: lqw.
Site visit date:
• Hazardous Waste
Manifests:
• Employee training documentation (if required):
• Hazardous substance spill control andeontingency plan:
• MSDS on site?
• HazMat Inventory records (if applicable): ,;�;,tom
• HazMat Waste Shipping documentation:
• Spill records (if applicable): �q�