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Home My WebLink About0123 FALMOUTH ROAD/RTE 28 - Health 123 Falmouth Rd 311-078 Hyannis ,, 1 TOWN OF BARNSTABLE Date: Yl 1` l t 3 '5oee� TOXIC AND HAZARDOUS MATERIALS FORM ►�NAME OF BUSINESS: r►�.��uL � B o BUSINESS LOCATION: 123 a /rhoJ �r.0 . 4nr� 1 S INVENTORY MAILING ADDRESS: S4►e. TOTAL AMOUNT- TELEPHONE NUMBER: 5-0& - S 7-7--7 'V A-7 k I CONTACT PERSON: ` q%0_ o EMERGENCY CONTACT TEL PHONE NUMBER: 71 y -2Do- y P LtD MSDS ON SITE? TYPE OF BUSINESS: An.e l Ay+a Snee/ R,,,Pq i.-' otit, Con*-, e INFORMATION / RECOMMENDATIONS: L4b<-I 'Tll 40LgAr-ebu--- cwks+Q— Fire District: Cow-,a, L.5" -b I,Jas+,e.!' + " Ie_" , obtQ NvariK, s low k-s o -Fo C4 ► 11 e-1A�CAe,5 w 4L saa o ,s rod. b. Waste Transportation: Last shipment of hazardous waste: ;�e + zo,z Name of Hauler: t9, Destination: L "Ie�./ ti, IQZ Waste Product: (dk5fx. ,04,K,¢t f' iv,w_K Licensed? es 'No M✓77Yz08 q1 ya NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) ( Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals(Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED I Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Z Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform,formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) ti Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS " Applicant's Signature Staff's Initials y YOU WISH TO OPEN A BUSINESS? . For Your Information: Business certificates(cost$40.00 for 4 years]. A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G,L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form.to the Town Clerk's Office, 1st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE:Q6` -1.2 `� Fill in please: APPLICANT'S YOUR NAME S: (A 29d n " BUSINESS YOUR HOME ADDRESS: 1'�5 v, 'S (6,. d d rvdh,,;1 o�ovT � & ° TELEPHONE # Home Telephone NumberJ74-Y„�-o j �/!VQ IMP r NAME,OF';CORPQRATION: UC -t- NAME.OF.NEW BUSINESS;' TYPE OF:BUSINESS IS THIS A._HOME.00CUPATION? YES O ADDRESS OF BUSINESS a'oZ `� (w, .MAP/PARCEL`_NUMBER ( � . �L (Assessing] When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd.& Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMI$SIO R'S OFF This individual a infdi?n d a y aritte uir meats that to this type of business. Au gnature** COMMENTS: Vj 2. BOARD OF HEALTH This individual has do e equirements that pertain to this type of business. Auth r' ed Signature* COMMENTS: _ eT7G/C-f7C �f/o 7- I-D 1 x Ce"� Z S� GAt-l-4 z�S d� 11"� y V/S/T o,V/ E 051.u&5 ,41) TN,a AJ SO /S NOi 5u/3 71--Cr 7-0 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: 7 i Town of Barnstable Hazardous Materials On-Site Inventory and Inspection FACILITY INFORRMATION: /� Business Name: /�/�,fL jU N &e),S VC_77 LS 1?—PAIR " Business Location: /°" 15 I�WW lfpA-64 A1WA--,✓A11S(_f*W1 c�+P�MOTaRS) Mailing Address: Telephone Number: �!(/-xe Contact Person: %/ ALA ii 6AA1 e2[.! Emergency Contact Telephone Number: Type of Business: /e'/N01r Au 7U 160,6Y HAZARDOUS MATERIALS (CHAPTER 108) Virgin Product Total Quantity Container Size(s) Storage Location Major Materials Gallons or Pounds Quarts,gallons, Shed,retail store, drums,tank,etc... cabinet,closet,etc E �� G�cj Ust 6A-u6,AJ /_e64T o2_64-4"AJS 6A'uaAl cAAJ � E l�/Q//'�� /�5�2-fob G� ��►Ls 8 3-0-�"X 6 C,+&"AJ5 / �A-%_UAJ C 4VAIr o2 C'�uov / �AJ �5-LW AjCE�AAh) /6 ,cf�(- 'eA&/A1E - ;PA/�(/TS � �,rat-C-Q�cJ,� VA,S 7r A-i 0'I' (i) (i1 3(-A- "A) 6AA) ,aura C" LIRETN,��/� / ��T ci�lv ,✓1L C, � �� Misc. Combustibles Misc.Corrosives Misc.Reactive Misc.Toxics Inventory Total Amount: m25. 6A-1-"A1 S Tll C Sf G kU-NJ WA-S? Mi of- Hazardous Materials License Posted?Yes b"-A m -S �'0'f �7hW n� (99,r- 1n/specre cl. Contingency Plan Posted? Yes No Fire District: ` ,+AI N« Fire Extinguisher Service Date: Metal Covered Rag Bin: Yes No Absorbent Material Available? Yes No Type of Absorbent: Speedy Dry Pads Pigs Other: MSDS on site? Yes (G Hard Copy Computer Access Hazardous Waste Handling Hazardous Waste Generator Identification Number: Type(s) of hazardous waste product(s): Date of last hazardous waste shipment,type of waste and quantity: Hazardous Waste Transporter(s): Designated Hazardous Waste Facility: Hazardous Waste Storage Area Description: Is hazardous waste storage area labeled: Yes �o Are tanks/drums/containers labeled with the words "Hazardous Waste",the type of waste and the associated hazard(i.e. ignitable,corrosive,reactive or toxic) Yes & If hazardous waste is stored out of doors is it covered from the elements? Yes No a/4 Is it in 110% containment? Yes No If hazardous waste is stored indoors is it on an impervious floor?6 No - 2 - FLOOR DRAINS (Chapter 381) Town Sewer Account Number: Indoor floor drains: Yes ® If yes,circle one,does it discharge to a: holding tank dry well on site septic. Outdoor surface drains: Yes No If yes,circle one,does it discharge to a: holding tank dry well on site septic. FUEL AND CHEMICAL STORAGE TANKS (Chapter 326) Underground Storage Tank(s) on site? Yes & Age: Is removal required? Yes No If yes,when? Is testing required? Yes No If yes,when? Out of doors above ground storage tank on site? Yes If yes,is it protected from the elements? Yes No If yes,how? Is it on a foundation larger in size than the tank? Yes No COMMENTS/RECOMMENDATIONS/CORRECTIVE ACTIONS v� 4 Date: SepT x.Z. ;W// Public Health Inspector: Facility Representative: - 3 - Final Touch Cosmetics Repair Comments/Recommendations/Corrective Actions The facility does not store, use, and/or generate more than one-hundred and eleven gallons of hazardous material and is therefore not subject to Town of Barnstable ordinance Chapter 108. However, the following actions are to be taken: The business is to obtain a Hazardous Waste Generator Identification Number. A "Self Assigning a Hazardous Waste Generator Identification Number" fact sheet was provided to Mr. Manganelli with this report. All hazardous waste, including but not limit to waste paint, waste solvents and thinners are to be disposed of by an approved hazardous waste transporter. A list of Department of Environmental Protection Hazardous Waste Transporters was provided to Mr. Mangeanelli with this report. All hazardous waste containers are to be labeled as indicated in the "A Summary of Requirements for Small Quantity Generators of Hazardous Waste" which was provided to Mr. Manganelli with this report. Manifest sheets for the proper disposal of all hazardous waste are to be maintained on site for five years. Absorbent material is to be available on site in order to control any potential spills. Material Safety Data Sheets are to be available on site at all times. 4 of 4 CERTI'r_IED MAILT�, RECEIPT 'iax;; (4ymetic Mail l7nly;No Insurance�CoveragejProvided) EF,3'r,ilelive,informationb isit ou��websitevat,www.usps.com� ": I _ r � PS Form 3800 Ai,gust 2006 See Reverse for Inslr�u�@ctioiis� 3;t°-0.wdw —w_:=�',�,,�,rat;;A::ma�.rr..: ,..ir�mr,,. ^s=�arM:�•ns ,saan�:;w;.= Certified Mail Provides: s.. s A mailing receipt ® A unique identifier for your mailpiece m A record of delivery kept by the Postal Service for two years L Important Reminders: a Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. ® Certified Mail is notavailable for any class of international mail. ® NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail e 0 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 USPSO postmark on your Certified Mail receipt is required. m 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°. n 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,August 2006(Reverse)PSN 7530-02-000-g047 SENbER: CP�IWP`LETE THIS SEPiloN. COMPLETE THIS SECTION ON DELIVERY, ® Completa items 1,2,and 3.Also complete A. Sig ature item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. eiv by(Printed Name) C. Date of Deliv� • Attach this card to the back of the mailpiece, / or on the front if space permits. a D. Is delivery address different from Rem 1? ❑Yes 1. Article Addressed to:ff � n —i If YES,enter delivery address below: ❑ No I I 3. Service Type ; certified Mail ❑Express Mail Z ❑Registered ❑Return for Merchandise O ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number . i i ; ; ;E7 011 0 4 740E E0 0 01 r i4 5 2 5 f 6 3 0.0 i !I (Transfer from SEN%Ce tabeo I PS Form 3811,February 2004 Domestic Return Receipt y 102595-02-M-1540 UNITED STATES POSTALSERvc 6C §M■ I ms 7& e d . uSP ` - , Permit No.G-m � | - Sender: Please print your name, address, and Z P+in this box � { ( ( VIM | / P\a H 6@ D&Ron ;» . » \7ot8amwt1§1 .i 200 gain Aaa | - HyphRisw« 0601 _ N. .._. .r .. -: :._..��.w..+,•,+r/...r,..r ._.. l:....... -,.r,.� -.+..y,...**..h^sew*.-t:^.-_..� ...`.-.... ". '�'!'y_„4 ..�. "^y+^++'„��.�.-... .-.-.t ... TOWN OF BARNSTABLE BAR-W 6 Q Ordinance or Regulation WARNING NOTICE Name of Offender/Manager " ? L�.` `' " +�� 5_ -3� r i Address of Offender -��-r�� V'�`�.��`�1+_ MV/MB Reg.# Village/State/Zip Business Name am/pm, on "/ Z" 20 1 1 Business Address Signature ,of Enforcing Officer Village/State/Zip -t Location of Offense < !i Enforcing Dept/Division Offense , r Facts r' - This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town N' Ordinances, Rules and Regulations. Education efforts and warning 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. COMPLETE ■ Complete items 1,2,and 3.Also complete A. Sig ature item 44f Restricted Delivery is.desired. X ❑Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. eceived by(Print Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: D. Is delivery address different from item 1? ❑Yes If YES,enter delivery address below: ❑No Cc V-1\ S W I Cc n d1 (7> ry)A. 3. EWloe Type E ( 6ertified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise I Q Z Fj0 ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Numtier [ �E i7 p p 68!H 110€ 0 GO 0;'3 5 2 5 f 5 I 5! (Aansfer firm service label) i PS Form 3811,.February,2004 ; ; ;Domestic Return Receipt 102595-02-M-1540 I UNITED STATES POSTAL SERVICE First-Class Mail ,Postage$Pees Paid USPS Permit No.G�10 I • Sender: Please print your name, address, and ZIP+4 in this box • I I I i� town of Barnstable I Health Division 200 Main Street Hyannis,MA 02601 !I . 111ti7ll�Ili�llill9}!{E��i1.it�ffl1!-I`iil3!!!I{�tF31�Yiil�i�l� M I. ■� 1 qr: .s i. �" to� r: r I .t b '•'. rUix 4t, Ln ru �. F F VC1, A L. ..''U 's-E Ln m Postage $ C3 Certified Fee Cj O O Return Receipt Fee �� Postmark O (Endorsement Required) s Are O Restriofed DellwryFee r=1 (Endorsement Regwred) co O Total Postage&Fees $ O-Sent Ton '' ` to c -- --- ... ....:.. ..:...:. ..:.:: [\ Street,Apt: o. ^ i S or POBo..No. Q C p�� C�. .e ZIP+4 ----_..---- t I - ... - .. Certified Mai! Provides: ,Q A mailing receipt (asianay) uuod Sd '® A unique identifier for your mailpiece y — ia A record of delivery kept by the Postal Service for two years Important Reminders: • Certified Mail may ONLY be combined with First-Class Maile or Priority Mail®. to Certified Mail is not available for any class of intemational mail. io 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 mallpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a PS®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". • If a postmark on the Certified Mail receipt is desired,please present the art!- Cie 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 resent it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. ,4: 1 Town of Barnstable �-flR1E91C8C1f11 Barnstable °f THE T°� , y��P Regulatory Services Department A y i• RARNSTAULE,j• , "ASS.i639. Public Health Division �0 �'Arfo MAMA' 200 Main Street Hyannis MA 02601 2007 m Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO 04/04/2011 Bryan W. Reardon TRS ' 730 Bearse's Way Hyannis, MA 02601 IMPW "I N,T NOTICE Re: E,' j-,nouth Rd., Hyannis, MA. 02601 Map &el: 311-078 Dear Mr. Reardon: According to our records, your property at 123 Falmouth Rd., Hyannis, MA has a septic system and is not connected to the public sewer system. Public sewer lines have been available in your neighborhood for many years. 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 123 Falmouth Rd., Hyannis, MA, } to public sewer on or before Sept. 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. cKean, R.S., C.H.O. Agent of the Board of Health TOWN O1' BARNSTABLE OMPL ANCE: CLASS: 1. Marine,Gas Stations,Repair BOARD Off' HEALTH O_ satisfactory 2.Auto ers Bo 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY ( ('� °((`) ` (see Orders ) 5.Retail Stores J 6.Fuel Suppliers ADDRESS RS 6 .01 UM Class: 7.Miscellaneous QUANTITIES AND STORAGE (IN= indoors; OUT=outdoors) MAJOR MATERIALS MMMMMM •• . IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline Jet Fuel (A) D Diesel, Kerosene, #2(B) Heavy Oils: waste motor oil (C) new motor oil (C) t transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: paa .... 3 C i 1LL Ct u DISPO ALIR.ECLAMATI N REMARKS: 1. Sanitary Sewage later Supply O Town Sewer Apublic )kon-site OPrivate 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 ORDERS: O Holding tank:MDC i-pi IN it u m O Catch basin/Dry well O On-site system 5.Waste Transporter "Waste Pro uctil. 1 Name of Hauler YES NO 1. 2. Person(s) Intervie Inspector Date TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANY �i .�� /� .& (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS /ZJA;?ZeVAMO i�_ Class: 47 1 7.Miscellaneous l QUANTITIES AND ST RAGE (IN=indoors; OUT=outdoors) MAJOR IALS ' Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2(B) Heavy Oils:wnTste new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: DISPOSAUR.E(:LAMATION REMARKS: 1. Sanitary Sewage 2. ater Supply O Town Sewer ublic Pn-site O Private 3. Indoor Floor Drains YES-I/ NO O Holding tank:MDC_ 0 Catch basin/Dry well stem On-site s �� G� O y 4. Outdoor Surface drains:YES NO_z ORDERS: r•. 0 Holding tank:MDC P O Catch basin/Dry well O On-site system <. 5. Waste Transporter Name of Hauler Destination, Vaste Product YES NO 1. 2. rson (s) Interviewed 'ector Date P TOWN OF BARNSTABLE COMPLIANCE: CLASS 1.PMrarine,Gas Stations,Repair BOAR Off' HEALTH O satisfactory 3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANY VC-le (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS Class: 7.Miscellaneous QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors) MAJOR MAT LALS Case lots Drums Above Tanks Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: r t DISPOSALJRECLAMATION REMARKS:. ,� o 1. Sanitary Sewage 2. Water Supply O Town Sewer OPublic D69A f 31 O On-site OPrivate R /g V 3. Indoor Floor Drains YES NO �. O Holding tank: MDC o 0 O Catch basin/Dry well o V AIMS O On-site system j m � i 4. Outdoor Surface drains:YES NO 10. W O Holding tan4k:MDC O Catch basin/Dry well O On-site,system 5. Waste Transporter Name of Hauler Destination Waste Product YES NO 2. LA M 2A Person (s) Interviewed Inspeeto Wa _ J 1'.. 7 ,7477117 C TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 0 3.Auto Body Shops, 0 (see"Orders") 5.Retail Stores unsatisfactory- 4.Manufacturers COMPANY A�/-0 , - " �-I,I _�- ry � 1 6.Fuel Suppliers ADDRESS ft 12,r,-r/1 Z Class: 7.Miscellaneous QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots -Drums Above Tanks Underground'ranks!� IN OUT IN I OUT I IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) I Diesel, Kerosene, #2 (B) Heavy Oils: I waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: DISPOSALIRECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply 0 Town Sewer OPublic e 0 On-site OPrivate li Val) , 3. Indoor Floor Drains YES NO 0 Holding tank: MDC 0 Catch basin/Dry well D/A Pa 3A,/10 0 On-site system pf5l rooV) . 4. Outdoor Surface drains:YES NO 0RDER& /Y,) 0 Holding tank:MDC It-- 0 Catch basin/Dry well 0 On-site system 5. Waste Transporter Name of Hauler Destination Waste Product Licensed?' YES NO 2. Person (s) Interviewed Inspector Date SENT- BY: 5-23-95 8:43AM 50871884,48-0 5087753344;# 2 HYANNIS FIRE DEPARTMENT 96 HIGH SCHOOL ROAD EXTENSION HYANNIS, MASS. 02801 PAUL D.CESHOLK CHU FIRE PREVENTION BUREAU LT. DONALD H. CHASE, JR. LT, ERIC HUBLER Inspector Inspector AGENCY NOTIFICATION [ ] Health [X ) Building [ ] Wiring [ ) Consumer Affairs [ ] Gas ursuant to Mass. General Law - - Enforcement Authotb Section 1 .03 (2) requires notification of any other agency whose codes or laws are observed to have been violated. The following violation/s �has been observed during an re ampon nt 1995 at the property located on 123 Falmouth Road Reliable Fence Co, 1 _.a�g� f az Speedy Muffler and resident abutters on noxious odors making everyone sick and nauseous- from wood stove. — -' — -- 2 - Past resorts 4 16/90 and 11/2/92 on burning pressure treated and sta#ed woods in wood stoves. On file at F,D. 3 _ S)7ee_dX Muffler claims to have notified B.O.H. and b,E,P. in the past. i Owner of record: George Conduris, Jr. 420-0116 as of 4/90 Stanley Pratt 394-4160 123 Falmouth Road —Hyannis MA 02601 --v_ phone (if known) business 775-4124 Fie Prevention Office Lt. Donald Chase, Jr. Hyannis Fire Department ` c : File PAGE NO. a3� DATE: /�.j- ASSESSOR'S MAP & PARCEL: COMPLAINT LOCATION: COMPLAINT DESCRIPTION: f. r ORIGINATOR OF COMPLAINT(NAME): ADDRESS: PHONE: !/ DATE: v INSPECTOR: Day) p _ INSPECTOR'S ACTIONS/COMMENTS: �oFTNEto� TOWN OF BARNSTABLE OFFICE OF HeaasTem. raR BOARD OF HEALTH 367 MAIN STREET HYANNIS, MASS. o2so1 February 17, 1988 Mr. Stanley Pratt RO-BO Car Wash c/o Reliable Fence Co. 123 Falmouth Road Hyannis , MA 02601 NOTICE M ABATE VIOLATI�",S Q1 ZJA OR 5 . 00 . CHAPTER 21, SECTION AZ OF M GF.NER,AT, LAWS AM SECTION 4 Q1 ARTICLE XXXIX, CONTROL Q1 TOXIC Ak HAZARDOUS MAZERIALS U 1U TOWN BYLAWS, The RO-BO Car Wash facility, operated by you, located at 123 Falmouth Road, Hyannis, was inspected on February 10, 1988 , by Donna Miorandi, Health Inspector for the Town of Barnstable. At that time you were observed washing cars and issued a hand written abatement notice to obtain a valid groundwater discharge permit within seven (7) days . Mr. Clint Watson, employee of Department of Environmental Quality Engineering , may be notified at 292-5693, in order to obtain a permit. Failure to comply with the seven (7) day abatement notice issued on February 10, 1988, may result in the possible closure of your car wash facility. You are again directed to obtain a groundwwater discharge permit within seven (7) days of receipt of this notice. Failure to comply with this notice may result in a fine of $200 . 00 ,daily, authorized by Article XXXIX of the Town Toxic and Hazardous Waste By-Law. In addition' a fine of $10, 000 . 00 a day may be imposed-: on violator of General Laws, Chapter 21 , Section 42 . PER ORDER OF THE BARNSTABLE BOARD OF HEALTH Thomas A. McKean Acting .Director of Public Health yoFtHETo� TOWN OF BARNSTABLE OFFICE OF B�MASK KI BOARD OF HEALTH 1639. 367 MAIN STREET 'FD Y11Y�� HYANNIS, MASS. 02601 February 16, 1988 Mr. Stanley Pratt RO-BO Car Wash c/o Reliable Fence Co. 123 Falmouth Road Hyannis, MA 02601 Dear Mr. Pratt : The RO-BO Car Wash facility, operated by you, located at 123 Falmouth Road was inspected on February 10, 1988, by Donna Miorandi , Health Inspector for the Town of Barnstable. At that time you were issued a hand written abatement notice to obtain a valid groundwater discharge permit within seven (7) days. You are directed to cal Mr. Clint Watson, of the Department of Environme:ntal Quality Engineering, at 292-5693 , in order to obtain a permit. Failure to comply with the seven (7) day abatement notice issued on February 10, 1988, may result in the poszible closure of your car wash facility. Yours Truly, Thomas A. McKean Acting Director of Public Health TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF FIRM: , GCME CAR-- W,4SN , /,VG PO MAILING ADDRESS: 2 S, C'NA714A AA . i�'1�55 62-6 TELEPHONE NUMBER: 20 ZOIj CONTACT PERSON: IEj(f ELP)ZE )GE c� Does your firm :stone _any< of, the.- toxic or -hazar-dqus--materials listed-b'elow.; 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 0 x. 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: 12 LMOVT4 PO 1J ANAIIS MASS TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous characteristics and must be registered when stored in quantities totalling more than 50 gallons liquid volume or 25 pounds dry weight. Please put i a check beside each product that you store: k i Antifreeze (for gasline or coolant systems)_ Refrigerants Automatic transmission fluid Pesticides (insecticides, Engine and Radiator flushes herbicides,rodenticides) Hydraulic fluid (including brake fluid) Photochemicals ! k Motor oils/waste oils Printing Ink Gasoline, Jet fuel Wood preservatives y- Diesel fuel, Kerosene, #2 heating oil (creosote) Other petroleum products: grease, Swimming Pool chlorine lubricants Lye or caustic soda Degreasers for engines and metal Jewelry cleaners Degreasers for driveways & garages Leather dyes Battery acid (electrolyte) Fertilizers (if stored Rustproofers outdoors) v' Car wash detergents . PCB' s Car waxes and polishes Other chlorinated hydro,- Asphalt & roofing tar carbons, (inc.carbon Paints, varnishes, stains, dyes tetrachloride) Paint and lacquer thinners Any other products with Paint & Varnish removers, deglossers "Poison" labels (including Paint brush cleaners chloroform, formaldehyde, Floor & Furniture strippers hydrochloric acid, other Metal polishes acids) Laundry soil & stain removers Other products not listed (including bleach) which you feel may be Spot removers & cleaning fluids toxic or hazardous (please (dry cleaners) Other cleaning solvents R E C E I E list) sue... HEALTH DEPT. Bug and tar removers TOWN (�F BARNSTASLE Household cleansers, oven clean rs Drain cleaners Toilet cleaners Cesspool cleaners Disinfectants MAY 8 1981 Road Salt (Halite) L r - y�FTHE tO�o TOWN OF BARNSTABLE OFFICE OF i BAflAM N � BOARD OF HEALTH iva 039. 367 MAIN STREET HYANNIS, MASS. o26oi February 17 , 1988 Mr. Stanley Pratt RO-BO Car Wash c/o Reliable Fence Co. 123 Falmouth Road Hyannis , MA 02601 NOTICE TD ABATE VIOLATIONS OF aa SIB. 5 , 00 , CHAPTER 21, SECTION AZ Qj = GENERATE LAWS AIM SECTION $ QE ARTICLE XXXIX, CONTROL a TOXIC AIM HAZARDOUS MATERIALS Qj THE. TOWN BYLAWS . The RO-BO Car Wash facility, operated by you, located at 123 Falmouth Road, Hyannis , was inspected on February 10, 1988 , by Donna Miorandi, Health Inspector for the Town of Barnstable. At that time you were observed washing cars and issued a hand written abatement notice to obtain a valid groundwater discharge permit within seven (7) days . Mr. Clint Watson, employee of Department of Environmental Quality Engineering , may be notified at 292-5693 , in order to obtain a permit. You are again directed to obtain a groundwwater discharge permit within seven (7) days of receipt of this notice. Failure to comply with this notice may result in a fine of $200 . 00 daily, authorized by Article XXXIX of the Town Toxic and Hazardous Waste By-Law. In addition a fine of $10, 000. 00 a day may be imposed on violator of General Laws , Chapter 21 , Section 42 . PER ORDER OF THE BARNSTABLE BOARD OF HEALTH Thomas A. McKean Acting Director of Public Health oFT gT�� TOWN OF BARNSTABLE Q ! i OFFICE OF i H t asTAk B"t BOARD OF HEALTH soo 1639. ,. 367 MAIN STREET HYANNIS, MASS. 02601 February 17 , 1988 Mr. Frank Mezzacappa Department of Environmental Quality Engineering Southeast Regional Office Lakeville Hospital Lakeville, MA 02347 Dear Mr. Mezzacappa: It is my understanding that Mr. Stanley Pratt, operator of the RO-BO car wash facility, located att123 Falmouth Road, Hyannis , MA has not obtained a groundwater discharge permit. Donna Miorandi, Health Inspector for the Town of Barnstable, issued Mr. Pratt an abatement notice on February 10, 1.988 to obtain a groundwater discharge permit within seven (7) days. This facility recently reopened after being closed since about the time of March 6 , 1987 when Nancy Leitner, former Health Inspector for the Town of Barnstable, also issued RO- BO car wash an abatement notice to obtain a groundwater discharge permit within thirty (30) days . Thank you for your assistance in this matter. Sincerely yours,' Thomas A. McKean Acting Director of Public Health 1 PyoF fT E Tod TOWN OF BARNSTABLE �r OFFICE OF 2 ssaVA89 BOARD OF HEALTH 039 i639. � 887 MAIN STREET \ �•0 YA`f Ir' HYANNIS, MASS. o28o1 1 February 17 , 1988 Mr. Stanley Pratt RO-BO Car Wash c/o Reliable Fence Co. . 23 Falmouth=Roan Hya-nnis;MA=0,2601 NOTICE TD ABATE VIOLATIONS QZ ,UA MR 5 , 00 , CHAPTER 2J, SECTION 4Z. Q_ THE. GENERAL LAWS ANC SECTION 4 Q1 ARTICLE CONTROL QZ TOXIC AIM HAZARDOUS MATERIALS U THE TOWN BYLAWS, The RO-BO Car Wash facility, operated by you, located at 123 Falmouth Road, Hyannis , was inspected on February 10, 1988 , by Donna Miorandi, Health Inspector for the Town of Barnstable. At that time you were observed washing cars and issued a hand written .abatement notice to obtain a valid groundwater discharge permit within seven (7) days . Mr. Clint Watson, employee of Department of Environmental Quality Engineering , may be notified at 292-5693 , in order to obtain a permit . You are again directed to obtain a groundwwater discharge permit within seven. (7) days of receipt of this notice. Failure to comply with this notice may result in a fine of $200 . 00 daily, authorized by Article XXXIX of the Town Toxic and Hazardous Waste By-Law. In addition a fine of $10, 000 . 00 a day may be imposed on violator of General Laws , Chapter 21 , Section 42 . PER ORDER OF THE BARNSTABLE BOARD OF HEALTH Thomas A. McKean Acting Director of Public Health LO,C AT ION SEWAGE PERMIT NO. 4 yafitiiS VILL ffGE INSTALLER'S NAME & ADDRESS ' y B UI,LDERR OR OWNER, DATE P, ERM.IT ISSUED DATE DATE COMPLIANCE ISSUED _ .. :. _ �' �� : �� . - t .. � .� r � _ fi � c �� . --� �. � - � , f. �. � � .. �_� . r �,;r, -. PyoFI"ETowy OFFICE dP THE BOARD OF HEALTH OF THE 9B��P9 TOWN OF BARNSTABLE, MA S. pp 163g. �� .rid• 1 f j< 0 MAY TM ., F-- `" ------ 194 { SEWAGE DISPOSAL �ERIVII'I', Permission is granted to ____ to construct S tCTI rt Upon the Premises of � IQ_the va,llage of 100 or more feet from any source of �tc er supply 20 feet from buildingf 10 feet from property line f —i"~ Health Officer. } Oc&,TION : 5EW&6-4E PERMIT UO. — /�3 Y�t/g^C1 ► F �r au — IWSTQLLER51J&ME ADDRESS -i7lc; 15UILDER 5 Q / MF- ADDRESS DIaTE PERt-AlT ISSUED la- — O ATE COMPLI A MCE ISSUED : , _ _ � I t � �� '�� c�a �� ems_ r�., � . .�:::.er Vic-, . a --..,�.... _ �� _ � �t� h __ -_� �rs_.� a� �'�' �� W 4. � ``J ` �� iL � _' THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH _t. /040A�_.....-- ..oF .R.PJ.9779LF4E-------------------------........ Appliration -for Ii,4�potial orko Tonotrurtion Pprutit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal .............................................................. L ion-Address Igor Lot No. 4rr..-................................... ...................��'�!�L......................................................... (� -mod Owner Address W --•-------------- ---- Installer Address Q Type of Building Size Lot----------------------------Sq. feet V Dwelling—No. of Bedrooms_..........................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building .--------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) 0.' Other fixtures --•-------------------------------------------•------------------------------------------•----------------_-•-------•-------------------------------- d W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity_-.-_---_-__gallons Length---------------- Width.._.__.__.... Diameter________________ Deptll.___.____.-._. x Disposal Trenc .................... Width....____....___.._.. Total Length..__._....._..._.._. Total leaching area-------------------- ft. Seepage Pit o_________ __________ Diameter-------------------- Depth below inlet.................... Total leaching are-1------------------sq. ft. Z Other Distritets] oxosing tankPercolationt soukKeby Date Test Pit 1 0. 1---_______------minutes per inch Depth of Test Pit_.-__-_____-_-__. - Depth to ground water..--_----__-_--.__.--.-. rX4 Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water--.--._--__-__-.______.. Ix --------------- --- ------------•---------------•---•-•-•-•.............................................................................................. ODescription of Soil--------- ----------------------------------------------------------------------------- ----------------------------------------------------------------------- W x W __ UNature of Repairs or Alterations—Aiaswer when applic e......_ _ 1 --.._____-._--e _dlz, _.__.___N_ vim - -------------- ........... ------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees place the sy tem in operation until a Certificate of Compliance has be �d th and of health. tgn -- --- -- --- -- -•------_. --------• -- ----------------- iQ Date Application Approved BY ..... � � .---� .. .. _.. ._ Bate . Application Disapproved for the following reasons:.................................. - ... -•.•--•-----------------....---•--------------.....------•--•••-------- .........---••-•-•-•--------•-----------------------------------------------•-------••---- PermitNo........................................................... Issued....¢- ---------------- ........ t Date 3 ' No....... Ficic... ................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -. -------OF.LB*R..PQ1;..— N4.��.............................. � ApphrFation fair Uifipas al Vorkfi Tomitra$rtioaa Prruait Application is hereby made for a Permit to Construct ( ) or Repair ( �'an Individual Sewage Disposal S}ryete at Yam/ / .... ....------ -•-�t--------- ...•- -•- - -...................................................... Lo ion-Address or Lot No. -----------!7e�'Z .- ------..� ......-----•--•----•----------•-----------•-----•---•-. Owner Address .......... a t °' Pt 17- ' �.s----------------•--- -- -------------------- --------dres- � Installer Address Q Type of Building Size Lot..................: ........Sq. feet U Dwelling—No. of Bedrooms_____________________________________ ______Expansion Attic ( ) Garbage Grinder ( ) p-I-, Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) p' Other fixtures W Design Flow............................................gallons per person per day. Total daily flow-------------------------...................gallons. W Septic Tank—Liquid capacity.--__-_-_-_gallons Length................ Width---------------- Diameter---------------- Depth--------------- N. x Disposal Trenc — --------------------- Width------------------ Total Length___--__-__-.-----.-. Total leaching area--------------------sq. ft. Seepage Pit o......... .......... Diameter-------------------- Depth below inlet.................... Total leaching area....________--____sq. ft. z Other Distri uti o losing tank ( ) `~ Percolation est stilx'S S>e`ffot e bY-------- -------------------------------------------------•------- Date-------------------------------------..: Test Pit i o. I................minutes per inch Depth of Test Pit.................... Depth to ground water-..___-..-_--.---------- Gi, Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 9 ------------------------------------------------------------•--------------------------•---....•----.............................................----------- 0 Description of Soil------------------------------------------------------------------------------------------------------------------------------------------------------------------------ x V ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ VW ---------------------------------------------- --------------------------------------------------------------- ------------------------------------------------------------------- Natu� of Repairs or Alterations—A4tswer when ap 1}` a _... - __.______ A r ✓-- Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary Code—The undersigned further agrees place /estem in operation until a Certificate of Compliance has been`i" d t oard of health. J ign (.�•--- • ---- Application Approved BY 'Y ...... . f "' •2 mate` Application Disapproved for the following reasons_........................._•-----.--•__-- .............................................................. ..........--•-•--------•---•----•--•------••-----•-------••-•------------•--••-••-•---------•-•---------------•-----•--••-..._....--•-•------•---•-----•---•••........-----•----•-......•-------------- Date Permit No. --------------------------------------- Issued Date �.. THE COMMONWEALTH OF MASSACHUSETTS BOARD O EALTH .+! .......:OF.............................. ... .................................. Trdifiraatr of TIMpliaurr Aeeninstalled T ERTIqFb the Individual Sewage Disposal System constructed ( ) or Repaired by ---- •- --------- Installer at--•• ......-- - --- -- - dated-- .... application for Disposal Works Construction Permit No............. -_-_._._-_ ._ d„escribed in the has i accordance with the provisions of Article ql ;L e State Sanitary de as r d in t THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...................... -------•--•------•------.................................. Inspector...................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH f,/ 1 .............OF.--...... rr�+'rr .. . . ............ ..�.�..+....^ No..l FEE. ----••----•---- Permission is eby grant` _ _ - ---•------------ - to Constr ( ) o Rep ,r an ivldual Sewage i osal S t rr l h atNo.- •--- •. •- ---- _._ ... �..v-1'f{--�d ----•• --------------------------- - •. Street as shown on the application for Disposal Works Construction :Per o...... ......... e ... � __.�/.F.. ------ --- ---- �1.�- o d of eal DATE.... ---�l__��---------------•-......------..--- FORM 1255 HOBBS'& WARREN. INC.. PUBLISHERS - 77 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH c_-. _.._..._.....OF................................... rj;� � Apli iration -for Bhipoiittg Workii Towstrnrtion Vantit � Application is hereby"made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: l A or Lot No. H TrtiAddress' a��C� p Owner .� Ads ' owl..E................................. -ddresress Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedroo ...._.... ....P__,,txyansion Attic Garbage GrinderOther�ype of Building _ .. ( No. oc-i r ..... ..�...��Showers ( ) — Cafeteria ( ) a' Other fixtures ..................... .................................. ............_. J Q W g w ---------�.).•------•.._..----•--gallons"Per� Per day. Total daily flow-------------�>---------- ---_-- ---gallons. WLiquid capacity-.-------_-gallons Length________________ Width-----.---------- Diameter---------.------ Depth.--------------- Disposal Trench—No- -------------------- W*dt11...._____...___._ _To` h Total leachingarea....................s ft. Seepage Pit No------Z---__-___ Diameter._�1 t��_;er t �eIow�le�:................ Total leachi g 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_...-___.-__.--_- -___. (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--.-.._.-_-._--.__...___ - j� •------------------------------------------ O Description of Soil------ ..�--- ; e --- �°° e --- ------ V .....--•........................•--------•-•------•---.•----•----.... ------------------e ........................................................ ------•----•----------------- W ----•-----------------------•- --•--------•----- •------------------------------------•----------------•-•-- / V Nature of Repairs or Alterations—Answer when applicable._..--. .�� ----.-_-_ ._____... ---------•----------------••------•---------------------------------------------------------------- --- -------------------------------------- ------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i ued by the board of health. Signed----- -=-• ------------------ Date Application Approved BY --------- ----- ._. Z -7 Date Application Disapproved for the following reasons---------------------------------------- ---------------------------------------------------- ------------------- --•-------••--•---••----••---------------•------------------•-•---••-•-------------•• ------------ ------- Date PermitNo......................................................... Issued.....................--................................. Date i ' 17 No............1?....... ' Flzs.../5. ................ THE s THE COMMONWEALTH,-OF,MASSACHUSETTS BOARD OF HEALTH �'� .._........ OF..................................... ....... ..........:...... ... ApplirFation -for Rho oottt Works Towitrnrtioaa PProait Application.is hereby'made for a Permit to Construct ( )Vor Repair ( ) an Individual Sewage Disposal System at F --------- ------------------------------------- Locatio` Address or Lot No. �r Ow`ner ------•--•------•-------•---•---------'--.'.Address•-•---•--•-•---•---•----------------------- ak s s - -------------------------------•---••----•----.....-••-•---•---•.. Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedroo -.-- --.,,...-_[[ ---�,�jxcansio2n Anttiic Garbage Grinder`��OtherT eof Bulldin1 _L&lL�f: No o _._.__ Showers — Cafeteria ----- FCer fixtures ----- ------- ----..._... . - -•--••--•"--•-------------------------------- .r w fi-------------- Ills s er per day. Total daily flow.___________ gallons. W N g p P P Y Y R; =Liquid caplclty gallons Length----------------- Width_____.....,__.. Diameter-----....-.----- Depth.. ___._.__._ . Disposal cg erbdh 'h 1Fldth'` l �r To h Total leaching area------ sq. ft. Seepage Pit No_ ________ _____ Diameter_ ___._ .._ .__ epth e ow.Inlet_....:. Total leaching area.-- ---------sq. ft. z Other Distribution-box ( . ) Dosing tank ( ) Percolation Test Results - Performed by.-•........:.:..:.:::..:..:.................... � --••-•-------------....... Date-----""--••------------------------------ Test Pit No I_._. _.minutes per inch Depth of Test Pit-.------------------ Depth to ground water. -----.-- .--_-.-_-- (xq Test Pit No. 2__._ inutes.per inch Depth of =rest-Pit____________________ Depth to ground water--.--._-___-_--_-_-.--. . _ ._.__m ---- ------------------------- ------ D Description of Soil___. ".._._ 44- ,Z.�A.___. ____ .. ---------- V ------------------- ------. •-••------•---- . •-��/ .._..- - - ----- --- ----------- ---- ----- ----- --------------- --------------- - j� U Nature of Repairs or Alteratiofis—Answer"when applica.bl.e----__ --- __,_,_{/___% ......... ___.._..__..... . ----------------------------------------- r Agreement: The undersigned agrees to install the aforedescribed` Individual Sewage Disposal System in accordance with the provisions of Article NI of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i ued'byythhe.�board of health. Signed--- :'fir',•-- -- Date A A •^fir Application Approved BY _-------- ------ - - - ---{-- Application Disapproved for the following reasons............................... •------------ •-------------•--------------•-------Date---------•---- ----------------------------------------------------------••- -------------------------------------------- Date PermitNo..............................-------------- .. �? Issued......................----------=-...................... x f }:e 0 :A°` Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r ....... .... .......OF......... .. ... .... ...................................... Tprtifirtr of f�om�rii�tnre THIS TqCEFY t the Individual Sewage Disposal System constructed ( or RepairedbY • = %...... --. ----- =-- 7 - ------------ ............ jA nn Iler at-� f ....... - ----- -- � ...1 has been installed in accordance with the provisions of Arti I of T e State Sanitary C as described in the application for•Disposal Works Construction Permit No._" ........................ -- ... dated----- -f..__....•••••. THE ISSUANCE OF THIS�CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........................................... •. --------------------='----- ------------------•---••-•---. Inspector................................................=.................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF. HEALTH ""` .. .. .OF_.. -------------------------------- : . :..G�.% - No.-------��.... FEE4_ Z� .... Rr. spoott rk trnrtion rrmn t Permission ereby granted-- ---- ---G' +�r :► to Constru 'nor Re ( ) n dividu S Disposal ys ewage Street as shown on the application for Disposal Works Construction tPermi ated__._y-:=..____2' 7 -:--- kl? 4. :.............................- Board of Health DATE.....` ----------. ------7...............:.••--••--------•... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS s { rE �r 1 ! I f � 1 f d , t f � 5 1. ` .rw...+++.r-..__n-..�.+ww✓•-won - _.•W+`-�n..-•wr--..........r�..-�+.w_.v.-.r..._...v.<aw�.ww.•..nnr-w.'.....F�u•:M1w�a-r..�r'.�wM.J4"•'-•.-ra._..�.....w....n:.x..w•....�wt...:....-.y..-._.w,...... ., ... ..-� .. .. .-r x.� _,.. ( ' a "c t: a 1 ' w y w j < f ro �`�`:? •�,� 4_.-��,�'.. ��+,3 w�`art` ,