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HomeMy WebLinkAbout0228 NORTH STREET - Health tr"NORTH ST. A=308-039 s HYANNIS r x 9 Y F[i A 1 y . ..-...�:m-,..,.r..-., ...�..-:..-.�-.-.-s..�.......,.,..,_....�,.._ �•-^-.•,.,,..,,,r..,,�.-.-...-^,...-.....-•---,•.-...:ns^....-�,.,r-.-.ti....:-.,.�. ..:,.. .•.�«v-....�'e.., f ram., ,,.....-},.. ... -.- _ .. � .. .. TOWN OF BARNSTABLE BAR-W 5203 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager TXVVU /. Address of Offender 4 C7r. lY, 1�/i�'1 � MV/MB Reg.# Village/State/Zip W)k-6-. f��r '�'t t'un. j(� ' V d klw `� �Q ,aa/ m on t4l]R� 20�Q Business Name �t "tyw�e � 6'A?? P Business Address ( Signature of Enforcing Officer Village/State/Zip A'1 /01'Ac Location of Offense � � � " � Enforcing Dept/Division Offense � � 'fir /� L.( lct l tee /, /t .�t (1, Facts 4V10.1 lfi 1 at' `� r �''i � t+ '""� w t_[t� r'� # °t�" fi r .t,� r,,r _ �., '' mod ��t� }S a� . r l �t:�,��,�� t t ' hIn4.I This will serve only as a warning. At"this time no legal actiEon has been taken' . It is the goal of Town agencies to achieve voluntary compliance of Town 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. --...-,F ._. .,-. -. .•r.•.•.. �,-.. .,.,.r..i. . ....:,F. ..r..m TA.w«.* .rr_ .:-.. :..,.'•r-..va_.. :...» v.....-v..wrr . .+ .. ..s...,.. 'v .w .. . _ . TOWN OF BARNSTABLE BAR-W M,270 Ordinance or Regulation WARNING' NOTICE t Name of Offender/Manager ,/ x k:, ,,.a€ -•, N dob ✓ - y. ., C N , , - 1 Address of Offender "8 y`1 < ? .. < a.� , ,. .>,. l.} MV/MB Reg.# r' Name 1', $ r amm p ,/ on t if _1 20_)t`� � , ��6, p t'/ }._._,- �/.. Business Address : 4-,771Z . '~i ✓ .f �_ . .r -, Signature of Enforcing- Officer Village/State/Zip 11, ,.�.,. _. , 1, z 1 Location of Offense /� ,/ , ',, ± ,, $`� t_I. if A T), F'"fir Enforcing Depit%Div`isr n Offense r c, Facts V J" ! „,, ,r ,g .. t 4 4-v This will serve only-.is`�'a `warning. 'Att"th"is time`no legal action has`been 'taken: It is the goal of Town agencies to achieve voluntary compliance of Town 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. D Commonwealth of Massachusetts ` Executive Office of Energy &Environmental Affairs Department of Environmental Protection Southeast Regional Office•20 Riverside Drive, Lakeville MA 02347 .508-946-2700 DEVAL L.PATRICK RICHARD K.SULLIVAN JR. Governor Secretary TIMOTHY P.MURRAY KENNETH L.K.IMMELL Lieutenant Governor Commissioner September 12,2011 David Thornton RE: BARNSTABLE--BWP Thornton Realty 242 Joe Thompson Road (North Street Automotive West Barnstable, MA 02668 240 North Street f Hyannis,MA 0i601 527 CMR 9.05 and 310 CMR 30.00 RETURN TO COMPLIANCE Air Quality Status:UST Waste Oil Status:VSQG DEP Facility ID No. 397060 NON-SE-11-U012-2 Dear Mr.Thornton: On August 8, 2011 and September 6, 2011, Thornton Realty submitted responses in reference to the Department of Environmental Protection (MassDEP) Notice of Noncompliance addressing the repair of broken covers relative to the Underground Storage Tanks and the registration of the generation and recycling of the waste oil at North Street Automotive, 240 North Street, Hyannis. The purpose of these submittals was to demonstrate compliance with the requirements outlined in MassDEP's "Notice of Noncompliance" effective July 13, 2011,relative to the Underground Storage Tank Regulations as contained in 527 CMR 9.05 and the Hazardous Waste Regulations as contained in 310 CMR 30.00. Based on the submittal of the information relative to the Underground Storage Tank Regulations and Hazardous Waste Regulations,the MassDEP has determined that the violations cited in the Notice of Noncompliance referenced above have been corrected. This information is available in alternate format.Call Michelle Waters-Ekanem,Diversity Director,at 617-292-5751.TDD#1-866-539-7622 or 1-617-574-6868 MassDEP Website:www.mass.gov/dep Printed on Recycled Paper L Should you have any questions relative to these issues at your company, please contact Steven Risi of this office at(508)946-2774. Very truly yours, This final document copy is being provided to you electronically by the Department of Environmental Protection.A signed copy or this document is on file at the DEP office listed on the letterhead. Gregg M. Hunt, Chief Compliance and Enforcement Section Bureau of Waste Prevention H/SR/lm RTC/NorthStreet.docx cc: MassDEP-SERO Attn: Laura Black, Data Manager Attn: Regional Enforcement Office Hyannis Fire Department 95 High School Road Hyannis, MA 02601 Ecc: Gordon Bullard, Department of Revenue Gordon.H.Bullard@state.ma.us Barnstable Board of Health Department health@town.barnstable.ma.us MassDEP—Boston Attn: Veronica ODonnell MassDEP—SERO Attn: Deneen Simpson r Town of Barnstable Hazardous Materials On-Site Inventory and Inspection FACILITY INFORMATION: Business Name: 4/OR-N 37RCE7- 4U-7D/-f6TIdL" yi Business Location: �r oR T /}-WA)IS AK/4-2Y,9,141'r/s r) Mailing Address: -2-�41) Ale R 771 c�'� ,40,/,otS Telephone Number: .f-PS— ?�ZS-/(- Contact Person: /me souz u D mv.),72 Emergency Contact Telephone Number: ! ;4/-f__ �� - &�/ Type of Business: -867-*/L Qf-3o&i,16 <—,&nazJ +t Ub *v7ZH62 VC- eG-",40K 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 V/�U/,cJ /�55 Cif L0AJ DXUAf 64P-A&E-6,41 &,vq n. C At" A--,s olve 6�wgav, r�llhSEft7 /) 4 At�o AJ 7**, G,+9i446_13lf f +AaD I A / A� 6��� V/kL;/,q/ ,�- ff6l vC oar® -M-Mt *dU b 64-L" 59vnvWes r V14STC OIL 305'64ao,4 e&-U1AJ44VA01" 6Ama cP QA42A4r i e it C/> 5v 64u,OAJ /5e--Aqe_dG 6 A"4 E DR�KS CA-P-/46- bAy `.""'KL-'�Z�ll® � l Cy�LLfi� LaNTJi-�nJdLS �iV/c( �i$ zt.A7ve7�uS �A/4/✓16v i_ �kA�t S 1, 6-64 eos A -7,pusoL_ e-".s oa 4 Ad - 1 - Misc. Combustibles Misc. Corrosives Misc.Reactive Misc.Toxics Inventory Total Amount: Hazardous Materials License Posted?Yes Contingency Plan Posted? Yes � Z1771W-4`L&bL�-� `N Fire District: 1VY -A1AJ/S Fire Extinguisher Service Date: Metal Covered Rag Bin:<TSs; No Absorbent Material Available No Type of Absorbent: eed D Pads Pigs Other: MSDS on site es No Hard Co Computer Access Hazardous Waste Handling Hazardous Waste Generator Identification Number: /lV-4-4,8- 7 7/6 � e Type(s) of hazardous waste product(s): �,"Ous�BG" )av/b(F�-0JC" 01,1-1 Date of last hazardous waste shipment,type of waste and quantity: .Just;//, Z-6/�- i�C 01�L Sao 644Z-6/os. Hazardous Waste Transporter(s): `t 637EXAJ ®IL Designated Hazardous Waste Facility: WC S W OIL, LiAJ 4bW RX Hazardous Waste Storage Area Descripti4)3-8� 0 -.1-5v 64'eer Aj Ai0eiye-a/2v e,u h %-i :yK.I k) Ca*e,44�e' %P/pm 1-3 `7�ez�lr--. ( %t) �Cp�FZC6.c1 �J C.KS 1AJ eete(jG`7 dr- Is hazardous waste storage area labeled: Yes Are tanks/drums/containers labeled with the words "Hazardous Waste",the tvQe of waste and the associated hazard (i.e. ignitable,corrosive,reactive or toxic) Yes 4 0 If hazardous waste is stored out of doors is it covered from the elements? Yes No AIJ, Is it in 110% containment? Yes No If hazardous waste is stored indoors is it on an impervious floo Yes No - 2 - Y FLOOR DRAINS (Chapter 381) Town Sewer Account Number: 0AJ 3�PnG s ysr 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? a No Age: � Is removal required? Yes No If yes,w�h�en? Is testing required?6 No If yes,when? 02011 Out of doors above ground storage tank on site? Yes 6� 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 J A-t-,f- rA-A1,VJ A-,y6 90,U77f-/1J69s k1,4-Sim /z_ 7P 13 e- ,Baff- &_, AR,- 77 3er L_4x3e7_,A le//Tl7 J��7�LA?�D Rt-. c_pBm' A "-sm - lC6T'` coLn%wixiG- /E-6s ow-P__eu ' PA-65, g1(,5 old Bootts A-ijb 5Pezz)y l>F::� f/m Star Alb QUA-ti"TLry APPieoPRCIA-rc7n toruTAJ A- FOTEI1MA-- 5P1LZ. 6iJ 5 ITC, /5 _77) 96 ObrAIA36b . ") Q3a/,J A .2_042_ rE91-e-17 7V A-,Nb/®2 L)77 LIZC ,cc®A,- VqAf d/U6_-f0ffKAfhA D ELEiIC;tJ 04t,ZoaJ,9 p,P IM2:2p .Oyj u 6v/a PA&P,+Ajr- 6AS C y�f,J bOaS AXE 4,4je • Date: , OMIZZ Public Health Inspector Facility Representative: xD/.� L/CCitJS� [/PJ���DIIL�'D ✓Gl Ni�•Z,�f�Z . - 3 - -P sw Cove"Imerlt I PWrW am sax) other bw kmcF,. --- -- ....... .... 0 Lvcat ao6rr nod El PIWID and s p T are owned by nW"Anwri�n Rehm,fife,or i[dWdual. V. Tym or FttCnjw .,led the Faf�r Desr�ttarr(cttedc ap theft — fzas Sta»r�n 1Aettrla Tmcbx ffranspod PehnbMn 019hundor Raboad WNW Ahpod ReWdimlhd A Owner b Farm Vetdde Dsakwft C (mob" VI. Cou rmT Pit w oiF Twats Name- (J .'� T HOWQ PA Address Ptone Number( area cock): Job TM: (9ytfni�- 140 NnUTA ST. � 4z0-I i t tWNi 5 a p1'1A. D26ol V1i. Fnumema. R Ls" M have not the*mciW respwm'bft mauirumfis in accordance with W7 CAM 9.00. Check aq fhat apply- p W kmcance O Guww tee - D Leber of credo l Cemmer"kmrance ❑Surety Bond O Tnud Furl ❑Risk Riderdion GrouP Q State Ffmd O Other Mediod Mined-Specify Provide poky vdnrmation,certificate of cw4twwe Wforrr eMon or othm verification. Villa ENtV _01H WTAL SM INFOMATWU Th s inform Mw should be available ftom klcat heatih agent eommvahon co mnnion.or plmft depa*=L t.Tank ske be a fed in weEmad pwUmfim area pYw Ono, 2.Tank site braked in surface dm ton .wafersuPPty pmtmbn eras oyes ❑No 3.Tank site bcated within 100 W of a wend O Yes Oft 4 Tank s#e i)cated withm 3o0 feet of a stream or wad body Dices ONO . DSSCMpnolf OF SSE TAHM AND f%PfU f (CouKE1E FOR EACH Tic AT IM LOCATION) Tank kkmdficatiaf Number Tank No. Tank NM Tarn No- Twdc No- TW*NoL_ 1.Tank statrrsa Tank m %sedW*(it known) h.Cr randy in Use s—1 a Thy Out of to(Start Date) d.Permanendy Out of tlse e.thwmgmund swrage tank 1UST) t 13UST ❑UST OUST DUST I e of k►wblatbn( yhR) l�i•�yL 3 Eetimaw Tow Capsay ) rl V 641 -- Pdge 2 A- Sudan m-Gummy or L SRIM � L40wvetdclgor h tw ow'OMariru OW OMwM ❑MV OMOM OMV ❑Marka OMv OAAMina Doom DOOM Oai6wr Oolhor 006M b.cat Ljotorvet"orOUMuee UMV oMRdna vUv ORWM OW OAUM OW ❑Marta OMV ❑Marra Doom UG1hw Ooher Oadw OottM C.Konumm CL ,c "tW kid used emdusrreg►for am WRIBL e.waste ON F IV f.00W.Please specify (other CERCL A nam and/or CAS number ————— Mbdm of Substarwes Please City Mai lofCarte-Tank(mako*o* Bare sty ruickides asptot and epoxy C� r—�--1 Gaihodre8y mooed 1�—� Cam(swel with lass) C� r Fftwolm rebft©ed pla sk(FRP). Concrete 71 E-- �� Q C� U —1 Urdmown other Please specify 6_Type of C0n5hrnicfi0n-TaF* (hkvk onl 0w) Single wad Double vraW PWWSPBCW is to*fined? q� ❑ram OYm Elm Oym oao orr� o� ova ONO �tarktweexcavzrt��' O� over arm o, ❑No ores oNo Ones o� Page a FFL2w(w i-d p E' f Tank rder->tificatlon Number(cons.) Tank NO--& Tank No. Tank No— Tnnk No_ Tank No: 7. Material of Con6ruc w Piping(niaik al One) Dare steel Cncludes asph p.galvanizedc� ) �� �� � C�_, Cathodically protected steel Fiberglass reinforced plastic(FOP) Flexible Copper Unknown Other Please specify 8- Type of Construction-Pqping(mark only Single warted Double walled Unimown _ Other Please specify Has piping been repaired? Oyes pNo OYes Oft OYes ❑No OYes ❑No ❑Yes ONo Is PIRi►9 gravity feed? O Yes OW ❑Yes ❑No O Yes O No ❑Yes ❑No O Yes O No bate X. INSTALLATION COMPLIANCE 1. Installation A. Installer certified by tank and piping manufacturers B. Installer certified or licensed by the implementing agency C.Installation inspected by a registered PS engineer D.Installation inspected and approved by �� 0 the implementing agency E_Manufacturers'installation checklists "'1Z �� u have been completed F. Another method allowed by 527 CMR 9.00. Please specify _ 2_Tank Leak Detection Tank -- ° = Tank s? '. Tank Tank -T Tank -; , (mark only one) A.Double-wall tank-Interstitial monitoring x '" �q ❑ - - D ❑ B.Approved in-tank monitor El F1 `� _ - El C.Soil vapor monitoring(check one below) �. - -";bL - i ae+ Q rtAnnlldy l-1 ContinUOUS - r; E.Other method-allowed by S27 CMR 9.00. Please specify R r Tank Identification Number(coat.) Tank No. A Tank No: Tank No. Tank No- Tank No. 72 -3_ Piping Leak Detection(mark only one) Pik �A�9'" - Ong —---fi�-�. Pi�rtg Riving 'k. PressurizedX ❑ - ❑ ❑ El Ela. Interstitial space monitor b.Product line leak detector (mark off that apply balow) _ s - v '� : aS s>= Automatic flow restrictor* ,• �•_ _ Y 'i ❑Automatic shut-off device' -�N"` ' a D Continuous alarm' s —Q� ter-, Also requires annual best of device and piping tightness test or monthly vapor monitoring of soil. V - n Suct ion:Cheek valve at tank o --s B.Su - (Requires interstitial space monitor or -_'4 --; '.a ❑ - ❑ ❑ ❑ test ev ears line tightness ery three Y ) ❑Interstitial space monitor O Line tightness test dispenserC. on - v- ;- Suction:Check valve valee at (No monitor required) - ❑ =_ ❑ ___ D.Other method allowed by 527 CMR 9.00.Please specify 4. Date of last tightness test(tank&piping) Gravity feed piping ❑ ❑ ❑ ❑ ❑ ti.Spill containment and overflU protectitm ~Tank~;K* Tank rank I Tank �n r Tank31 A.Spill containment device installed _- ram- ❑ 2�• ❑ .. ❑ � � - '� •� B.Overfill prevention device installed ❑ Y - El ❑ ❑ El onme) 7. Daily Inventory Contra (mark only one j A. Manual gauging by stick and records El � � ❑ _, reconciliation ❑ ❑ 1 ❑ _ F - B. Mechanical tank gauge and rewrds ❑ reconciliation El : ❑ l Elr= ❑ =: Z ;' ' . C.Automatic gauging system ❑ El =}`_ = A El j 8. Cathodic Protection(if applicable) Tmdk pqftTank P'qft Tank Piping Tank Piping Tank Piping A Sacrificial Anode Type El El ❑ ❑ ❑ El El ❑ ❑ ❑ B. impressed Current Type ❑ ❑ ❑ ❑ ❑ ❑ ❑ Lla ❑ El C_ Date of fast Test Inspection:P - - Last Th -of pection: Date _- a - D - - X1. CEIMFICATION (tom and sign alter oolWeft eU seWTSo ) Ea B9th the b"IMb"sari tame 0e13t;of Fee Senrieea anti aye try taws led to the local fire deaarft t mug[be ffipried A 0WbwPW signalme WM fiat be wed an either p agwy tlmt 1 Rave p 1 declare under penally of lften�=a wn mmuir whh tha kdbrma6on aulmnuad in this and ag attaet� .and that based an my Itiguily of those indhrtduais inwwc ately tt orm>ble the 6dontmtiott,l tlelteVe third the suttmtued dtrumtetlo+r is bur,awAnater mrd sompieta. Gate, '.Name and olfxiai we at owner or owrrer^S euUtCliZed r (P" � ^ ,.► P—r. Septic System Sketch ' SAS "D" Box 59.5' ' s •s, Septic Tank 3js. j�l' ✓oo #228 ■ ' To Bassett Lane ► North Street ' A D Location: 228 North Street Figure 2 �1 1� mar Hyannis, MA 1 Not To Scale ` Date: May 28, 2008 o� 2 Based on Visual Observations Town of Barnstable Orr SHE Tp� P o Regulatory Services BARNSTABLE. « Thomas F. Geiler, Director 9Q 6 9. g ArEo �a Public Health Division Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAIMER This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observations and interpretations contained within this .1 report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would be listed on the "Disposal Works Construction,Permit". If you should have any questions regarding this report, please contact the certified Septic � System Inspector who conducted the inspection. Q-\SEPTlc\Disclaimer Private Septic[nspections.DOC h,{gt C7£ ��Z 1.� • _ ^ L t°.:' ( i ) iY Septic System Irpc ' n Re orta :, 'fir ,� y � `u� � Ai•: f 228 North,Street �R 2 J T. -. HyannislVlassaclusetts Ay x i t t r t F y A a r�+� ,,t ! !�'� -t. �x[r^.r) -� ,7 1 x a `. Y; ; - !.. .x ,ti,*r = x a!+' �" F �' ti v`.,� "-'.ti ,j.f FF r",•Y A1^'�/ +r� - - y �y[). e [ ei -+�� . :�a?` 4A•�r,t a t� M } °' »..May 29, ►2008 fi t 7 r A -� '� �. - �..� '}k i:', y � •_ �f t`.: ' ^`''y t j` i•A.t 1 F,r � -tT� �'. T t � ..! v� A � ! 1 a� `� !,< i Fw 4� ;.F»► t4 - , ", Y 7 r klA rd.. .• �J , •� � ' �' ,+ ra a I ` ^r aN ) J Y: r ^,'� d„ S ,�j4 e ' {z J •' s< ° if- µr» •'L, s� 7. L.• 1 i 1 :x'+ ' / r .,,] A � ,. ✓x �' ` }. f <t '?`� Wipare�l For: , ,•ter f .. n5 ��.^ s t, ♦ L .:'' t / 41 \�� r-c+'r+x.t Lommumty Dank r � •�. � r 1 1 .;1. �337 CoWlfk6ad. Sandwich' Massachusetts.02563 + vFtij � s +y � ! h {; J .Lx t Fr.. �� .r.dA` y r•j'. r,t i 1 1 •..� x m; • �. �. t' .y` l.,l ,✓ k.: f ,� J � '4 r(• F Y���5 '{i i x :�+ F� 1 7 t..- ! ,• r-_ y ., pY`Yi`_,. J R} t , ` ' i. '� �. x a �j .� `''�'� S.. .:.��'1.. J t d: j .r t 1 + J `� )# �? t - y • y' ,, '+ , Y Fst� ,,,. 3 ,! L .t '! r, y C','^x A� �t'�R. •• .` ' -. �� }#,. _.A+k t_ t t 77' ,s r ��}r. t A >,a +44 f t ':•„t a ti.. � }�t T -'�� � * �t A T '�'>° ��, J x' F '1 ^ f k., � �.t! C " �' � [ J • _ */ 4 -*` � b/ r. J,J Win' � _J rr.h r,y � f 1,t h [ .•x ',+r A i A Y,�y.� t' ,r.i+ •,,, r � r ' xY „*' . x'y Yl^r 1�- 1 ? r;i i k rY i i i d, •_ i , tr �'y �.:. Provlding'Innovative Solutions FO`r ' r '�` " ' �k• Solid Waste `� )'� f ' Health,& Safety ) Hazardous Waste Environmental Monitoring 1 ^` r t Glro:riefi ,, i 1V,Iaterials,Management, y Compltarice Outsourcing' 'r x., a i qK'v A Y r,` f,.. _ ✓ > M ?. .:< it ;::a �..;. '* i�� �y [`T � �.s x t � f kalll Office _ " c r F"F r r NeW,Hampshi e Office Y A ;: -,y' t�r�Hi+ hwa 1VI rrim�ck NHD3 54.'28 Roite 6A Sa d. ich A`0 563 w 0 a e ebs e e a 0 Phone: (508)'M 6034 Fax (508) 888 150.6" c www gseenv com '' ' '�t '€ ';Phone`(603)424.3004 •Eax;(603)424 3241 qu'. C� ' Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments f 228 North Street 1 { ��'1 ' Property Address Maghrabi Realty Trust, Yousri A. Maghrabi, Trustee b Owner Owner's Name ' information is H annis MA 02601 May 28, 2008 required for y y every page. t Cityrrown State Zip Code Date of Inspection ' Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important:When filling out A. General Information forms on the computer, use 1. Inspector: only the tab key ' to move your Terry F. Bauer cursor-do not Name of Inspector use the return key. Green Seal Environmental, Inc. Company Name 28 Route 6A Company Address Sandwich MA 02563 ' n Cityrrown State Zip Code 508.888.6034 3471 Telephone Number License Number B. Certification r� ' I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(316 CMR 15.000).The system: ' ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority , —7 &,, May 29, 2008 L or's Sig ure Date i inspection r h A rovin Authority Board The system Inspector shall submit a copy of thisreport to the Approving o ty of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Community Bank-228 to 240 North St,Hyannis.doc•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 2 Commonwealth of Massachusetts W Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ° M 228 North Street ' Property Address Maghrabi Realty Trust, Yousri A. Maghrabi, Trustee Owner Owner's Name ' information is Hyannis MA 02601 May required for Y Y 28, 2008 every page. City/Town State Zip Code Date of Inspection ' B. Certification (cont.) ' Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ' ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. ' Comments: System was in good working condition on the day of inspection. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be ' replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes, no or not determined (Y, N, ND) in the❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. ' System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate ' of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ' ❑ obstruction is removed ' Community Bank-228 to 240 North St,Hyannis.doc-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 2 ' Commonwealth of Massachusetts W Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 228 North Street ' Property Address Maghrabi Realty Trust, Yousri A. Maghrabi, Trustee Owner Owners Name ' information is Hyannis MA 02601 May 28, 2008 required for Y y every page. Cityfrown State Zip Code Date of Inspection ' B. Certification (cont.) ' B) System Conditionally Passes(cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The ' system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: C) Further.Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR ' 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ' ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh ' 2. System will fail unless the Board of Health (and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank n❑ y p and SAS and the SAS Is within a Zone 1 of a public water ' supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ' Community Bank-228 to 240 North St,Hyannis.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 3 ' Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 228 North Street Property Address Maghrabi Realty Trust, Yousri A. Maghrabi, Trustee Owner Owner's Name ' information is Hyannis MA 02601 Ma 28, 2008 required for y y every page. Cityrrown State Zip Code Date of Inspection ' B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ' **This system passes if the well water analysis, performed at a DEP certified laboratory, for coli form bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or ' less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: ' Yes No ' ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool.is less than 6" below invert or available volume is less than '/day flow ' ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ' Community Bank-228 to 240 North St,Hyannis.doc-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 4 ' Commonwealth of Massachusetts . Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 228 North Street ' Property Address Maghrabi Realty Trust, Yousri A. Maghrabi, Trustee Owner Owner's Name ' information is Hyannis MA 02601 May 28, 2008 required for y _y every page. Cityrrown State Zip Code Date of Inspection ' B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ' ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ' ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This ' system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis ' and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. r Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ' ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ' ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the ,system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. ' Community Bank-228 to 240 North St,Hyannis.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 5 ' Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments lip w 228 North Street Property Address Maghrabi Realty Trust, Yousri A. Maghrabi, Trustee Owner Owners Name ' information is Hyannis MA 02601 May 28, 2008 required for Y Y every page. Cityrrown State Zip Code Date of Inspection ' C. Checklist Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No ' ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ' ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? r ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ' ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] Community Bank-228 to 240 North St,Hyannis.doc-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 6 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 228 North Street Property Address Maghrabi Realty Trust, Yousri A. Maghrabi, Trustee Owner Owner's Name ' information is Hyannis MA 02601 May 28, 2008 required for y Y every page. CityrFown State Zip Code Date of Inspection D. System Information ' Residential Flow Conditions: Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ❑ No ' Laundry system inspected? ❑ Yes ❑ No ' Seasonaluse? ❑ Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): ' Sump pump? ❑ Yes ❑ No ' Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Gasoline station/Repair facility Design flow(based on 310 CMR 15.203): Unknown, assume at least 400 gpd Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): 2 islands, 2 bays Grease trap present? ❑ Yes ® No ' Industrial waste holding tank present? ❑ Yes ® No Non-sanitary waste discharged to the Title 5 system? ElYes ® No Water meter readings, if available: - 2006-637 gpd, 2007 123 gpd ' Last date of occupancy/use: Unknown (likely 3 months ago) Date Other(describe): Community Bank-228 to 240 North St,Hyannis.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 7 Commonwealth of Massachusetts W Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ;M 228 North Street Property Address Maghrabi Realty Trust, Yousri A. Maghrabi, Trustee Owner Owners Name information is' Hyannis MA 02601 May 28, 2008 required for y y every page. Cityrrown State Zip Code Date of Inspection ' D. System Information (cont.) General Information Pumping Records: Source of information: Wastewater treatment facility(last pumped in 2005) Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: ' Type of System: ® Septic tank, distribution box, soil absorption system ' ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: ' Unknown age, but system repaired in 2005 Were sewage odors detected when arriving at the site? ❑ Yes ® No Community Bank-2211 to 240 North St,Hyannis.doc-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 8 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 228 North Street ' Property Address Maghrabi Realty Trust, Yousri A. Maghrabi, Trustee Owner Owner's Name ' information is Hyannis MA 02601 May 28, 2008 required for __y y every page. City(rown State Zip Code Date of Inspection ' D. System Information (cont.) ' Building Sewer(locate on site plan): Depth below grade: 0.5 feet ' Material of construction: ® cast iron ❑40 PVC ❑ other(explain): ' Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Sewer below slab. No leaks noted. No other sewer line components able to be seen. ' Septic Tank(locate on site plan): 1.5 Depth below grade: feet 1 Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 10'x5'x4.5' Sludge depth: off. Distance from top of sludge to bottom of outlet tee or baffle N/A Scum thickness Intermittant Distance from top of scum to top of outlet tee or baffle 4' Distance from bottom of scum to bottom of outlet tee or baffle 36" ' How were dimensions determined? Direct measurement ' Community Bank-228 to 240 North St,Hyannis.doc•03/08 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 9 ' Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ;M 228 North Street Property Address Maghrabi Realty Trust, Yousri A. Maghrabi, Trustee Owner Owner's Name ' information is Hyannis MA 02601 May 28, 2008 required for Y Y every page. Cityrrown State Zip Code Date of Inspection ' D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, ' liquid levels as related to outlet invert, evidence of leakage, etc.): No pumping required at this time. Inlet and outlet"T's" in good condition, no leaks in tank. Liquid level is at the outlet invert. Tank in good condition. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ' ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date ' Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: ' Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Community Bank-228 to 240 North St,Hyannis.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 10 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 228 North Street Property Address Maghrabi Realty Trust,Yousri A. Maghrabi, Trustee Owner Owners Name ' information is Hyannis MA 02601 May 28, 2008 required for y Y every page. Cityrrown State Zip Code Date of Inspection ' D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day ' Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No ' Date of last pumping: Date ' Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(If present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): ( "D" Box is level and flow equal using speed levelers. Minor solids carryover. No leakage into or out of"D" Box. ' Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No ' Alarms in working order: ❑ Yes ❑ No ' Community Bank-228 to 240 North St,Hyannis.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 11 Commonwealth of Massachusetts W Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 228 North Street Property Address Maghrabi Realty Trust, Yousri A. Maghrabi, Trustee Owner Owner's Name information is Hyannis MA 02601 May 28, 2008 required for Y y every page. Cityrrown State Zip Code Date of Inspection !. D. System Information (cont.) Comments(note condition of.pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 2-500 gals each ❑ leaching galleries number: r ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ' ❑ innovative/alternative system Type/name of technology: 1 Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil moist at bottom, no signs of hydraulic failure. No ponding. No lush vegetation nearby. i Community Bank-228 to 240 North St,Hyannis.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 12 I ' Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M s 228 North Street Property Address Maghrabi Realty Trust, Yousri A. Maghrabi, Trustee Owner Owner's Name information is Hyannis MA 02601 May 28, 2008 required for Y Y every page. Citylrown State Zip Code Date of Inspection ' D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration ' Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer ' Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): r ' Privy(locate on site plan): Materials of construction: ' Dimensions Depth of solids ' Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 1 Community Bank-228 to 240 North St,Hyannis.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 13 ' Commonwealth of Massachusetts W Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form- Not for Voluntary Assessments �M 228 North Street ' Property Address Maghrabi Realty Trust, Yousri A. Maghrabi, Trustee Owner Owner's Name information is Hyannis MA 02601 May 28, 2008 required for y y every page. City/Town State Zip Code Date of Inspection ' D. System Information (cont.) ' Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 1 Community Bank-228 to 240 North St,Hyannis.doc-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 14 Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 228 North Street Property Address Maghrabi Realty Trust, Yousri A. Maghrabi, Trustee Owner Owner's Name ' information is a Hyannis MA 02601 M 28, 2008 required for Y _Y every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) ' Site Exam: ® Check Slope ' ® Surface water ® Check cellar ' ® Shallow wells Estimated depth to high ground water: 14' below the SAS bottom ' feet Please indicate all methods used to determine the high ground water elevation: ' ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ' ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ' ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: ' See below. You must describe how you established the high ground water elevation: The Barnstable GIS map indictes a surface elevation of 39.73 at the SAS. The elevation of groundwater in an on-site monitoring well near the SAS is elevation 17.8'. The latest Cape Cod Commission indicator well data (Well Al W-230, Zone C, April 2008) indicates a groundwater flucuation of 2.2 feet upwards resulting in high groundwater at elevation 20. The bottom of SAS was measured to be at elevation 34.23, which results in a sepration from high groundwater of 14.23'. 1 ' Community Bank-228 to 240 North St,Hyannis-doe•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 Town of Barnstable oF'THE T Regulatory Services Thomas F. Geiler,Director Public Health Division BARNSTABLE, Thomas McKean,Director 1 MASS. . , 200 Main Street, Hyannis, MA 02601 ArFD MA't A Phone: 508-862-4644 Email: he alth(a,town.bamstable.ma.us Fax: 508-790-6304 Office Hours: M-F 8:00—4:30 July 29,2008 Mr.David Thornton, RE: Toxic and Hazardous Materials Owner On-Site Inventory and Inspection, North Street Automotive North Street Automotive, 240 North Street 240 North Street, Hyannis,MA 02601 Hyannis Dear Mr.Thornton: On July 17,2008, a Toxic and Hazardous Materials On-Site Inventory and Inspection of the above referenced site was conducted by the Public Health Division(PHD).An On-Site Inventory and Inspection is a review of the sites storage,transport,utilization and/or disposal of toxic and hazardous materials as it relates to the Town of Barnstable Ordinance,Chapter 108:Hazardous Materials. This Ordinance was adopted to protect the public health and welfare,especially as it pertains to the public drinking water supply. Please be aware that the Town of Barnstable has determined that a minimum of one-hundred and eleven(111)gallons of toxic and hazardous materials requires an annual license. The Inventory of this site indicates the use or storage capacity of approximately forty-one thousand, three hundred and ten(41,310)gallons of toxic and hazardous material.This material is used in vehicle repair and maintenance,and for retail sales. • The vehicle repair and maintenance garage houses an above ground oil storage tank,acetylene kit, covered oily rag bin and a work bench area.Used oil is drained into a wheeled container and emptied into the below ground waste oil storage tank. This business is newly operational and it is anticipated that Cyn Oil will be the waste oil hauler of choice.There were no floor drains observed. • The storage room adjacent to the garage contains shelving for quart bottles of oil,cans of miscellaneous spray cleaners,and automatic transmission fluid.Containers are comprised of plastic and in quantities of one gallon or less.This room also houses the new and old batteries. The batteries are provided by and returned to Interstate Battery for recycling.New England Environmental is the anticipated hauler for any waste antifreeze generated at the facility. • The store front area contains shelving for the retail sale of windshield washer fluid,engine oil and transmissions fluid. • The three underground gasoline storage tanks and one diesel tank were leaked tested on June 12, 2008 prior to the business starting operation,these storage tanks are equipped with a Veeder Root leak monitoring system.According to personnel from Smith&LaMountain Service Corp., leak detection service,the underground heating oil and waste oil tanks are equipped with an outer wall -2- alarm monitor,but are not equipped with an inventory sensor.The facility is not locatedlin.a'Zone of Contribution to Public Drinking Water Supply. • The Material Safety Data Sheets License to Store Handle Hazard ous s Mater ials,and Conting ency Plan were not available on site. • The building is served by an on site septic system. Any deficiencies which were discovered in the course of this inspection with regards to the Hazardous Materials Ordinance are described below. CORRECTIVE ACTIONS TO BE TAKEN: The used waste oil tank and satellite wheeled containers are to be clearly marked with the words "Regulated Recyclable Material","Used Fuel Oil'and"Toxic'. A"Spill Kit"containing absorbent pads,pigs or booms and speedy dry,in size and quantity appropriate to contain a potential spill on site,is to be obtained. A Contingency Plan is to be completed and submitted to the Town with the 2008—2009 Application for Permit to store and/or utilize more than 111 gallons of hazardous materials(enclosed).This Plan,at a minimum,is to list emergency contact telephone numbers to be used in the event of a hazardous materials spill(i.e. Owner,local fire and police,hazardous waste hauler,and the Department of Environmental Protection),the location of the Material Safety Data Sheets,and the location of the Spill Kit. Please be aware that,in the fixture,manifests sheets are required to be filed on site as documentation demonstrating the proper disposal of all hazardous materials/waste. The PHD appreciates your cooperation and acknowledges your intent to maintain compliance with the Hazardous Materials Ordinance. This office will conduct a follow-up inspection within four weeks to verify that all corrective actions have been taken. Please contact me at the above telephone number should you have any questions or comments regarding the Inspection of your site. Very ly yours, Cyn�x' A.Martin Hazardous Materials Specialist All orders to correct iolations of Chapter 108 of the Town of Barnstable.Ordinance: Hazardous rials shall be com eted upon receipt of this letter omas A.Mc ean,RS,CHO Director of Public Health Enclosures: Toxic and Hazardous Materials On-Site Inventory Application for Permit to store and/or utilize more than 111 gallons of hazardous materials Date: TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: AZO47,Y 137. &7V "ai/Ve BUSINESS LOCATION: .7-09 ✓VOR77I ST_ &AAJ&Ll ' INVENTORY MAILING ADDRESS: 601/� _ TOTAL AMOUNT- TELEPHONE NUMBER: 7 /- (n CONTACT PERSON: 6 AVI-6 71Ao✓-XJ7T'J EMERGENCY CONTACT TELEPHONE NUMBER: ,-D,f - /6 510 MSDS ON SITE? TYPE OF BUSINESS: C$S +A)j S C7ei/la S 7A-770AJ �Vo INFORMATION/RECOMMENDATIONS: S eZE �/ �iuS�°��?lot� Fire Dis rict: Le7l9:P-- b A7PF_6 L-V �� zca- / h�JIVls Waste Transportation: Last shipment of hazardous.waste: Name of Hauler• D E 'c.+A,)4 Destination: Waste Product� &_A'v' 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 Motor Oils + -e usl- Pesticides -13VNEW JV USED (iApA r �-/ (insecticides, herbicides, rodenticides) orr� Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) �0 �! 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 removersNn (including bleach) Spot removers & cleaning fluids &�n 6N (dry cleaners) SL-�y�cE �p 7�cNuici�,u -yr.�� s� red Other cleaning solvents WA-SIV oic- rAQK A-,vb �Z of(- TA-A1kS Bug and tar removers u.1Cl� r:-mvI 0u37"'H1 A-jj ourr'e_IAJ -cam 11 Windshield wash Q ��2�. M�t-� A,v �/��,�,rod y st`N3o�. WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS ci ' YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$30.00 for Ayears). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do b M.G.L.-it does not give you ermissi6n�o a`p j Y Y 9 Y P era C�usiness Certificates are available at the Town Clerk's Office, 1"FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) N, DATE: I Fill in please: ` APPLICANT'S YOUR NAME/S: //i97/i>O i1/�7?J-+� �SINESS YOUR HOME ADDRESS: 9r —Z&eITT- � ju �:= 's,x►/�e 9 .. 0ol�6�i _,.. TELEPHONE # Home Telephone Numbe NAME::OF CORPORATIOWA—V;7/ NAME:OF NEW BUSINESS�a�Tl� st' iz 7Nri�r ,, TYPE OF BUSINESS Sc: ✓i Lc. S1>97.p, IS THI S'A HOME OCCUPATION? YES NO ADDRESS OF BUSINE9S2' MAP PARCEL NUMBER / (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 COMMISSIONER'S OFFIC This individual has 42Rninforme any permit requirements that pertain to this type of business. Authorized Signatur COMMENTS: 2. BOARD OF HEALTH This individual has be nfor o the rm' quirements that pertain to this type of business. MUSTCOMPLYWITHALL. HAZARDOUS MATERIALS REGULATIONS utho gnat COMMENTS: 3. CONSUMER AFFAIRS (LICENSING,AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: Date: TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORYf �z NAME OF BUSINESS: ��� �� �'`� ej.c ^,O_ -vlq-e�- BUSINESS LOCATION: �a��a`�y /ter ` S% INVENTORY MAILING ADDRESS: hl�j I'V1 TOTAL AMOUNT: TELEPHONE NUMBER:�� � CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: Sy�f �� "��7/ MSDS ON SITE? TYPE OF BUSINESS: Sel-Ji Zc% -�'*0/22;41 INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous.waste: Name of Hauler: _ Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. 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 AntifnN ze (for gasoline or coolant systems) Misc. Corrosive EW vUSED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) bnlf Hydraulic fluid (including brake fluid) Refrigerants Motor ils Pesticides r NEW USED (insecticides, herbicides, rodenticides) I Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) l� Diesel Fuel, kerosene, #2 heating oil NEW USED 0A11 Misc. petroleum products: grease, Photochemicals (Developer) �-6-cl/ lubricants, gear oil NEW USED r 6001l Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine � cec'l 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 &A)77C-/PA7E 0j9Wj,06- Sus)OESS K1ii7f/r (including bleach) Vllt-� S Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents /7 Bug and tar removers �•/ • (� Windshield wash v' \ (j�l I WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Date: / .:P?.,71 TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: BUSINESS LOCATION: 77 f 0 xlOFw T1 INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: S 0, -�i 7 CONTACT PERSON. EMERGENCY CONTACT TELEPHONE NUMBER: O� �a' "�6�� MSDS ON SITE? TYPE OF BUSINESS. 4r.TT INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: A,�szw_ Name of Hauler: . 'V,8) Destination: Waste Product: r3 ► ( Licensed? s o 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. Ob erved/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 Motor Oils �-- p Pesticides NEW USED ; (insecticides, herbicides, rodenticides) r 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)/BatteriE((; Z/ Lye or caustic soda Rustproofers /1 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 (including bleach) Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers s �- Windshield wash WHITE COPY-HEALTH DEPARTMENT!CANARY COPY-BUSINESS ♦M +^,+n.se .btq,..x qT•b°-�ru- ^. r:u''7L:. '• . .., t.. �-++. �.z npu. ,r"•''�.«.s.tE.tZ n. 4,,.}y+.+,. ...� ° „�•ji�'�?�y y,�,�1pG�.:,�� � 41.. . . . . . . . . . . . . . . ... .:.,...._ :. .:. . . �,; Date': TOWN- OF BARNSTABLE t TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY 0"11 NAME OF BUSINESS- ' 35_ Y BUSINESS.LOCATION: Y / *'INVENTORY MAILING ADDRESS-'—. /�'�'�t TOTAL_AMOU'NT. TELEPHONE NUMBER: . : f G 7X7 CONTACT PERON: f . . S EMERGENCY CONTACT TELEPHONE NYUMBER: Sy ' �°� V f a - MSDS ON SITE? TYPE OF BUSINESS: � f INFORMATION/RECOMMENDATIONS: E Fire District: Y* _ . ' ,•:� �:,.��. � �:, -. �`�r:; � �� art_ 4 .:''�� �. -e ...•. - "4 .Q y- n�- Waste a o Tr `ns rtatio -Last shi merit of hazardous waste: ' P Name of Hauler: � =-",. -`' Destination: Waste Product. Licensed? YiK3io NOTE: Under the provisions of°Ch. 111, Section 31,,,of the General Laws of MA, hazardous materials use, storage and disposal of 1-1'1 gallons or more a month\re, uires a license from the Public Health Division. I; LIST OF TOXIC AND HAZARDOUS.MATERIALS � r .The Board"of Health and the Public Health Division have determined that the following products,exhibit toxic v � r fvolume. or`hazardous characteristics and must be registered rega dles's,o .Oi $erved/Maximum` Observed/Maximum Antifreeze (for gasoline or coolant systems) Misc. Corrosive NEW USED Cesspool cleaners Automatic transmiss.ion�fyluiyl r " ' Disinfectants k.Engine and radiator flushes i �� f i Ro'a'd7Salts (Halite) Hydraulic fluid'(rncluding brake fluid) Refrigerants ---_ �__-:: 'Pesticides ,r � : - d•=• .. __ ''-IS i r !,^ e.» fCJ 1.,-.../, � N-E-W USED v7jf,�,� � + / (in,ecticides, herbicides, rodenticides). Gasoline, Jet fuel, Aviatio,.n;.gas tart 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 — Degreasersrfor driveway's &garages Wood preservatives (creosote). # F Caulk/Grout Swimming pool chlorine / s ` Battery acid (electrolyte)/BatteriE rl 2� Lye or caustic soda Rustproofers , Misc. Combustible Car wash detergents a Leather dyes 4 F ' Car waxes and polishes Fertilizers .` Asphalt & roofing tar PCB's r` _—Palnts7varr1isbe's-'stains-dyes _____ w: Other chlorinated hydrocarbons, Lacquer thinners ,, (inc. carbon tetrachloride) AE-W USED Any other products with "poison" labels Paint &varnish remo ers, deglossers (including chloroform, formaldehyde, Misc. Flammables }�" hydrochloric acid, other acids) 1; ;Floor &furniture strippers Other products not listed which you feel ,'r°41` Metal polishes ` ' may be toxic or hazardous (please list): `yFt Laundrytsoil & stain removers (Incl'uding-!blea6h): k+• - h Spot removers & cleaning fluids (dry cleaners) y ' Other cleaning solvents ' Bug and tar removers 4 , Windshield Aash �. t, WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS d ,��/tom 7/ TOWN OF BARNSTABLE l�"`� � S b TOXIC AND HAZARDOUS MATERIALS ON-SITE INVEN NAME OF BUSINESS: G�15{�i CfU ' 20 6b BUSINESS LOCATION: 'GzIP MAILING ADDRESS: it TOTAL AMOUNT: TELEPHONE NUMBER: M ^ PP.2 - 0) �ll!� Z1� CONTACT PERSON: � EMERGENCY CONTACT TELEPHONE NUMBER: ��' ��ea ' � MSD�S(ON SITE? TYPE OF BUSINESS: WKLill 1V10 INFORMATION/RECOMMENDATIONS: Fire District: 11oh' ' 11 � 11 Waste Transportation:�fj Last shipment of hazardous.waste: I2��9 DSO Name of Hauler: &4n Piz Destination, Waste Product: W&Ue 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 4 NEW USED Cesspool cleaners Au omatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils _ Pesticides 7/NEW S USED (insecticides, herbicides, rodenticides) t_j ,fib 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 (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: A+Auto Repair and Fuel Fax: — ........ - € Corp Name: Mailing Address Location: ::240 North Street,Hyannis Street: 240 North Street _...._ __... ......... ......... mappar: City: Hyannis Contact: Hassan Eissa State: Ma Telephone: '508-862-2758 Zip: 02601 Emergency: Person Interviewed: Hassan Eissa ......................_.................................................._..._......__. Business Contact Letter Date: Category: ,Fuel Inventory Site Visit Date: 6/21/2006 Type: 'Auto Repair Follow Up/Inspection Date: .._.. .... .....__._.. __... public water W indoor floor drains ❑ outdoor surface drains ❑d license required ❑ private water W indoor holding tank mdc ❑ outdoor holding tank mdc d❑ currently licensed ❑ town sewage ❑ indoor catch basin/drywell ❑ outdoor catch basin/drywell expir ..... ............ .. date: ..... 6/30/2007 on-site sewage y ❑ outdoor onsite system --- ----- ----g El on-sites ste HANDEX TEMP.PLUGGED DRAINS. MDC TRAP IN PLACE BUT compliance: S f� FOLLOW-UP LEACH SYSTEM WAS PLUGGED. ALSO NO A/C WORK. Unsatisfactory OILFILTERS RECYCLED WITH CRT. RECYCLES ANTIFREEZE. Remarks: 2/3197 MSDS sheets on site. Recycle antifreeze on site. Multifold towels for spills. Laundry-Apparel Master-rags for spills. I Spedi dry for spills. Brass tags on tanks. See 1997.inspection form for undated list of toxic&haz.Mat.At site.REMARKS: MSDS in office. MAD 0985279991. Antifreeze recycling machine on-site. Interstate or NAPA takes old batteries. Unifirst dies rags and uniforms. Floor drain in Inspection bay. Speedy dry used on-site. 8/26/04 Went to this location for hazmat inspection. No occupant. Building is being gutted by const.crew and being renovated at this time. No 2004 r � � inspection completed yet. 9/14/2005 alp-OBSERVATIONS: New business owner,no MSDS,no manifest yet but will use Cyn Oil when transporting hazardous waste oil.Upon arrival of inspection,anitfreeze was draining from car and running out of garage. Asked them to clean ���� up immediately with speedy dry(they were slow in response time,had to ask them to do it),550 gallon underground holding tank for waste oil and waste antifreeze,we think they combined,outside.Procedure is to open the lid up,unscrew cap and pour the waste into the drain. Could / �a\'� /I (} � hu R L be a problem if there is an accidental spill or release,kind of a messyS V� procedure.Mop bucket is full of oil/water from floor clean up,when .a asked where they dump it,it goes into the outdoor holding tank.Not on a well head protection area,will be implementing a car wash unit in the future.Had septic problems,had a tank removed on 9/1 with DEP and DS present.ORDERS:empty containers immediatelyly,,obtain an oily S �i rag container with lid,obtain a spill kit,ask Cyn Oil about the seperation of antifreeze and oil-use a 55 gallon drum for the waste antifreeze.Label all waste oil containers with"haz waste"or"waste v oil",remove tires from out back.6121/06 alp-rags on floor-not in rag can with lid-stated one was ordered and should be on it's way, approximately 125+tires stored outdoor in back of building,no labels on the waste oil accumulation stations, preset ,l ep caps and lids on containers all times,containers a are not labeled must have a labeling on it with its contents,must have all manifests on site at all times with disposal information. 4Ad , 46 ) 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 r umt "` su e. r .:v "? riescnption. ..:.. of antifreeze(for gasoline or coolant systems) 27 gallons au_ __...�.� _.... __....... ........ tomatic tran nss m�issiono flui. d 5 gallons✓ hydraulic fluid s(in clu d in g break fl uid) 2'gallons✓ t _..._.... _..._.___--_ - _ -- ..... ._ .... ____........ .. .........._...__ motor oil ._....____....._....,__4.. gallons ___..._.._..............__... gasoline 30000 gallons J11A diesel fuel,kerosene,#2 heating oil 10000 gallons Batteries 26 gallons��� Misc.Flammable 2 gallons ._.__ Freon waste oil ( 565 gallons Windshield Wash 35 gallons / V __..._.._._._.........__.. misc.petroleum products:grease,lubricants 7 gallons Waste Transporter: ',Cyn Oil Fire District: ;Hyannis Last HW Shipment Date: 12/19/2006 Waste Hauler Licensed: Yes 11.41 OIL WASTE OIL OIL FILTERS ANTIFREEZE WASTE ANITFREEZE V/ boy w� W GASOLINE WASTE GAS DIESEL FUEL W/W FLUID ATF ro HYDRAULIC/ MISC. MISC. MISC. MISC. BRAKE FLUID COMMBUSTIBLE FLAMMABLE CORROSIVE PETROLEUM I (GEAR OIL/GREASE/ ILUBRICANTS) FREON ACETYLENE CAR WASH CAR WASH PAINTS/ 3 WAX DETERGENTS THINNERS 'I SEALANT CLEANING BATTERIES/ POISION/TOXIC CAULK/GROUT SOLVENTS BATTERY ACID @up FERTALIZERS WASTE SOLVENT MSDS MANIFESTS Town of Barnstable t�E T Regulatory Services Thomas F. Geiler,Director Public Health Division * s�xxsrAs Thomas McKean,Director MASS` 200 Main Street, Hyannis,MA 02601 Phone: 508-862-4644 Email: health()town.bamstable.ma.us Fax: 508-790-6304 Office Hours: M-F 8:00—4:30 July 3,2006 Mr.Eissa Hassan A+Auto Repair and Fuel 240 North Street I Hyannis,MA 02601 Dear Mr. Hassan: Thank you for your time and cooperation during the hazardous materials inventory and site visit at A+Auto Repair and Fuel on June 21,2006. This letter contains information from that visit that will help you become compliant with Chapter 108 of the Town of Barnstable Ordinance: Hazardous Materials. Enclosed is a copy of the Toxic and Hazardous Materials On-Site Inventory form from the visit to your business and a sample contingency plan. Please note the problems identified at your place of business during the hazardous materials inspection and their corresponding orders or recommendations listed below: PROBLEM: • No Material Safety Data Sheets on location. ORDER: • Please obtain Material Safety Data Sheets immediately for all hazardous materials stored on site. • The Material Safety Data Sheets shall be made available upon request of the Health Department and/or the Fire Department. See Chapter 108: Section 108-4(B). PROBLEM: • Waste oil is not properly labeled. ORDER: • Please label all waste products,including satellite accumulation stations,with the words "Waste Oil"or"Used Oil". �b PROBLEM: • Contingency plan not posted in areas throughout the facility. ORDER: • Please refer to the Town of Barnstable General Ordinance: Chapter 108: Hazardous Materials, Section 6(A-H). Reviewing your contingency plan for hazardous materials spills and related emergencies (and its location throughout the store)is highly recommended at this time. • Post contingency plan near all phones and at the site of generation. (see enclosed example) PROBLEM: • Stockpiling of tires outdoors. ORDER: • Remove tires that are currently being stored outside behind building. All amounts over ten(10)is considered stockpiling. Tires have the ability to hold water inside which attract mosquitoes that have been linked to carrying the West Nile Virus. PROBLEM: • Used shop rags have no specified storage. RECOMMENDATION: • Used shop rags must be picked up and stored in a metal container with a lid at all times. Containing your shop rags properly can prevent a fire hazard. Mr.Hassan stated that a rag can was ordered and will be available within one week. RECOMMENDATIONS: • Obtain a spill kit composed of proper personal protective equipment(i.e. gloves,glasses, absorbent pads, speedy dry). On Site Inventory Total The Toxic and Hazardous Materials On-Site Inventory from June 21, 2006 shows that you have approximately 41,163 gallons of toxic and hazardous materials being used, stored, generated and disposed of at A+Auto Repair and Fuel, 240 North Street,Hyannis,MA(Please see enclosed Toxic and Hazardous Materials On Site Inventory sheet). The Board of Health has determined that the using, storing, generating and disposing of over 111 gallons of hazardous materials per month requires businesses in the Town of Barnstable to obtain an annual Hazardous Materials License. This license has been obtained for the fiscal year 2006- 2007 and will expire on June 30, 2007. Please refer to the Town of Barnstable General Ordinance: Chapter 108, Section 6 (A-H). Reviewing your contingency plan for hazardous materials spills and related emergencies(and its location throughout the store)is highly recommended at this time. A representative from the Public Health Division will re-visit your business during the next 30 days as a follow up to further advise you on your compliance. If you have any questions about these problems,the orders and recommendations, or you need further information, guidance or assistance,please do not hesitate to contact the Public Health Division. Sincerely, Alisha L. Parker Hazardous Materials Specialist All orders to correct violations of Chapter 108 of the Town of Barnstable Ordinance: Hazardous Materials shall be co eted upon receipt of this letter. McKean,RS, C Director of Public Health Enc. On-Site Inventory(copy) , Contingency Plan(copy) Chapter 108 (copy) 1 A Plus Auto Repair & Fuel General Auto Repair Foreign&Domestic Tires&Electronic Wheel Balancing Exhaust-Brakes A/C Service Tune-Ups Alignment-State Inspections. Eissa,Hassan - 508-862-APLUS 2758 240 North Street Fax 508-862-2754 Hyannis,MA 02601 Y ' acC� a ff-ed Date: TOWN OF BARNSTABLE Pins �ctPc�• TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: &h fio&r, BUSINESS LOCATION: D 4 INVENTORY MAILING ADDRESS: �l �i TO/T/AL/AMOUNT: J TELEPHONE NUMBER: CONTACT PERSON:— EMERGENCY CONTACT JELEPHONENUMBER- MSDS ON SITE? TYPE OF BUSINESS: 61 17d INFORM TION/RECOMMENDATIONS: � � 5 �p- 6�1 � Fire District: 0 D' 4d Lf Waste Transportation: Last shipment of hazardous waster " Name of Hauler.• Destination: Waste Product: GU icensed? es 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) 3 Refrigerants Motor Oils Pesticides JLNEW JWLISED (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 (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS L Town of Barnstable-Health Department Page 1 HAZARDOUS MATERIALS INVENTORY SITE VISITS DBA: —Norte 4..es T_.___ Fax: Corp Name: Mailing Address Location: 240 'North Street,Hyannis Street. 240 North Stre t _.._ ......... __. mappar: City: Hyannis Contact: i—Being Renovated-No Occupant at this time State: Ma Telephone: Zip: 02601 I Emergency: A M O u4 Person Interviewed: CA/10 o .... . va Business Contact Letter Date: 8/20/2004 Category: Fuel Inventory Site Visit Date: 8/26/2004 Type: �O�Q�'/ Follow Up/Inspection Date: JJ T V w �.�'�� ❑� public water 0 indoor floor drains ❑ outdoor surface drains ❑ 0 license required �6f ❑ private water indoor holding tank mdc ❑ outdoor holding tank mdc ❑ currently licensed Q (� ❑ town sewage ❑ indoor catch basin/drywell ❑ outdoor catch basin/drywell expir - - - --- �►�1 r�. J t U l� ❑� on-site sewage ❑ indoor on-site syste ❑ outdoor onsite system date ........ .. ........... 0 / Q/� ,, 1'l HAN EX TEMP.PLUGGED DRAINS. MDC TRAP IN PLACE BUT compliance: �ll�� F LOW-UP LEACH SYSTEM WAS PLUGGED. ALSO NO A/C WORK. incomplete OILFILTERS RECYCLED WITH CRT. RECYCLES ANTIFREEZE. I W il.l emarks: 2/3197 MSDS sheets on site. Recycle antifreeze on site. — Multifold towels for spills. Laundry-Apparel Master-rags for spills. /J OI' Spedi dry for spills. Brass tags on tanks. See 1997 inspection form for undated list of toxic&haz.Mat.At site.REMARKS: MSDS in office. , MAD 0985279991. Antifreeze recycling machine on-site. Interstate or PL _kAI NAPA takes old batteries. Unifirst dies rags and uniforms. Floor drain IJ l b in Inspection bay. Speedy dry used on-site. 8/26104 Went to this location for hazmat inspection. No occupant. Building is being gutted by const.crew and being renovated at this time. No 2004 n"� 4Rspection completed yet. 0en255 Dui V aub ,pacr : Vj �� ✓ IlV( - r b UU(t OkA�� n tk F BYI pjl ) I 0 J `Ivll/�'C Q I"� ✓ rr Oil V 0�, VV0- 5 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 descr pt'ion 9 ,�, y ,';� unitof measure ,; antifreeze(for gasoline or coolant systems) 75;gallons __._._.._.__.........._...__.._.._.___._...__..........._...._._._....._._...._............._..____.____.._._...___.__..._..___ ._._._....--...__._.........:._....---__....._.__.__._........._._._....____...._.._.._...... automatic transmission fluid 12 gallons _._..._._.__._.__._ ._. __..._..__,._,,,,,,,,,,,,,,,,„____._____._....,___..__ __.. hydraulic fluids(including break fluid) .5gallons motor oil 370gallons ___._....._....__.__—................._._.................._.__...._.._._._...._.._....._._............._.._..____._..............._._._.._..._......._.__. .:_........_.__._......._........__._....__._........_.__.._._. gasoline _ 90Wgallons diesel fuel,kerosene,#2 heating oil 2000 gallons misc.petroleum products:grease,lubricants 150gallons degreasers for driveways and garages 25pounds__..______ _—_.__._..........__.__.___...____......_.__....._.......---__.___........_..._..._.__ .___—.__.___._...__.__..._____.__.._............_.,............._._......_.........................._........._......__........__. rustproofers 1gallons car wash detergents 2gallons __.... ............. _.__.._.. _ ._...._.._ ___..-__.._. _____....___ .. _.__._.. _.__... _. ...-.__..._._. _.. car waxes and polishes 1_gallons paint,varnishes,stains,dyes 4gallons _.__..._.._....__....__._......_.......__.__.._.._..............__.___.....__..._..__.....__.....______._._........___._....__.__._..._._._...................._..._......._._._...._..........._......._.._........._..__._._.__... Misc.paint product 1gallons metal polishes 1gallons Household cleaners,oven cleaners.�. 4gallons _._...—._..........._............ _.._..__._____. ..........................._.._ _ ......._. ___ _._._....... ...._._.__;._.,...__.._..._................,................._._...._....._ toilet cleaners 3 1'gallons disinfectants 1 gallons road salt 100 pounds pesticides 1,gallons Waste Transporter: !;Cyn Oil Fire District: Hyannis Last HW Shipment Date: Waste Hauler Licensed: No• Town of Barnstable-Health Department Page 1 HAZARDOUS MATERIALS INVENTORY SITE VISITS DBA: A+Auto Repair and Fuel Fax: _.. _. _.. Corp Name: Mailing Address Location: 240 North Street,Hyannis Street: 240 North Street ._......... _.._ ..... .......... .......... mappar: City: Hyannis Contact: Hassan Eissa State: Ma Telephone: i.508-862-2758 Zip: 02601 Emergency: ` Person Interviewed: Business Contact Letter Date: Category: .Fuel Inventory Site Visit Date: 9/14/2005 __......._... ......... ....... Type: ';Auto Repair Follow Up/Inspection Date: 0 public water ❑d indoor floor drains ❑ outdoor surface drains 0 license required ❑ private water 0 indoor holding tank mdc ❑ outdoor holding tank mdc ❑ currently licensed ❑ town sewage ❑ indoor catch basin/drywell ❑ outdoor catch basin/drywell expir - - - - - 0 on-site sewage ❑ indoor on-site syste ❑ outdoor onsite system date: ...................... ........... __.. HANDEX TEMP.PLUGGED DRAINS. MDC TRAP IN PLACE BUT compliance: FOLLOW-UP LEACH SYSTEM WAS PLUGGED. ALSO NO A/C WORK. incomplete OILFILTERS RECYCLED WITH CRT. RECYCLES ANTIFREEZE. Remarks: 2/3197 MSDS sheets on site. Recycle antifreeze on site. Multifold towels for spills. Laundry-Apparel Master-rags for spills. Sped!dry for spills. Brass tags on tanks. See 1997 inspection form for undated list of toxic&haz.Mat.At site.REMARKS: MSDS in office. MAD 0985279991. Antifreeze recycling machine on-site. Interstate or NAPA takes old batteries. Unifirst dies rags and uniforms. Floor drain in Inspection bay. Speedy dry used on-site. 8/26/04 Went to this location for hazmat inspection. No occupant. Building'is being gutted by const.crew and being renovated at this time. No 2004 inspection completed yet. 9/14/2005 alp-OBSERVATIONS: New business owner,no MSDS,no manifest yet but will use Cyn Oil when transporting hazardous waste oil.Upon arrival of inspection,anitfreeze was draining from car and running out of garage. Asked them to clean up immediately with speedy dry(they were slow in response time,had to ask them to do it),550 gallon underground holding tank for waste oil and waste antifreeze,we think they combined,outside.Procedure is to open the lid up,unscrew cap and pour the waste into the drain. Could be a problem if there is an accidental spill or release,kind of a messy procedure.Mop bucket is full of oil/water from floor clean up,when asked where they dump it,it goes into the outdoor holding tank.Not on a well head protection area,will be implementing a car wash unit in the future.Had septic problems,had a tank removed on 9/14/2005 with DEP and DS present.ORDERS:empty containers immediately,obtain an oily rag container with lid,obtain a spill kit,ask Cyn Oil about the seperation of antifreeze and oil-use a 55 gallon drum for the waste antifreeze.Label all waste oil containers with"haz waste"or"waste oil",remove tires from out back. 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 qty's 111 gals or more ri � scnptlon �:' g un t ofineasure. ,f automatic antifreeze(for gasoline or coolant systems) _._.._...._.................._..E..,__........................_49�gallons_...._....... ........__....._..._.._..__ ..... ............... ......... ........ atic transmission fluid 9•gallons hydraulic fluids(including break fluid) 1 gallons motor oil 395 gallons _ ....._.... ._ ._ .....__._. . ... �� . ..._._.... .......... gasoline 30000 gallons diesel fuel,kerosene,#2 heating oil 10000 gallons __. _____...... _.,_.._.._...___ Batteries i42 gallons waste oil 565 gallons _ _.�.. ._____-__........._._ .......�..____. _ _ _....e._....._..__... _.. .._...._._.___.._.�._e._.._.... Windshield Wash 301gallons misc.petroleum products:grease,lubricants 6 gallons _. ....��. ....__ ._. _ _.._ __. .....�......� g _...... _ ..._........._.__....33 gallons_ _.......____ .... refri erants ........ Waste Transporter: Cyn Oil Fire District: ,Hyannis _ .........._. .......... .............. Last HW Shipment Date: Waste Hauler Licensed: No - - a TOWN OF BARNSTABLE LOCATION �� /VC RT 1 ' SEWAGE # 0,'•- VILLAGE ASSESSOR'S MAP & LOT�r d3 9 INSTALLER'S NAME&PHONE NO. ism dvla-Tz- 41.20-W0 SEPTIC TANK CAPACITY ��dd LEACHING FACILITY: (type) �' � ✓}✓�/� (size) NO.OF BEDROOMS BUILDER OR OWNER f- —cad' PERMITDATE: L7-2�0< COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility'(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by c7�9�� �� � ��� 7 -..y 9 !� r - e i No rn o r �. ti Fee®0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipprttation for Mfigpool bpgtem Congtruction Permit Application for a Permit to Construct( . )Repair(4/)Upgrade( )Abandon( ) D Complete System ❑Individual Components Location Address or Lot No.,2oV MOO 9--r Owner's Name,Address and Tel.No. ih 'uo� / Assessor's Map/Parcel ���t� � ° (uv I /`r• M g y h"I.j1' Installer's Name,Address,and Tel.No. 499w/yl� Designer's Name,Address and Tel.No. @0 tr C4. pef mftra is 4�-415 Type of Building: a��!fdl"J,. e2 °Yf Dwelling No.of Bedrooms N Lot Size 079'7q7 sq.ft. Garbage Grinder( ) Other Type of Building p No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow lh�o gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank ;h'^C�l� Type of S.A.S. t A w Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of vir 1 Code and not to place the system in operation until a Certifi- cate of Compliance has been is s ar f e Signed Date I S Application Approved by I Date !2"a�'�r t Application Disapproved f e foil wing reasons Permit No. 2 &E—!Z 7 Date Issue ot_ 1 t �•Z-" � Fee / �4t! "No `" '` Entered in computer: ,�r THE COMMONWEALTH OF MASSACHUSETTS ; Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS , Zippricatton for Migpo!641 *#Meta Contructton Permit A PTiation fora"Pemto`Construct Repair(J Upgrade Abandon O Complete System •E1 Individual Components Location Address or Lot No- Sr Owner's Name,Address and Tel.No. Assessor's Map/Parcel ��1,f ,L� ^ �1P 0, Installer's Name,Address,and Tel.No. F-�R /�}y�/"T�- Designer's Name,Address and Tel No. @b Trwmr.Cto- Po � IJnf� 1•a�J� m�c-L ��?v-�5� -e Mc Type of Building: Dwelling No.of Bedrooms Lot Size d 7y7 sq.ft. Garbage Grinder( ) Other Type of Building f Gf�S No.of Persons Showers( ) Cafeteria( Other Fixtures �� Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date w; Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) c;a, 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 oJ'acof vi ©n 1 Code and not to place the system in operation until a Certifi- cate of Compliance has been issue b. this B e Signed DatetS Application Approved by r Date -cr t' Application Disapproved a following reasons Permit No. 2 b&9S_- c[7 '7 Date Issued 6� THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS a} 'S IcOs f Certificate of Compliance THIS IS TO C RTIFY,that the On-site Sewage Disposal System Constructed( )Repaired (�)Upgraded( ) Abandoned )by &PPAI)I*Tub at c a /VO)Qy/ fsr- has been constructeid in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. Our-t/-7 ° dated 9 � of Installer L3 OY &OM6 Designer The issuance of thig permit shall not be construed as a guarantee that the s e 1 c 'on as designed. Date Inspecto No. c� U 7 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS 1=igpogal *pgtem Contructiotf Permit Permission is hereby ranted to Construct( )Repair(/)Upgrade( )Abandon( ) System located at d0T5 11164 tr7 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 th s pe t. Date: I' Or Approved by k Town of Barnstable i Regulatory Services i Thomas F. Geller,Director t iNAM a Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: '1 0 1^JS-�;-Sewage Permit## 0. = 474 Assessor's MapiParcel� Designer: Installer: -I (i cvtn Aytl � Address: �'Z �N_ c�G'4 C 1�ICC�Zi11 Address: 26 Tk`Q 1 u Cl-2 s 4, rk le b a ZQ Lk(k r1Ok�f-s+CA-XJ J LAJ f MA On. 11610 S Srt-ckvt _ was issued a permit to install a 7-6 (date) 2,4tj (inst ller) septic system at I'2s (066-k S 4-. based on a design drawn by 1� (addr ss) dated -Z . ( signer) ' I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as'=built by designer to follow. J �O H OF Mass � qc �g PETER T, tiG ) "— MCENTEE -- ACIVIC y I ler'nstal na e)r No.35i09 90'�(c 9�Q/,T,nlO 2 �AlVR esigner's Signature) (Affix Designer's Stamp Here) PLEASE RETURN To '§,&R iSTABLE PUBLJC HEALTH DIVISIQN. CERJfFJ!CAJE OF GUIlIPLIAN_ E V!'ILL �iU1 BE ISSUED LTN I IL i<fU'ri4 'I HI5 FURM AND A S-BUILT C�4IiD ® RECEIVED BY THE BAI3'VSTABI.E PUBLIC HEALTH DIVI ION. THANI{ Q:Health/Septic/Designer Certification Form 3-26-04.doc On September 7 at 2:30 PM Don Desmarais, Mike Whiteside (DEP), and Brian Ayotte dug up the D-Box at A Plus Auto Repair, 228 North St. Hyannis. We discovered oil in the D-Box. The Station(water) is closed until a new title v system is installed. r 6a4�A Plus Auto Repair & Fuel General Auto Repair Foreign&Domestic Tires&Electronic Wheel Balancing Exhaust-Brakes A/C Service Tune-Ups Alignment-State Inspections Eissa, Hassan 508-862-APIUS- 2758° 240 North Street Fax 508-862-2754 Hyannis,MA 02601 t� P�OpIHETO Town of Barnstable 0,0 Department of Health, Safety, and Environmental Services * BARNSTABLE, MASS. 163939• Public Health Division �0 ArFD�AP�A 367 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas A.McKean FAX: 508-790-6304 Director of Public Health Eissa Hassan August 31, 2005 240 North St. Hyannis, MA. 02601 The property managed by you located at 240 (AKA 228) North St., Hyannis, MA. was inspected on August 30, 2005 by Donald Desmarais R.S., Health Inspector for the Town of Barnstable, because of a complaint regarding septic smells. During the inspection, you admitted sufficient facts that car washing was occurring at the A Plus Auto Repair and Fuel and using the septic tank to gather the water. I was also told that the septic tank was "full" and had to be pumped out. Violation of Town of Barnstable Code 081-02) Requirements for existing facilities. In addition to the above it was discovered that a Title V Inspection Report from 8/5/2003 referenced that there was oil in the D-Box and the line going out to the leaching. You are hereby ordered to Cease and Desist car washing at this site. You are also ordered to have a Title V Septic System Inspection done within 20 days. No water is to be introduced to the septic system until the inspection is done. When an inspector is hired to do the inspection, Donald Desmarais is to be notified no less than 3 days prior to the inspection so it can be witnessed. Non-compliance could result in a fine of not less than $200 Nor more than $1000. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Donald Desmarais R.S. Health Inspector Town of Barnstable Original received: Date: 05 9 P PERMIT To Maintain an Existing/New Storage Tank Facility for Storage Tanks Regulated under 527 CMR 9.00 In accordance with the provisions of 527 CMR 9.00 this permit to maintain an existing/new storage tank facility is granted to: Location of property: 2.d(lo Street address Owner of property: �bUa M"AKA.$ Full name of person,firm or corporation Number of storage tanks: 0 aboveground underground Facility to be maintained in accordance with the restrictions described below: X 101 X 1 b U00 DIES I t 000 F4eA-r W14S1-E Fee paid: $ 0 (M.G.L. Chapter 148, section 10A) 00 This permit will expire f<Z 31 ?ot �� Date Sign tune of Head of Fire Department or ap o ted designee (Owner's copy—To be posted at the storage facility) FP-`290 Permit(revised 3/00) 1010 COMMONWEALTH AVENUE. BOSTON City or Town) (Date) 1110 L In accordance with the provisions of Chapter 148 of the General Laws, a license is hereby granted to use the land herein described for the lawful use of the building.... or other structure.... which is/are or is/are to be situated thereon, and as described on the plot A(plan .�filed with the application for this license. Location of land .. ..! '� t40K ST ................................Nearest cross street her) Owner of land .... UIN..... .�s IYi� ..............................Address I ...��'1�}Ll�!�. 11� ....d Nuinber of buildings or other structures to which this license applies ........1.................................................................I.................... Occupancy or use of such buildings .. ....` 'f1 L.p�............................................................................................................ ............... Total capacity of tanks in gallons:—Aboveground.........0...... ..................................Un erground Av-5,7�...........i................... Kind of fluid to be stored in tanks ..1. ..6 AS. . 1�5�.L ....��0 K G } �p. 1.....................2 ..(SEA't11...... . .........../...... Restrictions—If any: ................................................................ ......................................................................................................... (Signature of licensing authority) THIS LICENSE OR A PHOTOSTATIC OR CERTIFIED COPY THEREOF MUST BE CONSPICUOUSLY POSTED IN A PROTECTED PLACE ON THE LAND FOR WHICH IT IS GRANTED - W DEPARTMENT OF. PUBLIC SAFETY—DIVISION OF FIRE PREVENTION 1010 COMMONWEALTH AVENUE BOSTON W;�Ws (City or Town) (Date) APPLICATION FOR LICENSE For the lawful use of the herein described building.... or other structure...., application is hereby made in accord- ance with the provisions of Chapter 148 of the General Laws, for a license to use the land on which such building.... or other structure.... is/are or is/are to be situated, and only to such,extent as shown on plot plan which is filed with and made a part of this application.. Location of land... ..... ( ............ Q ..... ............:.............ATearest cross street... .. SFi!t� ............................................ (Stre t Nu U ) Owner of land.......Qt).! t........� 1.......................Address ..�lz-.. .�F4T1 .... W.Y.....1.. �,i�tQLj � Number of buildings or other structures to which this application applies...A................................:................................................ Occupancy or use of such buildings... 5.... ?? "i O!! ........:..........................�..U Total capacity of tanks in gallons: Aboveground........... .:...... ........... ............ nder r �'4�.. .'..Sd..............Kind of fluid to be stored in tanks...� ..G � D..IC .F.�.�....� l4 K ............ ........ .....N+CT....(..I..ar.S .�...t CU1P►ST� pprove Disapproved ........... . ......:............... �.�r .:...� ................................. /............................................................... (Signature of Applicant) ............................................................... .................................................................................................. (Head of Fire DePt.) (Address) DEPARTMENT OF PUBLIC SAFETY—DIVISION OF FIRE PREVENTION 1010 COMMONWEALTH AVENUE. BOSTON isFMI 519ZOOS� c�M SYe�o City or Town) (Date) In accordance with the provisions of Chapter 148 of the General Laws, a license is hereby granted to use the land herein described for the lawful use of the building.... or other structure.... which is/are or is/are to be situated thereon, and as described on the plot A(plan .�filed with the application for this license. Location of land .. ..! '� ""Mn...ST....................................Nearest cross street4 Uer) Owner of land ..... � .....M.�.LV r .. ..............................Address �r rT.. �...��-1A 1.1�')Wit.....0... Number of buildings or other structures to which this license applies .......(...................................................................................... Occupancy or use of such buildings '.. ....r7Tt.Q1 ............................................................................................................ .............. Total capacity of tanks in gallons:—Aboveground.........0.........................................Un erground .. I. �r,�.......................... Kind of fluid to be stored in tanks A)-6,A$-/D-LC-5e1 ....C�'�IO..................... �'�..1?u. N�?.. 1,.5$� WAr. _ Restrictions—If any: .................................................................................................................................................................................... ........................................................................................................ (Signature of licensing authority) THIS LICENSE OR A PHOTOSTATIC OR CERTIFIED COPY THEREOF MUST BE CONSPICUOUSLY POSTED IN A PROTECTED PLACE ON THE LAND FOR WHICH IT IS GRANTED Town of Barnstable P# 0/ — ��pF THE Tpk� p Department of Regulatory Services 3 3 ` s,►ruvsTaer.e. y Public Health Division Date . MASS. 1639• �mq 200 Main Street,Hyannis MA 02601 prf0 Mph A Date Scheduled . Time L� Fee Pd. UU Soil Suitability Assessment for Sewage Disposal Performed By: Witnessed By: LOCATIIO�NA GENERAL INFORMATION Location Address 0 m rn �li`t� F Owner's Name • ? ., Address ~ 61✓VI t 1 Assessor's Map/Parcel: Engineer's Name NEW CONSTRUCTION REPAIR Telephone# �` o �NiAf,4t �/% Surface Stones N/A Land Use ,M L A ff3'J�nQ� Slopes(/o) Distances from: Open Water Body (940 ft Possible Wet Area ��®� ft Drinking Water Well Z/ov� ft . DrainageWay-7/06 ft Property Line ZO r�/— It Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands in proximity to,holes) (nn PEa�' wen N O O 27 �• s,a Tg�ts �� i � R� /SSA/✓D S _._.-_.-.-__ /-,�ST Parent material(geologic) Depth to Bedrock y77 / Depth to Groundwater: Standing Water in Hole: /l(of U6Sa",E6 Weeping from Pit Face�/r a,BSrX&4 a Estimated Seasonal High Groundwater ZS' X g5ei)O,j ev 11d0,,YV?/1J6 wEZc 6u/r#//v Zc' DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: in. Depth Observed standing in obs.hole: in. Depth to soil mottles: Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level PERCOLATION TEST Date Time Observation Tinte at 9" Hole# j7/)l Depth of Perc Time at 6" 9 6 Start Pre-soak Time n �D D U� �� ��rtJeA� Time( '�- ��) End Pre-soak a Rate Min./Inch Site Suitability Assessment: Site Passed V Site Failed: Additional Testing Needed(Y/N) original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:HEALTI-UW P/PERCFORM l _ DEEP OBSERVATION HOLE LOG Hole# 046 I Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(In.) (USDA) (Mansell) Mottling (structure,Stones,Boulders. r;ottsistenov °%aOravel).- f 9 DEEP OBSERVATION HOLE LOG Hole# wnf 2 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) Z _ 99, SAUa -7.s-yl 06 ' �L 7�V v ✓ `i �a�.S DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) Flood Insurance Rate Man: Above 500 year flood boundary No Yes Within 500 year boundary No V Yes Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? --4-01-- - If not,what is the depth of naturally occurring pervious material? Certification I certify that on e1V1�,4l8tL1,? date))have passed the abovehe soil analysisevaluator was performed by me consistent with Department of Environmental Pr tecoved by the tion and that the required training,ex rtise d experience described in 310 CMR 1.5.017. Signature s/� Date /� Q:HEALTH/W PMERCFORM Sep . 1; 2004 3:44PM 11o .07cc r . 414 COMMONWEALTH OF MASSACHUSETTS EXECUT VE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION SOUTHEAST REGIONAL OFFICE 20 RIVERSIDE DRIVE, LA9EVILLE, MA 02347 508-946-2700 MITT ROMNEY }JI•L$N R0 M.RZFELDER Governor CGFIY 1 �Sccreruy KERRY HEALEY 408ERT VZ 60LLEDGE,Sr. I�ieuzensneGovernor _4 �Cottimissiones t)RGENT LEGAL-MATTER:PROMFT ACTION NECESSARY �— � September 10, 2004 --b m Mr. David Weeks,Senior Environmental Pngin= RE- BARNSTABLE--BWSC Motiva Enterprises LLC Fornier Texaco Service Station 1830 South Road,I;nir 24 240 North StrecL Hyannis Wappinger Falls,NY 12590 RTN#4-18632 NOTICE OF RESPONS11I1UTY M.G.L c.21E,310 CMR 40.0000 Dear Mr.Weeks; On August 23,2004 the Department of Environr)umtal Protection.(tbc"Department")rezicived a Release Notification Form("RNP"), which indicates that a release of oil andlor hazardous material has occurred at the location referenced above. Contaminated soils were discovered in the vicinity of the sanitary leaching field at concentrations greater than the Repcmable Concentrations for Soil Category 1 per 310 CMR 40.1600. The Department received a Release Abatement Measure(RAM)P)an,prepared by Corporate Environmental Advisors,Tnc-,(CPA)on August 30,M. The Massachusetts Oil and Hazardous Material Release prevention and Response Act, M.G.L. c.21E,and the Massachusetts Contingency Plan(the"MCA ),310 CMR 40,0000,require the petformance of response actions to prevent harm to health,safety,public welfare and the erlviranment which may result from this release and/or threat of release and govem the conduct of such actions. The purpose of this Notice is to inform you of your legal responsibilities under State law for assessing and/or remediating the release at this property. F(r purposes of this Notice of Responsibility, the terms and phrases used herein shall have the meaning ascribed to such terms and phrases by the MCP unless the context clearly indicates otberwise. The Department has reason to believe that the release and/or threat of release, which has been reported, is or may he a disposal site as defins:d by the MCP. 'rho Department also has reason to believe that you (as used in this letter, "you;' refers.to Motiva Enterprises LLC) are a Potentially Responsible Party (a. "PRP")with liability under M.G.L.c..21E§5,for response action costs. Thvs liability is "strict",meaning that it is not based on fault.but solely on your status as owner,operator, generator,transporter, disposer on other person specified in M.G.L.c.21E§5. This liability is also"joint and several",meaning that you may be liable for all response action costs incurred at a disposal site regardless of the a stence of any other liable parties. The Department encourages paities with liabilities under M.G.L. c.21E to take prompt and appropriate actions in response to releases and threats of release of oil and/or hazardous materials. Tay raking prompt action, you may significantly lower your assesstnent and cleanup costs and/or avoid liability for costs This woruration l;ava11eh1e in after„ate r(priamL Ca11 t)0nJ1d M.come.ADA Coordinaior at 617.556-10ST.TDD 5enke,1.800-299.21A7. DEP on 010 world Wide web: 1&9-./A~.1nas6.8ov/dep Princes on Recycled Paper V0iz0'd b722S212180S 8 YlEd1SMIJUE[ d0 NMOi 80:9T b00i✓-ST-d9S r Sep , 1 • 2004 3:44PM 140 - OU4 r - o/ I 2 incurred by the Department in taking such actions. You may also avoid the imposition of,the amount of or reduce certain permit and/or annual compliance assurance fees payable under 310 CMR 4..00. Please refer to M.G.L.c.21E for a complete description of potential liability, l:or your convenience, a summary of liability under M G.L. c..21E is attached to this Notice. You should be aware that you may have claims against third parties for damages, including claims for contribution or reimbursement for the costs of cleanup. Such claims do not exist indefinitely but are govmmed by laws that establish the time allowed for.bringing litigation. The Dcparttncnr.encourages you to cake any action necessary to protect any such claims you may have against third parties SITE INFORMATION Information on file with the Department indicates the following contaminants were detected in soil samples collected from the site at concencrations which exccaded the Reportable Conocatrations for Soil Category 1 per 310 CMR 40.1600.. t:HEMI('AL CONCENTIWION RCS-1 Tetrachloroethene 34.5 mgft 0.S mg/4, TPH 57900 tng/kg 200 tngk' K>LLi'ASr+ ABATEMENT MEASURE PLAN On August 30,2004 the Department received a Release Abatement Measure(RAM)Plan prepared by C2A. The RAM Plan proposes the excavation of up to 600 cubic yards of soil in conjunction witt the insinuation of a replacement sanitary leachitig b.eld. In accordance with 310.CMIZ 40.0445,a RAM Status Report or Completion Statc:r mt must be submitted to the Department within 320 calendar days of August 30,2004.. This sits;shall not be deemed to have had all the ncccssary and required response actions taken unless and until all substantial harards presented by the release and/or threat of release have been eliminated and a level of No Significant Risk exists or has been achieved in compliance with M.G.L. c,21E and the MCP. Unless otherwise provided by the Department,porential)y responsible parties("PRP's")have one year from the initial date of notification to the Department of a release or threat of a release,pursuant to 310 CMR 40.0300,or from the date the Department issues a Notice of Responsibility,whichever occurs earlier, to file,with the Department one of the following submittals:(1)a completed Tier Classification Submittal;(2) a Response Action Outcome Smt:t rnent or,if applicable,(3)a Downgradient Property Status_ The deadline for either of the first two submittals for this disposal site is August 23,2005. If requited by the MCP,a completed Tier I Pernik Application must also accompany a Tier Classification Submittal. Tote MCP requires that a fee of$1200.00 he submitted to the Departwent when a Response Action Outeofne (-RAO")statement if fixed greater than 120 days from the date of notification. You trust employ or engage a Licensed Site Professional("LSP") to manage, supervise or actually perform the necessary response actions at this site, The Department has Michael Bingham of CEA listed as the LSP of Record_ VO/20'd VV22SLL80S 8 3-18d1SNNU9 d0 NMOi 80:9T b00Z-ST-d3S b0'd -Id101 3 If you have any quesdoas relative to this Notice, please contact Lmi Williamson at the letterhead address or at(508)946-2794. All future communications regarding this release must reference the following Release Tracking Numbei:4-18632. Very truly yours, kN Richard F.Packard,Chief Ph rgoncy Rcspoasc/Release Notification Section P/LW/re 4 19(M-ear Attachments- Summary of Liability under M.G.L, e..21E cc, Board of Health Board of Selectmen Fire Dept Corporate Environmental Advisors,Inc.. 127?Jattwell Street West Boylston,MA 01583 Ann_Michael Bingham,LSP b0ib0'd bb22SL Boo 8 8-19d1SNaUa d0 NM01 60:9T VOOE-ST-dSS T l 4C� D A P TITLE 5 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION MAP 3 0� _R Property Address: 240 North Street PARCa- Hyannis,MA 02601 LOT • Owner's Name: Kessler Installation and Sales(David Bigelow) Owner's Address:_495 Whiting Avenue Dedham,MA 02026 Date of Inspection: 8/5/03 RECEIVED Name of Inspector:Janet E. DuPont Company Name:Wind River Environmental AUG 2 5 2003 Mailing Address: 120 Great Western Road F BARNSTABLE South Dennis,MA 02660 TOWN O HEALTH DEPT. Telephone Number: 508-760-4827 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site i1 ( sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 �b l� (310 CMR 15.000). The system: Passes �o Conditionally Passes _X_ Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Q Date: t/ 01 039 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of 3 Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a (� ; design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments: Inspection was done at gas station that has been closed for over a year. I found one cover of tank at grade in parking area. Tank is'h full,leaking at the seam. There is no outlet access. D-box was located and opened. It was found to be full of oil and congealed oil. Since there was no asbuilt on file,I ran a cable through d-box outlet to find leaching. (Plan located post inspection at BOH)It appears that there is a sag in the line as the cable came ran through water and came back covered in oil and petroleum products. Exact location of leaching is still unknown as cable ran out over 50' and it is possible that cable was curling up in pit. Pit is possibly located under area heavily overgrown or under paved driveway area. Unable to run sewer camera due to heavy oil and lack of power source at site. Potential biohazard. Floor drains removed prior to inspection. ****This report only describes conditions"at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. f' OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 240 North Street Owner:Kessler Installation and Sales Date of Inspection:8/5/03 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined" please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. . *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 240 North Street Owner: Kessler Installation and Sales Date of Inspection: 8/5/03 C. Further Evaluation is Required by the Board of Health: _X_ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _X_ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system'has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance I "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other:_See comments on front page f OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 240 North Street Owner: Kessler Installation and Sales Date of Inspection:8/5/03 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than Yz day flow _X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. _X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _X_ Any portion of a cesspool or privy is within a Zone 1 of a public well. _X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _X_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] _No (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered"yes" in Section D above the Large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:240 North Street Owner:Kessler Installation and Sales Date of Inspection: 8/5/03 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No _X_ _ Pumping information was provided by the owner,occupant,or Board of Health _X_ Were any of the system components pumped out in the previous two weeks? _X_ Has the system received normal flows in the previous two week period ? _X_ Has large volume of water been introduced to the system recently or as part of this inspection? NA_ Were as built plans of the system obtained and examined?(If not available note as N/A) _X_ _ Was the facility or dwelling inspected for signs of sewage back up? _X_ _ Was the site inspected for signs of break out? _X_ _ Were all system components,excluding the SAS, located on site? _X_ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions, depth of liquid, depth of sludge and depth of scum ? _X_ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes No Existing information.For example,a plan at the Board of Health. _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:240 North Street Owner: Kessler Installation and Sales Date of Inspection: 8/5/03 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no):— Is laundry on a separate sewage system (yes or no):— [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use: (yes or no):_ Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no):— Last date of occupancy: COMMERCIAL/INDUSTRIAL Type of establishment:gas/automobile service station Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): 400 GPD(2 islands with multiple pump stations and 2 bays) Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):None located Non-sanitary waste discharged to the Title 5 system (yes or no):Yes,oil present in d-box Water meter readings, if available: Last date of occupancy/use: Over 1 year ago_ OTHER(describe): Should be noted that plans were submitted for tight tank to be used for bus traffic,but no permit for work was located. GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection (yes or no):No If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _X Septic tank,distribution box,soil absorption system —Single cesspool —Overflow cesspool —Privy —Shared system (yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) —Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information:_25+years per owner's representative Were sewage odors detected when arriving at the site(yes or no):No i OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 240 North Street Owner: Kessler Installation and Sales Date of Inspection: 8/5/03 BUILDING SEWER(locate on site plan) Depth below grade: exits building through concrete floor Materials of construction:_X_cast iron _40 PVC_other(explain): Distance from private water supply well or suction line:_20+' Comments(on condition of joints,venting,evidence of leakage,etc.):_Line originally connecting floor drains has been ruptured,owner to replace SEPTIC TANK:_C_(locate on site plan) Depth below grade:_Cpver at grade,top of tank 20"below grade with riser Material of construction:_X_concrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 1500 gallons Sludge depth: 3' Distance from top of sludge to bottom of outlet tee or baffle:_24+inches_ Scum thickness:None_ Distance from top of scum to top of outlet tee or baffle:_NA Distance from bottom of scum to bottom of outlet tee or baffle: NA How were dimensions determined: visual estimation Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Inlet tee crooked,tank appears to be leaking as water level is at tank seam. GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:240 North Street Owner:Kessler Installation and Sales Date of Inspection: 8/5/03 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:Liquid level slightly below outlet,possibly due to evaporation Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box, etc.): D-box was full of oil and petroleum products,heavy fumes,congealed oil. Invert of outlet is 39"below grade,no riser. PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): OFFICIAL INSPECTION FORM.-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 240 North Street Owner: Kessler Installation and Sales Date of Inspection: 8/5/03 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) If SAS not located explain why:No asbuilt available. Unable to run sewer camera due to oil in loutlet line from d-box and lack of power source. Type leaching pits,number:Owner's representative believes SAS to be leach pit leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding, damp soil,condition of vegetation,etc.):_Unknown,no ponding,leaching could be under area overgrown with small trees and shrubs or under paved area. (See plan in folder at BOH) CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 240 North Street Owner: Kessler Installation and Sales Date of Inspection: 7/21/03 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet.Locate where public water supply enters the building. . f OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:240 North Street Owner: Kessler Installation and Sales Date of Inspection: 8/5/03 SITE EXAM Slope Level Surface water None Check cellar None Shallow wells None Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Estimated bottom of leaching separated from adjusted groundwater per records on file Barnstable BOH. Confirmation can only be done with actual measurement of leach pit depth. i �>, � � f�(Ir/i//(•/(/f, r`%ire�-�f!•r//i�r..t �.41C'9"// o"y. l(Yr/7�/.CIII/RM %C.7/I/ o Notification for Storage Tanks Regulated Under 527 CMR 9.00 Forward completed form,signed by local fire department,to: Mass. UST Program,Dept. c P -II - • of Fire Services, P.O. Box 1025-State Road, Stow, MA 01775 Use Form FP-290R to notify of tank removals or closures Date Received: Telephone (978) 567-3710 HAVOIS FIREPREVEN IO 4 ID# (Fire Department retains one copy of FP-290) HYAi�N1S FIRE DEPART; ERq Dept. Sig. L-1`a4� of A. New Facility(see instructions,#1) B. Amended )Q3(.AR J _ Only INSTRUCTIONS: Farm FP-290(Notification for Aboveground and Underground Storage Tanks)is to be completed for each location containing underground or aboveground storage tanks regulated under 527 CMR 9.00. if more than live tanks are owned at this location,photocopy the following pages and staple continuation sheets to the form. The FP-290 A. Facility Numb must be completed in duplicate. Although the form may be photocopied,the facility owner or owner's representative must r.; sign each copy,separately;photocopied signatures are not sufficient. Both copies of the FP-290 are to be forwarded B. Date Entered/�l to the local fire department,who will check all information and certify the forms. The fire department will retain one n , copy of the FP-290 for its records,and the facility owner shall be responsible for forwarding the other copy to the C. Clerk's Initicil y.A Dept.of Fire Services at the address above. The local fire department will issue the permit portion of the FP-290; /� however•registration is not complete until the FP-290 is received and checked by the UST Reguldtory Compliance Unit. D. Comments ,A ° AN questions on this form are to be answered.Incomplete forms will be returned.. /'New Facility"means a tank or tanks located at a site where tanks have not been previously located. 2'FadNty street address'must include both a street number and a street name. Post office box numbers are not o acceptable,and will cause a registration to be returned.If geographic location of facility is not provided,please indicate 3'r distance and direction from closest intersection,a-g., (facility at 199 North Street is located)400 yards southeast or ... 1i Qgmmons Road(intersection). J RAL • • Mass `a YA U ` a a farm or residential tankof 1,100 Mons or less capacftyused for storingmotor io on wired Exception•( ) Notification q Fire Prevention Form FP•290 is to be used as Notification.Registration,and Permit for fuellornoncomrnercialpurposes,or(b)atankusr:dlorstoringheatingoilforconsumpt ve aboveground and underground storage tanks and tank facilities regulated under 527 use on the premises where stored are not required to be registered under527 CMR9.00. Code of Massachusetts Regulations 9.00.No regulated aboveground or underground Penalties:Any owner who knowingly fails to notify or submits false information shall be subject storage lank facility shall be installed.maintained•replaced.substantially modified or to a civil penalty not to exceed$25.000 for each lank for which notification is not given or for removed without a permit(FP-290)issued by the head of the local fire department. which false information is submitted.(MGL Chapter 148.section 38H,527 CMR 9.00)The owner of any storage facility shall within seven working days notify the head of the local tire department and the Dept.of Fire Services of any change in the name. Aboveground Storage Tanks address,or telephone number of the owner or operator of a storage facility subject to 527 CMR 9.00 regtrres the registration of any aboveground storage tank which meets the tegtlation by Ghapter 148,Mass.Genera-lew.and by 527 CMR 9 00 following definition:a horizontal or vertical lank,equal to or less than 10,000 gallons capacity;that is intended for fixed Installation without back fill above or below grade,and is Underground Storage Tanks used for the storage of Hazardous Substances,.Hazardous Wastes or Flammable or Each owner of amunderground tank first put into operation on or alter Jan.t,1991 , Combustible liquids. shad,within thirty,days after ft.tank is first put into operation notify the Department of Fro Secvfoes(tt►e department)of the existence of such tank,spedfyln-" the extent Ezcep(ion#t:Aboveground Mks of more than10,000gallonscapadlyregulatedby520CMR known,the owner of the tank,dale of installation,,capaaly,type.location,and uses`of 12.00(Requirements for the Installation of Tanks Containing Ftukls.Otter Than Water in such tank 8yta later Than Jan.31.1991.each owner of an underground storago tank Excess of 10,000 Gallons)are not required to be registered under 52l,CMR 9.00. flat wash operation at any Into after Jan.1.1974,.,regardless of whether Or not such, , FYMgd;on 02:(a)a farm or resWential tank of 1,100 gallons or less capadly used for storing Will;was removed from beneath the surface of the ground at any time,shall notify the motor fuel for noncommercial purposes,or(b)a tank used for storing heating ON for depaninerN of the existence oh such lank.spec"N,to the etdord known.the owner of consumptive use on the premises where stored are not required to.be registered under 527 the lank,date of installation.capacity.type,and location of tte tank,and the type and CMR 9.00. quantity of substances stored in such tank or which were stored In such tank before the tank ceased being in operation If the tank was removed from beneath the surface Pis:Any person who knows gtyviolates any r le or regulation made bythe Board of Fire of the ground prior to the submittal of such notice to the department.Such notice shall Prevention Regulations shall.except as otherwise provided.be punished by a 8ne of not less also specify.to tie extent known.the date the tank was removed from beneath the than one tw dred dollars nor more than one thousand dollars. (MGL,Chapter 148.section with oe Of tle ground prior to the submittal of surch notice to the department.The 108.and 527 CMR 9.00) operator of any tank that has no owner or whose owner cannot be definitely Where to Notify?Two completed notification forms should be sigreul by both the tank owner ascertained,shall notify the department of the exlsterroe of such tank specifying•to the and the local fire department:One copy will be retained by the Ike department,and the tank extent known,any information relating to owners*of the tank.and date Of owner shall send a separate copy to the address at to lop of ttds page. kafa/aton,capacity,type.and location"of the tank and the type and quantity of substances stored in such tank,or which were stored In such tank before the tank When to Notify?1.Owners of storage tanks In use Or that have been taken rot of operation ceased being in operation If the lank was removed from beneath the surface of the must notify within thirty days. Wound prior to the submittal of such notice 10 the department.If the tank was Owner and operators of Regulated Storage Tank Systems must maintain records abandoned beneath the surface of the ground prior a the submittal of he o notice lo certifying that all leak detection.Inventory control and tightness folding requirements cafe department such notice snap also seedy,b the extent d awn lo the Owner or for the Regulated Storage Tank System are current.These records must be readily opeatat,hhe date the tank was abandoned lo the ground and an methods used to available for Inspection. atabifize the tank after the tank ceased being In operation. I. OWNERSHIP OF TANKS) II. LOCATION OF TANKS) Owner Name(Corporation.Individual,Public Agency,or Other Entity) If known,give the geographic location of tanks by degrees,minutes,and seconds.Example:Lat.42,36,12 N Long.85,24,17W Mots va FntPr1CiSES, 1 I C ------ Latitude Longitude 3 Edgewater Drive, Suite 202 Uislance and_r i�rediori Fom closest ion(see Instructions � — or star:as Norwood MA 02062 ��r L�GLSS �Q-r1�- —Z o e— t tiget.s�V4t;tiotlna.cc•pt•bl i.• _� Norfolk 78. do 1-551-5400 7..,0 '60. .* r I1rrmxNOR"M•h (kro Aron Curint rowthofis�niOA u , ul lh n County r, i Ill: TYPE OF OWNER IV. INDIAN LANDS Federal Government X Commercial Tanks are located on land within an Indian Reservation or on (storage and sale) other trust lands. State Government Private Tanks are owned by native American nation, tribe, or individual. Local Government (storage and use) V. TYPE OF FACILITY Select the Appropriate Facility Description: (check all that apply). rl X Gas Station Marina Trucking/Transport Petroleum Distributor Railroad Utilities Airport Federal-Military Residential Aircraft Owner _ Industrial __...__ Farm Vehicle Dealership Contractor Other(explain) VI. CONTACT PERSON IN CHARGE OF TANKS Name: —L�n n y��'at�, Address: Phone Number(include area code): .lob Title: Engi Weer 3 Edgewater Dr. , Suite 202_ Home: N/A Norwood, MA 02062 Business: 781-551-5400 VII. FINANCIAL RESPONSIBILITY I have met the financial responsibility requirements in accordance with 527 CMR 9.00. Check all that apply: ------ --------------r-------------- A Self Insurance ) Guarantee Letter of Credit' Commercial Insurance Surety;Bond Trust Fund Risk Retention Group State Fund Other Method Allowed Specify Vill. ENVIRONMENTAL-SITE INFORMATION This Information should be available from local health agent,conservation commission,or planning department. 1.Tank site located in wellhead protection area Yes •X No unknown 2.Tank site located in surface drinking water supply protection area Yes .X No unknown 3.Tank site located within 100 feet of a wetland Yes X No unknown 4.Tank site located within 300 feet of a stream or water body Yes .X No unknown IX. DESCRIPTION OF STORAGE TANKS AND PIPING (COMPLETE FOR EACH TANK AT THIS LOCATION) Tank Identification Number Tank No. Tank No.__a Tank No._3 Tank No. 4 Tank No.—(,f 1. Tank status a.Tank mfr's serial # (if known) b.Currently in Use 0 0 c.Temporarily Out of Use (Start Date) 0 0 E — d. Permanently Out of Use @.HtoV rO[111d 6t01" tank{AS�fir. AST 4/6ST AST L4T ;AST �T AST w1rST AST. <>� Un erottds 4 ta01� z. Date of httatlatlort(no day yr.) I q 59 1 _ 1q— —--- 3. Estimated1611611`ty90aalty(ttalfonsj 10 1 C00 lo/000 (0/000 /0 000 1, 000 III.`TYPE OF OWNER IV. INDIAN LANDS Federal Government X Commercial Tanks are located on land within an Indian Reservation or on State Government (storage and sale) other trust lands. Private Tanks are owned by native American nation, tribe,or individual. Local Government (storage and use) V. TYPE OF FACILITY Select the Appropriate Facility Description: (check all that apply). X Gas Station Marina Trucking/Transport Petroleum Distributor Railroad Utilities Airport Federal-Military Residential Aircraft Owner ___ Industrial _,._. Farm Vehicle Dealership Contractor Other(explain) /1 f/JV1�. CONTACT PERSON IN CHARGE OF TANKS Name: Address: Phone Number(include area code): Job Title: Engineer 3 Edgewater Dr. , Suite 202_ Home: N/A Norwood, MA 02062 Business: 781-551-5400 VLL. FINANCIAL RESPONSIBILITY I have met the financial responsibility requirements in accordance with 527 CMR 9.00. Check all that apply: ------ --------------r---------------- X Self Insurance I Guarantee ( Letter of Credit Commercial Insurance L_ Surety'Bond :' I Trust Fund Risk Retention Group I State Fund : I Other Method Allowed Specify: ; VLLL. ENVIRONMENTAL SITE INFORMATION This Information should be available from local health agent,conservation commission,or planning department. 1.Tank site located in wellhead protection area Yes •X No .Unknown 2.Tank site located in surface drinking water supply protection area Yes .X No Unknown 3.Tank site located within 100 feet of a wetland Yes X No Unknown 4.Tank site located within 300 feet of a stream or water body Yes X No Unknown IX. DESCRIPTION OF STORAGE TANKS AND PIPING (COMPLETE FOR EACH TANK AT THIS LOCATION Tank Identification Number Tank No. Tank No. Tank No. Tank No. Tank No. 1.Tank status a.Tank mfes serial# (if known) b.Currently in Use © 0 c.Temporarily Out of Use(Start Date) �� 0 d. Permanently Out of Use 0 U @.Aboye roU,nd'StOrr� 1S11k((1_�� AST UST AST UST AST UST AST UST I1�STA `UST Underground 2. Date of Installation(moJday/yr)' 3. Estimated total Capaotty(0116ns)' �OO Tank Identification Number(cont.) Tank No.__L Tank No..C:2 Tank No. Tank No.-A Tank No.�5 4. Substance Currently or Last Stored a. Gasoline 0✓ ✓� �il� �� V :Marina u�(V . Marina vr01V Marina MV Marina MV Marina Motor vehicle or other use ;other other other other other b. Diesel I I Motor vehicle or other use MV Marina MV : Marina MV . . Marina Vf V Marina MV Marina other other other other other c. Kerosene d. Fuel Oil" 0 "Consumptive Use"tanks need not be registered. Consumptive Use"fuel used exclusively for area heating and/or hot water. e. Waste Oil f. Other, Please specify. Hazardous Substance �� � (other than 4a thru 4e above) j CERCLA name and/or CAS number Mixture of Substances 0 U U Please specify 5. Material of Coristivction-Tank.(mark only on( ) Bare steel(includes asphalt,.galvanized; and epoxy coated) Cathodically protected steel Composite(steel with fiberglass), Fiberglass reinforced plastic(FRP) Concrete Unknown Other C� Please specify 6.Type of Construction-Tank (mark only one) Single walled Double walled © © u Unknown Other Please speotty (S Wnk lined? Yes 1. 6, Y66 LACO :Yes u'Aa Yes two YeS, LIQo r Does tank have excavation liner? yes ,ENO Yes taco Yes 4.410o Yes. Lf ro Yes. LAo. Tank Identifioation Number(cunt.) Tank No. Tank No. Tank No. Tank No. Tank No. 4. Substance Currently or Last Stored a. Gasoline MV ; :Marina + MV . Manna .MV Marina MV Marina MV Marina Motor vehicle or other use : ;other other other other other b. Diesel __j MV : i Marina MV Marina MV . .Marina MV Marina MV. Marina Motor vehicle or other use other other other other other c. Kerosene d. Fuel Oil' '"Consumptive Use"tanks need not fie registered. "Consumptive Use"fuel used exclusively for area healing and/or hot water. e. Waste Oil f. Other, Please specify. Hazardous Substance (other than 4a thru 4e above) CERCLA name and/or CAS number Mixture of Substances �_� �� 0 Please specify 5„Material of Construction Tank(mark only on ) _ Bare steel(includes asphalt,galvanized and epoxy coated) Cathodically protected steel Composite(steel with fiberglass) Fiberglass reinforced plastic(FRP) Concrete �� 0 Unknown Other U �� Please specify 6.Type of Construction-Tank (mark only one) Single walled Double walled Unknown Other I f Please specify fs tank lined? ` ' Yes L*4 : !Yes: No- :Yet i No Yes No Does tank have excavation liner? Yes Yes No Yes - .No Yes .No Yes No. Tank Identification Number(cont.) Tank No. Tank No. Tank No. Tank No. Tank No. f' 7. MatedaGd Constnxtion-Piping(mark only one Bare steel(includes asphalt, galvanized and epoxy coated) �� 0 rD�1 Cathodically protected steel E� E:� Fiberglass reinforced plastic (FRP) L� �✓ 0 L� Flexible 0 0 0 Copper Unknown Other �� 0 Please specify 8. Type of Construction-Piping(mark only one) Single walled 0 0 0 Double walled 0 0 Unknown 0 Other Please specify Has piping been repaired? Yes 'limo Yes Vlfo i Yes l/�lo Yes I'm Yes No Is piping gravity feed? Yes ."'No Yes Flo Yes L4o- Yes L,46- Yes No p Date L X:'CERTIFICATION OF COMPLIANCE 1. Installation A. Installer:certified by tank and:pipin9 manufacturers B. Installer certified or Ilicensed by the Implementing agency C.Installation inspected by a registered engineer D.Installation inspected and approved by the implementing agency E.Manufacturers'installation checklists have been completed F.Another method allowed by 527 CMR 9.00. Please specify 2.Tank Leak Detection Tank Tank Tank Tank Tank (mark only one) A.Double-wall tank- Interstitial monitoring l/" B.Approved in-tank monitor ® a' C.Soil vapor monitoring (check one below) Monthly Continuous E.Inventory record-keeping and tank testing F. .Other method allowed by 527 CMR 9.00. Please speclt~y —�-- Tank Identification Number(cont.) Tank No.__& Tank No. Tank No. Tank No. Tank No. 7. Material of Cons"ion-Piping(mark only one Bare steel(includes asphalt,galvanized and epoxy coated) Cathodically protected steel Fiberglass reinforced plastic (FRP) Flexible Copper Unknown Other Please specify S. Type of Construction-Piping(mark only one) Single walled Double walled Unknown Other Please specify Has piping been repaired?. Yes L Yes No Yes: No Yes No Yes No S f Is piping gravity feed? ✓Yes ;No Yes No Yes. , No Yes No Yes No Dater X. CERTIFICATION OF COMPLIANCE 1. Installation _ A. Installer certified by tank and piping manufacturers B.Installer certified or licensed by the Implementing agency C.Installation inspected by a registered engineer r�---� D.Installation inspected and approved by the implementing agency E.Manufacturers'installation checklists have been completed F. Another method allowed by 527 CMR 9.00.Please specify 2.Tank Leak Detection Tank Tank Tank Tank Tank (mark only one) A.Double-wall tank-Interstitial monitoring a El ❑ ❑ ElB.Approved in-tank monitor ❑ El ❑ ❑ C.Soil vapor monitoring (check one below) El ❑ ❑ ❑ El Monthly Continuous E.Inventory record-keeping and tank testing ❑ ❑ ❑ s F.ether meth allowed by 527 CMA 9.00. Please specl y —� Tank Identification Number(cont.) Tank No._4 Tank No.j 2,"2 Tank No,1,3, Tank No. Tank No..�,5 3. Piping Leak Detection (mark only one) Piping Piping Piping Piping Piping A.Pressurized a. Interstitial space monitor 2- ❑ b. Product line leak detector (mark all that apply below) Automatic flow restrictor' Automatic shut-off device' Continuous alarm' ' Also requires annual test of device and piping tightness test or monthly vapor monitoring of soil. B. Suction: Check valve at tank only ❑ ❑ ❑ El El interstitial space monitor or line tightness test every three years) Interstitial space monitor Line tightness test C. Suction: Check valve at dispenser only ❑ ❑ El ❑ 1-1(No monitor required) D. Other method allowed by 527 CMR 9.00. Please specify, jarl� /1C,1 4. Date of last tightness test (tank& piping) _ la i iolci U nc to.6i`.i: L16,7LOIC0 5. Gravity feed piping El El 6.Spill containment and overfill protection Tank Tank Tank Tank f Tank A.Spill containment device installed --_ ❑" [2 ❑' B.Overfill prevention device installed ©' 7. Daily Inventory Control (mark only one) A. Manual gauging by stick and records ❑ ❑ ❑ ❑ f;], reconciliation tlGl B. Mechanical tank gauge and records ❑ ❑ ❑ ❑ ❑ reconciliation � De � � ❑ C.Automatic gauging system 8. Cathodic Protection (if applicable) Tank Piping Tank Piping Tank Piping Tank Piping Tank Piping El ❑ ❑ ❑ El El El El El ❑ A. Sacrificial Anode Type B. Impressed Current Type ❑ ❑ ❑ ❑ ❑ LQ ❑ ❑ ❑ ❑ C. Date of Last Test Certification of Compliance No.: X1. CERTIFICATION (Read and sign after completing all sections) NOTE:Wh the copy being sent to the Dept.of Fire Services and the copy retained by the local fire department must be signed separately. A photocopied signature will not be aocepted on either document. 1 declare under Penalty of penury Thal I have personapy examined and am tamlAar with the Inlomtallon sued b thlsi,and.aq attached documents,and that tiesed,on'ttty rngiAry a those Yblviduab Yr ately.m0i stale Wobtaining im,information;l.beGeve fat the submit .intom►aflon k kue;accurate,utd complete, Jennifer Varnerin, Permit Analyst Name and omcial Nib of owner a owner sauthCdzed n presentathre`(Ftlnil Signature: Odle; ' Tank Identification Number(cunt.) Tank No. Tank No. Tank No. Tank No. Tank No. 3. Piping Leak Detection(mark only one) Piping Piping Piping Piping Piping A.Pressurized a. Interstitial space monitor ❑ ❑ ❑ ❑ ❑ . b. Product line leak detector ❑ ❑ ❑ ❑ ❑ (mark all that apply below) Automatic flow restrictor" Automatic shut-off device' Continuous alarm' Also requires annual test of device and piping tightness test or monthly vapor monitoring of soil. B. Suction: Check valve at tank only ❑ ❑ ❑ ❑ ❑ (Requires interstitial space monitor or line tightness test every three years) Interstitial space monitor Line tightness test C. Suction: Check valve at dispenser only ❑ ❑ ❑ ❑ ❑ (No monitor required) D. Other method allowed by 527 CMR 9.00. Please specify 4.bate of lasttighMess test(tank& piping) - 5. Gravity feed-piping. 6.Spill containment and overfill protection Tank Tank Tank Tank Tank A.Spill containment device installed--- ❑ ❑ ❑ ❑ B.Overfill prevention device installed ❑ ❑ ❑ ❑ 7. Daily Inventory Control(mark only one) A. Manual gauging by stick and records ry a ❑ ❑ ❑ reconciliation lYJ B. Mechanical tank gauge and records ❑ reconciliation El ❑ El ❑ 1-1C. Automatic gauging system 8. Cathodic Protection(if applicable) Tank Piping Tank Piping Tank Piping Tank Piping Tank Piping ❑ ❑ El ❑ ❑ ❑ El El El ❑ A. Sacrificial Anode Type B. Impressed Current Type ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ C. Date of Last Test Certification of Compliance No.: X1. CERTIFICATION (Read and sign after completing all sections) NOTE:Both the copy being sent to the Dept.of Fire SerA es and the copy retained by the local Tire depanmani must be signed separately. A photocopied signature will nofi e accepted on either docutnehi. 1 d@*M under penaay of penury ftt t have perWmk#y.exaff*W and am laniWar with fhe kdwwoon sutx go in this and ll atleched doarments,and tha[;bOO on n y d Moose kbWtduala ftnerxatey impor�le/or obtalhiry the intomratkrn;l beNeye that the cubmNl '_Iitlormatlon is true,aocurate,aid complete, Harm Jennifer or i�leo(oro ii (0mo n Pe>it Analyst s na e bee: ` »r»ronwe Cif�aaaac/iiaetta "e uaxCmze�ato�,/u -r�c.��o�r• �e VCate C��'t ye C/f&�ol3 'PAW — � GC%CJ' �"^ •cc�alowr� (porn r�irnce GC�rrl . � c. Notification for Storage Tank$, egulated Under 527 CMR 9.00 Forward completed form,signed by local fire department,to:Mass USIT Program,Dept. of Public Safety,One Ashburton Place-Room 1310,Boston,lt�l:��Oe� -1618 9,s dap Date Received: _ (Fire Department retains one copy of FP-290) Fire Dept. ID# ftJl9 2 L: A. New Facility(see instructions,01) �L B.,Amended ��'� , c � l� Fire Dept. Sig. VIANo.of tanks at facility _� No.of continuation sheets _ INSTRUCTIONS: Form FP•290(Notification Iw Aboveground and Underground Storage Tanks)is to be corn nit are A• . location containing underground or aboveground storage tanks regulated under 527 CMR 9.00. II more than five are 6/• owned at this location•photocopy the following pages and staple continuation sheets ro the form. The FP-290 must be. A. Facility Number- completed in duplicate. Although the form may be photocopied,the facility owner or owners representative must sign each copy separately;photocopied signatures are not sufficient. Both copies of the FP-290 are to be forwarded to the local B.. Date Entered lire department,who will check all information and certify the forms. The Tire department will retain one copy of the FP- 290 for its records,and the facility owner shall be responsible for forwarding the other copy to the Dept of Public C. Clerk's Initials _Safety at the address above. The local lire department will issue the permit portion of the FP-290;however,registration is not complete until the FP-290 is received and checked by the UST Regulatory Compliance Unit. Ali questions on this form D. Comments are to be answered.Incomplete forms will be returned. _ 1-New Fatuity'means a tank or tanks located at a site where tanks have not been previously located. 2-Facility street address-must include both a street number and a street name. Post office box numbers are not acceptable, and will cause a registration to be returned.If geographic location of facility is not provided.please indicate distance and direction from closest intersection,e.g., (facility at 199 North Street is located)400 yards seuthract of Go mans Road (intersection). Notification Required EXCC0t1> ;(a)alarmorresidenlial tank of1,100 gallons or less capacity used for storing motor Fire Prevention Form FP-290 is to be used as Notification,Registration,and Permit for fuel for noncommercial purposes,or(b)a rank used for storing heating oil for consumptive use aboveground and underground storage tanks and tank facilities regulated under 527 on the premises where stored are not required to be registered under 527 CMR 9.00. Code of Massachusetts Regulations 9.00.No regulated aboveground or underground Penalties-Artyownerwhoknowinglyfailstonotiyorsubmitsfalseinformationshallbesubject storage tank facility shall be installed,maintained,replaced,substantially modified or to a civil penalty not to exceed S25.000(or each tank for which notification is not given or lot removed without a permit(FP-290)issued by the head of the local fire department which false information is submitted.(MGL Chapter 148.section 38H,527 CMR 9.00) The owner of any storage facility shall within seven working days notify the head of the local fire department and the Dept of Public Safety of any change in the name, Aboveground Storage Tanks address,or telephone number of the owner or operator of a storage facility subject to 527 CMR 9.00 requires the registration of any aboveground storage tank which meets the regulation by Chapter 148,Mass.General Law and by 527 CMR 9.00. following definition:a horizontal or vertical tank.equal to or less than 10.000 gallons Underground Storage Tanks capacity,that is intended for fixed installation without back fill above or below grade.and it Each Underground owne d St underground tank first put into operation on or after Jan 1,1991, . used for the storage of Hazardous Substances,Hazardous Wastes,or Flammable or shall,within thirty days after the tank is first put into operation,notify the Department of Combustible Liquids. Public Safety(the department)of the existence of such tank specifying,to the extent Exception 01:Aboveground tanks of more Von 10.000 gallons capacity regulated by 520 CMR known,the owner of the tank date of installation, capacity•type,location,and uses of 12.00(Requirements for the Installation of Tanks Containing.Fluids Otter Than Water in such tank By no later than Jan.31.1991.each owner of an underground storage tank Excess of 10.000 Gallons)are hot required to be registered under 527 CMR 9.00. that was in operation at any time after Jan.1,1974, regardless of whether or not such Gxeeotion 412(a)a tarn or residential tank of 1.100 gallons or less capacity used for storing tank was removed from beneath the surface of the ground at arty time,shall notify the motor fuel for noncommercial purposes, or (b) a tank used for storing heating oil for department of the existence of such tank specifying.to the extent known,the owner of consumptive use on the premises where stored are not required to be registered under 527 the tank date of installation,capacity,type.and location of the tank and the type and CMR 9.00. quantity of substances stored in such tank or which were stored in such tank before the tank ceased being in operation If the tank was removed from beneath the surface PPn,alties,Myperson who knowingly violates any rule orregulauon made bythe Board of Fee of the ground prior to the submittal of such notice to the department Such notice shall Prevention Regulations shall,except as otherwise provided,be punished by a fine of not less also specify,to the extent known,the date the tank was removed from beneath the than one hundred dollars nor more dw one thousand dollars. (MGL.Chapter 148,section surface of the ground prior to the submittal of such notice to the department The 108.and 527 CMR 9.00) operator of any tank that has no owner or whose owner cannot be definitely Where to Notify?Two completed notification forms should be signed by both the tank owner ascertained,shall notify the department of the existence of such tank specifying,to the and the local fire department-One copy wit be retained by the fire department and the tank extent known.arty information relating to ownership of the tank and date of owner shall send a separate copy to the address at the top of this page. Wistal ation,capacity,type,and location of the tank and the type and quantity of substances stored in such tank or which were stored in such tank before the tank When to Notify?1.Owners of storage taroks in use or that have been taken out of operator ceased being in operation it the tank was removed from beneath the surface of the must notify within thirty days. ground prior to the submittal of such notice to the department.L'the tank was Owners and Operators of Regulated Storage Tank Systems must maintain records abandoned beneath the surface of the specify prior to submittal of notice to certifying that all leak detection,inventory control and tightness testing requirements the department such notice shall also specify, the extent known to thehe owner wner or for the Regulated Storage Tank System are current These records must be modify operator,the date the tank was abandoned in thh e ground and all methods teed to available for inspection. stabilize the tank after the tank ceased being in operation I. OWNERSHIP OF TANK(S) If. LOcAnON OF TANKS) Owner Name(Corporation,Individual,Public Agency,or Other Entity) If known,give the geographic location of tanks by degrees,minutes,and ��`�� S seconds.Example:Lat 42.36.12 N Long.85,24,17W SbRIZNI Latitude Longitude 22 / . 9 Street Address lame art dvection from closest ihtershfx lion tsee iM1f7n ROi•2) ,333 PEA ;E 9RCH CRI12777 11-1 3-130�0 aaTity_N_ a Ccxnoany She as applicable SS 66 RonflZ1110� City State Zip coosSu Addiass(P:O:Box not,temptable--s"instructions tr2) �. Cagny r city ,,•l�C State ZO �V-- S3•SY00 6*— Phone Number(Include Area Code) owners Employer Federal 10 a courlty FP-won/ravisnd 6/961 Page III. TYPE OF OWNER IV. INDIAN LANDS O Federal Government O Commercial v O Tanks are located on land within an Indian Reservation or on, O State Govemment (storage and sale) other trust lands. ❑Private O Local Government (storage and use) 0 Tanks are owned by native American nation, tribe, or individual V. TYPE OF FACILITY Select the Appropriate Facility Description: (check all that apply) �Gas'Station Marina Trucking/Transport Petroleum Distributor Railroad Utilities I' Airport Federal-Military Residential Aircraft Owner Industrial Farm Vehicle dealership Contractor Other(explain) VI. CONTACT PERSON IN CHARGE OF TANKS Name: jLefPin Address: Phone Number(include area code): Job Title: �� -/"/') 1 Home: 'Business: VII. FINANCIAL RESPONSIBILITY 01 have met the financial responsibility requirements in accordance with 527 CMR 9.00. Check all that apply: ——— -- — E Self insurance 0 Guarantee � � 0 Letter of Credit 01commercial Insurance ( 0 Surety Bond p Trust Fund O Risk Retention Group O State Fund _ 0 Other.Method Allowed-Specify VIII. ENVIRONMENTAL SITE INFORMATION This information should be available from local health agent, conservation commission,or planning department. 1.Tank site located in wellhead protection area 0 Yes C-No 7 Unknown 2.Tank site located in surface drinking water supply protection area D Yes o No o Unknown 3.Tank site located within 100 feet of a wetland u Yes Q No o Unknown 4.Tank site located within 300 feet of a stream or water body 0 Yes '0 Nd: o Unknown IX. DESCRIPTION OF STORAGE TANKS AND PIPING (COMPLETE FOR EACH TANK AT THIS LOCATION) Tank Identification Number Tank No.-' Tank No. Tank No. Tank No. Tank No.—S 1. Tank status a.Tank mfes serial# (if known) • b. Currently in Use c.Temporarily Out of Use (Start Date) d. Permanently Out of Use e.Aboveground storage tank(AST)or 0 AST t3-OST O AST O AST '.B'OST O AST 0'TST O AST D'GST Underground storage tank(UST) 2. Date of Installation(moJday/yr.) C� t 129 _3 Estimated Total Capacity(gallons) /0 ��� lQ O /a d �O �� ,,1 � �onr�aoncve o Q(16, Jac1i%oe0 - 01 uLx4nzevaCo� ic�ie CVa��� c � ' -&,ee G'c e C/l�ci • - ' cca - �u`a�awr� �on�r�a>rce��rrC �rr,rsro�r ri��e CJ ' Notification for Storage Tanks Regulated Under 527 CMR 9.00 Forward completed form,signed by local fire department,to:Mass. UST Program,Dept of Public Safety,One Ashburton Place-Room 1310,Boston,MA 02108-1618 Date Received: (Fire Department retains one copy of FP-290) Fire Dept. ID# E, A. New Facility(see instructions,01) L: B.Amended ❑ C. Renewal Fire Dept. Sig. No.of tanks at facility No. of continuation sheets attached _ INSTRUCTIONS: Form FP-290(Notification for Aboveground and Underground Storage Tanks)is to be completed for each location containing underground or aboveground storage tanks regulated under 527 CMR 9.00. If more than five lanes are A Facility Number owned at this location.photocopy the following pages and staple continuation sheets to the forth. The FP=290 must be completed in duplicate. Although the form may be photocopied,the facility owner or owner's representative must sign each sufficient. Bath cop ies of the FP-290 are to be forwarded to the local copy separately;photocopied signatures are not s B. Date Entered FP- tire department.who will cheek all information and certify the forms. The fire department will 1 retain one c of the FP• 290 for its records,and the facility owner shall be responsible for forwarding the other copy to the Dept of Public C. Clerk's Initials Safety at the address above. The local fire department will issue the permit portion of the FP-290;however,registration is not complete until the FP-290 is received and checked by the UST Regulatory Compliance Unit All questions on this form D. Comments are to be answered.Incomplete forms will be returned. logted 1'New Facing/'means a tank or tanks located at a site where tanks have not been previously 2'Faality street address'must include both a street number and a street name. Post office box numbers are not acceptable. and will cause a registration to be returned,If geographic location of facility is now "t provided.Please indite distance and direction from closest intersection.e.g., (facility at 199 North Street is located)4on var. gnu ee t o _ (intersection): Gi-kitAiLINFORMATION Hipp;(a)a farm or residential lank of 1.100 gallons or less capacity used for storing motor Notification Required Fire Prevention Form FP-290 is to be used as Notification.Registration,and Permit for fuel for noncommercial purposes,or(b)a tank her a iste healing r 27 CMR 9.00.e use aboveground and underground storage tanks and tank facilities regulated under 527 on the premises where stored are not required to be registered under 527 CMR 9.00. Code of Massachusetts Regulations 9.00.No regulated aboveground or undergroundPenalties-Any.owner who knowingly fails tonootyorsubmits false infor ationshallbesubject storage tank facility shall be installed,maintained,replaced,substantially modified or to a civil penalty not to excised S25.000 for each tank for which notification is not given or for removed without a permit(FP-290)issued by the head of the local fire deparmenL which false information is submitted.(MGL Chapter 148.section 38H,527 CMR 9.W) The owner of any storage facility shad within seven working days nobly the head of the storage Tanks local fire department and the Dept.of Public Safety of any change in the name, Aboveground9 address,or telephone number of the owner or operator of a storage facility subject to SZ7 CMR 9.0DUequiirr h hori zontal tr vion of tank eQuve aboveground nlessn tank which beta the regulation by Chapter 148,Mass.General Law and by,527 CMR 9.00. followiCapacity,that is intended for fixed installation without back fill above or below grade.and is Underground Storage Tank used for the storage_of Hazardous Substances,Hazardous Wastes,or Flammable or Each owner of an underground tank first put into operation on or after Jan.1,1991. Combus11D1e Liquids. shall,within thing days after the tank is first put into operation,notify the Department of allonscapaeityregutaledby520CMR Public Safety(the department)of the existence of such tank,specifying,to the extent Fxeention I1:Aboveground tanks of more Chan 10.000g known,the owner of the tank,date of installation, capacity.type,location,and uses of 12-00(Requirements for the Installation of Tanks Containing Fluids Other Than Water in such tank.By no later than Jan:31.1991,each owner of an underground storage tank Excess of 10,000 Gallons)are not required to be registered under 527 CMR 9.00. that was in operation at any time after Jan.1,1974, regardless of whether or not such E&CC2tion y (a)a farm or residential tank of 1,10o gallons or less capacity used for storing I ank was removed from beneath the surface of the ground at any time,shall notify the motor fuel for noncommercial purposes, or (b) a tank used for storing healing oil for department of the existence of such tank,specifying,to the extent known,the owner of . consumptive use on the premises where stored are not required to be registered under 527 Me lank,date of installation,capacity.type.and location of the tank and the type and CMR 9.00. quantity of substances stored in such tank,or which were stored in such tank before P�Oa1tIC5:�Ype violates an rule or regulation made by the Board of Fire the tank ceased being in operation C the tank was removed from beneath the surface person knowingly Y Of the ground prior to the submittal of such notice to the department Such notice shall Prevention Regulations shall,except as otherwise provided,be punished by a fine 8 not less also specify.to the extent brown,the date the tank was removed from beneath the than one hundred dollars nor more than one thousand dollars. (MGL Chapter t 48,section surface of the ground prior to the submittal of such notice to the department.The 10B,and 527 CMR 9.00) bmhs should be signed by both the tank owner operator of any tank that has no owner or whose owner cannot be definitely Where to Notify?Two completed notification ascertained,shall noblythe department of the existence of such tank.specifying,to the wn'C be retained b the fire department and the ink and the brat fire department One copy Y extent known.any information relating to ownership of the tank.and date of owner shall send a separate copy to the address at the top of this page. installation,capacity,type,and location of the tank and the type and quantity of substances stored in such tank or which were stored in such tank before the tank When to Notify?1.Owners of storage tanks in use or that have been taken out of operation ceased being in operation C the tank was removed from beneath the surface of the must notify within thirty days. ground prior to the submittal of such notice to the department If the tank was Owners and Operators of Regulated Storage Tank Systems must maintain records abandoned beneath the surface of the ground prior to the submittal of such notice to certifying that all leak detection,inventory control and tightness testing requirements the department,such notice.shad also specify,to the extent known to the owner or for tie Regulated Storage Tank System are current These records must be readily operator,the date the laank was abandoned in the ground and all methods used to available for inspection. stabilize the tank after the tank ceased being in operations I■ OWNERSHIP OF TANK(S) II. LOCATION OF TANK(S) Owner Name(Corporation,Individual,Public Agency,or Other Entity) M known,give the geographic location of tanks by degrees,rrdnutes,and seconds.Example:Lat 42,36,12 N Long.85,24,17W Latitude Longitude SUeet Address Distance and direcrfon from closest intersegion(see im ruetbr►s•2) e/43- a r 3 (�L-'S5ARCH Caller T'-`'P"'' S��y. Cam- aaTityr Name or Comm"Site identrfisr.as app&able a00�2 /AY Cil0./sS Mate su.st Andress(P.O.Box not acceptable usnstihxaions m �. /�)/��[��� - Cky State zip code ^7 I Phone Number enduoe Area Code) Owners Employer Federal to• County r Pac III. TYPE OF OWNER. IV. INDIAN LANDS O Federal Government ❑Commercial ❑ Tanks are located on land within an Indian Reservation or on, O State Government (storage and sate) other trust lands. 0 Private ❑Local Government (storage and use) ❑ Tanks are owned by native American nation, tribe, or individual V. TYPE OF FACILITY Select the A/ppropriate Facility Description: (check all that apply) Gas Station Marina Trucking/Transport Petroleum Distributor Railroad Utilities Airport Federal-Military Residential Aircraft Owner Industrial . Farm Vehicle Dealership Contractor Other(explain) VI. CONTACT PERSON IN CHARGE OF TANKS _ Name: Address: Phone Number(include area code): Job Title: �� r /') I Home: ' Business: b�I VII. FINANCIAL RESPONSIBILITY D 1 have met the financial responsibility requirements in accordance with 527 CMR 9.00. Check all that apply: ------ -------- -----j--------------- E�Self Insurance ❑ Guarantee 0 Letter of Credit ff Commercial Insurance I t7 Surety Bond ❑ Trust Fund ❑ Risk Retention Group D State Fund D Other.Method Allowed-Specify VIII. ENVIRONMENTAL SITE INFORMATION This information should be available from local health agent, conservation commission, or planning department. 1.Tank site located in wellhead protection area Yes No 7 unknown 2.Tank site located in surface drinking water supply protection area D Yes D No D unknown 3.Tank site located within 100 feet of a wetland u Yes Q No0 unknown 4.Tank site located within 300 feet of a stream or water body D Yes 'D No` D unknown IX. DESCRIPTION OF STORAGE TANKS AND PIPING COMPLETE FOR EACH TANK AT THIS LOCATION) Tan Identification Number Tank No.;k Tank No. Tank No. Tank No. Tank No. 1. Tank status a.Tank mfes serial# (if known) b. Currently in Use c.Temporarily Out of Use (Start Date) d. Permanently Out of Use e.Aboveground storage tank(AST)or A ST t3'�1ST D AST [J D AST B-GST Underground storage tank(UST) D AST C ST D AST 13'6ST i 2. Date of Installation(moJdaytyr.) 3. Estimated Total Capacity(gallons) D . M-min 01 . Tank Identification Number(cont.) Tank No. Tank No.� Tank No.a Tank No. Tank No._ 4d Substance Currently or Last Stored a. Gasoline emV. O Marina p'fvlV O Marina L.;,,MV ❑Marina 0 V O Marina Li MV O Marina Motor vehicle or other'use pother o other o other.- D other_.L-- p other b. Diesel —=! �� L J L--� a<v 0 Marina �nnV O Marina BVV O Marina arVV O Marina C m4 O Marina Motor vehicle or other use p other r-O other O other r O—other —� D� of her C. Kerosene L----� u d. Fuel Oil e.Waste Oil f. Other, Please specify Hazardous Substance (other than 4a thru 4e above) CERCLA name and/or CAS number Mixture of Substances Please specify — 5. Material of Construction-Tank (mark all that apply) Asphalt coated or bare steel Cathodically protected steel Epoxy coated steel l_-J Composite (steel with fiberglass) Fiberglass reinforced plastic(FRP) E:i= -" Concrete Other, Please specify 6.Type of Construction-Tank .(mark all that apply) Lined interior - Double walled Single walled Polyethylene tank jacket Excavation liner - . Unknown - Other,,.please specify _ _ — Has tank been repaired? D Yes D No O Yes O No D Yes O No D Yes D No ❑Yes'O No Date - . ... .. ._ _ . • Tank Identification Number(cont.) Tank No. / Tank No. Tank No. 3 Tank No. Tank No., 7. Material of Construction -Piping (mark all that apply) Bare steel Galvanized steel C Fiberglass reinforced plastic K C Flexible Copper Cathodically protected U U C Secondary containment Unknown � U Other, please specify 8. Type of construction -Piping (mark all that apply) Double walled Single walled Suction: Check valve at tank only Suction: Check valve at dispenser only C� C Pressure Gravity feed. Other, please specify Has piping been repaired? 0 Yes 0 No G Yes a No 0 Yes 0 No a Yes 0 No G Yes u No Date X. TANKS/REMOVED OR CLOSED IN PLACE 1.Tank/Piping closed in place or removed (mark all that apply). A. Estimated date last used(moJday/yr.) --------------- B. Estimated date of removaUclosure . . (moJday/yr.) - C.Tank was removed from ground D.Tank was not removed from ground ,.. Tank was filled with inert material _ Describe: E.Piping was removed from ground F. Piping was not removed from ground G.Other, please specify - I q3- 1306 Tank ldentificetion Number(cost.) Tank No. Tank No. Tank No. Tank No. Tank No. 4. Substance Currently or Last Stored �� �� ^ �--•-� a. Gasoline O MV O Marina "V D Marina "V O Marina &4V O Marina uf✓IV O Marina Motor vehicle or other'use O other O other O other.- O other O other b. Diesel [� J C - I ,f MV 0 Marina <V O Marina "V O Marina M VIV O Marina li9<V O Marina Motor vehicle or other use O other o other O other O other O other C. Kerosene d. Fuel Oil �� �� L 71 e.Was, Oil f.Other, Please specify Hazardous Substance E= L� U (other than 4a thru 4e above) t-----� CERCLA name and/or CAS number -' Mixture of Substances Please specify 5. Material of Construction-Tank (mark all that apply) —I Asphalt coated or bare steel Cathodically protected steel Epoxy coated steel Composite(steel with fiberglass) l_� � 1 Fiberglass reinforced plastic (FRP) � �� Concrete Other, Please specify 6.Type of Construction-Tank .(mark all that apply) Lined interior Double walled Single walled �—� I--� C Polyethylene tank jacket _ y Excavation liner ��._ 7 Unknown Other, please specify Has tank been repaired? O Yes'O No- ❑Yes• O No- O Yes O No f O Yes ❑No O Yes O No - - Date _ - Tank Identification Number(cont.). Tank No. Tank No. Tank No. Tank No. Tank No 7. Material of Construction - Piping (mark all that apply) Bare steel Galvanized steel Fiberglass reinforced plastic Flexible Copper Cathodically protected Secondary containment Unknown C� u 17 1 C Other, please specify 8. Type of construction-Piping (mark all that apply) Double walled Single walled Suction: Check valve at tank only Suction: Check valve at dispenser only Pressure. C� E:= . Gravity feed Other, please specify iv Has piping been repaired? Yes No G Yes G No .0 Yes 0 No Yes 0 No 0 Yes u No Date X. TANKSjREMOVED OR CLOSED IN PLACE 1.Tank/Piping closed in place or removed (mark all that apply). A. Estimated date last used (moJday/yr.) B. Estimated date of removal/closure (moJday/yr.) C.Tank was removed from ground D.Tank was not removed from ground :.. Tank was filled with inert material �� �• �_� .• . � �� _ Describe: - -- . E. Piping was removed from ground F. Piping was not removed from ground G.Other, please specify r Tank No. Tank No. 2 Tank No. 3 Tank No. Tank No. C Tank Identification Number(cont.) �. Tank closed in accordance G Yes G No u Yes .G No G Yes G No 0 Yes ONO G Yes D No with 527 CMR 9.00 A. Evidence of leak detected % G Yes G No G Yes ONO [:)Yes O No -IYes C No C;Yes E:No B. Mass. DEP notified rJ Yes :G No D Yes 0 No O Yes 0 No 0 Yes ONO Yes —.No 1.Mass.DEP tracking number - 2.Agency or company performing assessment X1. CERTIFICATION OF COMPLIANCE 1. Installation A. Installer certified by tank and piping C manufacturers B. Installer certified or licensed by the implementing agency C.Installation inspected by a registered �� �� �� engineer D.Installation.inspected and approved by the implementing agency E. Manufacturers'installation checklists C= have been completed F. Another method allowed by 527 CMR 9.00. Please specify 2. Tank Leak Detection Tank Tank Tank Tank Tank (mark all that apply) ❑ A. Double-wall tank- Interstitial monitoring ❑ El ❑ B_Approved in-tank monitor C.Continuous vapor monitoring in soil ❑ ❑ ❑ ❑ El D.Monthly vapor monitoring in soil ❑ ❑ ❑ E.Inventory record-keeping and tank testing ❑ F. Other method allowed by 527 CMR 9.00. Please specify 3. Piping Leak Detection Piping Piping Piping Piping Piping (mark all that apply) A.Pressurized LW LLN Li Interstitial space monitor ❑ ❑ ❑ Automatic flow restrictor` EJ ❑ ❑ Automatic shut-off device' � ® ❑ Continuous alarm` ❑ ❑ ❑ ❑ ' Also requires annual tank tightness test or monthly vapor monitoring of soil. rD. Tightness ication Number(cont.) Tank No,__L Tank No. Tank No. Tank No: Tank No.— Piping Piping Piping Piping pi : Check valve at lank only. ❑ ❑ ❑ titial space monitor El ❑ ❑ C Check valve at dispenser only ❑ ❑ required ❑ ❑ ❑ c tested --- ____-- r—' 1yr. C3yr. 0lyr_03yr. O 1yr. 03yr. 01yr. C3yr. 01yr. 031 E.Other method allowed by 527 CMR - 9.00. Please specify 4. Spill containment and overfill protection Tank Tank Tank Tank Tank A.Spill containment device installedID (� B.Overfill prevention device installed1Z LQJ ® ® ® ❑ 5. Daily Inventory Control A. Manual gauging by stick and records reconciliation ❑ E ❑ B. Mechanical tank gauge ❑ ❑ El a C. Automatic gauging system V V_\j IIN 0 rB. Impressed Protection (if applicable) Tank Piping Tank Piping Tank Piping Tank Piping Tank Piping cial Anode Type ❑ ❑ ❑ E ❑ ❑ ❑ ❑ Current Type ❑ ❑ ❑ a ❑ ❑ ❑ af Last Test — —— —— — ------ Certification of Compliance No.: XI 1. CERTIFICATION (Read and sign after completing all sections) NOTE:Both the copy being sent to the Dept of Public Safety and the copy retained by the local fire department must be signed separately. A photocopied signature will not be accepted on either document I declare under penalty of perjury that I have personally examined and am familiar with the information submitted in this and all attached documents, and that based on my inquiry of those individuals immediately responsible for obtaining the informa- tion, I believe that the submitted information is true, accurate, and complete. Name and official title of owner or owner's Signature: authorized representative(Print) Date: (� J_to e. �gwT�Iu S I y� M'4o , s , Tank`Identificotiop Number(cont.) Tank No. k Tank No. Tank No. Tank No. Tank No. 2.Tank closed in accordance G Yes O No O Yes C No O Yes. O No O Yes :)No O Yes O No with 527 CMR 9.00 A.Evidence of leak detected .` O Yes G No G Yes O No O Yes ONO - Yes C No C;Yes E:No B. Mass.DEP notified o Yes .7 No O Yes O No O Yes O No O Yes i No Yes No 1. Mass. DEP tracking number -- 2.Agency or company performing _ assessment XI. CERTIFICATION OF COMPLIANCE r—rat -r3 1. Installation A. Installer certified by tank and piping manufacturers B. Installer certified or licensed by the implementing agency C.Installation inspected by a registered D U engineer D.Installation inspected and approved by E= the implementing agency E. Manufacturers' installation checklists E­D t have been completed F. Another method allowed by 527 CMR 9.00. Please specify 2. Tank Leak Detection Tank Tank Tank Tank Tank (mark.all that apply) A. Double-wall tank- Interstitial monitoring ❑ ❑ ❑ ❑ ❑ B.Approved in-tank monitor ❑ ❑ ❑ ❑ ❑ . C.Continuous vapor monitoring in soil ❑ ❑ ❑ ❑ ❑ D.Monthly vapor monitoring in soil ❑ ❑ ❑ ❑ ❑ E. Inventory record-keeping and tank testing ❑ El ❑ ❑ ❑ F. Other method allowed by 527 CMR 9.00. Please specify 3. Piping Leak Detection Piping Piping Piping Piping .Piping (mark all that apply) ❑ A.Pressurized ❑ ❑ D D Interstitial space monitor ❑ ❑ ❑ ❑ ❑ Automatic flow.restrictor` ❑ ❑ ❑ ❑ ❑ Automatic shut-off device' ❑ ❑ ❑ D ❑ Continuous alarm' ❑ ❑ ❑ ❑ ` Also requires annual tank tightness test or monthly vapor monitoring of soil. panty Tank Identification Number(cont.) . Tank No.-L Tank No. Tank No. Tank No. Tank No: + Piping Piping Piping Piping- Pig B.Suction: Check valve at tank only. ❑ ❑ El Interstitial space monitor ❑ . C D C.Suction: Check valve at dispenser only El E None required ❑ ❑ ❑ ❑ r D.Tightness tested L ————————————— 1 yr. _3 yr. O 1 yr�'O 3 yr. G 1 yr. O 3 yr.. O 1 yr. C 3 yr. G 1 yr. O 3 y E.Other method allowed by 527 CMR ———— 9.00. Please specify 4. Spill containment and overfill protection Tank Tank Tank Tank Tank A. Spill containment device installed ❑ ❑ ❑ ❑ ❑ B.Overfill prevention device installed ❑ ❑ ❑ ❑ ❑ 5. Daily Inventory Control ❑ ❑ ❑ ❑ L ., A. Manual gauging by stick and records ❑ ❑ ❑ ❑ reconciliation B. Mechanical tank gauge ❑ ❑ ❑ ❑ C. Automatic gauging system ❑ ❑ ❑ ❑ ❑ rBilmpressed Protection (if applicable) Tank Piping Tank Piping Tank Piping Tank. Piping Tank Piping cial Anode Type ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑' ❑ ❑ Current Type————- ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑f Last Test — I Certification of Compliance No_: X1 1. CERTIFICATION (Read and sign after completing all sections) rall :Both the copy being sent to.the Dept.of Public Safety and the copy retained by the local fire department must be signed separately. A photocopied ure will not be accepted on either document lare under penalty of perjury that I have personally examined and am familiar with the information submitted in this and ached documents,and that based on my inquiry of those individuals immediately responsible for obtaining the informa- I believe that the submitted information is true, accurate, and complete. ------------- Name and official title of owner or owners Signature: authorized representative (Print) Date: 009v10 6. f 4W1nu S �am, fu v TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD O qALTH � � 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPS � 1r��`—�/-ei�L�a (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS Ccn�..Q��• �d'(�t�f fG7��, Class: � �0 7•Miscellaneous QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors) MAJOR MATERIALSUnderground IN OUT IN OUT IN OUT #&gallons Age Test /0 K e"4 Gasolide Jet Fuel(A) l�5 /v K lq ies 1, Kerosene, #2 (B) eavy Oils: .S Yv.5 19 waste motor oil (C) To e) new motor oil(C) A-9'F t 0 V transmission/hydraulic Synthetic Organics: degreasers rc's Miscellaneous: D(Mf DISPOSALIRECLAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply � C)A, -,1k4 MT 777 7 own Sewer Gublic a all-, a�- 0 On-site OPrivate I _ / 4Lf 0 3. Indoor Floor Drains YES� N0 V 0 Holding tank:MDC_ 0 Catch basin/Dry well ✓ t d o,J1)4, O On-site system 4. Outdoor Surface drains:YES—NO-P<- ORDERS: 0 Holding tank:MDC O Catch basin/Dry well 0 On-site system 5.Waste Transporter Name of Hauler Destinatior�-, Waste- Product YES NO 2. i 0-1 4 c/ X - L9,/t"A' 9 f Petsfin(s) Interviewed Lispector Date FLU - : Date: / . TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: /L/e BUSINESS LOCATION: c)1- ® V /'�� S a a MAILING ADDRESS: Mail To: Board of Health TELEPHONE NUMBER: SS- Town of Barnstable CONTACT PERSON: 4~ �Z� P.O. Box 534 EMERGENCY CONTACT TELEPHONE UMBER: °7 Si- S.1-09 Hyannis, MA 02601 TYPE OF BUSINESS: 6xiso e e, e ,I e- Does your firm sto a ny of the toxic or hazardous materials listed below, either for sale or for you own use? YES ! NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity c;4 L 3 ® Antifreeze(for gasoline or coolant systems) Drain cleaners 2-';7—NEW -5'-USED Cesspool cleaners 206 "Automatic transmission fluid Disinfectants Engine and radiator flushes / 0110%ad Salt (Halite) 3 64Hydraulic fluid (including brake fluid) Refrigerants 6"Motor oils Pesticides ZVO NEW SOUSED (insecticides, herbicides, rodenticides) IV �asoline, Jet Fuel Photochemicals (Fixers) 2_ O `Diesel fuel, kerosene, #2 heating oil NEW USED Ld s Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) G 8 A11`rc`cf Swimming pool chlorine Rustproofers Lye or caustic soda /C4A_Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers G�Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Any other products with "poison" labels o6 Paint brush cleaners (including chloroform, formaldehyde, Floor & furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids w` CeAX4-e A SR /v e,,v"? `/8 64C (dry cleaners) /o6�- Other cleaning solvents ®, Xf5 1-0-174, Bug and tar removers WHITE COPY—HEALTH DEPARTMENT/CANARY COPY-BUSINESS a 1 D TE --- --'- ITEM GONE 1OW30 1 OW40 5W30 20W50 0 4.,f-6C eSL , MERCON TRANS. FL. WIND. WASH FL. 3 8' PWR. STR. FL. B G STOP LEAK STARTING FLUID BRAKE FLUID OUTBOARD OIL / �f FUEL INJ. CLNR. DIESEL COND. INTAKE VALVE CLNR S PWR. STR. FLUID E ANTI FREEZ Wo Ecl� r a CRATE RY II Q®OaMam MAP IDrnWs CASH rds Cards Paid Out rds old j'mts. Total C.C. Over/Short IDROP ANOUNT 1 28 37 TOWN OF BARNSTABLE CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH WOMPLIANCE: satisfactory 3.2.Printers O 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY PTO �� �� (see"Orders") 5.Retail Stores ,/ 6.Fuel Suppliers ADDRESS ayP VoA W Class: 7.Miscellaneous QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: ivi e 60 l�� Gasoline,Jet Fuel (A) �° �� Diesel, Ke #2 (B) Heavy Oils: waste motor oil (C) AA I 1'9" �' a new motor oil (C) W . transmissionlic Synthetic Organics: degreasers 0 Miscellaneous: o-u4o �9 V,),i JS - � DISPOSALIRECLAMATION REMARKS: IJ-bP- 1. Sanitary Sewage 2.Water Supply a-it dot O Town Sewer Public --'On-site OPrivate 3. Indoor Floor Drains YES NO O Holding tank:MDC Y O Catch basin/Dry well _ O On-site system D�� 4. Outdoor Surface drains:YES NO R O Holding tank:MDC atch basin/Dry well On-site system 5.Waste Transporter Name of Hauler Destination Waste Product Licensed. 1 Old 1 j 4 J D(/ /�I SV S 2. D �iPa i Person (s) Interviewed Inspector Date TOWN OF BARNS TABLE oMPL1ANCE: CLASS: 1.Marine,Gas Stations,Repair 2.Printers BOARD OF HEALTH satisfactory 3.Auto Body Shops ��> O unsatisfactory- 4.Manufacturers COMPANY o 3/ (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRE�,S� ® Class: 7.Miscellaneous HV�' 1� QUANTITIES AND STORAGE (IN. indoors; OUT-outdoors) MAJOR MATERIALS 1Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test uels: Gasoline,Jet Fuel (A) J '_- esel, Kerosene, #2 6)0 �motor new motor oil (C) transmissi ydraulic Synthetic Organics: degreasers Miscellaneous: IGO '2a V z-. Gse DISPOSAIJRECLAMATION REMARKS: 1. Sanitary Sewage 2,,Nyater Supply hAw O Town Sewer Public On-site OPri at , 3. door Floor Drains YESZNO W ALSO ,'l -folding tank:MDC / f W O Catch basin/Dry ell 1 . '� cs O On-site system 0 � 4. Outdoor Surface drains:YES NO O Holding tank:MDC �6 O Catch basin/Dry well (:::� / O On-site system HOLLAk, [Rep 5. Waste Transporter Name of Hauler Destination Waste Product O, YES NO 1. t4sar6 01 2. r� Person (s) Interviewed Inspector *Da I w TOXIC AND HAZARDOUS MATERI S7�rA TION FORM NAME OF BUSINESS: 6,45 0,4-195 ' _ni CZ019 /1/,,e_j� EyAca ail To: BUSINESS LOCATION: oz- �veici s7: �' �44 1 / y�,�,N;Board of Health MAILING ADDRESS: d yo Na g t-A s 7 . i� y�.�,�r`s own of Barnstable P.O. Box 534 TELEPHONE NUMBER: 3 -- 7S-1 .S-0 9 Hyannis, MA 02601 CONTACT PERSON: ; 4lf-y A • Go e_oL EMERGENCY CONTACT TELEPHONE NUMBER: Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities 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: q 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 610/ Antifreeze (for gasoline or coolant systems) Drain cleaners � c Automatic transmission fluid to TS Toilet cleaners Engine and radiator flushes Cesspool cleaners =s 57 6#L Hydraulic fluid (including brake fluid) a ►0 is Disinfectants 3'70&.4 Motor oils/waste oils /oo Lbs Road Salt (Halite) ooe /Gasoline, Jet fuel Refrigerants ,)-oav6ot Diesel fuel, kerosene, #2 heating oil 1 )0 7" Pesticides (insecticides, herbicides, bS Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) ;St s Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Pi Rustproofers Swimming pool chlorine 260/ Car wash detergents Lye or caustic soda J i01- Car waxes and polishes Jewelry cleaners As halt & roofing tar Leather dyes &Pi- 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 4/ jOt_S 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) _V Other cleaning solvents Bug and tar removers ; 6&1 Household cleansers, oven cleaners r White Copy- Health Department/. Canary Copy-Business PENNONI ASSOCIATES, INC. u' EnviroTEL Division .. 82 South Street 4 i, Hopkinton, Massachusetts 01748 Telephone(508)435-8080 Fax (508)435-4351 PAI Job Number. GVNST001 Date: 6-Dec-95 M, p; Q "� Test;'Loatiori;and;Address:5.., " �;t ,�,; ,y,z?Client;Adtlres`s;and Phone'N'umber° r{,.M1M1ti t Texaco(Star Enterprise) Govoni and Sons Construction Co., Inc " North Street Texaco 847 West Boylston Street A North Street& Bassett Lane Worcester, Massachusetts 01606 Hyannis, Massachusetts 02601 (508) 853-0698 i R _ 9 . Uo•� Ka„����'TTS Vr�tT Uti; cn�nd s� v� IN Ccn```u� � J $ _ T el S 'L ------------------ T�l,4n —j � 3 ki r , .'!,1�+rt~��.�w ET �«y��--"�"T'c'r"Mt r ti�F.''t„ : •n 5;,k In �..:�� .t� �wr L ,,.,•ts .1 l„y��,,f.i .�. "k ,. �u R1 .f:;s r,_....:.Gwss�T"_k _'i`_ .s.��'+ t':.4�'A ,���,'F•»,7+i.r-t'�'�`.f. yv aY+� 'x� e4i� agk vrrJ�'I�5 ..�w�i?"� .rxWc.:�s a :41,i. Comments 4 Healy leak test.061 GPM -passed Govoni replaced 3 fill caps, and 3 dry brakes ,s; PESCE ENGINEERING & ASSOCIATES 3 Leona Lane Osterville, Massachusetts 02655 508-428-3712 January 6, 1992 Department of Environmental Protection RECEIVED. Southeast Region BAN 1 3 1992 ATTN: Mr. Brett Rowe Division of Water Pollution Control UHEAFTMpFPT TOW Post Office Box 1320 OF6RNSkLE Middleboro, Massachusetts 02346 -- RE: Sanitary Tight Tank Permit Dear Mr. Rowe, I am writing to you to confirm our prior phone conversations on November 221 1991, and in December regarding a proposed sanitary tight tank to be used to temporarily hold domestic waste collected from toilets of tourist type buses. This tight tank will be located at a Texaco service station owned by Mr. Richard Goral and located at the corner of 100 North Street and Bassett Lane, Hyannis, Massachusetts. I plan in February to submit a proposed design for approval by the Barnstable Board of Health. Upon their approval I will submit to DEP a Form BRPWP02 along with the $450.00 application fee for the Title 5 (Section 18.1) variance permit. Thank you for your help in this matter and please call if you have any questions. Sincerely, v Edward L. Pesce, P.E. cc: Mr. Goral Barnstable Board of Health ,:,� yyt.,: d'� onn -:.J_. - :�.P4 W J a 5'- ^Y•=z 4-! �.� r.y .f.. "'§.4a `�'$• 'Z.'2'tt ✓ y.�.e�:..:..-`�, '<'�'£'.t =•,n,y ,use. /{'r-- � r., .f„" � '�. � rs:_ �.;�,i, :zC,Y �,`.x'° +�.�� g ttr,tit � j,,,>.. � �'<•� �^ �� .;�� s�_r a: ;s-:.• _ . ..a `! _I- , - Y� 'F' '..-i iC``L':F � +tl yyr y. F •l Vi •4r 3 _ ya " c>.- •1 A,. ;ref r ��2' c`a�.. - �'�y - .s. r ,. n• :y..:e:..._,�-;;z, - � t._ '.. r; � _ ,`.` � ;.;� �7-- .g. w' xk d^ -.�. F�r_ - ;l r� r z e ss riM s ssY: 'a x 1 r _i ' :v°... :r r t- z ti; -?,:,,rl �• - a Z __AiA6 _Y.y�. - `� a. 's t+..� `. .� �-j.a., _?• too �e:�. Fes. SGH 40 PVC, CL - EAN PIPE—MIN.. PITCN _ •} i ti, ;d ,� ?� I/B., PER AFT _ t 1fJ .♦ < , PERFORATE4t; r t_ PVC :PIPE ,: 2 LAYER OF STONs T _'{.(�. .{ P ,d•}' R .4 per.' �4 :i'_a•- E � EL •: ; R< >: 2r,'FORCE LINE s• I LEVEL_ ' .t" wf�. J � do •� Fs .=`. 'E � .f �-O - � :f ${ '�IN. (• h. EIr1�� 1 h'! ,.}. _^iy.F 4 kl��. )YY S t }•"� f i t Sr -.a,. EL — a h` EL :ems_ 0 0 1 u - o-. D D .' D'sr v o � o � EL= D l S 1.' _ d. "1 - 'f.- 'Jh '{ q.u. Kin• 82 :.L. x .��` W BQxfit90VE -- WASHEO:STONE USED t�0 .(}CATIQN _ -LEGEND * BOTTOM.,OF° TEST.,HOLE OR., OBSERVED •-WATER..TABLE.- :EL A POT' EL ION , EXISTING�. CONTOUR',' DJUSTEO: GROUND WATER TABLE C2/16 68 S _ FINAL— 'rs ONTOt1R EvATs A PROFILE . OF :. A SOIL TEST tOGK TION DISPOSAL SYSTEM- TELEPHONE POLE ^ HYDRANT NOT TO SCALE . �_ - � CATCH `BASIN'� 000.'GAL.) " _ :4 000 GAL.) GENERAL NQTES - - - - - - - - - -- - _ ;a n MATT, 12-COVER ALL 4l...sZ a;ataSH�� AND - r It rnwFeaw. To D..E:O.F.. .TfTL� TOWN OF BARNSTABLE Bpi THE Taw ��Q w�♦� OFFICE OF aAU9T BOARD OF HEALTH y NAM aj i639' `em 367 MAIN STREET MP CEO M �' HYANNIS, MASS.02601 May 1, 1992 Mr. Richard Goral �f North Street Texaco Gas Station �[ --k North Street/Bassett Lane (((»> Hyannis, MA 02601 Dear Mr. Goral: You are granted permission to dispose "Tedford" paraformaldehyde solvent CAS #30525-89-4 from holding tanks of buses into the proposed holding tank at. 100 North Street, Hyannis d/b/a Texaco Gas Station, with the following conditions: 1) The alarm system shall be installed to sound off when only 1000 gallons of waste effluent accumulated in the tank. 2) Only "Tedford" paraformaldehyde CAS #20525-89-4 may be disposed in the tank at this time. Any other chemical deodorizer that you plan to dispose into the holding tank shall first receive the approval or disapproval from the Board of Health. The permission was granted because formaldehyde solvent is the "most rapidly biodegradable holding tank deodorant chemical on the market", therefore, "the low formaldehyde levels which are discharged from a septic tank, treating holding waste, will rapidly break down in the soil", according to Janis M. Rudnick, Regulations Chemist for Tedford Corporation. Also, this Service Station is not located within any zones of contribution to public water supply wells. In addition, it is not located within close proximity to any private wells or wetlands. Sincerely yours, oseph C. Snow, M.D. Chairman BOARD OF HEALTH TOWN OF BARNSTABLE CC: Mark Pesce Pesce Engineering TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory BOARD OF HEALTH 2.Printers3.Auto Body Shops / unsatisfactory- 4.Manufacturers COMPANYA yi ,--6�f-; �,X d d O (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS 6 _ Class: 7.Miscellaneous -'L' UANTITIES AND STORAGE (IN= indoors;OUT=outdoors) MAJOR MATERtALS Case lots Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) d Diesel, Kereserie, #2 (B) ®� Heavy Oils: waste motor oil (C) ' new motor oih(C) Xv transmissi" on/hydraulic Synthetic Organics: degreasers ol Miscell eons: DISPOSAURECLAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply O Town Sewer Public ��� On-site `OPrivate 3. Indoor Floor Drains YES NO _ _ O Holding tank:MDC ,o O Catch basin/Dry well O On-site system �� ✓p�✓ 4. Outdoor Surface drains:YES NO ORDERS: O Holding tank:MDC O Catch basin/Dry well O On-site system l° 5.Waste Transporter J&" � DestinationName of Hauler Product °/ 4Y`A, 's GC YES NO Person (s) Interviewed nspe for Date The Town of Barnstable Health Department 367 Main Street, Hyannis, MA 02601 rrua Office 508-790-6265 Thomas A. McKean FAX 508-775-3344 Director of Public Health May 12, 1992 Mr. Edward Pesce Pesce Engineering 3 Leona Lane Osterville, MA RE: North Street Texaco/ Sanitary Tight Tank Dear Mr. Pesce, The revised plans you submitted to the Health Department dated May 9, 1992 signed and stamped by you dated May 11, 1992, meets the conditions of the Board of Health approval letter dated May 1, 1992 . Thank you. Sincerely Yours, Thomas A. McKean Director of Public Health cc: Richard Goral • P�oFTHETo�y TOWN OF BARNSTABLE OFFICE OF HA"ST"L : BOARD OF HEALTH y NAB& o°quo MAY 367 MAIN STREET HYANNIS, MASS. 02601 April 16, 1992 Mr. Edward Pesce, P.E. Pesce Engineering 3 Leona Lane Osterville, MA. 02655 RE: North Street Texaco Dear Mr. Pesce Thank you for attending the Board of Health meeting held on April 14, 1992 . The Health Department Director, Thomas McKean, spoke to the Superintendent of the Department of Public Works, Mr. Thomas Mullen on April 15, 1992 . Mr. Mullen does not recommend disposal of the bus waste at the Wastewater Treatment Plant from a 2, 000 gallon tight tank due to the concentration of the effluent. He does recommend the bus waste be discharged into a Town sewer line which would need to be connected to the building at the subject property. This method is preferable due to dilution of the effluent in the sewer line. Please plan to attend the next Board of Health meeting scheduled to be held on April 28, 1992 . Attached is a copy of the agenda for your information. Sincerely Yours, oseph C. Snow whairman Board of Health Town of Barnstable cc: Richard Goral For office use only I� a TOWN .: �oFTNE roe C � 0 N OF BARNSTABLE Received by � L'S OFFICE OF Date S�r � JO q 2 DAB.dSTABL 1`' BOARD OF HEALTH M A!1. p '6 39•M� 367 MAIN STREET MAy HYANNIS, MASS.02601 "R 1� REQUEST FORM All variance requests must be submitted fifteen (15) days prior to the scheduled Board of Health Meeting. NAME OF APPLICANT � �MCI (MQA ADDRESS OF APPLICANT �J I wuQx41. 1iAA 0069 NAME OF OWNER OF PROPERTY <The SUBDIVISION NAME AIA DATE APPROVED ASSESSORS MAP & PARCEL NUMBER 3&0 4a—LOT SIZE 0, 6 6 Ao LOCATION OF REQUEST /V• ST ��Xia�_ %00 L Ste, VARIANCE FROM REGULATION (List Regulation) �)::;IhT=s� REASON FOR VARIANCE (May attach letter if more space is needed) ell-. f 4ei lodRARY 6L�,AQZ OP -3AQC1-AA 1 ",TF— PLAN - FOUR COPIES OF PLAN MUST BE SUBMITTED CLEARLY OUTLINING VARIANCE REQUEST. VARIANCE APPROVED NOT APPROVED REASON FOR DISAPROVAL Joseph C. Snow, M.D. , Chairman Susan G. Rask Brian R. Grady BOARD OF HEALTH TOWN OF BARNSTABLE v PESCE ENGINEERING AND ASSOCIATES 3 Leona Lane Osterville,MA 02655 508-428-3712 April 10, 1992 Town of Barnstable Board of Health 367 Main Street Hyannis, MA 02601 SUBJECT: Request for Approval for a Sanitary Tight Tank located at the North St. Texaco Station, 100 North St . ,Hyannis Dear Sirs, The purpose of this letter is to request approval for construction of a Sanitary Tight Tank to collect and temporarily hold domestic waste, mixed with a deodorant, from the toilets of tourist type busses . This tight tank is to be located at the North Street Texaco service station, which is operated by Mr. Richard Goral . Attached for your review are the following: a. Proposed design /site plan drawing No. 92.-03-129 b, copy of pumping service contract (signed work order form) from Bortolotti Construction Inc. This waste is to be disposed of at the Hyannis wastewater treatment plant . c. copy of MSDS for paraformaldehyde (holding tank deodorant) . Please call if you have any questions. Sincerely, Edward L. Pesce, P.E. BORTOLOTTI CONSTRUCTION, INC. 40 ° WOM 765 Wakeby Road MARSTONS MILLS, MA 02648 (508) 771-9399 DATE OF ORDER (508) 428-8926 /I:j_ CUSTOMER'S ORDER NO. PHONE MECHANIC HELPER STARTING DATE BILL TO ORDER TAKEN BY ADDRESS, DAY WORK CONTRACT EXTRA JOB NAME AND L CA O —Tin5 � JOB PHONE � DESCRIPTION OF WORK: --� ,, 1' X AI sal�1 L tZ�'ti"lti�i�iy T Pin r t:::� -rn i31L �1� uI C6j L-3 L(rf t PGt-�Y[ffkat ) 6� ma's TOTAL MATERIALS TOTALLABOR l TAX • DATE COMPLETED WORK ORDERED BY TOTALAMOUNT $ No one home Total amount due Total billing to Signature for above work:or be mailed after PRODUCE 258-3 a Inc completion 0 I hereby acknowledge the satisfactory completion of Work GI.N.Mass D1471. of the above described work. ' Matenal Safety Data Sheet U-So D• apartment of Labor May to used to comply waft Occupational Safety and Health Administration OSHA's Hazard Communication Standard. S-Ncr--ManftorV Form) 29 CFR 1910.1200. Standard must oe Form ApprovQU consorted for spetffk requirements. OMB No. 1218-0072 IOENTITy (As Used OA LaOM an0 Lrsq Note BAarw sofoaa are nor prrnaart A any it" ISnor ao0rcao�e.DRI-KEM .+rormaarsf a available. else space mum a maorev to Msy Section I Manufaaww's Name Emergency 1et10-0 Nianow Thetford Corporation 6 —6000• 313 769-6003 (24 hours Apprm (Nionpel, Saeu. Crty. Stem, ov ZIP Coos/ Tet»pMaM Numow for wdwn%wm 7101 Jackson R 313 769-6000 Oate P►eparep Sgnsure at Prepares(gpeon40 Section q_ Hawdous Ingredients/ldentlty Intwm don Mi2MMA COMOOnMM(SOMAC Ctlanrnl tda W. C n neon Wrnelt+l) OSt� PEL ovisir Vmas ACGiM TLV p4conwnencea ab (c Paraformn1 r1phvd AS EZn575—R4-4 t 0nm t STFT 2 i(nn_ (as formaldehyde) Section III - Physk4WChemical Chmactetiatlos . t30109 Pant Spec lk GrWay("go - 1) not applicable 1.45 vapor Preswre(mm Mg.) Me"Pont. 1.0 :.pus :.enesy%A4A - 1) Eve9orsuan Awe t (8ut1A Acetase - 1) Sauamty in Water 90% Appearance and Ooor blue granules with pungent odor Section IV — Fire and Explosion Matsrd Oats Flasn Pont (Metnoo Usm) Flanwnable l+rtrta LFIL UEL ° avai TCC not lable 7.0 73.0 Exungwsnwlq.Maple �_ water, dry chemical, carbon dioxide, or foram Special Fire Figntng Proaaum wear self-contained breathing apparatus unusual Fire am Explosion Man= None (Peprocuce locally) OSHA 174,.Sept. t Section V — Reactivity Oats Staal1 Gx+artwns t0 Av0t0 Slacle X elevated temperatures nComoat1011t1y.IMaterNla to Avord) strong alkalies inorganic acids, isocyanates, anhydrides, oxides. Mazarocus Oecomposit= at f3yprvauv Thermal decom osition maY Produce carbon monoxide and/or carbon dioxide Mazaraous May Occur ,Congtwq to Avted PaiymentaGan Will No Occur not b l e ... '. Section VI — Health Huard Data At7uleti) of entry: Innalalwn? Skirt? Ingpppni yes-irritant 'yes-irritant toxic reatfn Mazwos rAcure and CltMAV) Can 2roduce eve damage & skin sensitization Mutagenic acitivity in bacterial & mammnlia: cell test symptoms-but not mutaaenic in whole an systems. Not teratogenic High . inhalation exposure may cause bronchopneumonia and edema. Carunogenical NTP? Reasonably anticipated to be carcinogenic probably Monowacarcinogenic potential carcinoget Carcinogenic potential is based on animal evidence.. Human evidence shows no increased rick of ranter S gns aria Symptoms of Expos we Inhalation produces irritation to upper respiratory tract & eye irritation. May include c comfort such as nausea, ea ace or weakness. SKIn contacc proauc comfort and rash .. Eye contact causes irritation or severe burns. Medical Conaawns Generally aggravated by Espown Persons having preexisting diseases of the lungs eyes or skin may have increased susceptibility to hazards of excessive exposure. E:^ersency ano First Ab Proceaura Flush contacted area w t large amounts at water. IM—gaVe e yes a minimum of 15 minutes. If swallowed induce vomiting by giving 2 glasses of water and sticking finger down throat For eve contact or ingestion, calla physician Section VII — Precautions for Safe Handling and Uss Steam; to ae ralten in Cate Material Is Aeleased at saw" . . Sweep spilled material up. Neutralize remaining odor with dilute ammonia solution. Flush area with large amounts of water. - 'Nasm CIsoosal Moo= Incineration or biological treatment in a federal/state approved .treatment facility. Precautions ►o So Taken in ►+art10 and Storing Do not store above 110 F. Do not get on skin or in eyes. Do not inhale vapors or dust. ^trer Precautiwns Wash thoroughly after handling. Section Vlll — Control Measures Wear Peao�ratory Protect�.rt spcslr ryp,r� sel - ntain d breathing-apparatus for large spills- Von tilaLvn Local &h&M . .maintain adeguate � ventilation not necessary Mocnancal(GWOV Outer not recommended not. a licable Pratealve Gloves Eye Protettton �, recommended recommended Corer Prcteemre C;otfttnq or EgwpmerK Protective clothing to avoid skin contact. Eye wash and safety shower. Van jMVg1on1C P•aoxes Avoid unnecessary and prolonged exposures. Avoid breathing dust. PF-ra t I Epp�o TOWN OF BARNSTABLE y � OFFICE OF DARNSTADLE, o° yp MASS. 9 BOARD OF HEALTH po,t639. 'E0 MAX A" 387 MAIN STREET HYANNIS, MASS. 02601 October 24, 1989 Mr. Richard Falvey North Street Texaco Gas Station 100 North Street/Bassett Lane Hyannis, Ma 02601 Dear Mr. Falvey: The Board of Health recently received a letter from the Department of Environmental Protection Water Pollution Control Section Chief, Jeffrey Gould, dated October 13, 1989, concerning disposal of holding tank waste at your facility. Please be advised the wastes cannot be disposed into your septic system without a Groundwater Discharge Permit from the Department of Environmental Protection. You are directed to cease and desist disposal of the bus holding tank wastes until after you receive the approval of the Massachusetts Department of Environmental Protection. Please contact Jeffrey Gould or Brett Rowe at the following telephone number (508) 946-2750. Yours truly, r Grover C. M. Farrish, M.D., Chairman Ann Jane Eshbaugh James H. Crocker, . BVARD OF HEALTH "'"TOWN OF BARNSTABLE GF/bs */"ZOO, Daniel S.Greenbaum Commissioner Gilbert T.Joly �p i�er�c �Ladlh o� Regional Director October 13 198 '°e' 6 '`^'"'a "` `"'' � Board of Health RE: BARNSTABLE--Subsurface Sewage Main Street Disposal--Use of Subsurface Hyannis, Massachusetts 02601 Sewage Disposal Systems For The. Disposal of Deodorant Chemical ATTENTION: Grover C.M. Farrish, M.D. Waste, North Street Texaco Gas Chairman Station Dear Board Members: The Department of Environmental Protection is in receipt of your letter dated August 29, 1989, which stated that your board granted approval to the North Street Texaco Gas Station to dispose of "Tedford" paraformaldehyde solvent CAS# 305-25-89-4 from holding tanks of buses into their onsite septic system at the referenced location. Please be advised that this Department considers these wastes to be industrial wastes and therefore cannot be disposed by subsurface means without a groundwater discharge permit issued by this Department. Alternative disposal of those wastes employing an Industrial Waste Holding Tank in accordance with the enclosed approval guidelines may be more appropriate in this case. If you have any questions please call Mr. Brett Rowe at the following telephone number (508) 946-2750. Very truly yours, 7 WANDEPE 7MOF �r � O JBra (Afr Gould Chie V ri of ution Control Section G/BR/lm L C Enclosure .n � 1981 Original Printed on Recycled Paper 2 U E (Pn@PEnVV UjUnWEV IF©MN STREET ADDRESS OF PROPERTY BEING SURVEYED; —228 North Street - Hyannis, MA OWNER : star Enterprises PHONE:609-778-1400 ADDRESS : 303 Fellowship Road - cs - 18 Moorestown, New Jersey OCCUPANT: Texaco service station PHONE:508-771-1398 ADDRESS : 228 North street PRESENT FLAMMABLE PEhM I TTED STORAGE AT PROPERTY; TANK PRODUCT LOCATION AGE CONSTRUCTION SIZE (GAL) 550 gal. waste oil Underground 1990 Double Wall Fiberglass �0;11 3 - 10,000 cral. gasoline " �2- is-nn 1 normal_ hAating ou • ° n TANKS REMOVED FROM. THE PROPERTY; TANK PRODUCT LOCATION CONSTRUCTION DATE viZE (Gi REi'iO V ED "j 4___6QOQ gam. a o1;n __ Underground steel / 1965 11/89 1 - annn gal. niesei ° " 1970 J Snn gp].. wa-gtp ni 1 " If 1966 12 ZR9 1000 cral. # 2 fuel oil 1965 if SPILLS / LEAKS AT THE PROPERTY; DATE: MATERIAL - AP PROX. SIZE OF RELEASE None reported "HYANNIIS FIRE PREVENTION SURE&F INFORMATION PROVIDED BY, HYANNIS FIRE DEPARTMENT DATE ; 9/16/91 95 HIGH SCHOOL RD. EXT I! F 733 291 1 ?t8 RECEIPT FOR CERTIFIED MAIL7 NO INSURANCE COVERAGE PROVIDED NOT FOR INTERNATIONAL,All- (See Reverse) Sent to . Mr. Richard Falvey Street aNftth Street Texaco Gas tatio n. P.O.,State and ZIP Code Hyannis. Ma 02601 Postage S Certified Fee. 2.00 Special Delivery Fee Restricted Delivery Fee Return Receipt showing to whom and Date Delivered in OCR Return Receipt showing to whom, �- Date,and Address of Delivery m TOTAL Postage and Fees S 2.00 -a C ow Postmark or Date r� E July 27, 1989 o ' a N STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES. (see front) If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving e receipt attached and present the article at a post office service window or hand it to your rural carrier 1 no extra charge) 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return adUlress of ,the article,date,detach and retain the receipt,and mail the article. 3. if you want a return receipt,write the certified mail number and your name and address on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space per- mits. Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. . If you want delivery restricted to the addressee,or to an authorized agent of the addressee,endorse RESTRICTED DELIVERY on the front of the article. 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt. If return !receipt is requested,check the applicable blocks in item 1 of Form 3811. '^6. Save this receipt and present it if you make inquiry. I *U.S.O.P.0.1997.178.131 Q 1. %THEpo�y {' TOWN OF BARNSTABLE OFFICE OF BAB119TABTiS i >�0 639 BOAR® OF HEALTH �INI1Ylr� 367 MAIN STREET HYANNIS, MASS. 02601 9 July 27, 1989 Mr. Richard Falvey North Street Texaco Gas Station 100 North Street/Bassett Lane Hyannis, MA 02601 NOTICE TO ABATE VIOLATIONS OF 310 CMR 15.00. The State Environmental Code Title V Minimum Requirements for the Subsurface Disposal of Sanitary Sewage and Town of Barnstable Bylaw: Article 39: Control of Toxic and Hazardous Materials The property managed by you located at 100 North Street, Hyannis, d/b/a Texaco Gas Station, was inspected by Thomas McKean, Director of Public Health on June 8, 1989 because of complaints. The following violations of 310 CMR 15.00 of the State Environmental Code were observed: Regulation 15.02 (6) use: One 1500 gallon septic . tank connected to a leaching facility utilized for discharging holding tank wastes of several b g g uses. Section 4 (a) Prohibitors: "Tedford" solvent discharged into ground via septic system. You are directed to cease and desist acceptance of holding tank wastes into your onsite sewage disposal system upon receipt of this notice. You may request a hearing if written petition requesting same is received by the Board within seven (7) days. Sincerely yours, NL(7(,- Thomas A. Mclean Director of Public Health Town of Barnstable TM/bs Certified - P733291138 R TOWN OF BARNSTABLE CF THE p�� OFFICE OF L DAAl19TAHLL i BOARD OF HEALTH 9 MASS. °j 367 MAIN STREET o i639. OMAYk' HYANNIS, MASS. 02601 August 29,,.` 1989 Mr. Richard Falvey North Street Texaco Gas Station 100 North Street/Bassett Lane Hyannis MA 02601 Dear Mr. Falvey: ermission to dispose "Tedford" paraformaldehyde You are granted p tanks of buses into your solvent CAS #30525-89-4 from holding Hyannis d/b/a Texaco th onsite septic tank at 100 Norcond tionsStreetl y: Gas Station, with the following r 1 The total daily volume of the "Tedford" solvent effluent along containing paraformaldehyde disposed the servicento thePtic stationk cannot with the calculated sewage flow from exceed the design capacity of the onsite sewage disposal system. -4 may be 2) Only "Tedford" paraformaldehyde CAS #3052-89 chemical Any disposed in the septic tank s o e into mthe septic system shall deodorizer that you plan to dip approval or disapproval from the Board of first receive., the Health. You shall maintain weekly records of the volume of waste 3) our septic system. After a period discharged from buses into y of of one (1) year, you shall furnish the Board with a copy the records. The permission was granted because lrformaldehyde solvent chemical "mos rapidly biodegradable holding " therefore, the low formaldehyde levels which on the market , treating holding tank waste, are discharged from a septic tank, according to Janis M. will rapidly break down in the soil" , Rudnick, Regulations Chemist for Tedford Corporation• zones of Also, this Service Station is not ly we d s. In addition,wnyit contribution to public water suPP y to any private wells or is not located within close proximity wetlands. Sincerely Yo s► Grover C.M. Farrish, M.D. Chairman BOARD OF HEALTH TOWN OF BARNSTABLE TM:cst cc: Department of Environmental Protection P,O.BOX 1285 ® ANN ARBOR,MICHIGA,N 48106 a (313) 769.6000 i THETFORD June 12 , 1989 Mr. Richard Falvey c/o North Street Texaco North Street and Bassett Lane Hyannis, Massachusetts 02601 Dear Mr. Falvey: ` This letter is written in response to your inquiry regarding the effect of, formaldehyde on septic systems. Most of the studies =performed to date have been on treating formaldehyde in aerobic treatment plants as opposed to septic tanks. Formaldehyde is easily, biodegraded in a treatment plant as { long as the levels are kept below toxic levels. Many toxic chemicals are treated in treatment plants and septic systems daily. t The Biological Oxygen demand (BOD) is one measure of the biodegradability of a substance. Formaldehyde is readily biodegraded'. The five day BOD has been. measured at >99%j1) when subjected to the Standard Methods for .the Examination of Water and Wastewater Method of Analysis. . Formaldehyde is actually the most readily biodegradable holding tank deodorant chemical on the market. Various studies have been .conducted on the effects of formaldehyde on waste treatment systems. These studies result in a range of acceptable formaldehyde levels. The Environmental Protection Agency (2) conducted a study examining the waste from water craft' using. various chemical deodorizers including formaldehyde. After being subjected to conventional waste treatment means, the effluent was tested for removal .efficiency by biological oxygen demand, total organic carbon, suspended solids and turbidity. The EPA concluded that maximum non-toxic levels of formaldehyde are 100-120 ppm. Page 2 Work by Musterman & Morand ( 3 ) shows even higher formaldehyde levels tolerable. They arrive at this conclusion using data on oxygen utilization rate and soluble COD removal from sewage containing 200 ppm formaldehyde. Their work shows continued vigorous biological activity at these formaldehyde 1.e,,rel.s., The investigations go on to report that sewage treatee1 with up to and including 1000 ppm formaldehyde will rapidly recover from any inhibitory effects. At 5000 ppm, however, the short term viability of the sewage was sharply reduced. Smith,:& Wilsowk(4) `have recommended formaldehyde limits of 200 ppm for acclimated treatment processes. ' If the treatment plant-,his,gradually acclimated, however, higher�.levels of formaldehyde:Kcan be tolerated. Bacteria will adapt to the presence .of formaldehyde and will gradually develq a tolerance for ,higher levels. Grabinska-Loniewska(( reported waste containing 1750 ppm formaldehyde . is successfully treated in an activated sludge process by acclimated biota. Much of the work reviewed shows no disruption of biological waste processes .will occur unless formaldehyde levels exceed 100 ppm. , -Some studies show successful treatment at levels significantly ,higher than 100 ppm. As, a conservative guidelihe, ' however, . Thetford recommends,,.100�. ppm formaldehyde as an . allowable upper limit of formaldehyde' to be. introduced to an activated7sludge waste treatment system and to septic systems. : w , It is.-difficult to state.,,the average formaldehyde content. in a holding tank because formaldehyde is consumed by the waste. There are .many factors involved including initial charge, duration of, use, amount of waste. in the holding tank and temperature- conditions. , The EPA study .measured approximately 10 ppm formaldehyde( 2) tin a hojd}ng tank. The Brown study measured approximately ..170 ppm 1 Measurements of the influent would have to be taken to determine the formaldehyde content in your location. A septic system functions very differently from a biological treatment plant. A septic tank undergoes anerobic digestion, as opposed to ,aerobic digestion in a treatment plant. Septic tanks are not as easily upset as biological treatment plants, but the degradation takes longer. The drainfield is available as an aerobic digester to complete degradation. Septic tanks are not recommended for treating large volumes of waste. Page 3 A study by-Charles Brown (6) on the treatability of holding tank waste in a. septic tank shows formaldehyde removal to be 960. The formaldehyde"levels in the septic tank water and drainfield were measured at 5-10 ppm. Formaldehyde is readily broken down by the microorganisms in the soil . A study by Nazarenko, 1960, (7 ) shows an initial concentration of 5 mg/1 formaldehyde in a dilute soil tap water mixture was completely. biodegraded on the third day. Another study by A A. Polyakov, T.A. Dmitzieva. and T.A. r Trzhsetzetzkaya (8j involved spraying a 4% formaldehyde solution on;the, soil surfaces in-quantities-of,.5 ,and .10 liters per,: square rmeter.x,t;,x.After; one day,,formaldehyde was•.undetected ' at, a.;depth'fof. 15>cm; (applying 5 liters of solution) and formaldehyde could not be detected at a depth of 18 cm f6k (applying.10 liters of. solution) . he-low„,w;x c �f4 = formaldehyde levels wh ch' are ;dY`scharged,4from arseptic-tank, treating�:holdingr�tank waste ==w •ll--�rapidly=.break•N down ,in�,the . cr f The most-important,:aspect of, treating holding tank waste is -to ensure the--septic tank ,and drainfields are sized properly and maintained~ properly.),. Holding tank-waste.As very.,concen t rr ted compared to domestici'sewage. A, study by,.Charles'.Brown measured-holding tank waste to be about 15 times .more concentrated than domestic sewage. The waste in RV's and boats is so concentrated because so little water is used during. flushing;, one quart compared .to five gallons in a domestic . toilet.. Waterois also conserved when using the shower:and sink •facilities. t This-high, strength .waste must be taken into-consideration when sizing and maintaining a septic system.:;; The•.septic tanks•.must be pumped .out more frequently and the septic:�,tanks and ,drainfields must be.much-,larger than a typical domestic system. Most often when there..are problems with a septic system, it is because it is undersized or improperly maintained, not because of formaldehyde. There are other holding tank deodorant chemicals on the market. Close analysis of their chemical characteristics will show they are much less desirable to use than formaldehyde. Page 4 For example, quaternary ammonium chloride compounds are not as readily biodegraded as formaldehyde. They usually cause foaming problems in a 'treatme�t system also. The BOD of a typical quat is 22 percent l9 This means quats will pass through a treatment plant untreated. They also kill ba�ct;eria at levels as low as 0 .5 ppm. Another chemical used in holding tank deodorants is phenols. Phenols are not easily biodegraded. They also cause taste and odor problems at very low levels in a treatment plant. A recent .new` product. on. the market ,is based on glutaraldehyde. It; is,.as .readily-=biodegraded , a =formaldehyde-.,,. .The BOD of glutaraldehyde is >93 percent ) . Enzymes -,will 'not possibly harm a treatment plant. Enzymes are based on naturally occurring biological chemicals. . Enzymes are not as reliable for odor control, however. Most people, therefore, prefer to use chemical based deodorants. Enzyme products cannot be used in recirculating or portable toilets because of their poor deodorant performance. They should also not be used in recirculating toilets because the digestive powers •of the product will cause the solids to recirculate, clogging the pump:_. While enzymes will not possibly harm a treatment plant, they will not help one that is not sized properly or functioning properly. Thetford -Corporation will be introducing a new product this year called Aqua Kem Green. It is a unique revolutionary new deodorant product. It is,"based on a high molecular weight polymer. It is non-toxic and will cause no problems in waste treatment systems. The active ingredient is actually used to help waste treatment plants. It has very effective odor control. Distributors are beginning to stock it now'. Page 5 Hopefully, this information will be helpful. I have enclosed some other information which you requested. As requested, enclosed you will find the composition information on our products. This information is considered confidential and should be treated as such. The Aqua Kem Green prodi.7c t is not recommended for use in recirculating toilets. If the Aqua :Kem (blue) product, is not approved, however, you may- wish to try the Aqua Kem Green to see if you are satisfied with its performance. . The. active ingredient in Aqua Kem Green is z actually used by,municipal, waste treatment facilities to ,, improve>.their performance. ;;ThetfordzCorporation. is very . interested, in;,maintaining a: safe environment.:,-.After being in this field for over, twenty years, we have gathered a variety of informationuon,.the_treatment ,of .holding tank waste. We .are alwaysinterested. in working with people involved with treating holding „tank waste. . If you have any questions or , need further information, do not hesitate to contact me. sincerely, Janis M. Rudnick Regulations Chemist _ k MRB. jab y ,,,. Enclosures... htank2 i t, I REFERENCES 1. Analysis performed by National Sanitation Foundation, Ann Arbor, Michigan. 2 . Robins, J.G. and Green, A.C. , Development of Can=Sk ore Treatment Systems for Sewage from Watercraft Was-.-.e, Retention Systems, Environmental Protection Agency - 670/2-74-056, Contract #68-32-0220, National Environmental Research Center, Office of Research & 2 Development, United States Environmental - Protection Agency;,; Cincinnati, Ohio. Available from United States Government Printing office, Washington, D.C. 3. Musterman,.NJ:L4and Morand, J.M. , Formaldehyde as a Preservative oftActivated Sludge, J. Water Pollution Control Federation, January 1977, United States 4. Smith and.Wilson, Water and Wastes Engineering, March 1973 , pp. 48-57. 5. Grabinska-Loniewska, A. , Gaze Woda i Technika Sanitora,_ 47 (80) pp.' 284-288. 6. Brown, Charles Arnold, Treatability of Recreational Vehicle Wastewater at Highway Rest Areas, University of Washington, ,August 1982. 7. Reference in, EPA's •"Informal Guidance Level for Formaldehyde", August .1981 8. A.A: Polyakov, .T Aa: Dmitzieva, T.A. Trzhsetzetzkaya, Penetation of Formaldehyde into the Soil and Disinfecting Properties of it on Both Spprous and Non-Sporous Microflora, .Tr. Vses. Nauchno-Issled. Inst. Vet. San it. 1975 pp. ..131-138. 9. Krzeminski; Stephen, Martin,. John and Brackett, Charles, Environmental Impact of a Quaternary Ammonium Bactericide, Rohm and Haas Company, 1979. htank2 � it BIBLIOGRAPHY 1. Formaldehyde and Other Aldehydes National Academy Press Washington, D.C. 1981 2 . Treatability of Recreational Vehicle Wastewater at Rest Area; L Charles. A.IBrown; Thesis for. the University of Washington; 1982 ¢. ` 3 . Formaldehyde as a Preservative of Activated Sludge John L. Musterman Kansas...,State University, Manhatten; . New York. : James M. Morand, . University of Cincinnati, Ohio Journal of Waste- Pollution Conference on Formaldehyde January,, 1977 s 4. . Trucked Wastes Moreau , . Water -:and 'Waste Engineering T. March, 1973, R , 5. water:AQuality ,Criteria State of Illinois, Department of Public Health Division .of .Sanitary Engineering 2nd. Editioh by.McKee and Wolf. , The Resources Division of , California State Water Quality Control;. Board, Sacramento, California Publication No. 3-A 1976 6. Chemical Disinfectant of Holding Tank Sewage Mark D. Sobsey, Craig Wallis and Joseph-L. Melnick Department of Virology and Epidemiology Baylor College of Medicine, Houston, Texas August 26, 1974 7 . Action of Formaldehyde on Microorganisms I. Correlation of Activity with Formaldehyde Metabolism W. Brock Neely, Biochemical Research Laboratory The Dow Chemical Company, Midland, Michigan December 12 , 1?62 8. Development of Onshore Treatment System for Sewage from Watercraft Waste Retention System Environmental Protection Agency Technology Series EPA-670/2-74-056 July, 1974 9. Toxic Inhibition of Anaerobic Biodegradation Pearson, Frank, et al; University of California, Berkley WPCFJ, March 1980, Vol. 52 , No. 3 , pgs. 472-483 . 10. Penetration of Formaldehyde into Soil and its Disinfecting Properties with' Respect to Nonspore-forming 4. .'.. . ...-. _- and Spore-forming Microflora, Polyakov, . A.A. ; Dmitrieva, =:; .Tr zhetsetskaya, . T.A.�,s "Tr. Vses. Nauchno-Issled Inst.:-,, Vet. Sanit. " 1975; Vol. 51, :pgs. -.131-8. CAS# 1' 86:184411q t it Behavior and`Degradation of Technical Preservatives in the Biological Purification of Sewage. Pauli, O. ; > ' Franke, G. Biodeterior. Mater. Proc. Int. Biodeterior Symp. ; 1971, pgs. 52-60. CAS# 78:139920d •- 12 A Study of the Biological .Treatability of .the Trade Effluent Produced from the Manufacture of Ion Exchange „ .w Resins the Use of Adenosine Triphosphate' and_Adenylate Charge Measurement.. B. Simpson, et al; -University ., College, UK, "Process Biochemistry"., Jan.-Feb. ,1976, Vol. 11, No. 1, pgs. 21-25. ­­� 13.-- Metabolism of Single Carbon Compounds During the Biological Purification of Waste Waters. Makeeva, E.N. ; Makeev, A.M. ; Rodziller, I.D. ; Voronezhg State Univ. ; Prikl.�-ABiokhim. Mikrobiol. ; 1975; 11( 3) pg. 357 . CAS# -84:95118k ,­ b. htank F ' - •� it i Material Safety Data Sheet U.S. Department of Labor May be used to comply with OeeupatlOna)Safety and Health Administration ��, OSHA's Hazard Communication Standard. INon-Mandatory Form) 29 CFO 1910.1200. Standard must be Form Approved -. consulted for speafk reouirements. OM8 No. 121"72 icamm11 (As used on Leal and Leo Ntater sAerMr&oaoos are nor ov"Wied a anlr den a eased1 or no i DRI-REM a avamcr. ft space MW be 1"**"ra eiduv met Section 1 Manulaetwer's Name ErtNr90CY Telephone N~ Thetford Co 6. -6000; C-3].3 769603 (24 hours) Address (N oww, Sono, City. Smw. and ZIP COW) Teftftft Na r W inl=tra+eum ' 7101 Jackson Road-_ 313 769-6000 Dam fro . ----- .Ann Arbor, Michigan 48103 . Anril 1988 dun of Prepares(gooatall . R+RSe. Section II — Hazardous Ingredients/Identlty Information ;:.. . Wtuts aHaiaidoi s Coo Its(SpiaAe C,tlirtreal tderit tf,Comnan NWWO) OSHA PM ACGIM nV. Re=w wnded %fagoonaq Pa= armaldehviie CAS 30525=89-4 c` :`A" " °" " t �� 1 nrm SUL 2 �ffi .w. (as formaldehyde) Section III — PhysicaUChemical Characteristics Boding Pant SpsaAe Gravity(H20 - 1) . . licdble.,.,not a �.�., ,... ...:. ..,_„.- . -_. . 1.45 vaow Presswe(mn1 rig.) me"Paint _ ,.z.. 1 a :soar Cans ry(AIA • t) Evapo um Rate— I�N Aatasr � t) SAIu®i4ty in water ...,- _ 90% .. Appevance and Odor blue granules with pungent odor Section IV — Firs and Explosion Hazard Data Flash Point(Meawd Used) Flan swim t.E1, UEL 13l°F TCC not available 7.0 73.0 F,xenguanng Melia water, dry chemical, carbon dioxide, or foram Soma Fim Fightu►g Pmcedwea wear self-contained breathing apparafAls , Unusual Fire and Exokwon HUMM None o (Reproduce ierallY) OSHA 174, Sept. 1S65 Section V — Reactivity Oats S!aowq unstable Condrnons to Av" ®.�...®. stag. % elevated tem eratures InCOmOat0fity(Marenal9 to AVON" strong alkalies inorganic acids, isocyanates, anhydrides, oxides. Hazarocus OOComppa,twn or eypoduczs Thermal decomposition may produce carbon monoxide and/or carbon dioxide Maaarcous May OCCW Conomans to AvW Poiymen2anOn �"'®""" Will Not Occur -vanplIsable ction VI — Health Hazard Data Poutelsk of Entry: Inhalat*n? Skit? es-irritant .,�.�,.n..�,. ..�..�.:��... es-irritant. toxic . . .. .� Ingeatgn? �;.•: Heaun Hazards rAcure and C1+ranie) �e. .... x ;,,,,Can produce eve damaste T&,�'skin?lsen'sitizatiolil."-`mitasienic acitivity in bacterial & mammalian r call test symptoms but <not--mutaenic in whole`animal systems. Not teratogenic. High inhalati we osure ma cau tt se bronchopneumonia and adema. Carcinogenicity: NTF" ReasonablyARC antics aced to 'be carcino epic I obab�rcino eaic oteatia carcinogen `.Carcinogenic potential is based on animal evidence. Human evidence shows no increased signs ano Symptoms of Exposure . Inhalation Rroduces irritation to upper res irato tract-& eye irritation. May include dis- comfort such as nausea, headache or wen ess. con ac o u comfort and stasis,; E e contact causes irritation or severe urns. .,,,,comfort Conaltions GeMerady aggravated by Persons'havin reexistin ` diseases of the lungs, eyes or skin may have-increased'susce tibilit. "to' hazards`of excessive .ex osure. Emergency ano First Aid Procedures_ Flush contactedarea with arge amouII s or water. eyes for a_minimum of 15 minutes. If swallowed induce vomiting by giving 2 glasses of water and sti.Eld i fintter down throat. For eye contact or ingestion, call a physician. 'action VII — Precautlona for Safe Handling and Use Ml to ®e taken in Case Material Is ReNmW at Spiled .eeg spilled material up. Neutralize remaining odor with`dilute 'ammonia solution. ...Lush area with large amounts•of water. ° t w S A' Waste Olsoosal Memoo Incineration or biological-treatment in a federal/state 'approved treatment facility. Precauhons to So Taken in Hana m and Stonnq Do not store above 110 F. Do not get on skin or in eyes. . Do not inhale vapors or dust. !er P•ecauhons r , ash thoroughly after handling. ' Section Vill — Control Measures r?1;zPlratory^ Pr�otpa.,n (C Type) W s lf-contained breathing 'apparatus for large s ills venhlanon local uhaual uate ventilation not necessary Mecnan"(Ganmrel) �he1 not recotmmended not applicable Protective Gloves Eye Prvtet7tioll recommended recommended Ctn2r Prptt3ctNe C:otntng Or EQwpmom Protective clothing to avoid skin contact. Eye wash and safety shower. 'rvarwHygtenK P•aCt'C@S void unnecessary and prolonged exposures. Avoid breathing dust. P.O.BOX 1285 o ANN ARBOR,MICHIGAN 48106 a (313) 769-6000 5 THETFORD CORPORATION June 12, 1989 Mr. Richard Falvey c/o North Street Texaco North Street and Bassett Lane Hyannis, Massachusetts 02601 Dear Mr. Falvey: This letter is written in response to your inquiry regarding the effect of formaldehyde on septic systems. Most of the- studies performed to date have been on treating formaldehyde in aerobic treatment plants as opposed to septic tanks. Formaldehyde is easily biodegraded in a treatment plant as long as the levels are kept below toxic levels. Many toxic chemicals are treated in treatment plants and septic systems daily. The Biological Oxygen demand .(BOD) is one measure of the biodegradability of a substance. Formaldehyde is readily biodegraded. The five day BOD has been measured at >99%jl) when subjected to the Standard Methods for the Examination of Water and Wastewater Method of Analysis. Formaldehyde is actually the. most readily biodegradable holding tank deodorant chemical on the market. Various studies have been conducted on the effects of formaldehyde on waste treatment systems. These studies result in a range of acceptable formaldehyde levels. The Environmental Protection Agency ( 2) conducted a study examining the waste from water craft using various chemical deodorizers including formaldehyde. After being subjected to conventional waste treatment means, the effluent was tested for removal efficiency by biological oxygen demand, total organic carbon, suspended solids and turbidity. The EPA concluded that maximum non-toxic levels of formaldehyde are 100-120 ppm. Page 2 Work by Musterman & Morand (3 ) shows even higher formaldehyde levels tolerable. They arrive at this conclusion using data on oxygen utilization rate and soluble COD removal from sewage containing 200 ppm formaldehyde. Their work shows continued vigorous biological activity at these formaldehyde levels. The investigations go on to report that sewage treated with up to and including 1000 ppm formaldehyde will rapidly recover from any inhibitory effects. At 5000 ppm, however, the short term viability of the sewage was sharply reduced. Smith & Wilson (4) have recommended formaldehyde limits of 200 ppm for acclimated treatment processes. If the treatment plant is gradually acclimated, however, higher levels of formaldehyde can be tolerated. Bacteria will adapt to the presence of formaldehyde and will gradually develq a tolerance for higher levels. Grabinska-Loniewskac reported. waste containing 1750 ppm formaldehyde is successfully treated in an activated sludge process by acclimated biota. Much of the work reviewed shows no disruption of biological waste processes will occur unless formaldehyde levels exceed 100 ppm. Some studies show successful treatment at levels significantly higher than 100 ppm. As a conservative guideline, .however, Thetford recommends 100 ppm formaldehyde as an allowable upper limit of formaldehyde to be introduced to an activated sludge waste treatment system and to septic systems. It is difficult to state the average formaldehyde content in a holding tank because formaldehyde is consumed by the waste. There are many factors involved including initial charge, duration of .use, amount of waste in the holding tank and temperature conditions. The EPA study measured approximately 10 ppm formaldehyde(2) in a holding tank. The Brown study measured approximately 170 ppm 1 Measurements of the influent would have to be taken to determine the formaldehyde content in your location. A septic system functions very differently from a biological treatment plant. A septic tank undergoes anerobic digestion, as opposed to aerobic digestion in a treatment plant. Septic tanks are not as easily upset as biological. treatment plants, but the degradation takes longer. The drainfield is available as an aerobic digester to complete degradation. Septic tanks are not recommended for treating large volumes of waste. Page 3 A study by Charles Brown (6) on the treatability of holding tank waste in a septic tank shows formaldehyde removal to be 96%. The formaldehyde levels in the septic tank water and drainfield were measured at 5-10 ppm. Formaldehyde is readily broken down by the microorganisms in the soil. A study by Nazarenko, 1960, (7) shows an initial concentration of 5 mg./1 formaldehyde in a dilute soil tap water mixture was completely biodegraded on the third day. Another study by A A. Polyakov, T.A. Dmitzieva and T.A. Trzhsetzetzkaya (8j involved spraying a 4% formaldehyde solution on the soil surface in quantities of 5 and 10 liters per square meter. After one day formaldehyde was undetected at a depth of 15 cm (applying 5 liters of solution) and formaldehyde could not be detected at a depth of 18 cm (applying 10 liters of solution) . -As-can._be_seen,� the low formaldehyde levels which are discharged from a septic tank, treating holding tank waste, will rapidly breakdown in the soil . The most important aspect of treating holding tank waste is to ensure the septic tank and drainfields are sized properly and maintained properly. Holding tank waste is very concentrated compared to domestic sewage. A study by Charles Brown measured holding tank waste to be about 15 times more concentrated than domestic sewage. The waste in RV's and boats is so concentrated because so little water is used during flushing, one quart compared to five gallons in a domestic toilet. Water is also conserved when using the shower and sink facilities. This high strength waste must be taken into consideration when sizing and maintaining a septic system. The septic tanks must be pumped out more frequently and the septic tanks and drainfields must be much larger than a typical domestic system. Most often when there are problems with a septic system, it is because it is undersized or improperly maintained, not because of formaldehyde. 'there are other holding tank deodorant 'chemicals on the market. Close analysis of their chemical characteristics will show they are much less desirable to use than formaldehyde. Page 4 For example, quaternary ammonium chloride compounds are not as readily biodegraded as formaldehyde. They usually cause foaming problems in a treatTe�t system also. The BOD of a typical quat is 22 percent 9 This means quats will pass through a treatment plant untreated. They also kill bacteria at levels as low as 0.5 ppm. Another chemical used in holding tank deodorants is phenols. Phenols are not easily biodegraded. They also cause taste and odor problems at very low levels in a treatment plant. A recent new .product on the market is based' on glutaraldehyde. It is as readily biodegraded as formaldehyde. The BOD of glutaraldehyde is >93 percent 1 Enzymes will not possibly harm a treatment plant. Enzymes are based on naturally occurring biological chemicals. Enzymes are not as reliable for odor control, however. Most people, therefore, prefer to use chemical based deodorants. Enzyme products cannot be used in recirculating or portable toilets because of their poor deodorant performance. They should also not be used in recirculating toilets because the digestive powers of the product will cause the solids to recirculate, clogging the pump. While enzymes will not possibly harm a treatment pliant, they will not help one that is not sized properly or functioning properly. Thetford Corporation will be introducing a new product this year called Aqua Kem Green. It is a unique revolutionary new deodorant product. It is based on a high molecular weight polymer. It is non-toxic and will cause no problems in waste treatment systems. The active ingredient is actually used to help waste treatment plants. It has very effective odor control. Distributors are beginning to stock it now. Page 5 Hopefully, this information will be helpful. I have enclosed some other information which you requested. As requested, enclosed you will find the composition information on our products. This information is considered confidential and should be treated as such. The Aqua Kem Green product is not recommended for use in recirculating toilets. If the Aqua Kem (blue) product is not approved, however, you may wish to try the Aqua Kem Green to see if you are satisfied with its performance. The active ingredient in Aqua Kem Green is actually used by municipal waste treatment facilities to improve their performance. Thetford Corporation is very interested in maintaining a safe environment. After being in this field for over twenty years, we have gathered a variety of information on the treatment of holding tank waste. We are always interested. in working with people involved with treating holding tank waste. If you have any questions or need further information, do not hesitate to contact me. Sincerely, Janis M. Rudnick Regulations Chemist MRB: jab Enclosures htank2 REFERENCES 1. Analysis performed by National Sanitation Foundation, Ann, Arbor, Michigan. 2'. Robins, J.G. and Green, A.C. , Development of On-Shore Treatment Systems for Sewage from Watercraft Waste Retention Systems, Environmental Protection Agency - 670/2-74-056, Contract #68-32-0220, National Environmental Research Center, Office of Research & Development, United States Environmental Protection Agency, Cincinnati, Ohio. Available from United States Government Printing Office, Washington, D.C. 3. Musterman, J.L. and Morand, J.M. , Formaldehyde as a Preservative of Activated Sludge, J. Water Pollution Control Federation, January 1'977, United States 4. Smith and Wilson, Water and Wastes Engineering, March 1973, pp. 48-57. 5. Grabinska-Loniewska, A. , Gaz, Woda . i Technika Sanitora. 47 (80) pp. 284-288. 6. Brown, Charles Arnold, Treatability_of_Rgcreational Vehicle Wastewater at Highway Rest Areas, University of Washington, August 1982. 7. Reference in EPA's "Informal Guidance Level for Formaldehyde", August 1981 . 8. A.A. Polyakov, T.A. Dmitzieva, T.A. Trzhsetzetzkaya,. Penetation of Formaldehyde into the Soil and Disinfecting Properties of it on Both Sporous and Non-SRgrous Microflora, Tr. Vses. Nauchno-Issled. Inst. Vet. Sanit. 1975 pp. 131-138. 9. Krzeminski, Stephen, Martin, John and Brackett, Charles, Environmental Impact of a Quaternary Ammonium Bactericide, Rohm and Haas Company, 1979. htank2 BIBLIOGRAPHY 1. Formaldehyde and other Aldehydes National Academy Press Washington, D.C. 1981 2. Treatability of Recreational vehicle Wastewater at Rest Area Charles A. Brown; Thesis for the University of Washington; 1982 3 . Formaldehyde as a Preservative of Activated Sludge John L. Musterman Kansas State University, Manhatten, New York James M. Morand, University of Cincinnati, Ohio Journal of Waste Pollution Conference on Formaldehyde January 1977. 4 . Trucked Wastes Moreau Water and Waste Engineering March, 1973 5. Water Quality Criteria State of Illinois, Department of Public Health Division of Sanitary Engineering 2nd Edition by McKee and Wolf The Resources Division of California State Water Quality Control Board, Sacramento, California Publication No. 3-A 1976 6. Chemical Disinfectant of Holding Tank Sewage Mark D. Sobsey, Craig Wallis and Joseph L. Melnick Department of Virology and Epidemiology Baylor College of Medicine, Houston, Texas August 26, 1974 7. Action of Formaldehyde on Microorganisms I. Correlation of Activity with Formaldehyde Metabolism W. Brock Neely, Biochemical Research Laboratory The Dow Chemical Company, Midland, Michigan December 12 , 1?62 I' 8. Development of Onshore Treatment System for Sewage from Watercraft Waste Retention System Environmental Protection Agency Technology Series EPA-670/2-74-056 July, 1974 9. Toxic Inhibition of Anaerobic Biodegradation Pearson, Frank, et al; University of California, Berkley WPCFJ, March 1980,. Vol. 52, No. 3, pgs. 472-483 . 10 . Penetration of Formaldehyde into Soil and its Disinfecting Properties with Respect to Nonspore-forming and Spore-forming Microflora, Polyakov, A.A. ; Dmitrieva, T.A. ; Trzhetsetskaya, T.A. , "Tr. Vses. Nauchno-Issled Inst.. Vet. Sanit. " 1975, Vol. 51, pgs. 131-8. CAS# 86:18441lq 11. Behavior and Degradation of Technical Preservatives in the Biological Purification of Sewage. Pauli , O. ; Franke, G. Biodeterior. Mater. Proc. Int. Biodeterior Symp. ; 1971, pgs. 52-60. CAS# 78:139920d 12. A Study of the Biological Treatability of the Trade Effluent Produced from the Manufacture of Ion Exchange Resins: the Use of Adenosine Triphosphate and Adenylate Charge Measurement. B. Simpson, et al; University College, UK, "Process Biochemistry" , Jan.-Feb. 1976, Vol . 11, No. 1, pgs. 21-25. 13 . Metabolism of Single Carbon Compounds During the Biological Purification of Waste Waters. Makeeva, E.N. ; Makeev, A.M. ; Rodziller, I.D. ; Voronezhg State Univ. ; Prikl. Biokhim. Mikrobiol. ; 1975; 11(3) pg. 357-73 . CAS# 84:95118k htank Material Safety Data Sheet U.S. Department of Labor A May t» used to Comply with OtcupatiOnal Safety and Health Administration f OSHA's Hazard Communication Standard. (Non-Mandatory Form) �` 29 CFR 1910.1200. Standard ntuat to Form Approved consulted for sowfk requirwrierw OMB No. 1218-0072 IOENTrrY (As Used on LSW and L O NM &&*apart are nor Perr►rttea( M any,1Mn a not appyppN o►r+o DRI-REM Nwo"Neat 4 m OWN Mlo spas swat of Tam to v+acay that. Section 1 Manufacthuer's Name EnfMgency Temowne Number f Thetford Co o -6000• 313 769-6003 (24 hours) Address (Nkxnoar. SMK City. Stara and ZIP COW) TGWOWW Nurmw br Inlormawn 7101 Jackson Road 313 769-6000 Oae Prepared Signature of Pf"We►(aseoneQ Section If — Hazardous Ingradianblldentlty Inform itbn Other Um" Hazardous Components(Soeaft Ctuwraal Identify:Common Name(s)) OSHA PEL ACGIH TLV R@CW molded orb fooeonar► Paraormaldehyde CA0in529-89-4 1 nne 1 rime STRT. 2 nnm (as formaldehyde) Section III — PhysksUChemical Charactarlatles Sol" Pant Speabe Gr"(H2O � t) not applicable 1.45 ml vapor Pressure(mm mg.) me"Point 1 0 ° am Comity,(AlR 1) Evepora sun Rae (SW Acetate - 1) SOIuOhUty in water 90x Appeararxe and Oda blue granules with pungent odor Section IV — Fire and Explosion Hazed Cab Flasn Pane(Mea+oo used) Flartrn.M. Linhas LEL UEL 131°F TCC not available 7.0 73.0 MEx<hn9 ^9 water, dry chemical, carbon dioxide, or foram So=t Fri Fig" Procedum wear self-contained breathing apparatus Unusual Fire and F.xploNon Hazarda None (Reoroduce locally) OSHA 174,Sept. 190 i Section V — Reactivity Osta S�pmty unstaple Coed Z;to AvOW Stapp X elevated temperatures InCOMOati011ity(MarinalJ to AVOW) strong alkalies,-inorganic acids, isocyanates, anhydrides, oxides. Hazard" Oecornomoon or Syprodum Thermal decom osition ma roduce carbon monoxide and/or carbon dioxide Hazardous May Occur CoMMORe to AvW Polymerization Will Nag Occur cable Section VI — Health Hazard Data Aoutets► of Entry: Inhalation? Skit? es-irritant yes-irritant I^9adon? toxic Heath Hazards(Acute and Chrome) Can Rroduce eye damage & skin sensitization. Muta epic acitivity in bacterial & mammalian Q- 11 test symptoms-but not mutagenic in whole animal systems. Not teratogenic. High inhalation exposure may cause broncho neumonia and adema. Carcinogenicity: NTte? qq��,,���� Reasonably anticipated to be carcinogenic probabmor"carcinogenic poteatial-carcinogen Carcinogenic potential is based on animal evidence. Human evidence shows no increased S4gns and Symotoms of Exposure Inhalation Rroduces irritation to upper respiratory tract & eye irritation. May include dis- comfort and zash..nauseae contactecausesairritation oresevere burns. Medical Conditions Gener3py Aggravated oy Exposure Persons havinst r)reexistinst diseases of the lunits e es or skin may have increased susceptibility to hazards of excessive exposure. Emergency and Fitlt Aid Procedures Flush contacted area with arge amounts of water g e ey r inu s I swallowed induce vomitin b ivin Z lasses of�water and sticking f ineer down throat. For eve contact or ingestion, call a physician. Section VII — Precautions for Safe Handling and Use Steos to 9e Taken in Can Material Is Released or Settled Sweep spilled material up. Neutralize remaining odor with dilute ammonia solution. Flush area with large amounts of water. Waste Oisoost Melnod Incineration or biological treatment in a federal/state approved treatment facility. Precautions to So Taken m M Do not store above 1104F. SDDoo not get on skin or in eyes. Do not inhale vapors or dust. Other Precautions Wash thoroughly after handling. Section Vill — Control Measures Pespiratory Protectwn tsmay Type) Wear self contained breathing apparatus for larste spills Ventilation Local t:xhawl uate ventilation Soeaal MCCnan"(Gaterah not necessary not Other Protearve Gloves recommended not applicable recommended Eye mecum recommended Omer Protectne C;otninq or EGt+IOrnent Protective clothing to avoid skin contact. Eye wash and safety shower. WOO MYg1enic P!ac:cee Avoid unnecessary and prolonged exposures. Avoid breathing dust. r INtI ACE CESSPOOL SERVICE DATE p P. 0. Box 534 / CENTERVILLE, MASSACHUSETTS 02632 NUMB Phone 775-1056 4 1 i TERMS Jy PLEASE DETACH AND RETURN WITH YOUR REMITTANCE $ 5y� Iti "CH RGESAf�IDCYREDITS� xs ws DATE.. vt(. a e ,Lul't��'s:eiru,3.s. BALANCE FORWARD • T-- i 1 i i I 1 - I J P LAST AMOUNT IN COLUMN IN THIS COLUMN ACE CESSPOOL SERVICE PRODUCT 984 ....._..... K. I71 r; 114 w14Y l tJ:evju yt. F w�p< FRYI'.y 4;cRIAL-'SAF ETY:®ATA SHEET ... .�C� ROCHESTER MIDLAND :..: mplies with OSHA's 29 CFR P.O..BOX 1515 .410.1200 and State Hazard ROLHE,i ER,NY 14603-1515 Communication Standards. (716)266-2250 Medical Emergency Telephone(716) 266-2283 SECTIONA>:: . PRODUCT.IDENTITY: ONTRACK,ONTRACK BG,ONTRACK SS,Deodorizers DATE PREPARED: 112/88 NFPA/HMIS HAZARD CODES (minimal'='0; slight= 1, moderate=2;serious =3; severe.=4) Health: 1/1 Fire:.:0/0 Reactivity: 0/0 : Special: NA SECTION 2: HAZARDOUS INGREDIENTS/IDENTITY INFORMATION HAZARDOUS COMPONENTS CAS # OSHA-PEL ACGIH-TLV BY WT. Does not contain hazardous substances as determined in 29 CFR Part 1910.1200 "Hazard Communication" (OSHA);and State Worker and/or Community Right-To-Know laws. _ Contains the following nonhazardous ingredients: quaternary ammonium chloride . deodorizer,synthetic detergent,fragrance,dye'and water. SECTION 3: PHYSICAL/CHEMICAL CHARACTERISTICS BOILING,POINT::212°F SPECIFIC GRAVITY: . 1.00, VAPOR PRESSURE: As water PERCENT VOLATILE: 95 f VAPOR DENSITY (air= 1): As water EVAPORATION RATE: As water SOLUBILITY IN WATER: Complete pH: 3-4 APPEARANCE AND ODOR: Dark blue liquid; fragrance as labeled SECTION 4: FIRE AND EXPLOSION HAZARD DATA FLASH POINT: None FLAMMABLE LIMITS: NA EXTINGUISHING MEDIA: As for surrounding fire (product is mostly water and will not burn). i SPECIAL FIREFIGHTING PROCEDURES: None UNUSUAL FIRE AND EXPLOSION HAZARDS: None ' I SECTION 5: REACTIVITY DATA STABILITY: Stable HAZARDOUS POLYMERIZATION: Will not occur CONDITIONS TO AVOID: None INCOMPATIBILITY: None HAZARDOUS DECOMPOSITION PRODUCTS: None FORM: MSDS #606 _. - X4228 k J k ACE CESSPOOL SERVICE DATE P. 0. Box 534 / / CENTERVILLE, MASSACHUSETTS 02632 NUMB Phone 775-1056 v TERMS j - PLEASE DETACH AND RETURN WITH YOUR REMITTANCE $ G,r) ATE* r CHARGES ANDCRf=Df7SBALANCE , y�"}yjz31s''r. C BALANCE FORWARD P j 1 s • PAY LAST AMOUNT IN THIS COLUMN ACE CESSPOOL SERVICE v Yl l l7W PRODUCT 96.1 5 l ��P�OFTHFrOy TOWN OF BARNSTABLE OFFICE OF IDAMSTAMXMAM BOARD OF HEALTH 9�0 1639. 367 MAIN STREET HYANNIS, MASS. 02601 August 25, 1989 Mr. Richard Falvey North Street Texaco Gas Station 100 North Street/Bassett Lane Hyannis MA 02601 Dear Mr. Falvey: You are granted permission to dispose "Tedford" paraformaldehyde solvent CAS #30525-89-4 from holding tanks of buses into your onsite septic tank at 100 North Street, Hyannis d/b/a Texaco Gas Station, with the following conditions: 1) The total daily volume of the "Tedford" solvent effluent containing paraformaldehyde disposed into the septic tank along with the calculated sewage flow from the service station cannot exceed the design capacity. of the onsite sewage disposal system. 2) Only "Tedford" paraformaldehyde CAS #30525-89-4 may be disposed in the septic tank at this time. Any other chemical deodorizer that you plan to dispose into the septic system shall first receive the approval or disapproval from the Board of Health. 3) You shall maintain weekly records of the volume of waste discharged from buses into your septic system. After a period of one (1 ) year, you shall furnish the Board with a copy of the records. The permission was granted because formaldehyde solvent is the "most rapidly biodegradable holding tank deodorant chemical on the market", therefore, "the low formaldehyde levels which are discharged from a septic tank, treating holding tank waste, will rapidly break down in the soil", according to Janis M. Rudnick, Regulations Chemist for Tedford Corporation. Also, this sService. Station is not located within any zones of contribution to public water supply wells. In addition, it is not located within close proximity private wells or wetlands. Sincerely yours, Grover C.M. Farrish, M.D. , Chairman BOARD OF HEALTH TOWN OF BARNSTABLE Page No. of, Pages AYOUR ENGINEERING, INC. 414 Benefit PAWTUC ET, RHODE ISrLAND 02861 LETTER OF (401) 728-5533 TRANSMRTTAL JOB NUMBER DATE To 1864 May 5, 1989 Town of Barnstable ATTENTION Board of Health Donna P.O. Box 534 RE: Hyannis, Massachusetts 02601 Star Enterprise (Texaco_ North St. & Bassett Lane Hyannis, Massachusetts WE ARE SENDING YOUR Attached _ Under separate cover via the following items. — Shop drawings _ Prints _ Plans — Specifications _ Samples i _ Copy of letter _ Change order _ Other: ' COPIES DATE. NUMBEFI DESCRIPTION 2 plans 6 registration forms • a I { THESE ARE TRANSMITTED as checked below: For approval _ Approved as submitted _ Resubmit copies for approval > _ For your use _ Approved as noted _ Submit copies for distribution As requested _ Returned for corrections _ Return corrected prints _ For review and comment _ Other FOR BIDS DUE/DATE: _ PRINTS RETURNED AFTER LOAN TO US REMARKS As per our conversation, enclosed are the forms and plan for the tank replacement at the subject location. The forms are for the existing tanks, as you requested. Would you be kind enough to set up for approval so that we can proceed to the Board of Selectmen for a hearing for the increase. Your early attention to this matter would be greatly appreciated. If you have any questions, please do not hesitate tp call me. Thank you for your cooperation and assistance in this matter. qj P.S. Please note that the waste oil and fuel oil are on COPY TO the same form. I was short one form. SIGNED if enclosures are not as noted,please notify us at once. Thomas J. S i on, Project Manager P�oftNeTo�r TOWN OF BARNSTABLIE OFFICE OF NUIL aAa s BOARD OF HEALTH �s� >�O i639 oM 367 MAIN STREET HYANNIS, MASS. 02601 I September 17, 1987 Richard Falvey Texaco North St. ��� Hyannis , Ma Dear Mr. Falvey You are reminded that State regulations require periodic pumping and or cleaning of all MDC traps (Metropolitan District Commission, gas and oil separator tanks) . You are directed to contract with a licensed hazardous waste transporter\contractor to perform the required pumping and or cleaning of your MDC trap by October 17 , 1987 , or provide proof of such maintenance performed within the past three months . You are further directed to have your MDC trap inspected and cleaned if necessary, by a licensed hazardous waste contractor every three months . Written proof from a licensed contractor will be required. Inspections will follow by the Health Department to verify compliance. You are reminded that failure to comply could result in a fine of $200 . 00 daily under the Town of Barnstable Toxic and Hazardous Waste By-law. Very Truly Yours , hn M. Kelly irector Barnstable Health Department t� yy rr ,_. •ia- flat sect. FIRE RE DEPT, STATE USE ONLY_.CillyrICATIOls � I.D Number - , Submit to: , Djy Z"�' LOCAL FIRE DEPARTMENT Date Received i jtifi:ation is required bi Federal law for all underground tanks that have been 4. pipeline lacilitic%Iincludmg gathering line.) regulated under the \atura; (.as to store regulated substances since Januan 1,1974.that are in the ground as of Pipeline Saleq Act of 196h.tar the Ha!ardous I.ryu,d Pipeline Safer Act of 19-4.„+ 8.K96.or that are brought iniouse after!1L�8.1986.The infon rtatiunrequested which+.anmtra.taic pipeline lacilnx regulated under State law .;red b%Section 9002 of the Resource Consenationand Recovers Acl.(RCRA1. S.%urlacc impoundment..pits,pond%.or lagoon%: ,ended. 6.dorm water rat wade water collection.%dcm%: 7,flow-through procc%%tank%. e pitman purpose of this notification program i%to locate and maluate under• g hywd Craps tar a%%txialcd gathering hnr%dineth rclafcd to oil tar gas puducuun and -id tanks that %lure or ha%c stored petroleum or ha%ardou%substances. It is gathering op,ol U%% : :tcd that the information sou pro%idc will be ha%cd on rca%onatih a%ailable q, doragc tanks situated in an underground area Iwch as a hasemrm. cellar, Js.or.m the absence at such records.%nur knowledge,bcbcl,or rceullretiun. minework+ng.drift.shalt.or tunnel)if the storage tank t%situated upon tar aho%c the no %just notil`0 Section 9002 of RCRA. as amended• requires that, unless surface of the floor. peed,owners of underground tanks that store regulated substances must notih -sated State or local agencies of the existence of their tanks.Owner means— What Substances Are Covered? the noufiviown requuemcnis apph tit under• in the case of an underground storage tank in use on Nowinlxr S. 1984.or ground storage tanks that contain regulated substances.)his includes an suh%tancc :e.i into use alter that date.am person who owns an underground storage tank defined as hazardous in acetion 101 114) of the (omprchcnow En%uonmental s' :or the ntoragc.use.ordispensing of regulated%ubstances.and Rcsponw.Compcnwuon and Liahiht Act tit 19k0(CERCLA).wiihthcexcepuunof . in the case of am underground storage tank in use before No%emhcr K. 1994, those substances regulated as hazardous waste under Subtitle C of RCRA It aho F o longer in use tan that date.am person whoowned:ueh tank immcdiafcly before includes petroleum.e.g.crude oil or am Irac6on thereof w hich is byuid at standard.:=r -continuation of its use. conditions of temperature and pressure(W dcgrcc.Fahrenheit and 14.7 pounds per square inchahsolwc). tat Tanks Are Included? L'nderground%toragc tank is defined a%am one or 't +nation of tanks that(I f is used to contain an accumulation o1-regulated suh- Where To Notif)? Completed notification forms%hould he sent let the address,: .Y ; -and(21 whose volume(including connected underground piping)is 101 i or Riven at the top of this page trneath the ground-Some example.,are underground tanks storing:1.gasnhne. k .:!.or diesel tuft.and 2.industrial sol%enh,pesticides. I.Owner%ofunderground%toragetank%inu%c.or that ha%checn cidcs,herbicides or fumigants. s taken out tit operation after Januan I. 1974.but still in the ground.must molt hs:;: rat Tanks An Excluded? lank,rcmo%ed from the ground are not subject to Max 8.1986.2.Owner%who bring underground%forage lank,into use alicr Ma%8. cation Other tanks excluded Irum notification arc: 19u6,mud notil%within 30da%%of bringing the tank%into use. g -nr reswenual tank.of 1.100 gallons or ks%eapacit%used for storing motor luel aaomme:csal purpose%: Penalties: Aral owner who knowingh fails to rwlih or submits false information ;- .s usedlorsronnghcatingoilfnrcunsumpike use on the premi%e%wherestored: shall be subject to a civil penatt% not to exceed SI0.000 for each tank for which Lank.. notification is not given or for which false information is submitted. a -zs►1%pe or print in ink all item,except"signature-in Section N'.This form must by completed for Indicate number of Location containing underground storage tanks.If more than S tanks are oN'ned at this location. I continuation sheets v ' .aop� the ref erse side,and staple continuation sheets to this form. attached t ha:—,e 1;orporation,Individual,Public Agency,or Other Entity) (It same as Section 1,mark box here❑) _Lao Inc. Facility Name or Company Site Identifier,as applicable As= 11rh %rers i ty Park Texaco Service Station /1—/%3 Street Address or State Road,as applicable r, = .es North St. & Bassett Lane State ZIP Code County _*- -, Mass. 02254 Barnstable :xe Prone Number Cit (nearest) State ZIP Code 894-6010 ylanm s MA 02601 CA_ ncr (Mark aH that apply®) t ss ❑ State or Local Gov't ❑ Corporate or Indicate Mark box here if tank(s) b P number of are located on land within ❑ ❑ Federal Gov't ❑ Ownership tanks at this an Indian reservation or (GSA facility I.D.no. uncertain location on other Indian trust lands t . rea Code on Number — -E>�Section I,mark box here ❑) oh itle " -_ . ._• Re alter 611 77�5�9 08IV.TYPE OF NOTIFICATION r ❑ Mark box here only if this is an amended or subsequent notification for this location. y • Zi'. =X-CM!-Venalty of law that I have personally examined and am familiar with the information submitted in this and all attached : t r �-- an-v:at based on my inquiry of those individuals immediately responsible for obtaining the information,I believe that the , Y z�:rim-mzzion is true,accurate,and complete. �t =a!L:.e of owner or owner's author ed re resentativ Si na Date Sty�...��� !CONTINUE ON REVERSE SIDE ,4 Pagtf 1 , Form F.P. 290 P _ jcxaco inc. Hyannis , MA r Owner Name(from Section I) Location(from Section II) Page No. of DESCRIPTIONOF r • STORAGETANKS(`Q�plefe for each lank at this'llocation.). Tank Identification No.(e.g..ABC-123),or Tank No. / Tank No/ Tank No� Tank No. ✓`Tank No. Arbitrarily Assigned Sequential Number(e.g.,1,2,3...) 1/ ,/ ✓ 1.Status of Tank Currently in Use (Mark all that apply M) Temporarily Out of Use Pq N Permanently Out of Use Brought into Use after 5/8/86 2.Estimated Age(Years) 3.Estimated Total Capacity(Gallons) 1,f5 66Ooo GOO 4.Material of Construction Steel �--�-� (Mario one®) Concrete Fiberglass Reinforced Plastic 0 Unknown 0 [� Other,Please Specify 5.Internal Protection (Mark all that apply®) Cathodic Protection 0 0 Interior Lining(e.g.,epoxy resins) � � None Unknown [� Other,Please Specify 6.External Protection Cathodic Protection (Mark all that apply M) 0 - Painted(e.g.,asphaltic) � Fiberglass Reinforced Plastic Coated None 0 0 Unknown 0 0 Other,Please Specify CQ IAL ['d7A&A/ e-_&AW�l 1�-jo 7.Piping Bare Steel 0 (Mario all that apply®) Galvanized Steel R Fiberglass Reinforced Plastic 0 O Cathodically Protected 0 Unknown �] O Other,Please Specify 8.Substance Currently or Last Stored a. Empty [ 7 In Greatest Quantity by Volume (Mark all that apply M) b. Petroleum Diesel Kerosene F;9' 0 Gasoline(including alcohol blends) 0DQ Used Oil 0 Other,Please Specify c. Hazardous Substance Please Indicate Name of Principal CERCLA Substance OR Chemical Abstract Service(CAS)No. Mark box®if tank stores a mixture of substances d. Unknown 9.Additional Information(for tanks permanently taken out of service) a. Estimated date last used (mo/yr) b. Eslimated quantity of substance remaining (gal.) c. Mark box 13 if tank was filled with inert material (e.g.,sand,concrete) Page 2 r ' X Texaco Inc. Hyannis, MA d . Section 1) Location(from Section 11) Page No. off M. Identification No.(e.g..ABC-123),or Tank No. Tan',No. �Tank No. Tank No. Tank No. .s r nc bifrarily Assigned Sequential Number(e.g.,1,2.3...) i 1.Status o1 Tank Currently in Use 20 (Mark all that apply M) ® C� Temporarily Out of Use Permanently Out of Use [� U Brought into Use after 5/8/86 2.Estimated A (Years) (, 3.Estimated Total Capacity(Gallons) a D DO 4.Material of Construction Steel (Mark one M) Concrete �] 0 i Fiberglass Reinforced Plastic 0 Unknown j Other,Please Specify S.Internal Protection i hodc Protection Cat � (Mark all that apply®) O C] O 0 Interior Lining(e.g.,epoxy resins) None V � 0 Unknown Other,Please Specify 6.Extemal Protection (Mark all that apply M) Cathodic Protection Painted(e.g.,asphaltic) [3;;�] (� 0 Fiberglass Reinforced Plastic Coated 0 (� None O Unknown � Other,Please Specify 7.Piping Bare Steel (Mark all that aPP1Y®) ® Galvanized Steel Fiberglass Reinforced Plastic Cathodically Protected 0 Unknown O Other,Please Specify 8.Substance Currently or Last Stored a. Empty In Greatest Quantity by Volume (Mark all that apply M) b. Petroleum Diesel �Z W". ' a ® o o Gasoline(including alco of b O O O Used oil Other,Please Specify Q c. Hazardous Substance Please Indicate Name of Principal CERCLA Substance OR Chemical Abstract Service(CAS)No. Mark box 3 if tank stores a mixture of substances d. Unknown [- 9.Additional Information(for tanks permanently taken out o1 service) a. Estimated date last used (mo/yr) b. Estimated quantity of substance remaining (gal.) c. Mark box 3 if tank was filled with inert material (e.g.,sand,concrete) Page 2 LEGEND 5� LOCUS- zH s 1 � � r 93 PROPOSED CONTOURCn a ! 99 PROPOSED SPOT GRADE 9 79e—'; 102---• EXISTING .CONTOUR �R�� _ - 0.115 Y 915.63 EXISTING SPOT GRADE Ve 13.2' TEST PIT FORMER LEACH PITS 1 1 I REMOVED 4 BACKrILLED-9/05 -- - W— EXISTING WATER SERVICE oa FORMER DRYWELL LOCATION d8 6 REMOVED 4 BACKMUM=9/05 soot sT a WRE2 c� N o L J {� PROP05ED 5EPTIC TANK LOCUS MAP N.T.S. BENCHMARK: MAG NAIL le o ` f' EX15TING 5EPTIC'TANK ' ELEVATION = 100.00 05SUMED DATUM) `'tom. a REMOVE 4 REPLACE WITH NEW 1500 GALLON TANK(H-20 RATED) s,WRE1 GENERAL NOTES: _ ��g 4- 1. ALL+CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL N81902'2(7E ! BOARD OF HEALTH AND THE DESIGN ENGINEER. W 8 FUEL OIL 141.40 N' 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS STORAGE / OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE � �-- 1- }Ir------ LOCAL RULES AND REGULATIONS. _ ° s�. t CLEANOUT ' / 1 E 0'` .i / NO. 228 I-- -� t 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR /� I I TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE �J'TY.. I GASOIJNE i DESIGN ENGINEER. AS 51'ATIO STORAGE 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING rt1 ! I I FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN j (� I ! I ENGINEER BEFORE CONSTRUCTION CONTINUES. wl I `E3 0 r .� E V 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF I ' 1 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 4 } HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. f! 8. THERE ARE NO PRIVATE WELLS LOCATED WITHIN 150' OF THE S.A.S. APN 308 " 39 9. AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED TO A FUE PUMPING CONDITION ACCEPTABLE TO THE OWNER. ��6sA�Ps ZS,7J7±SF LAREA TI +I1FIC W 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE LI('FITJ THE LOCATION OF ALL UNDERGROUND UTILITIES,. PRIOR TO BEGINNING I CONSTRUCTION. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS I IN THE AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF THE S.A.S. AND REPLACE WITH CLEAN FILL AS SPECIFIED IN 310 CMR 255(3). / 175.19° 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY .r f R AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. `R3s 01-f x yBs5.-578°45'35°W �r3 - c 99.27 -- �Ilav� _ Of 41,4 NORTH PETER T. � EEngineeringWorb PROPOSED SEPTIC SYSTEM UPGRADE N McENTEE a CIVIL 228 NORTH STREET, HYANNIS, MA / No. 35109 ared for: MOTIVA ENTERPRISES LLC, c/o Yousri Maghrabi o �EGISlE� �`� 212 Teaticket Hwy, Falmouth, MA 02540 f y: Surveying by: SCALE DRAWN JOB. NO. LAYOUT gWorb Hood Survey Group 1"=30' P.T.M. 208-05S.A.S. LAYOUT sfield Road 16 Route 6ADATE(������ A 02644 Sandwich, MA 02563 CHECKED SHEET NO. ` 313 (508) 888-1090 9/24/05 P.T.M. 1 Of 2 N.T.S. t,, — 5. PROPOSED TANK NOTE: TO PREVENT BREAKOUT, THE PROPOSED INSTALL RISERS W/HEAVY DUTY FRAMES & COVERS f FINISH GRADE SHALL NOT BE < EL:94.95 OVER INLET & OUTLET TO FINISH GRADE F.G. 99.Ot (EXISTING VENT FOR A DISTANCE OF 15' AROUND THE EXISTING BUILDING F.G. EL: 100.05t F.G. EL: 100.Ot F.G. EL: 99.2t PERIMETER OF THE S.A.S. NO CELLAR (EXISTING) (EXISTING) (EXISTING) MAINTAIN 2% MIN SLOPE OVER S.A.S. 36" MAX. COVER LINSTALL RISER W/ HEAVY DUTY INSTALL INSPECTION RISER OVER ONE rFRAME & COVER TO FINISH GRADE. CHAMBER(MIN.) WITH HEAVY DUTY FRAME L =24' AND COVER SET TO FINISHED GRADE 4" SCH 40 PVC L =30' L =15'(MAX) 6" 4" SCH 40 PVC 4" SCH 40 PVC 2" LAYER OF 1/8" TO 1/2" ® S= 2% (MIN.) �p ®®®�®®® DOUBLE WASHED STONE x. PROPOSED 14" ® S= 1% (MIN.) 6„ I ® S= 1% (MIN.) Haaaaaaam[--" .� 1500 GALLON 2' EFF. DEPTH a®Haase INV. ELEV.=96.35 SEPTIC TANK INV, ELEV.=95.80 D-BOX 4' S 2' 4' 3/4"-1 1/2" GAS BAFFLE W/ RISER INV. ELEV.=95.63 DOUBLE WASHED INV. ELEV.=96.10 , EFFECTIVE WIDTH 13.2' STONE CONNECT TO EXISTING 4" SEWER AT I LOCATION OF EXISTING TANK INLET INV. ELEV.=95.45 INV. ELEV.=96.85t NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING 2-500 GALLON LEACHING CHAMBERS PIPE INVERTS PRIOR TO CONSTRUCTION. ' SURROUNDED WITH STONE AS_SHOWN 2) SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND i TRUE TO GRADE ON A MECHANICALLY COMPACTED TOP CONC. ELEV.=96.45 —BREAKOUT ELEV.=95.95 SIX INCH CRUSHED STONE BASE; AS SPECIFIED IN INV. ELEV.=95.45' mommob aaaaW- E-Rm- 4) 310 CMR 15.221(2). sasses®®®®®3) INSTALL INLET & OUTLET TEES AS REQUIRED. ® aaaBaaaaaBOTTOM ELEV.=93.45 GAS BAFFLE TO BE INSTALLED ON OUTLET TEE 4' 8.5' 4' 8.5' 4' AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. 5' MIN, ABOVE BOTTOM OF EFFECTIVE LENGTH = 29.0' (1) 4" DIA.INLET T.P. EXCAVATION OR G.W. (3) 4" DIAyjT LEACHING SYSTEM SECTION 4 TYP22" �4" SEPTIC SYSTEM PROFILE BOTTOM OF WRE2 EL.=91.0 * TNOTE: SOILS OBSERVED BY TOWN 9/05 TO 15 FOOT DEPTH DESIGN CRITERIA N.T.S.N.T,S. (EL.=84t) DURING STRIPOUT OF CONTAMINATED SOILS. p 22 i C i SOIL TEXTURE CONSISTANT AND NO G.W. OBSERVED. DESIGN CRITERIA: COMMERCIAL BUILDING - GAS STATION 9.5" 4" Dio. Inlets 8" 4" Dia. Outlets 2 ISLANDS 075 GPD/ISLAND + 2 BAYS ® 125 GPD/BAY TT4" SOIL LOG (2 x 75 GPD) + (2 x 125 GPD) = 400 GPD PLAN SECTION ; SOIL TYPE: CLASS I DESIGN PERCOLATION RATE: 2. MIN./IN. D—BOX SHALL HAVE H-20 RATING SDOTL EVALUATION REF NO 1 P10 696 DAILY FLOW: 400 G.P.D. P��� �f MgSs9� DISTRIBUTION BOX 4 DESIGN FLOW: 400 G.P.D. yG ' 48"Liquid Level 4'-6" WITNESS: DAVID STANTON R.S. _ N.T.S. GARBAGE GRINDER: NO g PETER T. BARNSTABLE B.O.H. McENTEE 6 1 LEACHING AREA REQUIRED: (400) = 540.5 S.F. o CIVIL Elev. .74 WRE2 Depth No. 35109 CTI�N 5" 99.2 0" FILL PROPOSED SEPTIC TANK: 1500 GALLON rE3EME@E3E5IE3E0UE0E2E@ E3 0 ®®®® 10'-8" { 11.5 C 24" 5 AL ®®®®®000 INVERT 37 - - USE 2-500 GALLON LEACHING CHAMBERS24" ®®®®®®®® 3 - 24" Dio. Covers SIDEWALL AREA: 2(13.2' + 29.0') X 2 = 168.8 S.F. 102" BOTTOM AREA: 13.2' x 29.0' = 382.8 S.F. 5'-10" TOTAL AREA: 551.6 S.F. SAND 4" KNocxour 0C)-l07.5YR 5/6 DESIGN FLOW PROVIDED: 0.74(551.6) = 408.2 G.P.D. 20" OBA. COVER 4" KNOCKOUT OJ 4" KNOCKOUT 62" — — 4" DiO. Outlets PLAN PROPOSED SEPTIC SYSTEM UPGRADE 4" KNOCKOUT NOTES' 1. UNIT SHALL JOINTS BE LED, WRAPPED RAP E DE WATERTIGHT.WATERTIGHT.T 98 91 0 228 NORTH STREET, HYANNIS, MA 2. Prepared for: MOTIVA ENTERPRISES LLC, c/o Yousri Maghrabi 1500 GALLON CAPACITY (H-20) 212 Teaticket Hwy, Italmouth, MA 02540 500 GALLON CAPACITY, H-20 LOADING PERC RATE <2 MIN/IN. ("C" HORIZON) 4 NO G.W. ENCOUNTERED Engineering by: Surveying by: SCALE DRAWN JOB. NO. CHAMBERS SEPTIC TANK j EngimmingWorks Hood Survey Group N.T.S. P.T.M. 208-05 12 West Crossfield Road 16 Route 6A N.T.S. Forestdole, MA 02644 Sandwich, MA 02563 DATE CHECKED SHEET NO. N.T.S. (508) 477-5313 (508) 888-1090 9/24/05 - P.T.M. 2 of 2 t . t,` l E ,,. ___ "I r E. ' ux _ EENE ST • �E 70.15 N72° 25 1LA pAVID' H • GR r 1 ti a j j w SEWAGE b LEACHING N FIELDS IN THIS AREA lu k, I 1 k HARO D H. WILLIAMS TRUSTEE 15'2" 1 - 40.00 0 30.50 . I , o O N RIM 39.50—® 3 N81 VENTS 02 20 E 141.4 o N co TRAILER STORAGE ILEA A A H O H D T L E . Tb W _ 3 - - T r .� Tb E Tb E T 3E z - i 38.29 Wcc , T b E ELEC . METER E 9 bE Tb LL J r _� J U/G ELEC. 3 LL tfi Q Z i C9 cr_co r CD cD c� � I I o r m m oo . 1 • CI C) ft Ci • P m TEXACO 3-BAY L -+L- J (n TYPE P COLONIAL SERVICE STATION cc•.N x 39.49 m .. o Ln] m I m M (w) ASPHALTIC PHA IC CONCRETE cn {6,000 GAL. 6,000 GAL. H I , CD 3` 0 0 0 0 0 O Co o 39.61 I U II p x-- 39.70 0 I o L _ JL-- ---� NOTE: x 38.91 3 — - — ( ALL UTILITY; LOCATIONS ARE 500 GAL. >F-39.63 39.65 M (' < — — — -i r -1 o o w APPROXIMATE AS GATHERED FROM 6, 000 GAL . 0'J N �V 6 Z W.O. TANK is,000 GAL. I �¢ I %3 LATEST AVAILABLE INFO. 43' � — J 61.6,, x-39.06 39.13 ( I I � o � • II R OD 3L °v F L ._JL NOTE: L V ( W 38.63 - THE PROPERTY LINE ON THIS PLAN IS �c J SHOWN INCOMPLETE DUE TO A 38.77 I L. — J m 4 DISCREPENCY BETWEEN THE PROPERTY m m ,a m DESCRIPTION AND THE TOWN STREET CD cocv CD • 0 LAYOUT TAKING. A FULL PROPERTY LINE SURVEY IS SUGGESTED TO RESOLVE In 3 { THIS PROBLEM M Cl) M U/U S R/R D CDM.H. ; 3 --RIM 38.23 REVISION RECORD DATE By DESCRIPTION RIM 38.11 1 2/24/83 MDC RE -DRAFT 8/22/84 MDC RE -DRAFT FROM FIELD SURVEY ASPHALTIC CONCRETE N N ASPHALTIC CONCRETE ) o o OD 3 CC w m D? rco -it � "THIS CCCUMEMT PPID THE IPTCFMATION HEREIN RELATING TO TEXACO INC. IS THE .� Q ) C9 PROPERTY OF TEXACO INC. AND HAS BEEN FURNISHED IN CONFIDENCE FOR THE PRIVATE • ODti USE OF TEXAC0 INC. AND 'ITS SUBSIDIARIES AND AFFILIATES. NO PART HEREOF SHALL m (w) m co BE COPIED. DUPLICATED. DISTRIBUTED. DISCLOSED OR MADE AVAILABLE TO OTHERS OR U/U S R/R N USED TO ANY EXTENT WHATSOEVER EXCEPT AS EXPRESSLY AUTHORIZED IN WRITING BY x— 38.00 ) TEXACO INC.. ANY PERSON, FIRM OR CORPORATION RECEIVING THIS DOCUMENT, HOWEVER OBTAINED. SHALL, BY VIRTUE THEREOF. BE DEEMED TO HAVE AGREED TO THE FOREGOING RESTRICTIONS AND THAT THIS DOCUMENT WILL BE HELD IN TRUST AND CONFIDENCE. c% SUBJECT ONLY TO THE PRIVATE USE EXPRESSLY AUTHORIZED BY TEXACO INC..' TBX&C® USA 1 31 20 3 i WATER m 1 j 7916 " , SERVICE (� NORTHEAST REGION v .Ni 38.43 1 PHILADEIPHIA DISTRIBUTION CENTER 3E.ii •� ! _W 37.43 0� MULCH b STREET LIGHT co lxa 38.0 o — .�� sHRues , H Y A N N I S, M A 3 WF ,1 374 NN -- -- -- NORTH ST . $ BASSETT LANE oCC P.L. S78.45'35"N 175.19GENERAL ARRANGEMENT PLAN SIDEWALK �r ASPHAITIC,.:APPROACH ASPHALTIC APPROACH c oo C&VE CO. *23M POLE #45/22 �„� ¢ 37.33- .G. w 6 CI .DRAWN BY MDC/LAW SCALE 1 10 0 �, W W ¢ W W W W W W W W IL W W W W W W W CHECKED BY DATE 02/24/83 It x c i 1 i GR CUB _ 1 S 30 , AN R 3 APPROV D 0 T � o E N R H ST E T R E a o 1 3 7 0 1 1 1 2 .. L C N 4 B0S 259 R 13 L L 3 lw_j L- m "I f- w Al -„ • w ' CA o, s _ MARK SASH'D1MEN # 7,. N D _ x - , 0 E LUM ,. 1 ?! 6 ? o i i ALUMINUM P�TTSBuWGH PLT. Guss Co R ! 4 PLAT �D A , RL.Qb• • SECURITY'x ; , a�VAN ZED _STEEL .p , 1 W 6'! 1 12 O G. TYPE pS D 7 4 D Z 2 6 2 .�,m W c2 x C� uL:EI? _,a r N/F DAVID R. GREEN, 'ET UX 5 70.15 N 72 2 5 1 0, E , DESIGN DATA N _ T CA AV FLOW A WORST SE HEAVY FROM THE OWNERS RECORDS,S 8 BUSES PER DAY DURING THE A SELECTED AS 0 CONDITION WAS S L _ CAST IRON CA 0 E R RISER ._ C G EACH B HOLDING TANK AP OC OB R E US L N TOURIST ST SEASON ( RIL T E ) . . 1 q.3 W / COVER DISCHARGES 3-8 GAL F 10 GALLONS D S ) CARRIES A MAXIMUM O LL S , _ 1 G FLOW: DESIGN _ 1 1 _ X E ISTIN :GRAD E X GAL/DAY BUSES � G WASTE 00 GAL D 50 / 0 SES AY 10 A WA I A 0 0 D L G I 0 A 5 0 L. - co 3 0 z, , c 2 O DIA. COVERS .O .� e T MINIMUM U 000 GAL. TANK NIM M USE 2 A M o 0 o b; } i , 1 1 6 STOCKADE, _ F OCKADE FENCE : _ 'd i 1 I2 0 • o 0 o .. a 0 L �. f , i i . TANK; HIGH I FvFl V p •.' .•p ..,.G ,-.a 's.•:e, ',' �O f'.: '.."0 ..o .. 0_•,'.O� •p,.b •o a °..0. 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