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HomeMy WebLinkAbout0110 ROSARY LANE - Health (4) 110 ROSARY LANE, HYANNIS A= r i i i r', Date: A0 TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY �I NAME OF BUSINESS: V10C-A S50CIA TYS BUSINESS LOCATION: //0 15105AX-V LAl Y'VIL 7 . A4,,10a/1 INVENTORY MAILING ADDRESS: S ��da�� TOTAL AMOUNT: TELEPHONE NUMBER: 3 YfZ ot/ 006 (14-t4aS If CONTACT PERSON: 2LI c /3 5-'7 EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: 3WINAO.A14 Pane- ,4,ve 11Ye1 k776AJ s s 1.,jsr7Uu*n0Aj y� Np SLE—feV C-E INFORMATION/RECOMMENDATIONS: A1SD5'. CVAI77A/I;-V_)vcy T[-A�/� -A'yD Fire District: 61cf-WSC- Q9,r 7-1 8 E uoaA-rZ7> A w) e0"PtZ--7Eb, 7V h1vA1U. ))S 66- .vLllbE AVA-1LA-_61E. s•T'o t_ oxl hat�S A w• 1 f K �o�f�vsnB �L A u-s o 2ZF'1 S/foa" yy7-8E 577x e-D tilt!n1 rK���TEN.Q.y[E ��'✓ikEa/T l!S/NG c14S d,,-°GA 4, OL/NE• Waste Transportation: 'VIA 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 &31_y' 1A1 POLL 1zC_AV1 )C%. Antifreeze (for gasoline or coolant systems) Misc. Corrosive jI•bb177cA.rR� yesvp6ovp-s /NEW USED fort �ooL�-iw� A-s 0oZ1Ds Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, „P Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Caulk/Grout 3(o Swimming pool chlorine Batter acid (electrol to)/Batteries vNIp�w�aen•Ta Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizes 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 AWOL sP"c*"n 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 176os- 5Al.Ts A5 Soz.IDs 1 `/SD Pau oDS (including bleach) 70 441.1.oM6 Lf,L-"Cfh t5 Spot removers & cleaning fluids (dry cleaners) W914 q 55OG. U-FI t-17-65 #j,f-5 A 8: Other cleaning solvents �.�r- A N a �o IT I> 15 St> T 5 Bug and tar removers JE7W,4�T RAiA1 n Windshield wash 1 //0 r WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS j/ L 4 Town P#own of Bar a Department of Regulatory Services • Public Health Division Date 200>Main Street,Hyannis MA 02601 100 - Date,S,cheduled � _ _ Time Fee pd C/o Soil Suitabli a hfirSewg is anal: __. Performed By:. �e ti�F✓^.M.0 _r� Witnessed Bg; L, .LOCATION& GENERAL" INFORMATION Location Address 1`Q l a na Owner's Name Address 3 r V S oz(0 p/ OZCy Engineer's Name �e}Q✓ M C g war�2"10 Assessor's Ma Parcel::.- .3 10 NBW.'GONSTRUCTtON R13PAIR Telephone# C ? 1 � ..Land=Use., 4�o/yl /1't.Q_!�t��C Slopes(%) Surface Stones L� Distance§from: Open Water Body?j tt Possible WeCArea;f� tt . Drinking Water Wel�i Sy ft` . Drainage Way.7/5�� ft :Property Line...�_O - -ft Other.. :.. .. : SKETCH ;,(Street name,dimensions of lot,exact:ocations of test,holes.&perctests,locate wetlkhds ih proximity to holes) _ to 10 C0 v7Q C� � r31oL l t o t L rLt ,j c + _ GiG� k Del %/UC`J Depth to Bedrock �.3. 1 Parent matenal;(geologic) P ?' c7 Depth to Groundwater. Standing.Water in Hole: /U�a'. . Weeping from Pit Face Estimated Seasonal High Groundwater 77 DETERMINATION FOR SEASONAL HIGH WATER TABU Method Used Depth Observedatanding inobs,hole: in, Dept11-to soil m0091s" an. Depth to'weeping'from.sidc of obs.hole: in, Groundwater Aet)uRment Index Well# Reading Date: Index Welllevel ,.--, Atu;&ctor..,,..� AdJ drnundwaterjl eval,,,,, </° PERCOLATION TESL' °)date "TINt Observation Hole# Depth of Perc � ✓ Tune lit 6" Start Pre-soak Time CD Time(9"-G") End Pre-soak Rate Min./Inch site Suitability Assessment Si►e Passed Site-Failed: Additional,Testing Needed:(YlN): Original: Public Health Division Observation Hole Data To Be Completed on Back'-=-------- * *If percolation testis to be conducted within 100'of,wetl'and,you must first:not>Efy the Barnstable Conseirvation Division at least one (1) week prior to beginning. DEEP OBSERVATION HOLE LOG Hole# Depth from Sol Horizon Soil Texture Soil Color Soil Other urfa Sce(rn) _? (USDA) (Munsellj: Mottling (Structure,Stones;,Boulders.' 77 t lOYi2�f,z �S L 46* 13 1© s DEEP OBSERVATION HOLE.LOG Hole# Z- tr Depth from Soil Horizon Scil Texture Soil Color Soil Other (USDA) Surface(in.p (Mansell)' • : Mottling � .(Structure Stone$,Boulders.Consis i d `f S� -� A S �- 1 0Y.{2 Y/Z 3 5 Lr. 1 O 2-I/� 7. DEEP OBSERVATION HOLE LOG Hole# Depth from 3oil:Horizon' ;Soi4Texture Sorl Color. Soll` :- pt(�er + Surface(m) .(USDA) . (Mansell) Mottling (Spvcpire,Stonai Widers. DIP OBSERVATION HOLE LOG Hole# Depth froth Sort HarIzon Soil Texture Soil Colot Soil : Other 5urface•(ig) (USDA) (Mansell) Mottling (3tructure,SFooes;Boulders, Flood Insurance Rate Man: `Y Above Si)0'.year flood boundary No Yes Within 5iw year boundary No Yes .I Vt!ithrrr t00:yaa`r flood boundary No Yes Occn�'P. 'iiate►'Ial Does at least four feet of naturally occurring pervious material exist in all areas observed thrptaghout;the . area proposed for�Ehesoilabsorpdon syt;tern7 _�f P S - If"not,what rs the depth-of naturally;occurring pervious tnaterial7 Certification. :,5 I Gerd that on , fy (date)I-have„passed the soil evaluator examination'approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the,required.teaming,experdse.and experience described`in I0'CMR 15.611.7 w' Si nature g Q Da P iq u ., to . E: Q;ISEPTICtP�itCFORM DOC :'` , ' ,`' YOU WISH TO.OPEN A BUSINESS? For Your Information: Business certificates(cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town(which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, V FL,367 Main Street, Hyannis, MA 02601 (Town Hall) DATE: v/7 k(o Fill in please: APPLICANT'S YOUR NAME: 11(ev n /'�• &adr BUSINESS YOUR OME ADDRESS: ( dSD />2czin c5 ' -774 999-/33`7 TELEPHONE # Home Telephone Number SOB °�362 -5?42C) NAME OF NEW BUSINESS a D »'!en TYPE OF BUSINESS C O/Y IS THIS A:HOME OGtUPATION STYES NIA ✓ Have you been given approval from..the building di[isibrt"?. YES NO . �vaD ADDFESS OF BUSINESS PD . Z'3® :z1 0!/� MAP/PARCEL NUMBER ys�ca� rrss,, �/o RO, Gn ., 41 n When starting a new business the 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 CO ONER'S OFFICE This in.divid al h en-inf e o any permit requirements that pertain to this type of business. . Vc Authorized ature* C MENTS• 1 2. BOARD OF HEALTH This individual has gen firmed o he permit requirements hat pertain to this type of business. Au 'orizeq Signature** / 0 COMMENTS: (,--r V. - C11V �l L`/ , 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: S / 17 /0� TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: kea41LQvelapiy" ,7rte BUSINESS LOCATION: Ub W A INVENTORY MAILING ADDRESS: -© IJ - TOTAL AMOUNT: TELEPHONE NUMBER: — 77 CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: 5-49 274—g7d9' MSDS ON SITE? TYPE OF BUSINESS: 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 _ Antifreeze (for gasoline or coolant systems) Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc, carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor & furniture strippers Other products not listed which you feel Metal polishes maybe toxic or hazardous (please list): Laundry soil & stain removers n' (including bleach) ITT' Spot removers &cleaning fluids (dry cleaners) �� I Other cleaning solvents 0 221+4 Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS r TOWN OF BARNSTABLE OMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH (satisfactory 2.Printers 3.Auto Body Shops _ unsatisfactory- 4.Manufacturers COMPANY _ (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS gg: 7.Miscellaneous UANTITIES AND STORAGE (IN= indoors;OUT=outdoors) MAJOR MATERIALS ,• - IN OUT IN OUTI IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) v Diesel, KPH�*24E? Heavy Oils: waste motor oil (C) t new motor oil(C) transmission/hydraulic - Synthetic Organic degreasers t Miscellaneous: 91 i DISPOSAL/RECI AMATION REMARKS: 1. Sanitary Sewage 2.Vater Supply O Town Sewer Wublic VOn-site OPrivate t . 3. Indoor Floor Drains YES NO s O Holding tank:MDC_ O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS_: O Holding tank:MDC <,XCatch basin/Dry well <- O On-site system 5.Waste Transporter Destination Waste Narne of Hauler od rro 2 Person ('s`f Inte ewed - Inspector Date