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0130 ROSARY LANE - Health
�Gi-,ROSARYL'ANE HYANNIS 1 / A = 345 018 - --- i ' Commonwealth of Massachusetts y: Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �N 130 Rosary Lane Property Address Merlesena Realty Trust Owner Owner's Name information is required for Hyannis MA 02601 December 24, 2007 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information When filling out forms on the {�l��jp� qj �j INAZ)ORIGL computer,use 1. Inspector: only the tab key to move your David D. Flaherty Jr., R.S. ' 0 cursor-do not Name of Inspector use the return key. Flaherty Environmental Services Company Name P.O. Box 81 Company Address Yarmouth Port MA 02675 City/Town State Zip Code 508-362-1657 S14713 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this addresi and thanthe information reported below is true, accurate and complete as of the time of the inspection. Tdae insp�iction was performed based on my training and experience in the proper function and mahenancepf on-.site sewage disposal systems. I am a DEP approved system inspector pursuant ti�iection 45.346 of Title 5(310 CMR 15.000).The system: ?`j _t ® Passes ❑ Conditionally Passes ❑ Fair rs ❑ Needs Further Evaluation by the Local Approving Authority ` December 26, 2007 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****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. t5insp 130 Rosary Lane Hyannis.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 15 Commonwealth of Massachusetts - A Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments —a 130 Rosary Lane Property Address Merlesena Realty Trust Owner Owner's Name information is H annis MA 02601 December 24, 2007 required for y every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as escribed in the"Conditional Pass"section need to be replaced or repaired. The system, on completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined , N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal a d over 20_years old*or the septic tank(whether metal or not) is structurally unsound, ex ibits substantial infiltration or exfiltration or tank failure is imminent. System will pass insp ' tion if the existing tank is replaced with a complying septic tank as approved by the Bo d of Health. *A metal septic t k will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance i dicating that the tank is less than 20 years old is available. ND Explain: ❑/Obvation of sewage backup or break out or high static water level in the distribution box due en or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will spection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed t5insp 130 Rosary Lane Hyannis.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 Commonwealth of Massachusetts l: o Title 5 Official Inspection Form ^ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 130 Rosary Lane Property Address Merlesena Realty Trust Owner Owner's Name information is required for Hyannis MA 02601 December 24, 2007 every page. City/Town 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 year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of t Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Requi d by the Board of Health: ❑ Conditions exist which requ' a further evaluation by the Board of Health in order to determine if the system is failing to pro ct public health, safety or the environment. 1. System will pass u ess Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the stem is not functioning in a manner which will protect public health, safety and the envir nment: ❑ Cesspool privy is within 50 feet of a surface water ❑ Cesspo or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System w' fail unless the Board of Health (and Public Water Supplier, if any). determines at the system is functioning in a manner that protects the public health, safety and nvironment: ❑ T e system has a septic tank and soil absorption system (SAS)and the SAS is within 100 fee f 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. t5insp 130 Rosary Lane Hyannis.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts 4n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 130 Rosary Lane Property Address Merlesena Realty Trust Owner Owner's Name information is required for Hyannis MA 02601 December 24, 2007 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of He (cont.): ❑ The system has a septic tank and SAS and th AS 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 ter analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and t presence of ammonia nitrogen and nitrate nitrogen is equal to or . less than 5 ppm, provided tha 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 Y2 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. t5insp 130 Rosary Lane Hyannis.doc-08/06 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 4 of 15 i Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 130 Rosary Lane Property Address Merlesena Realty Trust Owner Owner's Name information is required for Hyannis MA 02601 December 24, 2007 every page. City/Town 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 syste 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" es"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system ' within 400 feet of a surface drinking water supply ❑ ❑ the Sys m is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the stem is located in a nitrogen sensitive area(Interim Wellhead Protection Ar — IWPA) or a mapped Zone 11 of a public water supply well If you have answered ' es"to any question in Section E the system is considered a significant threat, or answered "yes" in ection D above the large system has failed. The owner or operator of any large system considered significant threat under Section E or failed under Section D shall upgrade the system in accord ce with 310 CMR 15.304. The system owner should contact the appropriate regional office o he Department. t5insp 130 Rosary Lane Hyannis.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form _ 9 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments C� .'� 130 Rosary Lane Property Address Merlesena Realty Trust Owner Owner's Name information is required for Hyannis MA 02601 December 24,2007 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? ® ❑ 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)] t5insp 130 Rosary Lane Hyannis.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts M a Title 5 Official Inspection Form 4 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 130 Rosary Lane Property Address Merlesena Realty Trust Owner Owner's Name information is 24 b MA 02601 D i H anns December , required for y 2007 Ci !Town State Zip Code Date of Inspection every page. tY P p D. System Information Residential Flow Conditions: Number of bedrooms (design): Number edrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 1 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage syste . [if yes separate inspection required] ❑ Yes ❑ No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if vailable (last 2 years usage(gpd)): Sump pump? ❑ Yes ❑ No Last date of cupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Landscape Office Design flow(based on 310 CMR 15.203): 180Gauons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): 75 gal/1000 s.f./2400s.f. Grease trap present? ❑ Yes ® No Industrial waste holding tank present? ❑ Yes ® No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ® No Water meter readings, if available: 75,715 gals last(2)yrs: 104 gpd ave. Last date of occupancy/use: present Date Other(describe): t5insp 130 Rosary Lane Hyannis.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments —, 130 Rosary Lane Property Address Merlesena Realty Trust Owner Owner's Name information is required for Hyannis MA 02601 December 24, 2007 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons I 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 4/24/1997 Were sewage odors detected when arriving at the site? ❑ Yes ® No t5insp 130 Rosary Lane Hyannis.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �� ,..•`p 130 Rosary Lane Property Address Merlesena Realty Trust Owner Owner's Name information is required for Hyannis MA 02601 December 24, 2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: >30feet Comments(on condition of joints, venting, evidence of leakage, etc.): joints good, venting through structure adequate, no evidence of leakage Septic Tank(locate on site plan): Depth below grade: 1.5 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) H-20 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 1500 gallon Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle 31" Scum thickness <1 11 Distance from top of scum to top of outlet tee or baffle 911 Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? sludge judge, tape measure L15m.p30 Rosary Lane Hyannis.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 130 Rosary Lane Property Address Merlesena Realty Trust Owner Owner's Name information is required for Hyannis MA 02601 December 24, 2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): cast iron covers to grade in pavement, inlet&outlet tees ok, tank seems structurally sound, liquid level appropriate, no evidence of leakage I� Grease Trap(locate on site plan): Depth below grade: /eetMaterial of construction: ❑ concrete ❑ metal ❑ fiberglane ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of ou et tee or baffle Distance from bottom of scum to ttom of outlet tee or baffle Date of last pumping: Date Comments (on pumping r ommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related t outlet invert, evidence of leakage, etc.): Tight or Hol ng Tank(tank must be pumped at time of inspection) (locate on site plan): Depth be w grade: Mater. I of construction: concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): t5insp 130 Rosary Lane Hyannis.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 130 Rosary Lane Property Address Merlesena Realty Trust Owner Owner's Name information is required for Hyannis MA 02601 December 24, 2007 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/ion Date Comments rm 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 n/a 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.): H-20 dbox in excellent shape, 2 outlets equal, no evidence of solids carryover, no evidence of leakage Pump Chamber(locate on site pla Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5insp 130 Rosary Lane Hyannis.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts 4 Title 5 Official Inspection Form P Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 130 Rosary Lane Property Address Merlesena Realty Trust Owner Owner's Name information is Hyannis MA 02601 December 24, required for Y 2007 every page. City/Town 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: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: (1) 15'x 35' ❑ 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.): infiltators and stone under pavement, no observation port(note dbox in excellent shape with no evidence of solids carryover) t5insp 130 Rosary Lane Hyannis.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments —,. 130 Rosary Lane Property Address Merlesena Realty Trust Owner Owner's Name information is required for Hyannis MA 02601 December 24, 2007 every page. Cityrrown 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, s' ns of hydraulic failure, level of ponding, condition of vegetation, etc.): Privylocate on site an : ( ) Materials of constr ction: Dimensions Depth of soli s Comment (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp 130 Rosary Lane Hyannis.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts VIA Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,..'` 130 Rosary Lane Property Address Merlesena Realty Trust Owner Owner's Name information is required for Hyannis MA 02601 December 24, 2007 every page. Cityrrown 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. I P2 ✓ L(3�Cvl� R' 3 23� � 3 � � �� r� t5insp 130 Rosary lane Hyannis.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 g Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 130 Rosary Lane Property Address Merlesena Realty Trust Owner Owners Name information is required for Hyannis MA 02601 December 24, 2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ❑ Check cellar Shallow wells Estimated depth to ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: checked Town of Barnstable Groundwater Contour Map, groundwater at 17'+/- t5insp 130 Rosary Lane Hyannis.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 tHE Town of Barnstable 1p� ti Regulatory Services Thomas F. Geilerf Director RN• BASTABL.E. • �$ �9. •�� Public Health .Division AjED��A Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 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/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this 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 Work Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. Date:S / (5,/l TOWN OF BARNSTABLE TOXIC AND HA ZARD- OUS MATERIALS REGISTIjATION FORN� NAME OF BUSINESS: Iv t l� 1ra,I�.2 5ko BUSINESS LOCATION: I a1K 0-.> v,— Q INVENTORY MAILING ADDRESS: TOTAL AMOUNT- TELEPHONE NUMBER: 7 Vi—2- $— 066 ( I 9a CONTACT PERSON: 1 oA 06e4j5 EMERGENCY CONTACT TEL PHONE NUMBER: MS S ON SITE? TYPE OF BUSINESS: INFORMATION / RECOMMENDATIO S: )1�Jfl lIc -Ksc- ,J <Kz Q- Fire District: �� ��(7b�a�v1, ,NIS�S sl�.�s �.H.�. �1�,0 o►ti 5��� 3) �,cc,n �.0�11 aY1t11 A D-r SA2 4 Co j%Ag vs.� At-} .ew e00m- aQ Waste Transportation: _ � SD'9o-7-7 I Last shipment f hazardous waste: Name of Hauler: 5i°A pev`. Destination: _ (Z� 3-y Waste Product: ► I Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants / Moor Oils / Pesticides L� NEW CAUSED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous(please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials Town of Barnstable Hazardous Materials On-Site Inventory and Inspection FACILITY INFORMATION: Business Name: 4&7XV //R Business Location: 130 e- SA�ft Z.A- r X&AW/S Mailing Address: Telephone Number: Contact Person: T M V X7S Emergency Contact Telephone Number: Type of Business: 4u?a HAZARDOUS MATERIALS (CHAPTER 108) i 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 VIA-5 L- ,5Y6A-U0AJJ N �5!/K e o� �A-�4 C� RAy 77:�' / ,�A-L"AJ a r & riz- _s cii-e44E e47 /V&W &A-t-z-0,03 Q T B 0 777-t'_S - 1 - �I Town of Barnstable Hazardous Materials On-Site Inventory and Inspection } FACILITY INFORMATION: Business Name: kl7i-0 Business Location: /.30 e 1120 sA#-V Z-,N,E &A-AVIE Mailing Address: Telephone Number: 17 d, 3Y' 6 fi_(o Contact Person: �/V V /Q.6 &_-X 7S Emergency Contact Telephone Number: Type of Business: /7 /*RA HAZARDOUS MATERIALS (CHAPTER 108) Virgin Product Total Quantity Container Size(s) Storage Location Major Materials Gallons or Pounds Quarts, gallons, Shed,retail store, 4: {* /drums,tank,etc... cabinet,closet,etc WA 0/L_ C'vAye,4GE O Tf �,f L.L.o AJ a r /3o /TEES CA dell GE f3,4 0 +S' New G.,f c-c.C/J s C�?' 3 0 7T1-t S C7!t�c'.�4 C l3 f .4Kg — 4/6 A t 6A- -Z-"J3 IQ I- i30 /TzrS (a'4-g4 4t 0/I'l b,4 �-X/E1 G, A GL GN S 5 N+ - 1 - Misc. ` / 4 k, F�E OS Misc. Corrosives Misc.Reactive Misc.Toxics Inventory Total Amount: v 3 • S c,,+ Hazardous Materials License Posted?Yes No Contingency Plan Posted? Yes No Fire District: Fire Extinguisher Service Date: Metal Covered Rag Bin: Yes No Absorbent Material Available? Yes No Type of Absorbent: Speedy Dry Pads Pigs Other: MSDS on site? Yes No Hard Copy Computer Access Hazardous Waste Handling Hazardous Waste Generator Identification Number: /Ll �.5-a�" '77/J/Sa'� Type(s) of hazardous waste product(s): �5E7) Ole- Date of last hazardous waste shipment,type of waste and quantity: L54A /)/z- . D 6A-4"AJS Hazardous Waste Transporter(s): o t LEA r Designated Hazardous Waste Facility: ;kj Hazardous Waste Storage Area Description: 3/AU4LE Is hazardous waste storage area labeled: Yes No Are tanks/drums/containers labeled with the words "Hazardous Waste",the type of waste and the associated hazard (i.e.ignitable,corrosive,reactive or toxic) Yes 0 If hazardous waste is stored out of door ered from the elements? Yes No Is it in 110% containment? Yes No A If hazardous waste is stored indoors is it on an impervious floorO- es No - 2 - Misc. /CA 6e__DAj �4E7LE S cL GA iJ J' Misc. Corrosives Misc.Reactive Misc.Toxics Inventory Total Amount: 7 C,A L-L0�J S Hazardous Materials License Posted?Yes No /VIA Contingency Plan Posted? Yes No Fire District: Fire Extinguisher Service Date: Metal Covered Rag Bin: Yes No Absorbent Material Available? Yes No Type of Absorbent: Speedy Dry Pads Pigs Other: MSDS on site? Yes •No Hard Copy Computer Access Hazardous Waste Handling Hazardous Waste Generator Identification Number: Type(s) of hazardous waste product(s): 1/5C_6 0/4— Date of last hazardous waste shipment,type of waste and quantity: zew `4 6A-/.-t01j-S =1 Hazardous Waste Transporter(s): .S 'tGLn f fC E A Designated Hazardous Waste Facility: ,4- !�'��J U i¢it1 S�2,U f 1 rA Hazardous Waste Storage Area Description: S/A)GGE I7 �%� ia/E 6'd /l�l/��7�✓/GUS f b G Is hazardous waste storage area labeled: Yes No Are tanks/drums/containers labeled with the words "Hazardous Waste",the ty_ of waste and the associated hazard (i.e. ignitable,corrosive,reactive or toxic) Yes No If hazardous waste is stored out of door is i:P ered from the elements? Yes No Is it in 110% containment? Yes No /V`A If hazardous waste is stored indoors is it on an impervious floor? es No - 2 - FLOOR DRAINS (Chapter 381) Town Sewer Account Number:. xS aaiL% SEpTIG ScRN��✓�����-� Indoor floor drains: Yes /Nod If yes,circle one,does it discharge to a: holding tank dry well on site septic. (9 Outdoor surface drains: Yes � If yes,circle one,does it discharge to a: holding tank dry well on site septic. FUEL AND CHEMICAL STORAGE TANKS (Chapter 326) Underground Storage Tank(s) on site? Yes in Age: Is removal required? Yes o If yes,when? Is testing required? Yes No If yes,when? Out of doors above ground storage tank on site? Yes CY 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 as r N 1)L&:S 7--0 Z--e'S IBC 7 7---r,, L. 17,k -)50/e /S A107- .5U'6j?—'Zr 78 6, Pr- bt!�>U 1R-6-14CAJ lyd. 1-0,05ETZ:5 W,00- f N S Tx-u-CrEV TV 1,,f6C - rh4f pSTE Q/L Z2 g&AA er)2- T#C I-A"UR-4 c of A Sa.,uA-, o G- g"V1,ec7 r67j7'J u/s-s PRa d>��� zV H11-( X-3r ntE ZWE aF /NSOWeO. Date: Public Health Inspector:, Facility Representative: - 3 - FLOOR DRAINS (Chapter 381) Town Sewer Account Number: SEC Indoor floor drains: Yes (9 If yes,circle one,does it discharge to a: holding tank dry well on site septic. Outdoor surface drains: Yes No) If yes,circle one,does it discharge to a: holding tank dry well on site septic. FUEL AND CHEMICAL STORAGE TANKS (Chapter 326) Underground Storage Tank(s) on site? Yes �NoJ Age: Is removal required? Yes No If yes,when? Is testing required? Yes No If yes,when? ,,��--�� Out of doors above ground storage tank on site? Yes (No/ 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{ �ACIL.!� uS6-5 �� N �[.�S 5M2CS 41eT5 � �J O,cJ E— /fu�J�izt7� �?�✓�,� c�Lo�s 6F y�9��lzBaa.s Rp 7&-Ie/h C. t��'Fo/�� /S fl6 77 6 t---7>r" C G pU r3 u C 1-16;?( LTd/ /744 RA //1 GS c L-I G�-�US'�•v G IfR, ©_JCJ7.3 W4j 1Ns r'x-u crt--o r#�r Gc1 rE alp- . bgUA4 Pam- 77fE" t-A"UAC,C OIG " A SU of-' gri 14L,"6701 WHI"I KIAS 7-0 /Y//-( X T n7Y- 7WE ec /N5P6C7-10A) Date: &6- Public Health Inspector: Facility Representative: - 3 - i TREESCAp, ES ORNAMENTAL TREE/SHRUB PRUNING TREE REMOVALS,FULLY INSURED r� JOHN P.MERLESENA Mass.Cert.Arborist#1861 (508)255-6678 1 s ` r �.�,e—. .... r ....ter—....- .. w_ .,- .y . .. "• - 3 C Date: 057 TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: fr.P-P r BUSINESS LOCATION: L30 13 fP dam'-K-/ Zdde. W. AAMSMh& 02LPYINVENTORY MAILING ADDRESS: U)-.��'1 r�P_, /M 60gtp 0ef TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: — J�J� MSDS ON SITE? TYPE OF BUSINESS: tr.P.2. rLyA(Ilaj I (f'dw, J ' UA INFORMATION/RECOMMENDATIONS: Adz LdOUS Id a Fire District: GL r .3 a, Waste Transportation: AQ 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. UST 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 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 Date: TOXIC AND HAZARDOUS MATERIALS REGIS RATION FORM NAMEOFBUSINESS: BUSINESS LOCATION: /` PT, : MAILING ADDRESS: a`6 Board of Health TELEPHONE NUMB R: Town of Barnstable CONTACT PERSON: .O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: annis, MA 02601 TYPE OF BUSINESS: Does your firm store any of the toxic azardous 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 otherthan your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antifreeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Any other products with "poison" labels Paint brush cleaners (including chloroform, formaldehyde, Floor& furniture strippers Metal polishes hydrochloric acid, other acids) Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Date` t TOXIC AND HAZARDOUS MATERIALS 'REGIS RATION FORM NAMEOFBUSINESS: BUSINESS LOCATION: yl MAILING ADDRESS: / To. Y. Board of Health TELEPHONE NUMBER: r Town of Barnstable CONTACT PERSON:' 4 ' m,.: ,. .� .O. Box 534 -- EMERGENCY CONTACT TELEPHONE NUMBER: annis, MA 02601 TYPE OF BUSINESS: - AOIAjIT Does your firm store any of the toxic azardous 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 HA?,A+RDOUS MATERIALS ,. _0 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 ti +, Quantity I Antifreeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes .Road Salt,(Halite)., , Hydraulic fluid (including brake fluid)` Refrigerants Motor oils .Pesticides NEW USED (insecticides, herbicides, rodenticides). Gasoline, Jet Fuel Photoche'micals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, P_hotochemicals (Developer) lubricants, gear oil NEW 1 USED' Degreasers for engines and metal Printing ink r Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool-chlorine, Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt &roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners _ Other chlorinated hydrocarbons, NEW USED .(inc. carbon tetrachloride) Paint & varnish removers, deglossers Any other products with "poison" labels Paint brush cleaners (including chloroform, formaldehyde, Floor& furniture strippers Metal polishes hydrochloric acid, other acids) , Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers , i . % WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Town of Barnstable-Health Department Page 1 HAZARDOUS MATERIALS INVENTORY SITE VISITS DBA. 7 r nj.QCS Fax ./Corp Name: Mailing Address Location: I c34.. l� Sa _. .... Street .G�, . r. ✓rh mappar: City: Contact: JOAO (A State: Telephone: ��8• � � ��� Zip: CW_ 7 Emergency: Person Interviewed: T Business Contact Letter Date: /7 O mac - o t'�-e-e3 Category: Inventory.Site Visit Date: Lo D_S ... Type: Follow Up/Inspection.Date: .........._._.......................................................................... ... ❑ public water ❑ indoor floor drains ❑ outdoor surface drains ❑ license required ❑ private water ❑ indoor holding tank mdc ❑ outdoor holding tank mdc ❑ currently licensed ❑ town sewage ❑ indoor catch basin/drywell ❑ outdoor catch basin/drywell expir ----- - - ❑ on-site sewage ❑ indoor on-site syste ❑ outdoor onsite system date: ................................................................ compliance: 0 c A �S tom. c� -�-w� 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 Waste Transporter: ' Fire District: Last HW Shipment Date: Waste Hauler Licensed: No Town of Barnstable-Health Department Page 1 HAZARDOUS MATERIALS INVENTORY SITE VISITS DBA: Treescapes Fax Corp Name: Mailing Address Location: 130 B Rosary Lane W.Barnstable Street: PO Box 721 mappar. City: Contact: :John Merlesena State: Ma Telephone: 508-255-6678 Zip: 02668. Emergency: 774-238-6585 Person Interviewed: John Merlesena Business Contact Letter Date: 5/17/2005 Category: 'Landscapers Inventory Site Visit Date: 6/2/2005 Type: Follow Up/Inspection Date: ❑ public water ❑ indoor floor drains ❑ outdoor surface drains ❑ license required ❑ private water ❑ indoor holding tank mdc ❑ outdoor holding tank mdc ❑ currently licensed ❑ town sewage ❑ indoor catch basin/drywell ❑ outdoor catch basin/drywell expir - - ❑ on-site sewage ❑ indoor on-site syste ❑ outdoor onsite system date: __.._........ .............. 6/2/05 alp No hazardous materials on site,no permit required. Is compliance: interested in car wash policy. Directed John for now to use a Satisfactory biodegradable soap,wash on concrete,do not let drain into catch basin,must re-direct into grassy area,no under carriage cleaning.Will send him a policy once in place. Page 2 Town of Barnstable-Health Department HAZARDOUS MATERIALS INVENTORY Chemicals: 91 Zero Toxic Waste Materials ❑ gty's>25 lbs dry or 50 gals liquid but less than 111 gals ❑ gty's 111 gals or more Waste Transporter: Fire District: Last HW Shipment Date: Waste Hauler Licensed: No _.......................... r � .. .. .•,_!`.v-_ .A�•�. ,-.',w�-.�"i�r�1 �F..!'•''+^�.,ra,-r�..:�;. •t. Y.. � Y' r -. •wr ^k..• -✓`mx... r._. .� Date: 1� TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: r rQ -f m w s BUSINESS LOCATION: 0o B K L-5 ii-4 Zdw O)OW1NVENTORY MAILING ADDRESS: GUr t" . Od-064 TOTAL AMOUNT- TELEPHONE NUMBER: - 02C-_ b5- CONTACT PERSON: .. EMERGENCY CONTACT TELEPHONE NUMBER: �� - ��- 5�� MSDS ON SITE? TYPE OF BUSINESS: tyl e a m DUa I o a-ye INFORMATION/RECOMMENDATIONS: df0 �'t�Z-�tf^d0(AS ILIG( {'7Q�S Fire District: D h lam tz4o uS Q dj r MLA i ecs° i ' Widr Ldrrnhb(e Waste Transportation: —NU — 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 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 - r • TOWN OF BARNSTABLE BAR_W 14112 Ordinance or Regulation r WARNING NOTICE Name of off ender/Mana ender/Manager g Address of Offender A / PV MV/MB Reg.# V Village/State/Zip LVA ;/V / /S 0P-(00/ y Business Name am/pm, on _ ! � 2O Business AddressJJ �1` Signature .of EfYfo'rc ng Officer Village/State/Zip V 1 Location of Offense 1 0 A e0SUVIAN6, .� �1'►�' E�nforc1/i(n/g De�ptr/D�i vx i s�io!n W � Gr �OffensaVJAI I �c� c1 �� 31 ( Mk,51 (/0 PCs— Facts O � 0V This will serve only as a` warning. At this 'ti:me 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. TOWN OF BARNSTABLE BAR-W Ordinance or Regulation. WARNING NOTICE Name of Offender/Manager ,Address of Offender MV/MB Reg.# .Village/State/Zip AIAJ r MA av Business Name am'/pm,! onY. 20 Business Address )(7)r I" 'P G Signature .of Enforcing Officdr Village/State/Zip Location of Offense 0 A C , , t Enforcing Dept"/Divi's ion Offense _X) CMILJ-00 OJ Facts PAI 'C. This"will serve only as a-1warning. At this time no legal action has been taken. It is the goal' of Towp . agencies j to achi6,,�e, voluntary compliance of Town Ordinances, Rule"s and Regulations.. /Educat'ip'n effort's%, and warning notices are attempts to gain 'voluntary i compliance. Subsequent violitions will result in appropriate—legal lactio'n�by)the Town. WH,I-T-OFFENDER CANARY-ORD./REG.-PROG. PIN Kt ENFORCING OFFICER GOLD-,ENFORCING DEPT. TOWN OF BARNISTABLE BAR-W Ordinance ,or Regulation, WARNING NOTICE P f Name of Offender/Manager l Address of Offender MV/MB Reg. Village/State/Zip` Lk Business Name 'am/pm, on A 420 Business Address Signature of Enforcing Officer Village/State/Zip Location of Offense j; J� Enforcing Dept/Division Offense Facts This will serve only as a warning. At this time no legal action has been taken. It is the goa1j,.16f Town agencies 1 to achieve voluntary compliance of Town Ordinances, Rules and Regulations. /EducatioinI effores4and warning notices are attempts to gain -voluntary � compliance. Subsequent viofaitions will result in '�ac t i 'by the Town. 4 appropriate legal lon, ry WHITE-OFFENDER CANARY;ORD./REG.-PROG. PINKf`ENFORCING OFFICER GOLD-ENFORCING DEPT. _.. ..-i..' ..... .� ;.. .r: i.. '._ .r>. Y.• f .{ Y" r\. �k _ rR•^' 1,ISF - TOWN OF=BARNS TABLE BAR-W 4109 Ordinance -r Regulation WARNING NOTICE Name of Offender/Mana ger IPA-rcf- wods �/�(9 /� Address of Offender V �� ( :� MV/MB Reg.# . � � / /Village/State/Zip H A iNtc , V1— oa;,\/ / W, Business Name /1 ' am7e/pm, on 20 , Business Address /j'J 1 ,-AI_ r? .�l/1�9� �'I/!A f, ► _� Signature .of ,En'for`c ,ng Officer / Village/State/Zip y /f Location of Offense E23ARN I-Ae" 9 �LZ /oeV I&AA ,,(�OffenseWAf65 ►'t/��4 6t 0ISr-�/y ��jGi ' ` a �lV t✓l"Ir�``�°�p Facts 1A ) ASN1ar----' This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town 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. 1 WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE BAR-W 4109 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager '4`,'/ Address of Offender (� r �/ �'- -MV/MB Reg.# ( #,tom Village/State/Zip V {/�t1 t"j C- I � ! C7'( 0 r OD Business Name ' �, a-m,/p on �20 Business Address S-ignature _of Enforcing Officer ts Village/State/Zip } j ` ! Location of Offense ! P0--:-)A!, 7` 1 V Enforcing Dept/;Division Offense , � i � (-",.fC } �i i/' ;N' r, � � ✓' Ft + A� r a. ""''' f d^'"" , 1�.-1 .. f I f �.1 e d # s T p #� t •'4:�. ~.�•-- Facts , /l { 7,_'� �'q'' 1'���,t✓ _ , "-i r� /• f •/ ��,,t.-. This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are i attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. 1 WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE BAR-W 1009 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager Address of Offender �.-._. ?i _.r ep MV/MB Reg.# Village/State/Zip f f 'r r � �� � r� y ' � €f{T' d`t d f� Business Name t¢ h am/pm, on f20"_r,d Business Address Signature .of Enforcing Officer Village/State/Zip f ( t 5 1 r Location of Offense �.- �, r Enforcing Dept/Division Offense Facts This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town, 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 Towi . WHITE-OFFENDER CANARY;ORD./REG.-PROG. 'a PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. x v a - x - -_ �.. {y.`� Vim': ,�.-g _• � *t.. I " � t,• L + ,. Pp,�� "r`�'� �': � _ a - _ to �� ❑� � _ �"`'. ' nc+�. xr. ! .. f •, • M � y.. . 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';,t,:.. •� '+� ' .:� ,.-: "." i��ti Nt.t. �*-• rh 3;._++�•, "�•�`cvs .. ���.3 •1' '4�n%+, *•. �► kw � r. i `to y 4 - t •���.�� �g { '*" �� `'�'*., '°yam �A ""'4. a� �6'y�,'a` c'k' �y�,x'-�•. �` � I r .-� ��r �';� � 7fi,� crdx �-�.C'i"�� � -•�� r,�4 p��,w`$.+.: „p a ..�k d�i`.R'T" �'� '` �°� <G ty ,:�/k S��r "•*Wp'�,� ��'+k�'Z �„�^'.��µ��i•p r,y _ �' "� ..� t .� E r• � �{ "w+ �'� t; '�'., h'W'$w�'„' �Tfyu.,.fj� �� t¢s'5���A { /i- 1� At e 4 "df �hF• `x,y�„r,. •' r o' a"i * `� � add" '_ �'T� y,�R1! � f Ji� •�, t � T � R • 7 1 4 JJ] j 3 ^ } ' ✓'� '`_� P � tip ''' � � '�+ r p t 4k�a�F,�.iRA r� t.+ � m � � .� • w , i 130B Rosary Lane, Hyannis. y Water Works Irri . ation. "� • F "� i P G o wn Fn All, xr ,. r. o . r ; , r �y "�M�Fir i� �p7i�e rilE�p`�7�•�'•'t�..•�1 s+� _ �°�+�:. ., 1n tt js/ 41tok WWI c 14 i Vu • - t v 4 4 MW 41 vu Ai 1I i a n v � ` a � _ • y �+f L� i �'i.� .�i'Lft�i �� �0.W 1 1�•� i --� � "tom "ir-° �l�y t " ��'s:.� � �; �i .. L _ a i a a ' 1 t lir W�OI�•� � ...,3 ��**yyyy ,' f � 3 t :f 1 r r � a � 1 r { Q } { r, } n e� e i s Y ■lu[P a essWa j, 130A Rosary Lane, Hyannis"., .Ca e 5 Cod Chr slur/Central-Ca e.- D ,l e Recon Annex- r h ` 09/26/2003 11:23 5087716935 CENTRAL CAPE DODGE PAGE 03 MATERIAL SAFETY DATA SHEET ' '',The Valvoline Company Pa,The 001 13 a prepared: 07/18/02 Date Printed: 06/[Z3/03 115DS No: 510.0382740-001.001 PRO SUDSIKG CAR SOAP 4/128 OZ 1. CHEMICAL PRODUCT AND COMPANY IDENTIFICATION Material IdOntitY Product Name: PRO SUDSING CAE SOAP 4/128 OZ SAP Materiel No: B1610201 Nneral or Generic ID; PREKIUM AUTOMOTIVE DETAIL PRODUCT Company Telephone Numbers The Valvoline Company Emergency: 1-800-274-5263 P.O. Box 14000 Information: 1-859-357-7206 Lexingi:au, KY 40512 2. COMPOSITION/INFORMATION ON INGREDIENTS Ingredient(s) ----- GAS-Number--- �-(by-weight) ------------ ---------------.------ INERT COMPONENT 7732-18-5 84.0- 94.0 SURFACTANT 68439-57-6 4.1- 14.0 3. HAZARDS IDENTIFICATION .—.Potential Health Effects Eye May cause mild eye irritation. Skin May cause skin irritation. SxalIowing Swallowing small amounts of this material during normal pandling is not likely to cause harmful effects. Swallowing large amounts may as harmful. Inhalation Breathing this material is unlikely. Symptoms of Exposure Si a and symptoms of exposure to this material through breathing, a a'llowi:ng, and/or passage of the material through the skin may ,include: stomach or intestinal upset (nausea, vomiting, diarrhea) . Target Organ Effects No data Developmental information No data cancer Information No data Other Health Effects No data Continued On Next Page Ed WdGT:z0 £00E 92 'daS p200ZLz0Z9: 'ON XUJ D-i-j 'Ol d d�dddS: W08-d 09/26/2003 11:23 5087716935 CENTRAL CAPE DODGE PAGE 04 MATERIAL SAFETY DATA SHEET the Valvoline Company Page 002 Date Prepared: 07/18/02 Date Printed: 06/23/03 PRO SUDSING CAR SOAP 4/128 OZ MSDS No: 510.0382, 40-001.001 Primary NOUteCs) of BntrY Skin contact, Ingestion. A. FIRST AID MEASURES Eyes If symptoms develop move individual away from exposure and into fresh air. Flush eyes gently with water :chile holding eyelids apart. If symptoms persist or there is any visual difficulty, seek medical attention. skin First aid is not normally required. However it is recommended that exposed areas be cleaned by washing with soap and wafer. sxal ION Ing Do not induce vomiting. Give one glass of milk or water, and got medical attention immediately. If possible, do not leave victim unattended. Inhalation First aid is not normally required. If symptoms develop, move individual away from exposure and into fresh air. If symptoms persist, seek medical attention, Note to Physicians Preexisting disorders of the following organs ( or organ systems) may be aggravated by exposure to this material: skin. 5. FIRE FIGHTINO MEASURES Flash Point No data Explosive Limit No data Autoig.nition TemBerature No data Hazardous Products of Combustion carbon dioxide and carbon monoxide. Fire and Explosion Hazards No data Extinguishing Media alcohol foam, water fog, carbon dioxide, dry chemical. Fire Fighting Instructions No special precautions necessary When fighting fires involving this product, NFPA Rating Health 1, Flammability - 0, Reactivity - 0 Continued On Next Page Ld WdST:Z0 200Z SE b£00ZLZOM: 'ON XdJ '0-i"I Oinu 9 vHudS: WOad i 09/26/2003 11:23 5087716935 CENTRAL CAPE DODGE PAGE 05 MATERIAL SAFETY DATA SHEET '- The Vslvolin� Company Pa a 103 Da a Prepared: 07/18/02 Date Printed: 06//23/03 HSDS No: 510.0382740-001,001 PRO SUDSING CAR SOAP 4/128 OZ 6, ACCIDENTAL RELEASE MEASURES small Spill Absorb 'liquid on vermiculit® floor absorbent or other absorbent material. , Scoop or scrape up. Put in container for recovery or disposal. Flusb area with water. coop or vacuum transfer spilled product to clean containers for recovery. Large 5 11 S ills of this material are very slippery. The ar®a shguldp be thexoughly apply moretdry-sweeping water ®compound. Samevmethoddas. If sma lllspill,Hess remains apply P 7. HANDLING AND STORAGE Handling Not applicable storage Keep containers closed when not in use. Keep from freezing. ..__.8. EXPOSURE CONTROLS/PERSONAL PROTECTION five Protectfo cnitgqse�� isthem dssoou alesplhfolesrep $ conditions tnsafetyglaesrchemic However, a advised. Skin Protection Not required under normal conditions of use. Respiratory Protections Not required under normal conditions of use. Enoineering Controls NoL required under normal conditions of use. Exposure Guidelines Component INERT COMPONENT (7732-18-5) No exposure limits established SURFACTANT (68439-57-6) No exposure limits 'established 9. PHYSICAL AND CHEMICAL PROPERTIES Boiling Point (for component) 212.0 F (100.0 C) Continued On Next Page bd WdST:Z0 E00z SZ 'd% V200a420E9: 'ON XUJ 0'�'� 10inU :3 IN G: W0hLd 09/26/2003 11:23 5087716935 CENTRAL CAPE DODGE PAGE 06 MATERIAL SAFETY DATA SHEET "The Valvoline Company Pa Re 004 Date Prepared: 07/18r02 Date Printed: 06(23/03 MSDS No: 510.0382 40-001.001 PRO SUDSINO CAR SOAP 4/129 OZ Vapor Pressure (for component) 17.500 mmHg Specific Vapor Density No data Snecifio GravltY 1.016 @ 70.00 F Liquid l)a]isitY 8.500 lbs gal 70.00 F 1.016 kg/� @ 2 .00 C Percent Volatiles (Including Hater) No data Volatile Organic compounds (VOC) CHaximum) .000 g/1 NvapoFat'ion Rate No data At+pmarance PINK LIQUID LIQUID PltYsi ca'i Foam LIQUID Color PINK Odor ALMOND PH 9.0 - 10.0 V 3 90 850 0 - 950.0 cps @ 21 C 10. STABILITY AND REACTIVITY Hazardous PolYmerlZation Product will not undergo hazardous polymerization. Hazardous Decomposition No data Chemical Stability Stable. Continued On Next Page Sd W89 Z:Z0 Z002 SZ 'day 0,E00ZLEOE9: 'ON Xdd 3-i'1 `OUId 9-I>itltidS: wOtld 09/26/2003 11:23 5087716935 CENTRAL CAPE DODGE PAGE 07 MATERIAL SAFETY DATA SHEET 'r'rie Valvoline Cempeay Pa a 005 Da a Prepared: 07/18/02 Date Printed: 06``23/03 MSDS No: 510.0382 40_001.001 PRO SUDSING CAR SOAP 4/128 OZ IncompatibilitY No data li. TOXICOLOGICAL INFORMATION No data 12. ECOLOGICAL INFORMATION No data 13. DISPOSAL CONSIDERATION Waste Management Information Dispose of in accordance with all applicable local, state and fodcral regulations. „_„ 14, TRANSPORT INFORMATION DOT Information - 49 CFR 172.101 DOT DeserlPtian: Not Regulated Container/Mode— CASES/SURFACE - NO EXCEPTIONS MOS Component None RQ EReportablq QuantitY) - 49 CPR 172.101 Not applicable 15. REGULATORY INFORMATION US Pederal Regulations TSCA (Tv is Substances Control Act) Status TSCA (UNITED STATES) The intentional ingredients of this product are listed. CERCLA KQ - 40 CPR $02.4 None SARA 302 Components - 40 CPR 355 Appendix A None Section 311/312 Hazard Class - 40 CPR 370.2 Immediate( ) Delayed( ) Fire( ) Reactive( ) Sudden Release of Pressure( ) Continued On Next Page 9d Wd9t:Eo E00e S2 'daS KOOELZO29: 'ON Xd.� 13-11"1 'Olfld ��I�ItidS: WOad 09/26/2003 11:23 5087716935 CENTRAL CAPE DODGE PAGE 08 MATERIAL SAFETY DATA SHEET `—`-The Valvoline Company Pa a "' R Da a Prepared: 07/18J02 Date Printed: 06/J23J03 MSDS No: 510.0392740-001.001 PRO SUDSING CAR SOAP 4/128 Oz SARA 313 CDMPORB8t8 - 40 CFR 372-65 Nora International Regulations Inventory Status Not determined State and Looal Regulations California PrOPOSitiOn 65 None 16. OTHER INFORMATI ON The information accumulated herein is believed to be accurate but is not werraated to be whether originating with the company or not. Recipients are applicable, and ends suitablev advance theirn need that is current, . i Last Page Zd Wd9t:Z0 £00Z SZ 'daS v£00ZZZ0Z9: ON XUJ .0'�'� `oxu FrDudd5: WOad Date: TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: M ¢ <ah BUSINESS LOCATION: 13,59 S MAILING ADDRESS: Z K Mail To: Board of Health TELEPHONE NUMBER: 5fl 36) Town of Barnstable CONTACTPERSON: gf s pith f' P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: 5df- 7 7L —3 Y� ,� Hyannis, MA 02601 TYPEOFBUSINESS: -Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own use? YES ✓ NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate a the materials are stored at a site othVrthaA your mailing�B address: GtrAT ADDRESS: l U '" TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antifreeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerantsy,. Motor oils Pesticides, NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW , USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Paint brush cleaners Any other products with "poison" labels (including chloroform, formaldehyde, Floor & furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS LAAVQ�� TOWN OF BARNSTABLE PLIANCE: CLASS: 1.Marine,Gas Stations,Repair s isfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops unsatisfactory- 4.Manufacturers / rP (see"Orders") 5.Retail Stores COMPANYM4 A [`C" �.G ^T� 6.Fuel Suppliers ADD ESS -j' Class: 7.Miscellaneous QUANTIfTIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS [ Underground IN OUT IN OUT IN OUT #&gallons 777 Test F �S Gasoline,Jig Fuel(A) Die erosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: DISPOSAURECLAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply J tytj O Town Sewer ,kublic Q V!On-site OPrivate on vpwce 6 3. Indoor Floor Drains YES N0ek_ 0 Holding tank:MDC 0 Catch basin/Dry well 0 On-site system 4. Outdoor Surface drains:YES KNO ORDIE 0 Holding tank:MDC AK Catch basin/Dry well 0 ti 0 On-site system S'l 5. Waste Transporter Name of Hauler Destination Waste Prodiict Licensed? YES N0 1. 2. Person (s) Interviewed Inspect r Date L s, ;TOWN OF BARNSTABLE PLIAVCE: CLASS: 1.Marine,Gas Stations,Repair s isfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANYM4 Q I�tP (see"Orders") 5.Retail Stores . I c 6.Fuel Suppliers ADD SS _ 1' Class: 7.Miscellaneous QUANTIITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test F . Gasoline,J-d Fuel(A) S Die rosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil(C) transmission/hydraulic Synthetic Organics degreasers Miscellaneous: DISPOSAURECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply ,� 0 Town Sewer ;b ublic Q lJn-site OPrivate d'c- 3. Indoor Floor Drains YES N0 0 Holding tank:MDC C`(�to 0 Catch basin/Dry well 0 On-site system _ 4. Outdoor Surface drains: YES �NO O oHoldin tank:MDC S' (Catch basin/Dry well ��® 0 On-site system 5.Waste Transporter Name of Haulcr Destination Waste Product Licensed? YES INO 1. 2. Person(s) Interviewed Inspect r Date TOWN OF BARNSTABLE LOCATION IS C, T:O C`7 SEWAGE VII,LAGE �l`19f� i�/f ASSESSOR'S MAP&LOT A INSTALLER'S NAME&PHONE NO. UAYJ SEPTIC TANK CAPACITY. A5y 0 , ' LEACHING FACILITY: (type) !tip C C (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: '� y �� COMPLIANCE DATE: �1� ..9 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and L hing Facility(If.any wetlands exist within 300 f f a ng facility) Feet Furnished by CI CG Vj OJT ' V ro w C mil. • w. '� ��' ' off? No. °` Fee_ln2 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIpplication for Migo al *pgtem Con!5tructton Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) Complete System ElIndividual Components Location Address or Lot No. I��Rip �r y Owner's Name,Address and Tel.No HyahhiS Mtg446Pha Reo t- y eorP. Assessor's Map/Parcel?LIT— lry(,� Insta er's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 7 70 09'1Oti F - /Yl�r��a� _,�.��� y 9 hfGt r�p R Rd /pit y zH•�J�.S Type of Building: 0 �� Dwelling No.of Bedrooms�� Lot Size i , ft. Garbage Grinder( ) Gz No. of Persons Showers( ) Cafeteria( Other Type of Building /"t 7 ) Other Fixtures Design Flow J ® gallons per day. Calculated daily flow gallons. Plan Date f Z — 7-• i7 r Number of sheets Revision Date 12 Title Size of Septic Tank S-dD 9'C Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions o itle 5 f the Enviro o e a d not to place the system in operation until a Certifi- cate of Compliance has been issue y th' oard of a Signed -r Date Application Approved by Date /a,- ;L- Application Disapproved for foll tng reasons Permit No. _(p / Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACMS SNGINEER MUST SUPERVISE INSTALLATION AND CERTIFY IN WRITING Certificate of Q[oMXA (,M WAS INSTALLED IN STRICT CE TO PLAN, THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( )Repaired( ) Upgraded( ) Abandoned( )by at has been constructed in accordance with the provisions of Title 5 and&A for Disposal S stem Construction Permit No. dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector J TOWN OF BARNSTABLE LOCATION ISID 'D � r�y SEWAGE # �i' VILLAGE k`/ ASSESSOR'S MAP & L k INSTALLER'S NAME&PHONE NO. DAaQ SEPTIC TANK CAPACITY LEACHING FACILITY: (type) C ' (size) f// <f�� NO.OF BEDROOMS r BUILDER OR OWNER4 LA�v D SC/J�� PERMITDATE: ? y A.? COMPLIANCE DATE: y ��•U "9 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Lexching Facility(If any wetlands exist Feet within 300 f L f a ng facility) Furnished-by i JUT f ?t U' (55 _ � l j % [• +. r �.�' O l r mot" �`++ No. Fee / l THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes \PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS 01ppYication for Migogar *pgtem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) [Complete System ElIndividual Components l r y Location Address or Lot No. 30 90 S 4 i✓ Own is Name,Address and Tel.No Assessor's Map/Parcel �. .. S Sys _ /e' Y Installer's Name;Address,and Tel.No. Designer's Name,Address and Tel.No. 7 7 9';,_©D_ "� cJ6�lT/1/ �'�' O� Q Type of Building: Dwelling No.of Bedrooms Lot Size a oz Of 33 sq.ft. Garbage Grinder( ) Other Type of Building 7 Gr L, No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow ! gallons per day. Calculated daily flow gallons. Plan Date Z — Number of sheets = Reyision Date 42 - Title Size of Septic Tank /5O,te g'Gt Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) QS pf i 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 o itle 5 of the Enviro a ode and not to place the system in operation until a Certifi- cate of Compliance has been i sue y th's/Board of Signed Date �., Application Approved b Date PP PP Y Application Disapproved for t follil reasons Permit No. Date Issued ------------- - -------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance 4 THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( )by i at !i a has been constructed in accordance with the provisions of Title 5 and tYe for Disposal System Construction Permit No. dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector No. l��r ----------------------Fee THE COMMONWEALTH OF MASSACHUSETTS ° PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS =izpogal *pgtem Congtruction Permit Permission is hereby granted It onstruct(✓)Repair( )U grade( )Abandon( ) System located at / Yl ©�i li �/ n and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. ` Provided:Construction must be completed within three years of the date of this. its "0 / Date: Approved by �!%/ t- �- y THE TOWN OF BARNSTABLE �FtO� �„Q ♦� OFFICE OF ]IMSTAEL s BOARD OF HEALTH MASS. y °o i639• �� 367 MAIN STREET MpY k HYANNIS, MASS.02601 February 1, 1996 John Merlesena P. O. Box 721 84 White Birch Way West Barnstable, MA 03668 RE: A=345-18 Dear Mr. Merlesena: You are granted a variance from the Board of Health regulation limiting sewage flows to 330 gallons per acre per day within zones of contribution to public water supply wells. This variance allows you to construct an onsite sewage disposal system at Parcel 18 Rosary Lane, Hyannis with the following conditions: (1) The use or storage of any hazardous materials is not authorized at this building. (2) No more than 1936 square fee of the building may be utilized for office use. The remaining areas shall be utilized for dry storage only. (3) The designing engineer shall supervise the construction of the onsite sewage disposal system and shall certify in writing that the system was installed in strict compliance with the approved plan dated revised 12/28/95. (4) The building shall be connected to the public water supply. merle This variance is granted because the Board of Health is of the opinion that the installation of only one additional septic system which complies to the State Environmental Code Title 5 should not alter the poor quality of the groundwater in the area. Sincerely yours, Susan G. Rask, R.S. Chairman Board of Health Town of Barnstable SGR/bcs merle AltreRT f• r pRyy/�tL r=-,x vCj 6tk. se G'ITocKAO ht_ c b r.c / IA7.1 N, RLa emains natua-1 Centerline of t/w t3s 478is property line �'�x�•oas defined byDown. Cape Eng'r/� fRarateo NullbrNC, 4s:a f � il0000 s�= ;aV, o ? Lows uses tit 4 /• 204 1l �v/�' JN�i'clsc. AsnN�L .Sua,=Ace \\�� goo Sign ' _ 4 rode 1 �w_*� -� o >1 M & M Landscape 4 � Q\ r ^ & Tree Co. f �A9' �O Cer't. Arborist lot Y._.._....... � , / S'Na FrN t 48.E r � ¢.� o:ter '(508) -428-5030 C.B. fnd• aumpster iI•P. ` w/a'SrvNs '�o" 3 jx5 ' Free standir g Septic design ..\�� ,�a� wtu No. employees 10 rP► _: Dc�r t @: 15, gpd 150 Req. gpd rP ; ¢ 4, offices- 22x22m193.6 I .P. BM�'� 4 . <,r�> _ @-`75y.t000= 1.50- Req..: gpd r - — 5n _n suN�ti, --- -30• � r Bot.15 'x20=360 sf -` �SLallo slcN I.P. fnd 360 � x' .0.74 = 266.4 gpd r Sides156,x0 .74 = 115..E gpd ► 6 Soo I W/3'S*olvc Total 381::8 gpd Rosary Lane Var. width a1 -49's `'4F v _._ :�. 49 f Pa.sAr C B. • c # 1�z,01 -e Sc�ac� �. brkn. -� ISr Use 8 High Capacity; units ;�_. ._ 0 3 we� with ;3 ' of.. stone. .on;: ides i . !�•tv '9 v`9 ,,,: �'apaau C oos� ' in _middle. as: shown .. In viocu ta.,w. vaa and" 3 , - ; •: .,•..,�. ,r. 4; G4,uv1_•(; o;f.: i filtrators-. t r 1. - b/l (.�V7F.L 4'�'�, f o ,�:o�• tib� �i • 14w� Mlnj..V/iJ } Map 345 parcel 18 Zone. B ; Parking 15 spaces Owner: 508-428-5030 M: &: MLandscape & Tree Co. Site Plan of Land in Hyannis, MA og, P.O. Box 721 For M & M Landsca e& Tree' Co. West Barnstable 02668 Being a lot as shown on plan recorded id , t100 wat. sodium lights in book 19 page 65. P 0d�, N r Inside sprinkler system _ ' Elevations are on assumed datum. Building 2-8.66% :Parking .4.1,3'.4 Natual .30•-00A -------------------------------- - Ge IXed J r - --` Date: Agent; Barnstable board of Health Shrubs: in islands II Scale 1"=30 ' Date 11-7-95 ' .All Cape Engineering Rr_v. R-1.9S �' 3 49 Harbor Road rev12-18-95 i Hyannis, MA 02601 Rev.12-28-95 1 SECTION CAsr Ieeouf` 1 O U. �O t70 dp • Test pit P-8594 [ Made 10-26-95 l Wit. Ed Barry �NOF vw�,ds r.' (.' No water encountered _ PCr! Perc,'less 2 min 1" TP. 1 TP 2 cr�u '^ • 1J0.�tf7 p e o yP 4. oV�oc 0 0 brr� Cif t P� �G •o G v� T & S T & 5 ootrsv •Ft'" 4e..7 4-4.4 } medium edium 440 Al sand } sand + =ti �• * r`� #�x } /g'rav 1 /grav 1 a Fi. " MILN'E ,> Yy147 O y i No. 32a!wJ .�, j n' 17.7 1�,4-