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HomeMy WebLinkAbout0107 SEABROOK ROAD - Health .° Ill 07 - 109 Seabrook Road Hyannis n . ., A 307 217 i o 4 L o ` :I NO. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppYitation for.Vsposai *pste DnstrULtion i3Prmit Application for a Permit to Cpstruta( ) Repair( ) Upgrade( ) Abandon(X ❑Complete System ❑Individual Components Location Address or Lot N .(off w �b Owner's Name,Address,and Tel.No. 9 t4yv06 A1.IC%GL.0 VEF .10 Assessor's Map/Parcel va O OI Installer's Name,Address,and Tel.No.508 q77- 77 Design's Name,Address,and Tel.No. ,AA�-0� � �eQKts t X,- A Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this B and of Healt S' ed h Date Cl - ig -RDI Application Approved by A, Date Application Disapproved by Date for the following reasons Permit No. Date Issued �O r ' No. O I I - Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS k 21ppYication for Disposal`*pste oustructiou 3permit w . ` Application for a Permit to Cgosiruct( ) Repair( ) Upgrade( ) Abandon()q ❑Complete System ❑Individual Components Location Address or Lot No.(O7 Owner's Name,Address,and Tel.No. 1vq sr 2 �vK ANGcF(_0 VEuo Assessor's Map/Parcel 3 a Installer's Name,Address,and Tel.No.5Og-q77-9977 Designer's Name,Address,and Tel.No. l' Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) ' Other Fixtures J ' Design Flow(min.required) gpd Design flow provided' gpd .w.. ! Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs orAlterations(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 the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this B and of Healt ed J `Date 9 Application Approved by v M/ Date Application Disapproved by Date for the following reasons Permit No. a Q �I ' 1 Date Issued O ' ff ------------------ ----. ---------- - - - - _ - - - - -_ ._-, __ .._ . . __ ----- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned(X)by C3D(P&.-_)tP 6 450 eap I 3 LLB at /61 -109 S 8R %1_ ;kb NVAN1UIS has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.)0 `t dated Installer 0,A O&W IDC 6&?jV ®/ 15 E3 �� Designer �Q #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system will fin ctio as designed. - Date c'- t l Inspector ' r NO. (�' b Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon ) System located at l 0 l I o! s EA a6¢.00K R©dh t4YAKWIS and as described in the above Application for.Disposal System Construction Permit. The applicant recognized his/her.duty to comply with Title 5 and the following local provisions or special conditions. n i Provided:Constructio mus be completed within three years of the date of this pe t. Date ( ` Approved by V� AsBuilt Page 1 of 1 oTOWN //OF BARNSTABLE + LOCATION ���'��/ ��ib/oz� Kid' SEWAGE# 016 VILLAGE1/,ct CIr1/:s ASSESSOR'S MAP&LOT��— � J INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /SDD e,e1V;Y,a LEACHING FAcu rrY:(type/) �_�/� �i cl� (size) G X a 3 t NO.OF BEDROOMS `I BUILDER OR OWNER i a PERMITDATE:` �TIy}S COMPLIANCE DATE:-.. 07110I r Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility _lit"-f Pi4Y1 Feet r Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) N l A Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facili ) e r PlAn Feet Furnished by - tf4 rt1 C U G /�larr� B x ov+aoor.S*fe �A ' tsoo S'f' IO ' O j Aa 4�- 8a A = a5 � 09 , • 33 _•apt ' � 3 �3X�la p http:Hissgl2/intranet/propdata/prebuilt.aspx?mappar=307217&seq=1 9/19/2014 =!'2� No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for Migpogal *pgtem Congtruction Permit Application for a Permit to Construct( )Repair(v Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No./Q? t IO 9 PQ b O ner's N e,Addres d �1.No. ' yn 7�e p U-2 o Assessor's Map/Parcel 3 G? — c)/7 / 90y- 4/60 - 9a SS Installer's Name,AddcA,&4&i( ANCiO Designer's Name,Address and Tel.No. 350 Main Street W. Yarmoutt, MA 02673 Type of Building: L� Dwelling No.of Bedrooms / Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures 4 / Design Flow t/L7() gallons per day. Calculated daily flow �7 gallons. Plan Date X. 5-'3 Number of sheets / Revision Date N/A Title �� �1 h Size of Septic Tank /,f00 Type of S.A.S. Description of Soil P-e r P1411 Nature of Repairs or Alterations(Answer when applicable) l t!- �A17 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 th Enviro ental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Bo d f H lth-. Signed Date / Application Approved by Date Application Disapproved for the following reaso gs Permit No. Date Issued `. a" ..Tt+n F�;`. ...; �f r _".'� i 1 T e_r ..r` !_,....+� �. e r._;y y/'+z.7'+M i..-.,+. d wN��-•..:ti: .. . . .-.. f .,.. "No 4 a Fee TH�CqMMONWEALTH OF MASSACHUSETTS Entered in computer:% AV 'PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for Mo.pont 6p5tem Conotruction Permit Application for a Permit to Construct Repair(L-rupgrade Abandon El Complete System El Individual Components Location Address or Lot No./07 t I 9 ;f(_-_0bt0o0tZ 0 N Address d Tel.No. Owner's� Assessor's Map/Parcel 7 73 ine c)? — J 7 90q - '-'160 - 9 )5-�- Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers Cafeteria Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date /-),5_-3 Number of sheets Revision Date Title A, Size of Septic Tank -------jype of S.A.S. Description of Soil r Nature of Repairs or Alterations(Answer when applicable)—Pe `Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system i 4 n accordance with the provisions of Title 5 of thin al Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Boar f Signed r) Nj i Date- //P//` Application Approved by l. v o Date Application Disapproved for the following reaso&s Permit No. Date Issued U THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that th On-site Sewage Disposal System Constructed Repaired Lr6pgraded Abandonedby xi oc C) at has bee R constructed in accordance with the provisions pf TitlLC+,r, -and the for Disposal System Construction Permit No. dated Installer e-C) Designer Alvql C, The issuance of this permit shall not b cons rued as a guarantee that the sy tem u tr tioa lest ed. Date 005 —Inspector I,,-- -————— —————No ———— ———————-- ———— 1(2e Fee vU THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Miqw6al *p9tem Xn9truction Permit Permission is hereby granted to Construct Re (!! ) A I--pair i ��pgrade -andon System located atP% ro 0 t< 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 ust 'e completed within three years of the date,of this Date: V5 Approved by Town of Barnstable �ptNE Tp� ti Regulatory Services Thomas F. Geiler,Directu.• BMWSTAB9 Mass. Public Health Division 03q �0 Iclean, Director 200 Main Street,Hyannis,MA 02601 r Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: b O - Deesigner a�J e A-b _L�UA Installer:" - � -A& B -CANCO- S50 Mahe Street Address: Q , ,25 Address: W. Yarmouth, MA 02673 On /-?f r/-�.Clo was issued a permit to install a (date) (installer) n septic system at /0?ZO c}ea 6 ryz) ( based on a design drawn by (address) ; :.� • i�<, fZ & dated 2 6 / (designer) 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." �Q��H oFMASs9 ti RO AL0AlAiES oy CADUAG -' - (Installer's Signatu�re) #1U60�4 SgNIT01 (Designer's gnature) (Affix Des',ne, T ' PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE : OF COMPLIANCE WILL NOT .BE ISSUED UNTIL BOTH THIS FORM AND AS BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Desiper Certification Form i TOWN OF BARNSTABLE LOCATION AIV'/6)rQ J�LJ/" SEWAGE # r�GY�.S' 0/8 VIi,LAGE' &f/A.0n S ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (ty/pe/) r;d o (size) G X a NO.OF BEDROOMS �1 BUILDER,OR OWNER I COMPLIANCE DATE: PERMIT DATE: �—� Separation Distance Between the:, Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility he F P140 Feet Private Water Supply Well and Leaching Facility (If any wells exist A) 1A Feet 'on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist . within 300 feet of leaching facility) �� f �A�1 Feet Furbished by 64CC�. -Ji 107 l9 4MI 1® Oo-140ar 5*#e LA B (Soo 5"r Aa O a E:: A3 05 a x 3 1 i TOWN OF BARNSTABLE Date: TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: F_ . lJ. �_ PAI07/106 BUSINESS LOCATION: 07 S@,a /5,e00K RD Muamlij 0401 INVENTORY MAILING ADDRESS: !07 SW,6&ok R D NSI ,1114t 02601 TOTAL AMOUNT: TELEPHONE NUMBER: 5-D+ 8r7/// CONTACT PERSON: Drilt,n& yr jrl'0 EMERGENCY CONTACT TELEPHONE NUMBER: 5-09 6 Ar?l11?l11 MSDS ON SITE? TYPE OF BUSINESS: pa 1 n�I INFORMATION/RECOMMENDATIO S: 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 material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The board of health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED 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, G L 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 Si ' Staff's Initials � TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION I � � 1 Date J Time: In Out r Owner Tenant Address_ q Address l Compliance Remarks or Regulation# Yes O Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply 5. Hot Water Facilities Ir 6. Heating Facilities 1 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of_Facilities - _ - 10. Curtailment of Service 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17.Temporary Housing 18. Driveway Width 12-0 (� 19. Number of Tenants Observed PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms Number of Vehicles Allowed (max) Number of Persons Allowed (max) _ Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here FORM30 C&w HOBBS&WARREN TM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE TH � CITY/TOW < DEPARTMENT JJnn f - ADDRESS �GIN SV 9 y`ee " TELEPHONE lqc� Al Address 1 0� Occupant z_ ��""� y(_ I r� / I) Floor Apartment No. No. of Occupants No.of Habitable Rooms No.Sleeping Rooms �-- No.dwelling or rooming units No.Stories i Name and address of owner� IN Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B, ❑ F ❑ M Doors,Windows: rJ Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : { STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y .❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room ' Bedroom 1 Bedroom 2 Bedroom 3 ' Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR. (See Over) "THIS INSPECTION REPO IGNED AND CERTIFIED UNDER THE PAINS AND rf PENALTIES OF PERJU � INSPECTOR TITLE A.M. DATE 00 TIME P.M. THE NEXT SCHEDULED REINSPECTION uJ P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions,when found to exist in residential premises,shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises.This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation,any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficien:in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A),410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevent on and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heatng and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or fa lure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.533(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. FORM30 C&w HOBBSB WARREN TM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH i� CITY/TOWN DEPARTMENT �!•�\ ADDRESS Syey`e i """"' � TELEPHONE Address 0� �'�'�'�'' Occupant .Floor Apartment No. No. of Occupants.. No..-of.Habitable Rooms _No.Sleeping Rooms i " LL No. dwelling or rooming units No.Stories i -`Name and address of owner � L1 e` J Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish r r Containers:.. Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: A (` Dual Egress:and Obst'n.: „� ��;C) El [IF El M Doors,Windows: r .07 Roof Gutters, Drains: Walls: e Foundation: -- E Chimney: I f BASEMENT Gen.Sanitation: Dampness: Stairs: Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: f r Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central Q1f1.❑ N -:E 'ui :Re air_._r° •. TYPE: Stacks, Flues,Vents: PLUMBING: Su I Line: O MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT t Ventil. Lava. Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen ;- Bathroom Pantry Den Living Room Bedroom 1 M _ + Bedroom 2 't Bedroom 3 Bedroom 4 ' _ N Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: t Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats,Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IS-SIGNED AND CERTIFIED UNDER THE PAINS AND r PENALTIES OF PERJURY.' INSPECTOR TITLE %� �^�✓l�- ! A.M. DATE _ TIME !./ P.M. A.M. i THE NEXT SCHEDULED REINSPECTION � P.M. ' 's. , 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions,when found to exist in residential premises,shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises.This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the persoi tD whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the c•eation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 Y P CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which re-nain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition cr conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.533(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so crdered by the Board of Health. � , FORM30 ���'�' HOBBSRWARREN'" THE COMMONWEALTH OF MASSACHUSETTS BOARD OF T CITY/ OWN W ` DEPARTME T ` O-2-6 Q ADDRESS I G,,M SVBy`0w TELEPHONE, Q Address _ Occupant_!i� Floor Apartment No. No. of Occupants_ No. of Habitable Rooms_—No.Sleeping Rooms- No. dwelling or rooming units No.Stori Name and address of owner Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: i Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Su ply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom ` Pantry Den Living Room Bedroom 1 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: S s, Flues,Vents afeties: Kitchen Facilities i ve Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REP IS SIGNED AND CERTIFIED UNDER IHE PAINS AND PENALTIES F P �� c INSPECTORS TITLE DATE -7 TIME-1IVA--- P A.M. THE NEXT SCHEDULED REINSPECTION P.M. i 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions,when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness.for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold,to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electric`ty or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash,which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the -elease of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating,gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. I , Yyy G s N t 3 V O d 1 �t 1 °� cA F0RM30 C&W HOBBS&WARREN rn THE COMMONWEALTH OF MASSACHUSETTS F BOARD O H H CITY T WN W a ^ _ /► Y DEPARTMENT 0901 'o ADDRESS GSM SV6y`e� 1 , TELEPH E Address IL I a "-`�� \ _ Occu an p Floor Apartment No.of Occupants No.of Habitable Rooms No.Sleeping Rooms_ No.dwelling or rooming units No. ories Name and address f ow i- 1 ► ' ' Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: 44 BASEMENT Gen.Sanitation: Dampness: Stairs: Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ` ❑ Y ❑ N E ui . Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 . Hot Water.Facil. Sup.Ten.,Gas,Oil, Elect.: S s, Flues,Ve s feties: Kitchen Facilities in ove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats,-Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REP T SIGNED AND CERTIFIED UNDERjIJE PAINS AND PENALTIES OF PER " INSPECTOR TITLE_i;t� DATE �3 TIME ! v 07A.M. THE NEXT SCHEDULED REINSPECTION P.M. Y.'. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions,when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises.This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 41C.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410,254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash,which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns,shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin ano shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting,or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.1200 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. ' Town of Barnstable P �pf 1HE Tpk do Department of Regulatory Services BAMSPABLB, Public Health Division Date 9 MA89. Yb 039. �m� 200 Main Street,Hyannis MA 02601 plfD►M�a Date Scheduled JO _ 0a3 c Time �04^ Fee Pd. ICO r Soil Suitability Assessment for Sewage Disposal Performed By: 'RD tJ A I J - CA J N 14 L Witnessed By: _. .._.. ___ _ /r>IrocTIo & GENERAL IFORMATION Location Address � 7/, Yoa Owner's Na me /I [r ( 1� Address Assessors Map/Parcel: J?v�r 2 Engineers Name J NEW CONSTRUCTION REPAIR V Telephone# 5�g-77.5 700 Land Use /GCS/ �,IXi!� Slopes(%) a O Surface Stones /y0 Distances from: Open Water Body Possible Wet Area Drinking Water Well /V ft r �7 Drainage Way ft .Property Line 1/ / ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) &0 Jeq i No 167 f N13' 32; �y �rzo Parent material(geologic) ANMNSiAbIP Plfi-L� Z)f D'VB Depth to Bedrock Depth to Groundwater: Standing Water in Hole: C> I Weeping from Pit Face Estimated Seasonal High Groundwater DITERIVINA 't�N FOR SEASpNtAL'HIGI3 WAT/ER TABLE Method Used O l!Z e4vr �A�P_'PO it__.C41 ct�1 A I�li1��e �(.�f��') Depth Observed standing m Olt.hole: A-711 in. Depth to soil mo les: m. Depth to weeping from side of obs.hole: in. Groundwater Adjustment 3,3 ft. index Well#MA Reading Date:�& Index Well level�— Adj.factor 3,3 Adj.Groundwater Level 8 pi (�J 1- LG vr,1 Z r l��dve g " �J h— PERCOLAUON TEST Bate %0 2 by�i►ne 1�'�}✓�� Observation Hole# f �� Time at 9" Depth of Perc ILL /r Time at 6" Start Pre-soak Time @ /�0 Time(9"-6") End Pre-soak I-!2 o 6twv1 j0 p� Rate MinAnch Z Site Suitability Assessment: Site Passed Site Failed: Additional�Testing Needed(Y/N) � t Original: Public Health Division Observation Hole Data To Be Completed on Back----------- Q:HEALTH/SEPTIC/PERCFORM EOGODEP OBSERV Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Graven 36 ._ 3? 7 iq S'• % h0 ny St,"X0 ft CJ 4n<'_ 6c„ 8 fez. a�1�rv�� 8 7/' DEEP, OBSRVAT'ION HOLE LOO Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravely . DEEP OBSRVz�TION.HOL I�OG of Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency %Graven DEEP OBSETZVATIQN MOLE LOG T3ole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) Flood Insurance Rate Map: Above 500 year flood boundary No Yes Within 500 year boundary No Yes l ", 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? E ES If not,what is the depth of naturally occurring pervious material? Certification I certify that on I o J qq3 (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 require ,expertise and e . erience described in 310 CMR 15.017. Signature a L Date / s 3 Q:HEALTH/SEPTIC/PERCFORM RONALD J. CADILLAC, PLS, RS Professional Land.Surveyor Registered Sanitarian P.O."Box 258, West Yarmouth, MA 02673 (508)-775-9700 HIGH GROUND-WATER CALCULATION SHEET Locus y1 Qq Date of observed water be l , 27 2-003 Depth water observed below ground 67 " Well Zone Index well D j�RA ding 4 Month of Reading 0 c T U.S.G.S.(Frimpter) Adjustment for maximum groundwater 3=3 Well used below(usually same) M A 5 J 2q Date of Observation D CT 8 of 10 year high reading (from data below), Zone well is in_fL_. Years highest reading & month (cross'out two high readings in 10 yr span) . (record next highest-reading above) 11 i�.� py-kl (data represent distance-below ground) 3 16445 6,65 J L)A 7 I�Qq 02 K) 4 I0 l6 6 ,57 82006 7 6 Z. 01 Af 4�2 I 1 92001 2 ,�r� 10 ZodZ Current reading �1 O minus 8/10 yr. high= adjustment for Zone . Well Zone Adjustment: (Frimpter Adj. Zone xL_L=(8/10 yr. Adj. Zone x) (For locus.if needed) (Frimpter Adj. Zone y) = (8/10 yr. Adj. Zone y) High Ground-Water Elevation definition from 310CMR 15.002 "(a) Inland - The elevation above which in eight out of ten consecutive years the ground water table does not rise." 'Z 2b3 499 030 US Postal Service - Receipt for Certified Mail No Insurance Coverage Provided. Do not use for Internatio I Mail See reverse Sent Sjre &Nu e,&ZIP ostage Certified Fee, Special Delivery Fee Restricted Delivery Fee Return Receipt Showing to Whom&Date Delivered a Return Receipt Showing to Whom, Q Date,&Addressee's Address 0 TOTAL Postage&Fees Is Cq Postmark or Date ��o / tL c a Stick postage stamps to article to cover First-Class postage,certified mail fee,and charges for any selected optional services(See front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service a window or hand it to your rural carrier(no extra charge). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the m return address of the article,date,detach,and retain the receipt,and mail the article. 3. It you want a return receipt,write the certified mail number and your name and address rn on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article Q RETURN RECEIPT REQUESTED adjacent to the number. Q 4. If you want delivery restricted to the addressee, or to an authorized agent of the C addressee,endorse RESTRICTED DELIVERY on the front of the article. r') 5. Enter fees for the services requested in the appropriate spaces on the front of this E receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. o 6. Save this receipt and present it if you make an inquiry. 102595-97-B-0145 a �oFtNErti 'Town of Barnstable ins Department of Health, Safety, and Environmental Services RAM'""� 9� 1639. Public Health Division leg' �F01A0�� P.O. Box 534, Hyannis MA 02601 Office: 508-8624644 Thomas A.McKean,Rs,CHO FAX: 508-790-6304 Director of Public Health April 27, 1999 Mr. Angelo Delio 8 Weatherbell Drive Norwalk, CT 06854 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00 STATE SANITARY CODE II. MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE BOARD OF HEALTH NUISANCE CONTROL REGULATION NUMBER ONE The property owned by you located at 107 Seabrook Road, Hyannis was inspected on April 27, 1998, by Jerry Dunning, Health Inspector for the Town of Barnstable, because of a complaint. The following violations of the Nuisance Control Regulation Number One Regulation and the Sanitary Code II were observed: 410.600: Garbage stored in plastic bag. Loose garbage and rubbish absorbed on the ground behind the dwelling. You are directed to correct violation within forty-eight (48) hours of receipt of this notice by storing all refuse in rodent-proof containers with tight fitting lids. You may request a hearing if written petition requesting same is received by the Board of Health within seven(7) days after the date order is received. However, this violation must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. You are also subject to non criminal citations of$40.00 for the first violation and $15.00 for each additional violation. Tickets will be issued daily until the violations are corrected. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health delio/wp/q/Is NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE II, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE BOARD OF HEALTH NUISANCE CONTROL REGULATION NUMBER ONE The property owned by you located at 107 L l 1, Dh� was inspected on 1997, by Health Inspector for the Town of Barnstab e, be use of a c`o*mp'l aint. The following violations of the Nuisance Control Regulation Number One Regulation and the Sanitary Code II were observed: Li You are directed to correct violations within t f $ of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Health within seven(7) days after the date order is received. However, this violation must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. You ,are also subject to non criminal citations of$40.00 for the first violation and $15.00 for each additional violation. Tickets will be issued daily until the violations are corrected. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health Health Complaints 27-Apr-99 Time: Date: 4/27/99 Complaint Number: 1830 Referred To: JEROME DUNNING Taken By: BARBARA SULLIVAN Complaint Type: NUISANCE CONTROL REG. 1 RUBBISH Article X Detail: Business Name: Number: 161/164 Street: Seabrook Rd. Village: HYANNIS Assessors Map_Parcel: Complaint Description: Garbage bags on property. Actions Taken/Results: Investigation Date: Investigation Time: 1 PAR ] Real Estate System - General Property Inquiry] Help [ ] Parcel Id: 307 217- - Account No: 21907 Parent: Location: 107 SEABROOK RD Neighborhood: 61AC Fire Dist: HY Devel Lot: 1 Lot Size: . 18 Acres Current Own: DELIO, ANGELO V State Class: 104 DELIO, MARY LOUISE No. Bldgs: 1 Area: 2400 8 WEATHERBELL DR Year Added: NORWALK CT 6854 Deed Date: 100185 Reference: 4782/131 January 1st: DELIO, ANGELO V Deed MMDD: 1085 Deed Ref: 4782/131 Comments: Values: Land: 20700 Buildings: 99400 Extra Features: Road System: 107 Index: 1453 (SEABROOK ROAD ) Frntg: 89 Index: 791 (JANICE LANE ) Frntg: 69 Control Info: Last Auto Upd: 050695 Status: C Last TACS Update: 011387 Land Reviewed By: Date: 0000 Bldgs Reviewed By: ML Date: 0488 Tax Title: Account: Taken: Account Status: Hold Status: [ ] Press XMT for more data Cancel Next screen [QAR ] Action [ ] Owners Name [ ] Road Index [ ] Road Name [ ] Parcel Number [307] [224] [ ] [ ] [ ] J r !' Z 203 ` 499 �067 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for Intemationa Mail See reverAel Sent t Street&NumbVr Post Office,State,&ZIP Code Postage $ Certified Fee Special Delivery Fee Restricted Delivery fee LO Return Receipt Showing to Whom&Date Delivered o Return Receipt Shoving to Whom, Q Date,&Addressee's Address 0 TOTAL Postage&Fees $ CO Postmark or Date % p o_ Stick postage stamps to article to cover First-Class postage,certified mall fee,and charges for any selected optional services(See front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service m window or hand it to your rural carrier(no extra charge). m 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the QQi return address of the article,date,detach,and retain the receipt,and mail the article. I' u9 i 3. If you want a return receipt,write the certified mail number and your name and address rn on a return receipt card,Forth 3811,and attach it to the front of the article by means of the p gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article a i RETURN RECEIPT REQUESTED adjacent to the number. 0 4. If you want delivery restricted to the addressee, or to an authorized agent of the C addressee,endorse RESTRICTED DELIVERY on the front of the article. c00 rh 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. LL f# 6. Save this receipt and present it if you make an inquiry. 102595-97-B-0145 rn o�IMNEti Town of Barnstable Department of Health, Safety, and Environmental Services » EA MSTABM 9� '� �0� Public Health Division P.O. Box 534, Hyannis MA 02601 Office: 508-8624644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health September 30, 1998 Angelo V. Delio 8 Weatherbell Drive Norwalk, CT 06854 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00 STATE SANITARY CODE II, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE, ARTICLE 51 The property owned by you located at 107 Seabrook Road, Hyannis, was inspected on September 29, 1998 by Edward Barry, Health Inspector for the Town of Barnstable, because of a complaint. The following violations of 105 CMR 410.00, State Sanitary Code II, Minimum Standards of Fitness for Human Habitation were observed: 410.501: A glass pane was missing from the front storm door. 410.501: The air space between front door and casing exceeds 1/16". 410.551: Window screens contained holes or are detached. 410.552: No screen provided on rear sliding door. 410.351: Carpet in living room and kitchen were both badly stained and torn. 410.482: No 20 square inch sign with owners name, address and telephone number provided. You are directed to correct the above listed violations within ten (10) days of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, these violations must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH s . cKean Director of Public Health cc: Maria Luz delio/wp/q/order Al. t The Town yof Barnstable J e • - Health Department 1 """"' 367 Main Street, Hyannis, MA 02601 Office 508-790-6265 g �,� t ,2�Z �' Thomas A. McKean FAX 50b-j7PLP344,a �� j �� L� r3 6�v'� Director of Public Health NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE II, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION The property owned b you located at /D'/3'ZF176''m`-&'g'Wa�s����'1 inspected one , • 199 by, Health Inspector for the Town of Barnstable, because of a complaint. The following violations of 105 CMR 410.00, State Sanitary Code II, Minimum Standards of Fitness for Human Habitation were observed: ,�/fit ; �..�� : /,�/� ����.�� �•Y/ �.Q�� v���t,�,��J�c�-�-` You are cted to rre these yx ation ithi we� four 4) hour rec 'pt of t notic . You are silam directed to correct Aj;la-rz, e Z,141� within - 6J days/ of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, these violations must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of. not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health �` � �r � ' � �l 1 . � � � � � � � � � � � � � � � � � � Cry ��� � � � � � � � � � C � � � � � �, � � � ^ � 2 �T � � � � . � � � � � a , . � � � �. � � � � � � . �� - � � � � � � �� � � � � � � P >� :�..�-f--,..i '",rnX',...r- 1.,•.,,..q, .s., .. ,.,....• %/1.A'`C/`- ,'...q;T�,�jd?',pF"" .`" .l' .-.."yr�,/'Y-°*"`,,,, ;. ,:.,%- ,1 �+`��,F"�t FORM30` C&w HOBBS&WARRENrTM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CITY/TOWN �. DEPARTMENT ` AD�SS TELEPHONE f Address� ` '�''. t �+ Occupant /"1"' a�+ L/ Floor Apartment No. No.of Occupants No.of Habitable Rooms__No.Sleeping Rooms No. dwelling or rooming units ;d No.Stories Name and address of owner-A Al I-Okf l f �.✓. ' � p , '" i Remarks Reg. Vio. YARD Out Bld s.: Fences: .,Garbage and Rubbish Containers: Drainage ;v, Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: ll'Q.rIntfilAz ^`"`01l ✓'","' , k ¢ �" s� '7" Roof Walls: l7,rQ .Y/,dv sp . Foundation: SzZA " "'t' i A J v Chimne 54, /d r s D &ejzee24z ^`54 IA,- , BASEMENT Gen.Sanitation: " Dampness: Stairs: Li htin ` STRUCTURE INT. Hall,Stairway: ; Obst'n. ", Floor, Hall Li htin f`rX , 4. 5. /$"I N/ A� Hall WinclowsA�,,v/,pf HEATING Chimneys: Central ❑ Y ❑ N E ui . Repair TYPE: Stacks, Flues,Vents:' PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: . H.W.Tanks Safety and Vent(s) ELECTRICAL IF 6 ?"!Cy ... 10V 4 ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: " DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks !' Kitchen Bathroom Pant Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: ,- Stacks, Flues,Vents,Safeties:"'` Kitchen Facilities Sink Stove 4 "''M Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted via i1"^S# X1 111L( Locks-en-Boors: .! s�► /` ` ONE OR MORE.,OF THE`VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY." r" INSPECTO TITLEOF \ DATE '" _ ` TIME .M tiolk A.M. THE NEXT SCHEDULED REINSPECTION P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health,or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be founc to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the oostruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or-ailure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else tc fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting,or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so o,dered by the Board of Health. UNITED STATES POSTAL SERVICE First-Class Mail oS MT q Postage&Fees Paid USPS Z r Qci °o Permit No.G-10 o Print \you n me,`1addreas, and ZIP Code in this box 0 S USpS Public Health Division Town of Barnstable PO Box 534 Hyannis,Massachusetts 02601 Fax(508)775-3344 Phone(508)790-6265 I ai SENDER: I O ■Complete items 1 and/or 2 for additional services. I also wish to receive the ■Complete items 3,4a,and 4b. following services(for an- nPrint your name and address on the reverse of this form so that we can return this extra fee): card ■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address 2 ■permit. Receipt Re uested'on the mail piece below the article number. d d p a p 2. ❑ Restricted Delivery rn ■The Return Receipt will show to whom the article was delivered and the date a C delivered. Consult postmaster for fee. c 0 3.Article Addressed to: 4a.Article Number d E 4b.Service Type «' 0 ❑ Registered if CertifiedIE rn ' ❑ Express Mail ❑ Insured all w o ❑ Retum Receipt for Merchandise ❑ COD 0 7.Date o Deli ery Z > N cc5.Received By:(Print Name) 8.Ad es e's Address(Only if requested 4 W and fee is paid) t g 6.Signs r : ddress or A t) i X - , PS Form 381 1V, December 1994` 102595-97-e-0179 Domestic Return Receipt TMET The Town of Barnstable ! • Department of Health Safetyand Environmental Services i DA"STAn i P f oo A9. Public Health Division 367 Main Street,Hyannis,MA 02601 Office 508-790-6265 Thomas A.McKean FAX 508-775-3344 Director of Public Health March 6, 1997 Ronei Claudio Goncalves 107 Seabrook Road Hyannis, MA 02601 Dear Mr. Goncalves: You are granted conditional permission to wash and wax vehicles at customer's residential locations. Permission is granted with the following conditions: (1) No person shall wash any engines and allow the wastewater to discharge onto the ground. (2) No person shall wash the under-carriage of any vehicles and allow the wastewater to discharge onto the ground. (3) No commercial vehicles shall be washed. (4) In order to maintain low background noise levels during early hours of the morning,the generator shall not be turned-on during any morning before 8:00 A.M. This permission is granted because you stated that you will only wash the exterior of vehicles (top and sides only) at the homes of customers. The Board members believe this would be no different than the customers washing their own cars at home. Currently there are no regulations which would prohibit this activity. Sincerely yours, =.S. Chairman Board of Health Town of Barnstable SGR/bcs ronei n� NO. TOWN OF BARNSTABLE DATE C�THE t0` OFFICE OF s HEALTH RECEIVED BY BOARD OF 39. 167 MAIN STREET 'fie �Y►� HYANNIS,MASS.02601 :,VARIAIQCI��RSOVEBT�FORN ALL VARIANCES MUST BE SUBMITTED FIFTEEN (151 DAYS PRIOR TO THE SCHEDULED BOARD OF HEALTH MEETING. , " OW � 7bPcA� ESTL. NO.( �c/ �O� NAME OF APPLICANT e -ADO ADDRESS OF APPLICANT Lo I jA,,h -D-A NAME OF OWNER OF PROPERTY SUBDIVISION NAME DATE APPROVED ASSESSORS MAP AND PARCEL NUMBER LOCATION OF REQUEST SIZE OF LOT SQ.FT WETLANDS WITHIN 200 FT.YES 0�� NO VARIANCE FROM REGULATION(List Regulation) c& az-11(t tz REASON FOR' VARI.ANCE(May .attach if more space is needed) r PLAN - FOUR COPIES OF PLAN MUST BE SUBMITTED CLEARLY OUTLINING VARIANCE REQUEST. VARIANCE APPROVED NOT APPROVED REASON FOR DISAPPROVAL BRIAN R. GRADYt R.S. t CRAIRIW SUSAN G.- RASRO, R.S. JOSEPH C. SNOW, M.D. BOARD OF HEALTH TOWN OF BARNSTABLE rt Ronei Gonsalves I. A. Express Wash B. Mobile car wash C. 7 am.to 5 pm. Mon-Sat D. 2 Employees 2. Materials Car wash solution Wax Tire dressing 3. See attached 4. Description of truck to be used 1989 4 x 4 Toyota truck High pressure washer 5 RPM 16 Sears standard buffer 3.5 Generator 5. Non applicable 6. Dumpster 7. Will use Health Department-Darren Meyer 8. Non applicable EXPRESS WASH 107 SEABROOK ROAD HYANNIS,MASS. 02601 508-775-0702 508-790-1757 RONEI AND ANDANUCIO GONCALVES 0 8. BOARD OF HEALTH REGULATION HANDLING & STORAGE OF TOXIC OR HAZARDOUS MATERIALS REGISTRATION FORM i Please provide the following on a separate sheet of paper. 1. Written description of business to include, a. name of business b. business operation c. hours of operation d. number of employees 2. List of all hazardous materials and quantities to be used or stored in the business operation. Hazardous materials include, Oils, Gasoline, Automobile Fluids, Paints, Glues, Chemicals, and other products that may be considered harmful to Public Health and the Environment. 3. M.S.D.S. (Material Safety Data Sheets) for each product used. 4. Floor plan: a. floor drains, number and location. b. chemical storage area, bermed area (150% capacity required) . 5. Town water or well. 6. Method of solid waste disposal: a. dumpster b. rag service 7. Emergency spill containment plan/procedure must include names and phone numbers of contact persons at appropriate State and Town departments such as, but not limited to: a. D.E.P. (formerly D.E.Q.E.) b. Health Department c. Fire Department d. Hazardous Waste Disposal Company e. manager/owner of business 8. Hazardous Waste Removal: a. licensed hazardous waste company - name; address. b. frequency (number of times per month, year that waste is removed). c. quantities generated/removed. The Health Department is registering all businesses that use or store toxic or hazardous materials under the Town of Yarmouth's Hazardous Waste Regulation, Handling and Storage of Toxic or Hazardous Materials. Your cooperation is appreciated. If there are any questions regarding this registration form, please call the Health Department at 398-2231 X241. Please mail your registration information to: Town of Yarmouth Health Department 1146 Route 28 South Yarmouth, MA 02664 TO ALL NEW BUSINESS OWNERS: Fill in below: NAME OF NEW BUSINESS: TYPE OF BUSINESS /A2,&/4 �� TO IS THIS A HOME OCCUP N? /9 ADDRESS OF BifSl /D7 SEBX-zPc K MAP/PARCEL NUMBE��d 7 �� If you are starting a new business there are quite a few things you need to do in order to be in compliance with all rules and retulations of the Town of Barnstable. Once you have been checked off on this sheet you may apply for a business certificate at the Town Clerk's office(Ist floor-Town Hall). 1. GO TO BUILDING INSPECTOR'S OFFICE(4TH FLOOR TOWN HALL) This individual is in compliance and has eeeen explained the procedures needed to start Building Insp is Signat �� 2. GO TO BOARD OF HEALTH (3RD FLOOR TOWN HALL) This individual has been informed of any permit requirements that pertain to this type of business. Health Inspector's Signature 3. GO TO CONSUMER AFFAIRS(LICENSING AUTHORITY)-(3RD FL SCHOOL ADMINISTRATION BUILDING This individual has been informed of any licensing requirements that will pertain to this type of business Licensing Authority Signature After being checked off by all of the above-r4member to return to the Town Clerk's office to actually obtain your business certificate. Ardex Laboratories Inc. MATERIAL SAFETY DATA SHEET (OSHA-20) 335 Camer Dr IN CASE OF LEAK, SPILL, FIRE, Bensalem, Pa. 19020 EXPOSURE, OR ACCIDENT, CALL (215) -639-8201 CHEMTREC: 1-800-424-9300. Fax 215-639-8222 FRMUCT NAME: LAST VERSION 05/22/90 SPSEDY BRIGHTENER #6224 CURRENT VERSION 02-01-96 CHEMICAL FAMILY: POLYDIMETHYLSILOXANE, PARAFFINIC HYDROCARBON BLEND DOT HAZARD CLASSIFICATION: COMBUSTIBLE LIQUID N.O.S. UN1991 SECTION 2_'�-• J si.. _: YJ _- '_ °..:-HAZARDOU$..INGR6D3EN1'3 -- _ .- CAS REG. NO. HAZARD RATING(HMIS) SCALE. 4=EXTREME POLYDIMETHYLSILOXANE (not regulated) 9016-00-6 TOXICITY 2' 3=HIGH ALIPHATIC HYDROCARBON 64742-88-7 FIRE 2 2=MODERATE EXPOSURE LIMITS: OSHA PEL 100ppm, ACGIH TWA REACTIVITY 0 1=SLIGHT 100ppm, NIOSH Limit 350mg/cum-8-hr. TWA; *LONG-TERM HEALTH EFFECT 0-INSIGNIFICANT 1800mg/cum as determined by a 15-minute sample OTHER COMPONENTS: FRAGRANCE, COLORANT PRODUCT APPFkRANCE: CLEAR BLUE, FREE-FLOWING LIQUID WITH A CHARACTERISTIC MILD FRUITY ODOR, SILKY AND SMOOTH TO THE TOUCH. OWLIVI'1 3�/1 L Ni'w:;Y.i 1Y•'�iMN4 i5f'� Y i,�,i YS:iiIYi4f5M1�.:�NC��i"IV'�� i fY:. ffJ LYi% fii J M ViiJ' wlltl Mi�Y ii i iJdli lii ii, ... .. .. INHALATION: THIS MATERIAL 'HAS A VERY LOW DEGREE OF TOXICITY AT AMBIENT TEMPERATURES ALTHOUGH, AT ELEVATED TEMPERATURES FUMES MAY FORM THAT CAN CAUSE IRRITATION OF THE NOSE 6 THROAT. SYMPTOMS OF LIGHTHEADEDNESS MIGHT ALSO OCCUR. NOTE: REPORTS HAVE INDICATED THAT REPEATED 6 PROLONGED INHALATION OF SOLVENT VAPORS HAVE ASSOCIATED PERMANENT NERVOUS SYSTEM DAMAGE--ALWAYS USE ADEQUATE VENTILATION KEEPING VAPOR CONCENTRATION BELOW TWA. INGESTION: WHILE THIS MATERIAL HAS A LOW DEGREE OF TOXICITY, INGESTION OF EXCESSIVE QUANTITIES MAY CAUSE: '� IRRITATION OF THE DIGESTIVE TRACT, SIGNS OF NERVOUS SYSTEM DEPRESSION (E.G., HEADACHE, DROWSINESS, DIZZINESS, LOSS (1 Y OF CONCENTRATION, AND FATIGUE.) y SKIN: ONE OR MORE OF THE COMPONENTS OF THIS MATERIAL MAY CAUSE MILD SKIN IRRITATION. PROLONGED OR REPEATED CONTACT MAY CAUSE REDNESS, BURNING AND DRYING AND CRACKING OF THE SKIN. EYES: ONE OR MORE COMPONENTS OF THIS MATERIAL IS AN EYE IRRITANT. DIRECT CONTACT WITH THE LIQUID OR EXPOSURE TO VAPORS OR MISTS MAY CAUSE STINGING, TEARING, REDNESS AND SWELLING. ACUTE TOXICITY DATA IS AVAILABLE UPON REQUEST READ THE ENTIRE MSDS FOR A MORE COMPLETE DESCRIPTION OF THE HAZARDS SECTION 4: _ ,,,, ... � i ,-:E�EA��WCY;.� �'�kS'r AIt� F�FQC�b�tEES'-,.. .. ,., ..,.... -- .• .. ..... ........ ,,, •..INHALATION: MOVE PERSON TO FRESH AIR AT ONCE. IF BREATHING HAS STOPPED, PERFORM ARTIFICIAL RESPIRATION. KEEP THE AFFECTED PERSON WARM AND AT REST. GET MEDICAL ATTENTION AS SOON AS POSSIBLE. INGESTION: IF THE PERSON IS CONSCIOUS, GIVE LARGE QUANTITIES OF WATER TO DILUTE. DO NOT ATTEMPT TO INDUCE VOMITING. GET MEDICAL ATTENTION IMMEDIATELY. SKIN: PROMPTLY WASH AFFECTED AREA WITH MILD SOAP AND WATER. REMOVE CLOTHING IF PRESENT. IF IRRITATION OR REDNESS PERSISTS GET MEDICAL ATTENTION. EYES: WASH EYES IMMEDIATELY WITH LARGE AMOUNTS OF WATER, LIFTING THE LOWER AND UPPER LIDS OCCASIONALLY. GET MEDICAL ATTENTION IMMEDIATELY. CONTACT LENSES SHOULD NOT BE WORN WHEN WORKING WITH THIS CHEMICAL. NOTE: THIS MATERIAL IS SLIPPERY. PROMPTLY REMOVE ALL SPILLAGE FROM FLOOR 6 WORK AREA VENTILATION: PROVIDE ADEQUATE THROUGHPUT OF FRESH AIR. 115 MATERIAL SAFETY DATA SHEET: SPEEDY BRIGHTENER 16224 P9 2 RESPIRATORY PROTECTION: LOCAL EXHAUST VENTILATION; GENERAL DILUTION VENTILATION; USE PERSONAL PROTECTION EQUIPMENT (VAPOR GAS MASK) WHERE EXPOSED TO ANY MIST OR VAPORS AT ELEVATED TEMPERATURES. PROTECTIVE GLOVES: WEAR IMPERMEABLE GLOVES (BUTYL OR HEAVY VINYL LATEX TYPE) EYE PROTECTION: USE DUST- AND SPLASH-PROOF SAFETY GOGGLES WHERE THERE IS ANY POSSIBILITY OF LIQUID, MIST, OR DUST CONTACTING THE EYES. PROTECTIVE CLOTHING: AREAS OF THE BODY THAT MAY CONTACT LIQUID OR MIST SHOULD BE SHIELDED WITH IMPERMEABLE RUBBER MATERIAL (APRON, BOOTS, ETC.) OTHER PROTECTIVE EQUIPMENT: IF POSSIBILITY EXISTS FOR SPLASHING WEAR FACEGUARD WITH SIDE-SHIELDS. USE RESPIRATOR WHEN WORKING IN A TOTALLY CLOSED SYSTEM. c°rrdlrr .................................r-; ..................PHYSi'CAT`;pFIO$E!i'1�TE.5r ;.. 7 -�--rs REACTIVITY: FLASH POINT: LOW RISK AT AMBIENT TEMPERATURE. 125 DEG. F. BOILING RANGE: 315-343 DEG. F. EVAPORATION RATE: CONDITIONS AFFECTING REACTIVITY: (n-BuAC-1) LESS THAN 0.1 (SOLVENT) HEAT $ SOLUBILITY IN WATER: 0.00 + SPECIFIC GRAVITY: INCOMPATIBLE MATERIALS: 0.775 (@20 DEG. C) AVOID CONTACT WITH STRONG ACIDS OR OXIDIZERS. PH: N/A VISCOSITY: HAZARDOUS DECOMPOSITION PRODUCTS: 10-11 cSt (@20 DEG. C) ,3 CARBON MONOXIDE AND/OR CARBON DIOXIDE. T.), HAZARDOUS POLYMERIZATION: VAPOR PRESSURE: WILL NOT OCCUR. (TORR) 4.5 (@20 DEG. C) POLYMERIZATION CONDITIONS TO AVOID: 9 VOLATILE NONE KNOWN. BY VOLUME 70% FREEZING POINT: AUTOIGNITION -50 DEG. F. TEMP: 619 DEG. F VAPOR DENSITY ^ LOWER-UPPER EXPLOSIVE LIMIT (%VOL) 0 9-9.0$ (air=1) 1.7 SfY TIf3N 7 -SPrLL'':�'IiFa4K".I+ROiCEbURES- x �---r' ---"-- -"--_ PRECAUTIONS IN CASE OF RELEASE OR SPILL: VENTILATE AREA. ABSORB INTO NON REACTIVE MEDIA SUCH AS DIATOMACEOUS'EARTH OR VERMICULITE; SWEEP INTO NON REACTIVE 'VESSEL (I.E., STEEL DRUM OR PAIL). IN CASE OF FIRE USE DRY-CHEMICAL, CARBON DIOXIDE, HALON, FOAM, OR WATER-SPRAY. ; EPA REPORTABLE QUANTITY: NONE WASTE DISPOSAL METHOD DISPOSE OF PRODUCT IN ACCORDANCE WITH LOCAL COUNTY, STATE, S FEDERAL REGULATIONS SECTION 8 ------------= -- �.' -7itANSP(37tPATiUN t_STORAGE t- ... r- ELECTROSTATIC ACCUMULATION HAZARD: GROUND ALL EQUIPMENT STORAGE TEMPERATURE: AMBIENT a TRANSPORT TEMPERATURE: AMBIENT + ;, SPECIAY FF2ECAb1`IONS OR'03?I�ft;'Zt�'1t3" _.:,« SECTION 9 - INSTRUCT ALL WORKERS ON HAZARDS AND PROTECTIVE MEASURES WITH THIS CHEMICAL. IF SPILL/RELEASE IN EXCESS OF EPA � REPORTABLE QUANTITY INTO THE ENVIRONMENT, IMMEDIATELY NOTIFY THE NATIONAL RESPONSE CENTER (PHONE A 800-424-8002). EGTZON ifl .. . •._-•'_� ,•:;iI1"ZAFU5;L�1;A.�t$I1i'2CATYON , � . U.S. DOT CLASSIFICATION: COMBUSTIBLE LIQUID N.O.S. UN1993 EPA HAZARDOUS SUBSTANCE: NO d THE INFORMATION CONTAINED HEREIN IS BELIEVED TO BE ACCURATE HOWEVER THE INFORMATION IS ALSO BASED ON INFORMATION SUPPLIED TO ARDEX FROM VENDORS ARDEX BELIEVES TO BE RELIABLE. THEREFORE ARDEX ASSUMES NO LI .i1ILITY FOR THE ACCURACY OR COMPLETENESS OF THE INFORMAT=ON CONTAINED HEREIN. ANY MATERIAL SUPPLIED BY ARDE:X IS THE SOLE RESPONSIBILITY OF THE USER. ALL MATERIALS W.Y PRESENT UNKNOWN HEALTH HAZARDS AND ARDEX CAN NOT GUAiANTEE THAT THE HAZARDS LISTED HEREIN ARE THE ONLY HAZARDS T:lAT EXIST. i 116 Ardex Laboratories Inc. MATERIAL SAFETY DATA SHEET (OSHA-20) 335 Camer Dr IN CASE OF LEAK, SPILL, FIRE, Bensalem, Pa. 19020 EXPOSURE, OR ACCIDENT, CALL (215) -639-8201 CHEMTREC: 1-800-424-9300. Fax 215 639-8222 SE�T�ON`1-= �..:.+,> __:,.. s.- ... ..«.._.._�-•--PRODUCT YNEC7RZ431T�ON- ... PRMUCT NAME: LAST VERSION 05/22/90 CAR WASH #5213 CURRENT VERSION 02-01-96 CHEMICAL FAMILY: AQUEOUS SOLUTION ANIONIC SURFACTANT DOT HAZARD CLASSIFICATION CLEANING COMPOUND, LIQUID, UN 1142 ..-...... 'sr+:HAZARDOUS - CAS REG NO. HAZARD RATING(HMIS) SCALE: 4-EXTREME SODIUM DODECYLBENZENE SULFONATE (TLV 2mq/m3 air) 25155-30-0 TOXICITY 2 3-HIGH SODIUM LAURYL ETHER SULFATE (TLV 2 mq/m3 air) 151-21-3 FIRE 0 2-MODERATE OTHER COMPONENTS: WATER REACTIVITY 0 1-SLIGHT 0=NONEXISTENT PRODUCT APPEARANCE: CLEAR, VISCOUS BLUE LIQUID WITH A FRUITY NON-DISAGREEABLE FRAGRANCE. 9ECTION:.3- ---- -= -` --fHAZARD:INFORMATION - -'- t INHALATION: FINE MIST PRODUCES RESPIRATORY IRRITATION. TLV 2mq/m3 air (calc'd as NaOH). THIS PRODUCT DOES NOT GENERATE TOXIC VAPORS OR FUMES. THE MISTED CONCENTRATE CAN PRODUCE RESPIRATORY IRRITATION; THE DILUTED WORKING- STRENGTH SOLUTION (1:64 OR LESS) IS HIGHLY LESS IRRITATING WHEN MISTED. INGESTION: THIS PRODUCT IS NOT PARTICULARLY TOXIC UNLESS THE CONCENTRATE IS INGESTED IN CONSIDERABLE AMOUNTS. IF INGESTED TREAT AS A POISON; KEEP THE PERSON WARM AND GIVE LARGE QUANTITIES OF WATER TO DILUTE TO INDUCE VOMITING. INGESTION OF LARGE QUANTITY OF CONCENTRATE CAN PRODUCE SHOCK. NEVER GIVE ANYTHING BY MOUTH TO AN UNCONSCIOUS PERSON. MINIMAL THREAT WHEN USING WORKING-STRENGTH SOLUTION (1:64 OR LESS.) SKIN: IRRITANT. PROLONGED EXPOSURE CAUSES PAIN. MAY CAUSE IRRITATION AND CRACKING OF THE SKIN AFTER REPEATED AND/OR PROLONGED CONTACT. MINIMAL THREAT WHEN USING DILUTED SOLUTION (1:64). EYES: IRRITANT. CAUSES CORNEAL EPITHELIAL DAMAGE {REVERSIBLE). MINIMAL THREAT WHEN USING WORKING-STRENGTH SOLUTION (1:64 OR LESS.) ACUTE TOXICITY DATA IS AVAILABLE UPON REQUEST READ'THE ENTIRE MSDS FUR A MORE COMPLETE DESCRIPTION OF THE HAZARDS 3F�TION°,4;-`--�-�...::.•. . - WFI�P1tLY d,f?3'FCST',A"XEI;;EA1RF9... .::.:... ... .. :... ....:...........�_- -.- . ..:.,:. ... r INHALATION: THIS CHEMICAL DOES NOT HAVE AN APPRECIABLE VAPOR TOXICITY AT AMBIENT TEMPERATURES, HOWEVER, AT ELEVATED TEMPERATURES NOXIOUS VAPORS MAY BE FORMED. FINE MIST OF CONCENTRATE CAN BE IRRITATING TO RESPIRATORY TRACT. MINIMAL THREAT WHEN USING DILUTED WORKING-STRENGTH SOLUTION (1:64 OR LESS.) i- INGESTION: IF THE PERSON IS CONSCIOUS, GIVE LARGE QUANTITIES OF WATER TO DILUTE. INDUCE VOMITING BY PLACING THE MIDDLE FINGER TO THE BACK OF THE THROAT. NEVER GIVE ANYTHING BY MOUTH TO AN UNCONSCIOUS PERSON. SKIN: PROMPTLY FLUSH AREA WITH WATER. REMOVE CLOTHING IF PRESENT. IF IRRITATION PERSISTS GET MEDICAL ATTENTION. EYES: WASH EYES IMMEDIATELY WITH LARGE AMOUNTS OF WATER, LIFTING THE LOWER AND UPPER LIDS OCCASIONALLY. GET MEDICAL ATTENTION IMMEDIATELY. CONTACT LENSES SHOULD NOT BE WORN WHEN WORKING WITH THIS CHEMICAL. .;. t: COMMENTS: THIS MATERIAL HAS NOT BEEN IDENTIFIED AS A CARCINOGEN BY NTP, IARC, OR OSHA. SPEC7�„Pli4'IFSCTIC3�I7�iFdRFIATL(1N VENTILATION,: PROVIDE ADEQUATE THROUGHPUT OF FRESH AIR i i 61 .ryr-�, MATERIAL SAFETY DATA SHEET: CAR WASH 15213 P9 2 RESPIRATORY PROTECTION: LOCAL EXHAUST VENTILATION; GENERAL DILUTION VENTILATION; USE PERSONAL PROTECTION EQUIPMENT (VAPOR GAS MASK) WHERE EXPOSED TO ANY MIST. PROTECTIVE GLOVES: WEAR IMPERMEABLE GLOVES (BUTYL OR HEAVY VINYL LATEX TYPE) EYE PROTECTION: USE DUST- AND SPLASH-PROOF SAFETY GOGGLES WHERE THERE IS ANY POSSIBILITY OF LIQUID, MIST, OR DUST CONTACTING THE EYES. PROTECTIVE CLOTHING: AREAS OF THE BODY THAT MRY CONTACT LIQUID OR MIST SHOULD BE SHIELDED WITH IMPERMEABLE RUBBER MATERIAL (APRON, BOOTS, ETC.) OTHER PROTECTIVE EQUIPMENT: IF POSSIBILITY EX=STS FOR SPLASHING WEAR FACEGUARD WITH SIDE-SHIELDS. USE RESPIRATOR WHEN WORKING IN A TOTALLY CLOSED SYSTEM. 3FCTiON:;b' ..... REACTY wt't i/I't1'``bit'I'A::#, PILYSIC�kf,.p1'T�S, '•:� .... REACTIVITY: FLASH POINT: LOW RISK AT AMBIENT TEMPERATURE (IN SOLUTION FORM) NONE BOILING RANGE: 105-112 C (221-231 F) (DECOMPOSES ABOVE 600 F.) EVAPORATION RATE: CONDITIONS AFFECTING REACTIVITY: (n-BuAC=1) N/A HEAT SOLUBILITY/WATER: MISCIBLE SPECIFIC GRAVITY: INCOMPATIBLE MATERIALS: 1-1.2 (@20 DEG. C) STRONG OXIDIZERS AND STRONG ACIDS. PH: 7.2-7.4 (@20 DEG. C) HAZARDOUS DECOMPOSITION PRODUCTS: VISCOSITY: TOXIC GASES (SUCH AS FORMIC ACID AND CARBON MONOXIDE) 600-800 cSt (@20 DEG. C) HAZARDOUS POLYMERIZATION: VAPOR PRESSURE: WILL NOT OCCUR. (TORR) 4.2 (@20 DEG. C) POLYMERIZATION CONDITIONS TO AVOID: 8 VOLATILE NONE KNOWN. BY VOLUME 45% FREEZING POINT: AUTOIGNITION -17 DEG C (0 DEG F FURMS SLURRY) TEMP N/A VAPOR DENSITY (air=1) «1 0 (@66 DEG. F.) SPLL"# t,EAK PFFOCFb(tf2L4_ y PRECAUTIONS IN CASE OF RELEASE OR SPILL: VEN-ILATE AREA. ABSORB INTO NON REACTIVE MEDIA SUCH AS DIATOMACEOUS EARTH OR VERMICULITE; SWEEP INTO NON REACTIVE VESSEL (I.E., HDPE DRUM OR PAIL.) EPA REPORTABLE QUANTITY: NONE WASTE DISPOSAL METHOD: DISPOSE OF PRODUCT IN ACCORDANCE WITH LOCAL COUNTY, STATE. AND FEDERAL REGULATIONS SECTION B. -=- -c ---=- =.- TRRNSPORTATION,,d:STORAGE- -.. ELECTROSTATIC ACCUMULATION HAZARD: NONE STORAGE TEMPERATURE: A B1207 TRANSPORT 101PXRhTURS: A BIJ21T SPECSAf:•i'RECA.tfTtONS � bTf#Eit,CONR�'#'$-_ �«� � .� . INSTRUCT ALL WORKERS ON HAZARDS AND PROTECTIVE MEASURES WITH THIS CHEMICAL. THE COMPOUNDS IN THIS PRODUCT BIODEGRADE IN THE ENVIRONMENT. THIS MATERIAL MAY ATTACK CERTAIN PLASTICS, RUBBER AND COATINGS. SECTION. HA2AfL0 CLASSIFICATION ------- U.S. DOT CLASSIFICATION: CLEANING COMPOUND, LIQUID, UN 1142 EPA HAZARDOUS SUBSTANCE: NO THE INFORMATION CONTAINED HEREIN IS BELIEVED TO BE ACCURATE HOWEVER THE INFORMATION IS ALSO BASED ON INFORMATION SUPPLIED TO ARDEX FROM VENDORS ARDEX BELIEVES TO BE RELIABLE. THEREFORE ARDEX ASSUMES NO LIABILITY FOR THE ACCURACY OR COMPLETENESS OF THE INFORMATION CONTAINED HEREIN. ANY MATERIAL SUPPLIED BY ARDEX IS THE SOLE RESPONSIBILITY OF THE USER. ALL MATERIALS MAY FRESENT UNKNOWP: HEALTH HAZARDS AND ARDEX CAN NOT GUARANTEE THAT THE HAZARDS LISTED HEREIN ARE THE ONLY HAZARDS THAT EXIST. 62 ' . . R a , R �•�, , :. . . m m x rawy :� a R Ardex Laboratories Inc. MATERIAL SAFETY DATA SHEET (OSHA-20) , 335 Camer Dr IN CASE OF LEAK, SPILL, FIRE, Bensalem, Pa. 19020 EXPOSURE, OR ACCIDENT, CALL Fax521539-820122 CHEMTREC: 1-800-424-9300. >• ......�—iCi—wl�.ti' i -�.L�. aiY.iY31.�1.L L"1�'�l+ LAST VERSION 05/22/90 PRODUCT MANX: CURRENT VERSION 01-30-96 STSR80 GLAZZ #1 #4210 CHEMICAL FAMILY: INORGANIC SUSPENSION IN ALIPHATIC SOLVENT WITH HIGH-MELTING POINT HYDROCARBON WAX DOT HAZARD CLASSIFICATION: COMBUSTIBLE LIQUID N.O.S. UN1993 S�TiON``2 -- -•• �:•«. .u }{p'ZARDOUS.INGREdIEtdT3 CAS REG NO. HAZARD RATING (HMIS) SCALE: 4 - EXTREME PARAFFINIC HYDROCARBON 900ppm OSHA 8008-20-6 TOXICITY 3- High FIRE 2 2 - MODERATE ALIPHATIC HYDROCARBON 100ppm OSHA 64741-41-9 REACTIVITY 0 1 - SLIGHT HYDROCARBON WAX 8002-53-7 0 - NONEXISTENT OTHER COMPONENTS: DIATOMACEOUS EARTH, WATER PRODUCT APPEARANCE: YELLOW, CREAMY LIQUID SLIPPERY TO THE TOUCH, WITH A CHARACTERISTIC BANANA LIKE ODOR. INHALATION: WHILE THIS MATERIAL HAS A LOW DEGREE OF TOXICITY BREATHING H IGH CONCENTRATIONS OF VAPORS OR MISTS MAY DIZZINESS, LOSSOFN OF THE CONCENTRATIONE6AND FATIGUUEE.) DUSTGNS OF ACCUMULATIONUS SYSTEM HAZARD WHEN MATERIALNBECOMES DRYY.ADACHE, DROWSINESS, INGESTION: WHILE THIS MATERIAL HAS A LOW DEGREE OF TOXICITY, INGESTION OF EXCESSIVE QUANTITIES MAY CAUSE: IRRITATION OF THE DIGESTIVE TRACT, SIGNS OF NERVOUS SYSTEM DEPRESSION (E.G., HEADACHE, DROWSINESS, DIZZINESS, LOSS OF CONCENTRATION, AND FATIGUE.)'. SKIN: ONE OR MORE OF THE COMPONENTS OF THIS MATERIAL MAY CAUSE MILD SKIN IRRITATION. PROLONGED OR REPEATED CONTACT MAY CAUSE REDNESS, BURNING AND DRYING AND CRACKING OF THE SKIN. EYES: ONE OR MORE COMPONENTS OF THIS MATERIAL IS AN EYE IRRITANT. DIRECT CONTACT WITH THE LIQUID OR EXPOSURE TO VAPORS OR MISTS MAY CAUSE STINGING, TEARING, REDNESS D SWELLING. ACUTE TOXIICITY DATA IS AVAILABLE UPON REQUEST READ THE ENTIRE MSDS FOR A MORE COMPLETE DESCRIPTION OF THE HAZARDS g{EKfENCY FrEIRST,ATD PROC.EFRIRES ;. jWTION d - INHALATION: MOVE PERSON TO FRESH AIR AT ONCE. IF BREATHING HAS STOPPED, PERFORM ARTIFICIAL RESPIRATION. KEEP THE AFFECTED PERSON WARM AND AT REST. GET MEDICAL ATTENTION AS SOON AS POSSIBLE. INGESTION: IF THE PERSON IS CONSCIOUS, GIVE LARGE QUANTITIES OF WATER TO DILUTE. DO NOT ATTEMPT TO INDUCE VOMITING. GET MEDICAL ATTENTION IMMEDIATELY. SKIN: PROMPTLY WASH AFFECTED AREA WITH MILD SOAP AND WATER. REMOVE CLOTHING IF PRESENT. IF IRRITATION OR REDNESS PERSISTS GET MEDICAL ATTENTION. AND E LIDS MEYES: WASH EYES IMMEDIATELY EDICAL ATTENTION IMMEDIATELY.WCONTACT GLENSESS�SHOULNTS OD NOT T BE,WORN WHEN WORKINGG LIFTING THE LOWEWITHH THIS PCH OCCASIONALLY. GET EMICA COMMENTS: EXPOSURE TO HIGH CONCENTRATIONS OF THIS MATERIAL (E.G., IN ENCLOSED SPACES OR WITH DELIBERATE ABUSE) MAY BE ASSOCIATED WITH CARDIAC ARRHYTHMIAS. EPINEPHRINE AND OTHER SYMPATHOMIMETIC DRUGS MAY INITIATE CARDIA ARRHYTHMIAS IN PERSONS EXPOSED TO THIS MATERIAL. REPORTS HAVE ASSOCIATED REPEATED 6 PROLONGED OCCUPATIONAL OVEREXPOSURE TO SOLVENTS WITH PERMANENT BRAIN 6 NERVOUS SYSTEM DAMAGE. I .. T;pp{. lIFORFt�1TION „. : _. s-- ...• VENTILATION: PROVIDE ADEQUATE THROUGHPUT OF FRESH AIR. USE OF A DUST MASK IS RECOMMENDED WHEN POLISHING (BUFFING). G' i { 2$ ..�'T•�+a'd+d'+t...� «� t'•sy.tro s r.„ .:n..�. c^:_•'_.��A:,,...ea.. 1 _-.L�.=��S:r�.. y. a MATERIEL SAFETY DATA SHEET: STEREO GLAZE /1 #4210 p9 2 RESPIRATORY PROTECTION: LOCAL EXHAUST VENTILATION; GENERAL DILUTION VENTILATION; USE PERSONAL PROTECTION EQUIPMENT (VAPOR GAS MASK) WHERE EXPOSED TO ANY MIST OR VAPORS. PROTECTIVE GLOVES: WEAR IMPERMEABLE GLOVES (BUTYL OR HEAVY VINYL LATEX TYPE) EYE PROTECTION: USE DUST- AND SPLASH-PROOF SAFETY GOGGLES WHERE THERE IS ANY POSSIBILITY OF LIQUID, MIST, OR DUST CONTACTING THE EYES. PROTECTIVE CLOTHING: AREAS OF THE BODY THAT MAY CONTACT LIQUID OR MIST SHOULD BE SHIELDED WITH IMPERMEABLE RUBBER MATERIAL (APRON, BOOTS, ETC.) OTHER PROTECTIVE EQUIPMENT: IF POSSIBILITY EXISTS FOR SPLASHING WEAR FACEGUARD WITH SIDE-SHIELDS. USE RESPIRATOR WHEN WORKING IN A TOTALLY CLOSED SYSTEM. REACTIVITY DATA t PHYSICAL-,MOPERTIES ---------- ---------------- .�. ,. .p . ... REACTIVITY: FLASH POINT: LOW RISK AT AMBIENT TEMPERATURE. 117 DEG. F. BOILING RANGE: 212-510 DEG. F. EVAPORATION RATE: CONDITIONS AFFECTING REACTIVITY: (n-BuAC=1) LESS THAN 0.1 HEAT % SOLUBILITY IN WATER: DISPERSIBLE SPECIFIC GRAVITY: INCOMPATIBLE MATERIALS: 0.981 (@60 DEG. F.) THIS PRODUCT FORMS COMBUSTIBLE AND/OR EXPLOSIVE MIX- pH: TURES WITH AIR OR OXYGEN. ALSO, AVOID STRONG ACIDS 8.0-8.5 (@21 DEG. C.) OR BASES, OXIDIZING AGENTSM AND SELECTED AMINES. VISCOSITY: HAZARDOUS DECOMPOSITION PRODUCTS: 10-15,000 CPS (@20 DEG. F.) CARBON MONOXIDE AND/OR CARBON DIOXIDE. HAZARDOUS POLYMERIZATION: VAPOR PRESSURE: WILL NOT OCCUR. (TORR) 5.2 (68 DEG. F.) POLYMERIZATION CONDITIONS TO AVOID: 8 VOLATILE NONE KNOWN. BY VOLUME: 84.5% FREEZING POINT: AUTOIGNITION 25 DEG. F. TEMP: 602 DEG. F. LOWER-UPPER EXPLOSIV) LIMIT (%VOL) : 1.6-6.5 VAPOR DENSITY 1.5 (air-1) SECTION 7--------- SPILL &`LEAK'PROCEDURES-=,=------- c----------- PRECAUTIONS IN CASE OF RELEASE OR SPILL: VENTILATE AREA. ABSORB INTO NON REACTIVE MEDIA SUCH AS DIATOMACEOUS EARTH OR VERMICULITE; SWEEP INTO NON REACTIVE VESSEL (I.E., STEEL DRUM OR PAIL) EPA REPORTABLE QUANTITY: NONE. WASTE DISPOSAL METHOD: DISPOSE OF PRODUCT IN ACCORDANCE WITH LOCAL COUNTY, STATE. AND FEDERAL REGULATIONS. SECTION 8 --------------------------------TRANSPORTATION t STORAGE-'= --- - Y`--""- ELECTROSTATIC ACCUMULATION HAZARD: GROUND ALL EQUIPMENT. STORAGE TEMPERATURE: IN®IENT TRANSPOIC! TlWZR7►TOA=: MMIZUT SECTION 9 -------------------------------' SPECIAL PRECAUTIONS OR OTHER COMMENTS--- ^+- _ INSTRUCT ALL WORKERS ON HAZARDS AND PROTECTIVE MEASURES WITH THIS CHEMICAL. IF S.PILL/RELEASE IN EXCESS OF EPA REPORTABLE QUANTITY INTO THE ENVIRONMENT, IMMEDIATELY NOTIFY THE NATIONAL RESPONSE CENTER (PHONE 8 800 424 8002). . SECTION 10 -- --------- KAZARD CLASSIFICATION-=---------=----- ^---------=-----= U.S. DOT CLASSIFICATION: COMBUSTIBLE LIQUID N.O.S. UN1993 (or POLISH, LIQUID UN1263) EPA HAZARDOUS SUBSTANCE: NO THE INFORMATION CONTAINED HEREIN IS BELIEVED TO BE ACCURATE HOWEVER THE INFORMATION IS ALSO BASED ON INFORMATION k SUPPLIED TO ARDEX FROM VENDORS ARDEX BELIEVES TO BE RELIABLE. THEREFORE ARDEX ASSUMES NO LIABILITY FOR THE ACCURACY OR COMPLETENESS OF THE INFORMATION CONTAINED HEREIN. ANY MATERIAL SUPPLIED BY ARDEX IS THE SOLE RESPONSIBILITY OF THE USER. ALL MATERIALS MAY PRESENT UNKNOWN HEALTH HAZARDS AND ARDEX CAN NOT GUARANTEE THAT THE HAZARDS LISTED HEREIN ARE THE ONLY HAZARDS THP.T EXIST. 26 I i TOWN OF BARNSTABLE W° r'ATION lo-la J4461" 9. SEWAGE # 016 f► ,LAGE MIA ASSESSOR'S MAP& LOT � INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:•(ty/pe/) if (size) NO.OF BEDROOMS �1 BUILDER OR OWNER h�A i o PERMIT DATE: I-)tU S— COMPLIANCE DATE: 07 r l U S Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Jpe.T Pktl Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) �A Feet Edge of Wetland and Leaching Facility(If any wetlands exist 7� �IA� Feet within 300 feet of leaching facility) Furnished by C 0 � o J o_ ��. 3 � 17 CA -p o 1 Eo c� Q.) W � a� Use 410 filter cloth, no peastone. JOB NO. B03-11 La perforated pipe level between humps shown of C-4 Units. Cap end � 5' Y P P P 5, 6, NOTES Delio.dwg o 5 to last pipe Q _ 1. LOCUS IS A.M. 307, PARCEL 217. o 0 Cr o 2. ELEVATIONS SHOWN ARE TOWN GIS± 0.3'.Stone (/r /r //r r ` //r /l r n 3. LOCUS IS IN FLOOD ZONE B ON FIRM DATED JULY 2, 1992. (ROADS NAMES WRONG ON FIRM) �H/ i �1--11 . �►1� . �trir . �t_i� i UZL i . �H� . i . �r-rr . � �t-1l i „ cn Seabrook Rd. 4. ALL PIPES TO BE 4 SCH 40, AND PITCHED AT 1/4 PER FOOT. (UNLESS NOTED) aocD 2 0, 5. MUNICIPAL WATER IS AVAILABLE. LOTS WITHIN 100' ARE ON TOWN WATER. o Seabrook fi \ ' r LEACHING CROSS SECTION A-A 6. COMPONENTS TO BE AASHTO H-10, UNLESS NOTED. ° d L�(J •� »_2� 7. INLET TEE TO PROJECT DOWN 13", OUTLET TEE DOWN 14". 8. IF TWO OR MORE LINES, WATER TEST D-BOX FOR EQUAL FLOW D-BOX EXIT PIPES TO BE LEVEL FOR FIRST TWO FEET. . 8.2 9. DEPTH OF COMPONENTS NOT TO EXCEED 3', OR VENTING MUST BE PROVIDED. NOT TO / COVERS: BUILD UP COVERS TO 6" BELOW GRADE--2 ON TANK, 1 ON D-BOX, & I ABOVE PUMP. SCALE EXISTING TANK BELIEVED TO BE 1500 GAL.--EXACT LOC- 10. STONE TO BE DOUBLE WASHED 3/4 TO 1 1/2" WITH 2" MIN. 1/8 TO 1/2" PEA STONE ON TOP. LOCATION MAP ATION NOT KNOWN--VERIFY 11. IF UNSUITABLE SOILS, OR SOILS DIFFERING FROM THE SOIL LOG ARE FOUND, THAT TANK IS SOUND AND CONTACT THE BOARD OF HEALTH, OR R.J. CADILLAC. p x Iq USABLE. 12. IF AN OVERDIG IS CALLED FOR BELOW, FILL MATERIAL FOR 5' AROUND AND UNDER LEACHING BENCH MARK--TOP & CENTER OF / IS TO BE CLEAN GRANULAR SAND MEETING SPECIFICATIONS OF 310 CMR 15.255(3). TEST HOLE 1 04 CONC. BOUND= 12.35 GIS t0.3 N�F 13. PUMP AND FILL ANY EXISTING CESSPOOLS. REMOVE ANY CLOGGED SOIL, BLOCK, AND STONE IN LEACH AREA, AND DISPOSE OF AS DIRECTED BY HEALTH AGENT. 57 0- 1 DEPTH (inches) ELEV.(feet) c� 3 �FRONTINO 14. ALL CONSTRUCTION TO MEET TITLE 5 AND LOCAL REGULATIONS. 0 12.0 15.8 Fill IF SEPTIC TANK METAL AND OR TEST HOLE DATE: October 27, 2003 30" A layer 10yr 3/4 2 ' 2� �FQ��' NOT SOUND IT WILL HAVE TO PERFORMED BY: Ron Cadillac, Soil Evaluator 37„ sandy loam 0° le,6 ` ,< N/F BE REPLACED WITNESSED BY: Sam White, RS a ST 5 PERC RATE: <2' 00"/inch (C layer) 40" E layer 10yr d 1 foam sand ENE N o HENDERSON SOIL SURVEY(1993): Carver coarse sand p�RT & / sal 30" W N 12 c. GEOLOGIC MAP(1986): Barnstable plain deposits 60„ B layer 10yr /8 � T �P �OO.QO• _tip BENCH MARK--S.W. CORNER OF 7.0 x ARK�NG 1,9 Thrust Bloc �` CONC. STOOP = 12.84 GIs t0.3 Invert 9.2t 10--C4 UNITS o 3' DEEP IMPERVIOUS 'o / IZ .. IN 23' x 26' BED C layer 10yr 6/6 BARRIER--130 L.F. OF 1 optional LOT 1 Use Gas Baffle 75"n medium sand 40 MIL POLYETHYLENE / Y 1 Estimated Exist. Invert 12.56 Londscap No 7,870f S.F Proposed 87" (-MILLER BREAKOUT** 11 T'es _observed water TOP BARRIER=TOP ) `- ��9 see detail 12.86 PEASTONE=12.86,GRADE �, �3, slob NO Pes FILTER CLOTH ABOVE BARRIER=13.3 MIN ...........: ::::..... EX� Existing S=1/8"/ft. ** BARRIER IS STIFF -`.••"• `?�3.`'.: y". - G 1500 Gal. P & OBTAINABLE FROM = -' X - _ rify Soundness MILLER ENVIRONMENTAL 2,3 -:l i 2 v �$4 �P�EX - Sanitary 4" 120" 2.0 0 5,2 508-697-3710. 12, 3, ": ��9. Slab Bottom 5.2f Tee T I No, o _ Proposed 12.15 o Q j j Q' ► 6'= 1 Q o Invert 12.73 Invert 12.48 , �/� N 6" Stone or compact Proposed Proposed • I 5 Bottom CO 8,_ _- *High Ground-Water - 10 ...� 13. , �:•�::. .. I I I ry I ... .......,� �p ••:::.;�. I I 4, Hi h Ground Water* Elevation "(o) Inland- El. 7.15 1 :::. ::::::. 13.8 ��•� �25 ,� I ( - , The elevation above ` 12� :.•••••�'- _ rn 2.4'--8 out of 10 year Calculated < which in eight out of 9 .4 Adjustment using MASH29-Oct. 03 I r''cp TH 1 5 DESIGN DATA - Zone B (see 310CMR 15A2)* ten consecutive years c� c^ the ground water cS O sue. 36 STONE & 'bserved Vv =4.75 table does not rise." BEDROOMS: 4 o 12,1 LEACH AREA " 1 PqR RT � N/F GARBAGE GRINDER: No 5� REMOVAL CAUTION: FOUNDATION FOR GUY 2 2.o KING REQUIRED CAPACITY. 440 GPD USE 10 C-4 UNITS, AS SHOWN, WITH WIRE IS NEAR DIG--DO NOT 12.7 DIMONTE EXISTING SEPTIC TANK: 1500 GAL. 3' OF STONE ON E. & W. SIDES AND DO 5' ALL AROUND AND UNDER DISTURB--MODIFY 5' REMOVAL 12,5 12 3 IF NEEDED. 3 �� BOTTOM LEACHING AREA: 598 SF 3 1/2' OF STONE ON N. & S. ENDS REMOVAL DOWN 5' t TO MED. �6�1• SEA _ 30" [(26' X 23')] FORA 23 X 26 X 4 DEEP LEACH SAND. SEE GUY WIRE NOTE. SIDE LEACHING AREA: 0 SF BED. SET C-4 UNITS LEVEL AND RUN E?R0 112,5 NONE 4 PERFORATED SCH 40 PIPES LEVEL DOWN UNITS. SEE SECTION A-A. ok DESIGN CAPACITY: 442 GPD ROAD [(598 SF) X .74 GPD/SF] BUOYANCY CALC'S-MONOLITHIC PUMP CHAMBER MONOLITHIC ALARM & PUMP NOTES PUMP CHAMBER STORAGE CAPACITY: 440 GAL. WEIGHT OF EMPTY CHAMBER AND 20" OF COVER 1. TO PROVIDE FOR EASY AND SAFE DOSES PER DAY: > 4 CHAMBER= 4.15 TON (PER SHOREY) H-10 1000 GAL. PUMP CHAMBER MAINTENANCE OF PUMP: 20" COVER= 1.8' X 5.42' X 8.25' X 0.055 TON/CU. FT. A. PROVIDE UNION/DISCONNECT IN 2" PVC DRILL 3/8" WEEP/VENT HOLE LINE AT TOP PUMP CHAMBER SO PUMP TOTALO 4R15 ON TON TON = 8.58 TON Recommend Floats CAN BE REPLACED FROM TOP OF TANK. B. RECOMMEND FLOAT BRACKET SO FLOATS WEIGHT OF WATER--MAX. HIGH GROUNDWATER DOWN adjustable from top CAN BE ADJUSTED FROM TOP OF TANK. 2. ALARM TO BE WIRED BY ELECTRICIAN ON (8.05 -4.6) X 5.42' X 8.25' X 0.0312 TON/CU. FT. SEPARATE CIRCUIT FROM PUMP. WEIGHT WATER= 4.81 TON 9.10 lar 28" Quick Disconnect/Union 3. ELECTRICAL WORK TO BE INSPECTED BY TANK AND 30" COVER ARE HEAVIER BY 3.7 TON. Invert On 22 Check Valve WIRING INSPECTOR. 4. ALARM TO BE LOCATED IN HOUSE. Off 17" 5. PUMP TO BE CAPABLE OF PASSING P 1-1/4" SOLIDS AND INSTALLED IN STRICT CONFORMANCE WITH MANUFACTURER'S 4.6 6" STONE UNDER SPECIFICATIONS. Bottom 6 EUSE MEYE QUIVALER MW50, 1/2 HP PUMP, OR SITE PLAN USE IPX OR CS-55 FOR WATERPROOFING THIS PLAN A VALID COPY ONLY IF IT BEARS ANGELO V. & MARY LOUISE DELIO AN ORIGINALL RED STAMP AND SIGNATURE. LEGEND tM OF Ivlgss LOT 19 107 & 109 SEABROOK ROAD, HYANNIS, MA TH 1 TEST HOLE LOCATION, NUMBER o6 �ME ME \ DECEMBER 5, 2003 SCALE: 1 n=20' W WATER LINE MARKINGS U I E- OVERHEAD ELECTRIC WIRES (IF SHOWN) # P 79 9.5 x 8.7 EXISTING & PROPOSED ELEVATIONS ('X' MARKS POINT) �FG/STE �goFESS�° o gNITAP0' EXISTING CONTOUR e- S " , �R\V' RONALD J. CADILLAC, PLS, RS • � � O 8-- PROPOSED CONTOUR PROFESSIONAL LAND SURVEYOR & REGISTERED SANITARIAN 0 UTILITY POLE (IF SHOWN) P.O. BOX 258 ® EXISTING DRAINAGE CATCH BASIN L WEST YARMOUTH MA 02673 x FENCE (IF SHOWN, NOT ALL SHOWN) Im '(6 / C�J 0 TREE (IF SHOWN, NOT ALL SHOWN) HEALTH ENT APPROVAL DATE (508) 775-9700 C 2003 BY R.J. CADILLAC PAGE 1 OF 1