HomeMy WebLinkAbout4650 FALMOUTH ROAD/RTE 28 - Health (2) --� 4650 Falmouth RdA'j)
010--008-002 Cotuit
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December 21, 1986
Edward J. Sheehan, D.C. R1 BARNSTABLE--hazardous Waste
Cotuit Clii-ropractic Cotuit Chiropractic
4650 Route 26 4650 Route 28
Cotuit, Massachusetts 02635 Cotuit
Notice of Inspection
310 CMR 30.000
Site 1D# MAVOOOOOI040
Dear Doctor Sheehan:
On November 2, 1988, the Department of Environmental Quality Engineering
conducted an inspection of your medical- facility located :at 4650 Route 28, Cotuit,
Massachusetts. lbe purpose of the ins[xction was to verify that you have corrected
the violations observed in a prior inspection and outlined in a Notice of
Noncompliance (NON) issued to you by the Department on April 25, 1988.
Ifie inspection revealed tjj,-.jt you have implemented the required corrective
actions as follows:
T. You have had your waste fixer and developer solutions and the
wastewater discharge generated from your X-ray film processing
unit analyzed for LP toxic levels of silver. 'M yqps_),were
I-K--rforpled on two separate occasions by a Massachusetts certified
laboratory and yielded equivocal results. In one instance the silver
levels exceeded the Departments allowable maximum contamination
-level of 5 milligrams per liter. (iiyg/L), while in another instance,
the silver levels were below this limit. 11i6refore, because the
silver levels in the waste effluents generated from your X-ray film
processing unit will vary depending upon, but not limited to,
the work load of the unit and the length of time the solutes have
been used in processing, you are required to manage said waste
materials in compliance with the Regulations pertaining to Regulated
Recyclable Materials and to the Very Small Quantity Generator (VSQG)
of hazardous waste as contained in 310 CMR 30.200 (specifically
30.270) and 310 MR 30.351, respectively. lbe only exception to the
requirement that you comply with these regulations would be your having
a Massachusetts certified lab analyze each waste effluent sample for
EP toxic levels of silver prior to each off-site removal of said
material. if you choose to pursue this option, YOU must notify the
Department, in writing, and be prepared to subnit the analytical
test results to this office which verify that each off-site shipment
of the waste is non-hazardous.
u
-2-
2. You have notified the Department�9,e sots Sla.�zaldocsVSQGwaste
registration
and have registered as a � VOOU001040.
number assigned to you is MA
3. You have ceased discharge of the wastewater effluent from your
X-ray film processing unit to your. on-site septic system and you
are managing this waste material
erialas regu,are reminded recyclable
thataanylal
in accordance with the Regulations.
discharge of non-hazardou atsy temrlis gonsideredenerated fan industrial
processing unit, to the septic
waste discharge which requires prior
Division of Water(�Pollution Control.uisition of r�t
from the Department's ['or
further information, you may contact the Water pollution Division a
this Regional Office, telephone (508)947-1231,
ext. 680.
have taken the corrective actions
The results of this inspection verify that you
required in the above referenced Notice of Noncompliance.
Should you have further questions regarding hazardous waste management,
please contact Ms. Stephanie Syler of this office.
Very truly yours,
0-_
Chri tophe Tilden, P.E. , Chief
Hazardous Waste Section
T/SS/kan
cc: DEQE-DI1W
AM: Compliance
Boston, MA
Barnstable Board of Health
P.O. Box 534
ilyannis, MA 02601
SERO-DWPC
AT1'N: Jeff Gould
Daniel S. Greenbaum nff
Commissioner
Gilbert T.Joly <"/> i� �, 09Y,. 7.
Regional Director oZIX�
p� ( V) .9/47 -911, 6TO 6'X-1
G�
December 21, 1988
Edward J. Sheehan, D.C. RE: BARNSTABLE--Hazardous Waste
Cotuit Chiropractic Cotuit Chiropractic
4650 Route 28 4650 Route 28
Cotuit, Massachusetts 02635 Cotuit
Notice of Inspection
310 CMR 30.000
Site ID# MAV000001040
Dear Doctor Sheehan:
On November 2, 1988, the Department of Environmental Quality Engineering
conducted an inspection of your medical facility located at 4650 Route 28, Cotuit,
Massachusetts. The purpose of the inspection was to verify that you have corrected
the violations observed in a prior inspection and outlined in a Notice of
Noncompliance (NON) issued to you by the Department on April 25, 1988.
The inspection revealed that you have implemented the required corrective
actions as follows:
1. You have had your waste fixer and developer solutions and the
wastewater discharge generated from your X-ray film processing
unit analyzed for EP toxic levels of silver. The analyses were
performed on two separate occasions by a Massachusetts certified
laboratory and yielded equivocal results. In one instance the silver
levels exceeded the Departments allowable maximum contamination
R", level of 5 milligrams per liter (mg/L), while in another instance,
the silver levels were below this limit. Therefore, because the
silver levels in the waste effluents generated from your X-ray film
processing unit will vary depending upon, but not limited to, .
the work load of the unit and the length of time the solutes have
been used in processing, you are required to manage said waste
materials in compliance with the Regulations pertaining to Regulated
Recyclable Materials and to the Very Small Quantity Generator (VSQG)
of hazardous waste as contained in 310 CMR 30.200 (.specifically
30.270) and 310 CMR 30.351, respectively. The only exception to the
requirement that you comply with these regulations would be your having
a Massachusetts certified lab analyze each waste effluent sample for
EP toxic levels of silver prior to each off-site removal of said
material. If you choose to pursue this option, you must notify the
Department, in writing, and be prepared to submit the analytical
test results to this office which verify that each off-site shipment
f of the waste is non-hazardous.
-2- r
2. You have notified the Department of your hazardous waste activity
and have registered as a VSQG. The site specific VSQG registration
n mber. assigned to you is MAV000001040.
3. You have ceased discharge of the wastewater effluent from your
X-ray film processing unit to your on-site septic system and you
are managing this waste material as regulated recyclable material
in accordance with the Regulations. You are reminded that any
discharge of non-hazardous waste material generated from your film
processing unit, to the septic system, is considered an industrial s
waste discharge which requires prior acquisition of a permit
from the Department's Division of Water Pollution Control. For
further information, you may contact the Water Pollution Division at
this Regional Office, telephone (508)947-1231, ext. 680.
The results of this inspection verify that you have taken the corrective actions
required in the above referenced Notice of Noncompliance. .
Should you have further questions regarding hazardous waste management,
please contact Ms Stephanie Syler of this office.
Very truly yours,
A,_
Christophe Tilden, P.E. , Chief
Hazardous.Waste Section
T/SS/kan
cc: DEQE-DHW
ATTN: Compliance
Boston, MA
Barnstable Board of Health
P.O. Box 534
Hyannis, MA 02601
SERO-DWPC
ATTN:' Jeff Gould
I
Daniel S.Greenbaum
Commissioner
Gilbert T.Joly � �, &"ad taelA 023.tv7
Regional Director f
p (5-0,J) 9JI7 MY G PO-6'01
a
December 21, 1988
Edward J. Sheehan, D.C. RE: BARNSTABLE--Hazardous Waste -
Cotuit Chiropractic Cotuit Chiropractic
4650 Route 28 4650 Route 28
Cotuit, Massachusetts 02635 Cotuit
Notice of Inspection
310 CMR 30.000
Site ID# MAV000001040
Dear Doctor Sheehan:
On November 2, 1988, the Department of Environmental Quality Engineering
conducted an inspection of your medical facility located at 4650 Route 28, Cotuit,
Massachusetts. The purpose of the inspection was to verify that you have corrected
the violations observed in a prior inspection and outlined in a Notice of
Noncompliance NON issued to you the Department on April 25, 1988.
Noncomp (NON) Y by
The inspection revealed that you have implemented the required corrective
actions as follows:
It 1. You have had your waste fixer and developer solutions and the
wastewater discharge generated from your X-ray film processing `
unit analyzed for EP toxic levels of silver. The analyses were
performed on two separate occasions by a Massachusetts certified
laboratory and yielded equivocal results. In one instance the silver
levels exceeded the Departments allowable maximLm contamination
level of 5 milligrams per liter (mg/L), while in another instance,
Y� the silver levels were below this limit. Therefore, because the
silver levels in the waste effluents generated from your X-ray film
processing unit will vary depending upon, but not limited to,
the work load of the unit and the length of time the solutes have
been used in processing, you are required to manage said waste
materials in compliance with the Regulations pertaining to Regulated
Recyclable Materials and to the Very Small Quantity Generator (VSQG)
30.200 (specifically
of hazardous waste as contained in 310 CMR ( Pe Y
30.270) and 310 CMR 30.351, respectively. The only exception to the
requirement that you comply with these regulations would be your having
a Massachusetts certified lab analyze each waste effluent sample for
EP toxic levels of silver prior to each off-site removal of said
material. If you choose to pursue this option, you must notify the
Department, in writing, and be prepared to submit the analytical
test results to this office which verify that each off-site shipment
of the waste is non-hazardous.
f
-2-
2. You have notified the Department of your hazardous waste activity
and have registered as a VSQG. The site specific VSQG registration
number assigned to you is MAV000001040.
3. You have ceased discharge of the wastewater effluent from your
X-ray film processing unit to your on-site septic system and you
are managing this waste material as regulated recyclable material
in accordance with the Regulations. You are reminded that any
discharge of non-hazardous waste material generated from your film
processing unit, to the septic system, is considered an industrial
waste discharge which requires prior acquisition of a permit
from the Department's Division of Water Pollution Control. For
further information, you may contact the Water Pollution Division at
this Regional Office, telephone (508)947-1231, ext. 680.
The results of this inspection verify that you have taken the corrective actions
required in the above referenced Notice of Noncompliance. .
Should you have further questions regarding hazardous .waste management,
please contact Ms. Stephanie Syler of this office.
Very truly yours,
A.,
Chri top Tilden, P.E., Chief
Hazardous Waste Section
T/SS/kan
cc: DEQE-DHW
ATTN: Compliance
Boston, MA
Barnstable Board of Health
P.O. Box 534
Hyannis, MA 02601
SERO-DWPC
ATTN:' Jeff Gould
QWHI-LE VOU,WEREAIA/AY.
7
E/ . G A.M.
FOR D TE TIM P.M.
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PHDiVED
OF
` RETURiVfQ
PHONE a O2 6 — 90 YttUR CAtL
AREA CODE NUMBER EXTE
LEASE CAtt
MESSAGE
lilkttl.FALL.::
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SEfDll
WAM'S TQ,'
SIGNED �niversal' 48002
"was
NOTES
1
January 6, 1995
Mr. Jim Sweenie
Sterling Pacific Company
6001 North 24th Street
Suite A
Phoenix, AZ 85016
Dear Mr. Sweenie:
This letter is to inform you that Dr. Edward Sheehan of Cotuit
Chiropractic located at 4650 Falmouth Road (Rt.28) ,Cotuit has ceased
discharging silver to his on-site septic system. Once Dr. Sheehan was
made aware of this violation he voluntarily came into compliance by
recovering his silver.
In addition, I have enclosed a copy of the state's notice of inspection
letter. If you have any further questions please feel free to call me
at this office, (508) 790-6265.
Sincerely,
o � I
Donna Z. Miorandi
Health Inspector
`t
Gilbert T. Joly
Regional Director M-� .
&d.. 680-60
COPY April 25, 1988
Cotuit Chiropractic RE: BARNSTABLE--Hazardous Waste
4650 Route 28
Cotuit, Massachusetts 02635
ATTENTION: Dr. Edward J. Sheehan
NOTICE OF NONCOMPLIANCE
THIS IS AN IMPORTANT NOTICE. FAILURE TO TAKE ADEQUATE ACTION IN RESPONSE TO THIS
NOTICE COULD RESULT IN SERIOUS LEGAL CONSEQUENCES.
Department personnel have observed that on April 1, 1988, activity occurred at
4650 Route 28, Cotuit, Massachusetts, in noncompliance with one or more laws,
regulations, orders, licenses, permits or approvals enforced by the Department.
The purpose of the inspection was to determine the status of your facility
relative to compliance with the Massachusetts Hazardous Waste Regulations as con-
tained in 310 CMR 30.000 which were adopted under the provisions of Sections 4, 6 and
9 of Chapter 21C of the Massachusetts General Laws, as applicable.
Attached hereto is a written description of 1. each activity referred to above,
2. the requirements violated, 3. the action the Department now wants you to take,
and 4. the deadline for taking such action.
If you fail to take any action the Department now wants you to take by the
prescribed deadline, or if you otherwise fail to retrain in compliance in the future .
with requirements applicable to you, you could be subject to legal action, including
but not limited to criminal prosecution, court-in-posed civil penalties, or civil
administrative penalties assessed by the Department. A civil administrative penalty
may be assessed for every day from now on that you are in noncompliance with the
requirements referred to above.
Very truly yours,
d(Christophe Tilden, P.E. , Chief
Solid and Hazardous Waste Section.
T/SS/lm
Attachment
f
-2-
CERTIFIED MAIL #P676 085 581
RETURN RECEIPT RDQUESTED
cc: DHW - Boston Office
AWN: Frances Jordan
DWPC - Southeast Region
AWN: Jeffrey Gould
Tom McKean, Acting Director
Barnstable Board of Health
P.O. Box 534
Hyannis, MA 02601
r
NOTICE OF NONCOMPLIANCE
NONCOMPLIANCE SUMMARY
NAME OF ENTITY IN NONCOMPLIANCE: Cotuit Chiropractic
LOCATION WHERE NONCOMPLIANCE WAS OBSERVED: 4650 Route 28, Cotuit, Massachusetts 02635
DATE WHEN NONCOMPLIANCE WAS OBSERVED: April 1, 1988
DESCRIPTION OF NONCOMPLIANCE, RBQUIRM4TS NOT COMPLIED WITH, ACTION TO BE TAKEN AND
THE DEADLINE FOR TAKING SUCH ACTION:
1. Department personnel observed that you are disposing of waste from
your x-ray film processing unit without first determining if the
material is hazardous waste pursuant to 310 CMR 30.302. Said waste
consists of developer, fixer and waste water which may contain con-
centrations of silver exceeding the EP Toxicity level of 5° milligrams
per liter. The developer and fixer are contained in separate 5 gallon
jugs and transported off site monthly, while the waste water is discharged
to an on site septic system.
Therefore, in order to comply with the Regulations you shall do the
following:
a. Within forty-five (45) days of receipt of this Notice,
contract with a Massachusetts certified laboratory to
obtain samples and to have analyzed your waste fixer
solution, your waste developer solution, and your waste
water effluent for EP Toxic level of silver. The laboratory
must utilize the testing procedures outlined in 310 CMR 30.155
and you shall provide the Department with these test results
immediately upon availability but not later than 60 days from
receipt of this Notice.
b. Should the waste be determined to be hazardous waste you
shall request a notification form from the Department to
register as a Very Small Quantity Generator (VSQG) of
hazardous waste and comply with the regulations so governing
the activity of a VSQG pursuant to 310 CMR 30.353.
c. Immediately cease and not resume the waste water discharge,
which is considered industrial disposal, to your septic system
until you have contacted and received approval from the
Department's Division of Water Pollution Control for this
method of disposal.
Relative to this Notice of Noncompliance, the Department requires a written
response within fifteen (15) days of receipt hereof, indicating actions taken in
order to achieve and maintain compliance with the regulations.
Should you have any questions relative to this matter please contact Ms. Stephanie,
Syler of this office.
DATE: 4� Y BY:
Christopher Tilden, P.E. , Chief
Solid and Hazardous Waste Sections
�fTHE) TOWN OF BARNSTABLE
_ SS OI"FICE OF
BARISTA19L j gg--�� pp��, HEALTH
�p-u
i639 BOARD
pp pp�e0�0 HA`( 1167 MAIN STREET
HYANNIIS, MASS. 02601
February 17 , 1988
Dr. Edward Sheehan
46:50 Route 28
Cotuit, MA 02635
:Dear Dr. Sheehan :
The Health Department recently received a complaint
alledging that he/she observed evidence of toxic and
:hazardous materials in your toilet .
The Town of Barnstable Regulation, Article XXXIX:
Control of Toxic and Hazardous Materials requires that you
fill out the enclosed registration form and to inform us. as
to where you store these materials and of how you dispose of
the waste products .
You are also required to have "Material Safety Data
Sheets" (MSDS) on file for the toxic and hazardous materials
stored on the premises .
If you have any questions please contact Donna Miorandi,
Hazardous Waste Coordinator, at 775-11.20 , Ext. 157 .
Yours Truly
Thomas A • McKean
Acting DLrector of Public Health
e°
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
satisfactory 2.Printers
BOAR OF H EALTH 3.Auto Body Shops
O unsatisfactory- 4.Manufacturers A /'
COMPANY (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS tfZ A3S: 7.Miscellaneous
QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors)
MAJOR MATERIALS case lots Dr tns'�
IN OUT IN OUT IN OUT #&gallons Age T st
Fuels:
Gasoline,Jet Fuel(A)
Diesel, Kerosene, #2 (B)
Heavy Oils:
waste motor oil (C)
new motor oil (C) 171
transmission/hydraulic
Synthetic Organics:
degreasers
Miscellaneous:
DISPOSALIRECLAMATION REMARKS:
1. Sanitary Sewage 2.Water Supply G� �
O Town Sewer Public
,On-site OPrivate
3. Indoor Floor Drains YES NO
O Holding tank:MDC_
O Catch basin/Dry well
O On-site system
4. Outdoor Surface drains:YES NO_j/ ORDERS:
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
5.Waste Transporter
Name of Hauler Destination Waste Product
� YES NO
1.
2.
Per (s) Interviewed Ins ector Date
11/21/94 14:53 $602 468 1292 STERLING ASSETS IM 001/002
FACSIMILE COVER MESSAGE
FAX NO. (602) 468-1292
The information contained in this facsimile message is CONFIDENTIAL
INFORMATION intended only for the use of the individual or entity named
below. If the reader of this message is not the intended recipient, you
are hereby notified that any dissemination, distribution or copy of this
telecopy is strictly prohibited. If you have received this telecopy in
error, please notify us immediately by telephone and return the original
message to us at the address below via the United States Postal Service.
Thank you.
Date:
TO: V M All ._
FAX NO. 77.C- , KeZ
From: > rY► �GC.Q.PB aV»Pi
Subject:
This message contains pages including the cover sheet.
Comments: " ev 'f
Original to follow Original NOT to follow
CONTACT AT 602-468-1090 IF YOU DO NOT RECEIVE ALL PAGES.
6001 North 24th Street, Suite A, Phoenix, AZ 85016
11/21/94 14:53 V602 468 1292 STERLING ASSETS
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TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
L Mail To:
NAME OF BUSINESS: (261 �t- mdfvlrnm Board of Health
MAILING ADDRESS: 06-tyyf ASS 0V is'" Town of Barnstable
TELEPHONE NUMBER: P.O. Box 534
CONTACT PERSON: t4flfl .a,"
Hyannis, MA 026bi
Does your.firm store any of the toxic or hazardous materials listed below, either for sale or for
your own use, in quantities totalling, at any time, more than 50 gallons,liquidvolume or 25 pounds dry
weight? YES NO VC —
This form must be returned to the Board of Health regardless of a yes or no answer. Use the
enclosed envelope for your convenience.
If you answered YES above, please indicate if the materials are stored at a site other than your
mailing address:
ADDRESS:
TELEPHONE:
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health has determined that the following products exhibit toxic or hazardous
characteristics and must be registered d
v Please put a check beside each product that you store:
Antifreeze (for gasoline or coolant systems) Drain cleaners
t Automatic transmission fluid Toilet cleaners
Engine and radiator flushes Cesspool cleaners
Hydraulic fluid (including brake fluid) Disinfectants
Motor oils/waste oils Road Salt (Halite)
Gasoline, Jet fuel Refrigerants
Diesel fuel,-kerosene, #2 heating oil Pesticides (insecticides, herbicides,
Other petroleum products: grease, lubricants rodenticides)
Degreasers for engines and metal _ Photochemicals (fixers and developers)
Degreasers for driveways=&=gararuesi4 =- Printing--ink`"
Battery acid (electrolyte) Wood preservatives (creosote)
Rustproofers Swimming pool chlorine
Car wash detergents Lye or caustic soda
Car waxes and polishes Jewelry cleaners
Asphalt & roofing tar Leather dyes
Paints,-varnishes, stains, dyes Fertilizers (if stored outdoors)
Paint & lacquer thinners PCB's
Paint & varnish removers,deglossers Other chlorinated hydrocarbons,
Paint brush cleaners (inc. carbon tetrachloride)
Floor & furniture strippers Any other.products with "Poison" labels
Metal polishes (including chloroform, formaldehyde,
Laundry soil & stain removers hydrochloric acid, other acids)
(including bleach) Other products not listed which you feel may
Spot removers & cleaning fluids be toxic or hazardous (please list):
(dry cleaners)
Other cleaning solvents
Bug and tar removers
Household cleansers, oven cleaners
i
White Copy-Health Department/ Canary Copy-Business
n CSC f Z.
N ..... .2___1 Fs .............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................O F.......................................-----------.............----._.....................
Appliration for Dispm al Works Tomitrnrtiun rumit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
system at: - ("t4lW44 6o "I %,
6Q , .... k.71 9
W .. .. _.:. Location-A res�.. s ��
t eNsso.
fiZ
. .............
•..----
5m .... 4 L
Owner Addr
�YV------------------------------------------- -----------
•.•-••••-------------•••..••••-•
Installer Address
Type of Building Size Lot.....L_ _�_ab Sq. feet
V Dwelling—No. of Bedrooms.............I............................Expansion Attic ( ) Garbage Grinder ( - )
Other—T e of Building ........... No. of persons............t............. Showers — Cafeteria
a
� Other fixtyLes ..................•-----------------------------...---.....-----------------••--------._._-----------------....---..........-----..__........-•-----..
W Design Flow__ ........ a.......................gallons per person per day. Total daily flow____-_gow......•_...._......._..gallons.
WSeptic Tank L Liquid capacity../Mgallons Length................ Width................ Diameter................. Depth................
x Disposal Trench-No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit No......./_------------ iameter......../0...... Depth below inlet..... .......... Total leaching area_RIO. .....sq. ft.
Z Other Distribution box ( Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1----- per inch Depth of Test Pit.................... Depth to ground water........................
" (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
x .... -- ...... ..............
O Description of Soil-------Q.-._vz .....Y., `_:- �. /�---mac `- - � re .--•-----
W
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
----------------•----•--.........:--•-------•---..•..---•--......_......----......................:--••-----------•------------------•----•.....................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of SIT I.;,,. 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
gn
e ; --..........
ate��Application Approved By-•-•_•.. . ........
•---•- -.. - --------------
" Date
Application Disapproved for the following reasons:------•--------•--------------------•-------------------....--------------------•---------............•....._._.
--------------•------•----------------.....------------------......--------------•-•-•------•-------.......------------------•--------------------------------•-----------•----------••-•--•••-.....---
• to
Permit No......................................................... Issued...G!..._.
D ---•------•--__
N ........�. `.. Fps....
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
::----...._. .... ......................OF.............................................
Appliration for Disposal Works Tonstratrt aan Prrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
S st at .. Ott ... _.
b- U ... � 1a -------•
Location-A ress
�i aO
f+ (jr ot;.Nyo
Owner Address .
a •- • '-�-------•--------•---•-----------•--------- ••--••-•--••-----•--•...--•.....-•--•-•-•__. ......... ....... .•-..... -
Installer Address
Q Type of Building Size Lot.... -.4Sq. feet
U Dwelling—No. of Bedrooms............. ____........................Expansion Attic ( ) Garbage Grinder ( )
Other-Type of Building.,............................. No. of persons.__-'......... ............. Showers ( ) — Cafeteria ( )
Q' Other fixtures .............
w
Design Flow_ _______ ____. :______.-gallons,per person per day. Total daily flow_..__.!�Q�- .................:....gall ons
x T Septic Tank Liquid capacity� gallons Length................ Width................ Diameter................. Depth................
Disposal Trench—No____________________ Width__ "..___.____.... Total Length.................... Total leaching area____ ,66.....................sq. ft.
/4
Seepage Pit No ............. Diameter....... ....... Depth below inlet....-:.......... Total leaching area_ .....sq. ft.
Z Other Distribution box ( Dosing.tank'( )
Percolation Test Results Performed by-----=---------%--------------------------------------------------......... Date........................_................
,aa Test Pit No. 1..... _minutes per inch ;Depth of Test Pit____________________ Depth to ground water........................
Test Pit No. 2................minutes per inch .'Depth of Test Pit.................... De h to ground water........................
x -• �'^ -
O Description of Soil.------ s1 _. `'" :4.
w
UNature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________
.
.............................................................
Agreement
The undersigned. agrees to install the aforedescribed Individual Sewage:�Disposal System in accordance with
the provisions of LITL, 3: ;5 of the State Sanitary Code. The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued.by the board of health::":
gne •-•-----•------•..........................•--••-•........-- ................................
p
Application Approve&By-•-• w -!!_''ce `
Date
Application Disapproved for the following reasons----------------•----•-•------•---•-------•-----.-..----------••----------------...-••-•-••--••••••----•----•---
.....---•••--•-•-•-•---••----------------•--••••••-•-•••-•--••-•--•-•-----...-•••-•-•---...._..•••-•••-•-••••--•-----•------•••••-•-------•---._...-•••-•••----•--•--•-•••---•---------••-•-••-----••---
Date
PermitNo......................................................... Issued................... te.-----------•-•-••-----------•--
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF EALTH
..........OF................. .. .........................................
Trrtifiratr of Toutplianrr
7;
T 0 CERT That the Individual Sewage Disposal System constructed ( or Repaired ( )
by 372L ......................... ._. .... , •-
at ue.... ��- � ........ ..
has been installed in aordance with the provisions of T r r of The State Sanitary de as describe in the
application for Disposal Works Construction Permit No_____ � � .."
= dated_.." . = 7. ----•----_----
THE ISSUA CE OF THIS CERTIFICATE SMALL NOT BE CONST E® ASA GUARANTEE;THAT THE
SYSTEM ldlllt NOTION 'SATISFACTORY.
DATE............. .. .......` ••-•--.L..... .----------••---. Inspector....
�. THE COMMONWEALTH OF MASSACHUSETTS
'rQ BOARD gg HEA,r�LTH
1.7
....... .......:OF.:........ . �r�/�!/.............................................
No......................... . FEE..."
5........
iar �t orko To lrn ' rrnti#
Permission reby granted....=--• -�• ---------- ---•----- -----------lr*p frrmit
........................................................
to Constpqct or Repair ) an n 'vldual Sewa D osal Syst`/pj/}7.j/��
at No.. �.._.:
Street
as shown on the aVication for Disposal Works Construction Per;;_ o __ __ Dated_._: .'... ........... ............
Board of fiealt
DATE---
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS - -
. r
bQ
N�
1 � x
1 1
VIAIE V14 2.D i EGT . .EASE,iKT. .:
-107x)t. Al°t
rn
InL=6(7/G
1 t
• . .� ..-tom t �U'Pa�v _ M j
coo C-ALL
I CO
COW-
oil
:i � t� I � �_ j•-��Gff r 1:
, �1 � ,, � �I � •i�P,k'cj�. taA9t�?'� SCf1✓!tE _ r _ '. r t
o<
III
--Q—DISTANCE AS CERTIFIEDP.
I HEREBY CERTIFY THAT;THE BUILDING SOTE PLAN
SHOWN ON THIS PLAN IS LOCATED ON THE
GROUND AS SHOWN HEREON &THAT IT��' � LOCUS: L 2 L—Asg.
CONFORM.TO THE ZONING B LAWS OF THE Q jH4 OF D
TOWN OF TILAr! Nam- � y E64�E�"B" 6
WHEN CONSTRUCTED. DATE O� ARNE yG
g REF: G C CTfi U LT'' ASS
dON//! CQpe e01�'Aft�.e rI/I�' cC.a OJALA PREPARED'FOR:' � I_L� ��Goc
#263 8
r CIVIL ENGINEERS
LAND SURVEYORS R_
Yarmouth&Orleans MA: - $UR��y. SCALE
i i� yo
S ,Q_
T,,,'O N - SEWAGE
=SEPTIC TANK - _ "D"BOX - LEACH �i T
TOP OF FDN
"2"OF t/8TO t!z"
WASHED STONE
A OUT.- IN
5. /��%Gi IN-
OUT
UT IN.
GO.�$ TANSEPTK i�d. SO
�___
ELEV. # ELEV. ELEV.
ELEV. . amiss
Q. ,`•n� ELEV. ELEV.
t
WASHED!
i
TEST HOLE LOG
TEST BY,�.iFgLQtSc�! �_7L � •;.V<<.`;'���.`. -®.0
TEST DATE.' CJ C WITNESS d. .
DESIGN BEDROOM HOUSE _
/ T.H. # 1 T.H. # 2.
�02.7 u ELEV. �o �. Cr ELEV. NO
PERC RATE 4 _MIN/IN DISPOSER. DISPOSER
--
G� FLOW RATE 3.3 (GAL./DAY) 330
SEPTIC TANK
REQ'D SEPTIC.TANK SIZE
}, CLEmM LEACH FACILITY
SIDE WALL G/D:
� �i +• BOTTOM i'%11�, (O.O I �', 78,;: , G/D''<
TOTAL
_._ ... USE: �'�''� LEACHING �`.7
WATER ENCOUNTERED
NOTES: •(UNLESS OTHERWISE NOTED)
1. DATUM (MSL)+TAKEN FROM --M- ��= -- -------- �
2.MUNICIPAL WATER--•--:--_1 ____-______._-____-______AVAILABLE
3..PIPE PITCH: 1/4"PER FOOTc-
4: DESIGN LOADING FOR ALL PRE-CAST UNITS: AASHO-__fit=
5.MIN..GROUND COVER OVERALL SEWAGE FACILITIES: (1) FT.
6.PIPE JOINTS SHALL BE MADE WATER TIGHT
7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS.
STATE ENVIRONMENTAL CODE TITLE 5
r �
REG.PROFESSIONAL ENGINEER.
BOARD OF HEALTH
CONTOURS (EXISTING)------------
(PROPOSED)—O O—O—O— APPROVED: DATE MA.
•' r a '� ,4 Y 4f; � Ems' '
f - �
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF BUSINESS: PtWvcF's -Z—keC��C c, TONIC, Mail To:
BUSINESS LOCATION: ' 6�0 _k�, �� ( 'V` ® 6 Board of Health
MAILING ADDRESS: Town of Barnstable
P.O. Box 534
TELEPHONE NUMBER: `�4 " y �— ��� Hyannis, MA 02601
CONTACT PERSON:
EMERGENCY CONTACT TELEPHONE NUMBER:
Does your firm store any of the toxic or hazardous materials listed below, either for sale or for
your own use, in quantities totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry
weight? YES NO
This form must be returned to the Board of Health regardless of a yes or no answer. Use the
enclosed envelope for your convenience.
If you answered YES above, please indicate if the materials are stored at a site other than your
mailing address:
ADDRESS:
TELEPHONE:
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health has determined that the following products exhibit toxic or hazardous character-
istics and must be registered regardless of volume. Please estimate the quantity beside the product that
you store:
Quantity/Case Quantity/Case
Antifreeze (for gasoline or coolant systems) Drain cleaners
Automatic transmission fluid Toilet cleaners
Engine and radiator flushes Cesspool cleaners
Hydraulic fluid (including brake fluid) Disinfectants
Motor oils/waste oils Road Salt (Halite)
�44L Gasoline, Jettte4 Refrigerants
Q Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, -
Other petroleum products: grease, lubricants rodenticides)
Degreasers for engines and metal Photochemicals (fixers and developers)
Degreasers for driveways & garages Printing ink
Battery acid (electrolyte) Wood preservatives (creosote)
Rustproofers Swimming pool chlorine
Car wash detergents Lye or caustic soda
Car waxes and polishes Jewelry cleaners
Asphalt & roofing tar Leather dyes
Paints, varnishes, stains, dyes Fertilizers (if stored outdoors)
Paint & lacquer thinners PCB's
Paint & varnish removers, deglossers Other chlorinated hydrocarbons,
Paint brush cleaners (inc. carbon tetrachloride)
Floor & furniture strippers Any other products with "Poison" labels
Metal polishes (including chloroform, formaldehyde,
Laundry soil & stain removers hydrochloric acid, other acids)
(including bleach) Other products not listed which you feel may
Spot removers & cleaning fluids be toxic or hazardous (please list):
(dry cleaners) (,�J
Other cleaning solvents
Bug and tar removers
i
Household cleansers, oven cleaners
White Copy- Health Department/ Canary Copy-Business
r `
TOWN OF BARNSTAB E COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
satisfactory 2.Printers
BOARD OF HEALTH 3.Auto Body Shops
O unsatisfactory- 4.Manufacturers
COMPANY (see"Orders") 5.Retail Stores
�� 6.Fuel Suppliers
ADDRESS Class: 7 7.Miscellaneous
QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors)
MAJOR MATERIALS Case lots Drums Above Tanks Underground
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels:
Gasoline,
Diesel, Kerosene, #2 (B)
Heavy Oils:
waste motor oil (C)
new motor oil (C)
transmission/hydraulic
Synthetic Organics:
degreasers
Miscellaneous:
DISPOSAIJRECLAMATION REMARKS:
1. Sanitary Sewage 2. Water Supply
O Town Sewer Public
)VOn-site OPrivate
3. Indoor Floor Drains YES NO
O Holding tank: MDC
O Catch basin/Dry well
O On-site system
4. Outdoor Surface drains:YES_LNO ORDERS:
O Holding tank: MDC ✓
O Catch basin/Dry well
O On-site system
5.Waste Transporter
Name of Hauler Destination Waste Product
014 YES NO
1. a
2.
2 27
P rson (s) Interviewed Inspector Date
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF BUSINESS: �� �� .��s1'L � � Mail To:
BUSINESS LOCATION: 1!V6 2 t a a ys Jf.'L ,,714 o 2 6 3 J Board of Health
Town of Barnstable
MAILING ADDRESS: P.O. Box 534
TELEPHONE NUMBER: S o 8- 4 2-k 5: q Hyannis, MA 02601
CONTACT PERSON: S T-AN L C/ W!L L/A n'I S
"EMERGENCY CONTACT TELEPHONENUMBER:5-66- y2-r q-r
Cl
Does your firm store any of the toxic or hazardous materials listed below, either for'sale or for
your own use, in quantities totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry
weight? YES wI NO
This form must be returned to the Board of Health regardless of a yes or no answer. Use the
enclosed envelope for your convenience.
If you answered YES above, please indicate if the materials are stored at a site other than your
mauling address:
ADDRESS: ill�3
TELEPHONE:
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health has determined that the following products exhibit toxic or hazardous character-
istics and must be registered regardless of volume. Please estimate the quantity beside the product that
you store:
Quantity/Case Quantity/Case
Antifreeze (for gasoline or coolant systems) .2 ftyl;Drain cleaners
Automatic transmission fluid Toilet cleaners
Engine and radiator flushes Cesspool cleaners
Hydraulic fluid (including brake fluid) Disinfectants
2 0/03 Motor oils/waste oils I Road Salt (Halite)
Gasoline, Jet fuel Refrigerants
e t-Diesel fuel, kerosene, #2 heating oil 2 C4,ys Pesticides (insecticides, herbicides,
Z i S Other petroleum products: grease, lubricants rodenticides)
Degreasers for engines and metal Photochemicals (fixers and developers)
Degreasers for driveways & garages i!i40 - Printing ink
Battery acid (electrolyte) Wood preservatives (creosote)
Rustproofers Swimming pool chlorine
Car wash detergents Lye or caustic soda
Car waxes and polishes Jewelry cleaners
Asphalt & roofing tar Leather dyes
CAC Paints, varnishes, stains, dyes Fertilizers (if stored outdoors)
w Paint & lacquer thinners PCB's
!i A, % Paint & varnish removers, deglossers Other chlorinated hydrocarbons,
POv Paint brush cleaners (inc. carbon tetrachloride)
IS-6-4L Floor & furniture strippers Any other products with "Poison" labels
/k% Metal polishes (including chloroform, formaldehyde,
l6 AV(, Laundry soil & stain removers hydrochloric acid, other acids)
(including bleach) Other products not listed which you feel may
Spot removers & cleaning fluids be toxic or hazardous (please list):
(dry cleaners)
15- C Other cleaning solvents
1 6ALCI S Bug and tar removers
Household cleansers, oven cleaners
White Copy- Health Department/ Canary Copy-Business
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
satisfactory 2.Printers
BOARD OF HEALTH 3.Auto Body Shops
O unsatisfactory- 4.Manufacturers
COMPANYt—',07 (see"Orders") 5.Retail Stores
erg, 6.Fuel Suppliers
ADDRESS 1l, O Z �� r Class: 7.Miscellaneous
QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors)
MAJOR MATERIALSCase lots Drums Above Tanks Underground
IN OUT IN OUT IN OUT #&gallons 777 Test
Fuels:
Gasoline,Jet Fuel (A)
V10i
(B) fr�'V
Heavy Oils:
waste motor oil (C) '
tra�rsmi��rro�lrpd�aulic�
Synthetic Organics:
degreasers
Miscellaneous:
l�
71411Z,1L Age
DISPOSAL/RECI.AMATION REMARKS:
1. Sanitary Sewage 2. Water Supply
O Town Sewer Public
Von-site OPrivate
3. Indoor Floor Drains YESjNO
O Holding tank:MDC t,,
,,(t'Catch basin/Dry well 4,r qg
O On-site system
4. Outdoor Surface drains:YES NO ORDERS:
O Holding tank: MDC
O Catch basin/Dry well
O On-site system
5.Waste Transporter
Name of Hauler Destination Waste Product
I . c YES NO
2.
Person (s) Interviewed Inspector Date
L
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
L Mail To:
NAME OF BUSINESS_: (!101 01(k6 EVIL21M - Board of Health
MAILING ADDRESS:` Y� b Pv+. 0--q 06-t wy� f'I S5 oyog— Town of Barnstable
TELEPHONE NUMBER:, �( P.O. Box 534
CONTACT PERSON:
Hyannis,:MA 02601
Does your firm store any of the toxic or hazardous materials listed below, either for sale or for
your own use, in quantities totalling, at any time; more than 50 gallonsliquid volume or 25 pounds dry
weight? YES NO _
This form must be returned to the Board of Health regardless of a yes or no answer. Use the
enclosed envelope for your convenience.
If you answered YES above, please indicate if the materials are stored at a site other than your
mailing address:
ADDRESS:
TELEPHONE:
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health has determined that the following products exhibit toxic or hazardous
characteristics and must be registered d
v _ Please put a check beside each product that you store:
Antifreeze (for gasoline or coolant systems) Drain cleaners
Automatic transmission fluid Toilet cleaners
Engine and radiator flushes Cesspool cleaners
Hydraulic fluid (including brake fluid) Disinfectants
Motor oils/waste oils Road Salt (Halite)
Gasoline, Jet fuel w -.Refrigerants =
Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides,
Other petroleum products: grease, lubricants rodenticides)
Degreasers for engines and metal X Photochemicals (fixers and developers)
Degreasers for driveways & garages Printing ink
Battery acid (electrolyte) Wood preservatives (creosote)
Rustproofers Swimming pool chlorine
Car wash detergents Lye or caustic soda
Car waxes and polishes Jewelry cleaners
Asphalt & roofing tar Leather dyes
Paints, varnishes, stains, dyes Fertilizers (if stored outdoors)
Paint & lacquer thinners PCB's
Paint & varnish removers, deglossers Other chlorinated hydrocarbons,
Paint brush cleaners (inc. carbon tetrachloride)
Floor & furniture strippers Any other products with "Poison"labels
Metal polishes (including chloroform, formaldehyde,
Laundry soil & stain removers hydrochloric acid, other acids)
(including bleach) Other products not listed which you feel may
Spot removers & cleaning fluids be toxic or hazardous(please list):
(dry cleaners)
Other cleaning solvents
Bug and tar removers
Household cleansers, oven cleaners
White Copy-Health Department/ Canary Copy-Business