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1047 FALMOUTH ROAD/RTE 28 - Health
1047 Falmouth Rd;Hyannis Fl= f o PI YOU WISH TO OPEN,A BUSINESS? For Your Information: Business certificates (cost$30.00 for years). A business certificate ONLY REGISTERS YOUR NAME i wn you must do by M.G.L.-it does not give you permission.to operate.) Business Certificates'are available at the Town Clerk's Office, 1� FL.(367which Main Street, Hyannis, MA 02601 (Town Hall) 733.Zazoi r /. DATE: & // Fill in please: i n5"";lni;i APPLICANT'S YOUR NAME/S: � ? �- l� �`� �.�:774va$�ai�"d���g� � � 'BUSINESS YOUR HOME ADDRESS._ YG, ��.,,c`ti-L✓� . enri Yl/ -s - f•Vl/"� �/ TELEPHONE # Home Telephone Number -Z -77 - � 3 iaufa NAME'`OF CORPORATION: NAME OF NEW BU51NE5S A�A1� =rilyStr ie� IS TH15 A HOME OCCUPATIONS YES NO AODRESS,OFBUSINESS : �h TYPE OF BUSINESS � �r r,n L�;,,� MAP/PARCEL:NUMBER O�l . . (Assessing) . . When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of J - Barnsta'ble. This form is intended.to.assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate,permits.and licenses required to legally operate your-business in this town. r 'I. _BUILDING COMMISSIONER'S OFf=ICE. This individual has been informed of;any permit requirements that pertain to this type of business: Authorized Signature** COMMENTS: 2. BOARD OF HEALTH This individual ha be" formed of the permit requirements that pertain to this type of business. MUST COMPLY WITH ALL ' ihVl�l HAZARDOUS MATERIALS ' Authorized Signature** ' LS REGULATIONS COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: . { TOWN OF BARNSTABL E Date:2 / TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: 41� BUSINESS LOCATION: I oLa FALmocrn-t _I�© HY+AVZS MA- 0a(00% INVENTORY MAILING ADDRESS: 047 4y4 1Vj.S , tAA Ja(oo i TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: .1oSE Poso EMERGENCY CONTACT TELEPHONE NUMBER: 5DFf -737-ORS8' MSDS ON SITE? TYPE OF BUSINESS: Oot�s'S-Ruc�nt)A3 L�N�Sc�t l INFORMATION/RECOMMENDATIONS: Fire District: BARNs�Bt-E -Try Waste Transportation: 57>47-IoN 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 y 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) i/' -N taulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes 5 Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison"labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials Date: $ / `) / o`/ - x TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: tQLAI'h BUSINESS LOCATION: �S VENTORY MAILING ADDRESS: 1t TOTAL AMOUNT: TELEPHONE NUMBER: S®R s '7°78 — d 9/6 _`� $. s a�ui(�(ons CONTACT PERSON:_ EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: INFORMATION/RECOMMENDATIONS: Fire District: 101 �1^ `GLe Gt�YLf1,c S e , Waste Transportation: ea- Last shipment of hazardous,waste: S- 25--c> Name of Hauler• C—. a Destination: Waste Product: s Licensed? es No NOTE: Under the provisions of Ch. 11, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) _ Ord Misc. Corrosive (®ate NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides INEW �— ED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel�ion gas Photochemicals Fixers Diesel Fuel, kerosene, #2 heating oil NEW USED 3 Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED S _ Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, _17 Misc. Flammables hydrochloric acid, other acids) Floor &furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers (including bleach) Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Date: 311 / o Ll TOWN OF BARNSTABLE ''TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: * U eCLA1•n BUSINESS LOCATION: •S�VENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: SOR -7-78 — D 8>/6 g• s � a•�S CONTACT PERSON:_L� �• �� l �•�AtA &TA'Q QS EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: P I u��vlorh �I-#2�1 -r`rta tMP INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: S— 25 C> Name of Hauler• C -P-- Destination: Waste Product: crit Licensed? es No NOTE: Under the provisions of Ch. 11, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division.. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum J Antifreeze (for gasoline or coolant systems) =5 0,cd_ Misc. Corrosive 6 NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) - Refrigerants Motor Oils Pesticides INEW ED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, viation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED 3aj Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil s 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 A Lye or caustic soda Rustproofers " Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar' PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED Sa cL4Any other products with "poison" labels Paint&varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor &furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): ICI Laundry soil & stain removers 114 rA ad (including bleach) Spot removers & cleaning fluids (dry cleaners) ti Other cleaning solvents Bug and tar removers f Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Town of Barnstable-Health Department Page 1 �i HAZARDOUS MATERIALS INVENTORY SITE VISITS ........... DBA: Briggs&Heino Pig&Htg Fax. ..... Corp Name: Mailing Address cation: 1047 Falmouth Road Hyannis Street: 1047 Falmouth Rd. .... _.._.._..___ _............ mappar: City: Hyannis Contact: 'Richard Briggs State: Ma /..� Telephone: 508-778-0816 Zip: 02601. N p� Emergency: P6rson Interviewed: Cindy Briggs i Business Contact Letter Date: 7/28/2004 Li _. Category: Builders/Contractors Inventory.Site Visit Date 8/6/2004 I1 Type: Follow Up/Inspection Date: 1 0 public water ❑ indoor floor drains ❑ outdoor surface drains ❑ license required ❑ private water ❑ indoor holding tank mdc ❑ outdoor holding tank mdc ❑ currently licensed ❑d town sewage ❑ indoor catch basin/drywell ❑ outdoor catch basin/drywell expir - ❑ on-site sewage ❑ indoor on-site syste ❑ outdoor onsite system date: _ _._.__ _....___................ Remarks: 5/20/97 MSDS sheets on site. Note:See 97 inspection report compliance: for current haz.mat.on site. Satisfactory `5 6 1 �e r Page 2 Town of Barnstable-Health Department HAZARDOUS MATERIALS INVENTORY Chemicals: ❑ zero Toxic Waste Materials ❑d gty's>25 Ibs dry or 50 gals liquid but less than 111 gals ❑ gty's 111 gals or more description., qty;:'' unitof"'measure waste oil I 25gallons ___.._._._ .___..___.....__....__....____.__.____....._......_.............._..........._....._._..........................._......_......._...._.._....____._..__ ..._...........__.____...__..._........_....._._.........._.. antifreeze(for gasoline or coolant systems) 2icases Windshield Wash 2cases S Waste Transporter: (s%✓�///���� � — Fire District: Last HW Shipment Date /zj i� Waste Hauler Licensed: ice/ l � TOXIC AND HAZ RDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: �.e_a (a'-'"®P-4Tr—.or,) Board of Health MAILING ADDRESS: 60. 8 oX 1145 Town of Barnstable TELEPHONE NUMBER: P.O. Box 534 CONTACT PERSON: le�N Rve�_o 6-ix t-cS Hyannis, MA 02601 021(e o 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 1� 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 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 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 & 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 a 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 DATE: . 2/23/00 A PROPERTY ADDRESS:Associated Alarmp _____ --.U4.7_SDULe..28 --------- 4 On the above date, I Inspected the septic system at the above address. This system consists of the following: 1 . 6-6 ' x8 ' bloc cesspools . 2 . 1-1000 gallon' precast leaching pit packed in. stone . . Based on my Inspection, I certify the.following conditions: 3 . This is not a .title five septic system. 4 . This is a sewage system. ...5 . The sewage sysem is in proper working order at the present time .- 6 . Pumped all of the inflow cesspools at time of inspection . SIGNATURE:.f — JGiI� • Name:_,L Company: Jose,ph_P. Macomber & Son, Inc . Address; Box_6.6 ------- __Centerville , Ma . 02632-0066 Phone: - 508-775_3338___ __ d THIS •CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY J6SEPH P. MACOMBER & SON, INC. Tsnks•Cesspools•Leichfields 3 Pumped L Instilled Town Sewer Connections P.O. box 66 Centervllle, MA 02632-0066 r 775.3338 775.6412 COMMONWEALTH OF M,ASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617)292.6600 TRUDY C Seu ARGEO PAUL CELLUCCI DAVM B. STF. Governor Go S. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION prper-tyAddrays:1047 Route' 28 Narneofowner Associated Alarms . C e nt�e r v1,11 M 02632 Address of Owner: Dsvoilnspectsor+: I/23�b Joseph. P.Macomber Jr . Marna of Inspecuw: (Please I wn a DEP oved sysn Impactor to Suction 16.340 of Thie 6(310 CUR 15.000) Cornpam Marna: J. '.r w Macomber & Son Inc . M—T, Address: Box 66 Cantarvi I I e Ma cc 02632 Tetaphorse Number. 3338 cERTIFIcATION STATEMENT certify that I have personally Inspected the sewage disposal system at this address and that the Information reported below Is true. acculste and complete as of the time of Inspection. The Inspection was performed based on my tralning and experience In the proper function and maintenance of on•slte sewage disposal systems, The system: /Passes Conditionally Pastas _ Needs Further Evaluation By the Local Approving Authority _ Falls 1 /� Inspoctoes S1gn+oue: Data: The System Inspec shall submit a copy of this Inspection report to the Approving Authority(Board of Health or DEP)wttNn thirty (30) deys completing this Inspection. if the system Is a shared system or has a design flow of 10,000 gpd or greater,the Inspedior and the system ow 0&11 submit the report to the appropriate regional office of the Department vKmvironmentsd Protection. The original shouldbe.sent to-r" system owner and copies sent to the buyer, If applicable, and the approving authority. . NOTES AND COMMENTS 1 •'1 r..9� ` V MAR 6 Zoo (O�NM Of OEPT tiLE s' �1 HEAL w revised 9/2-/98 Page lorll es Recycled hper - �,� Printed on ,. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) ' PropertyAddr"s: 1047 Route 28 Cente.rville ,Mass . Owner: Associated Alarms . Data of kup•ction:2 2 3/0 0 INSPECTION SUMMARY: Check A. B, C, of D: A. SYSTEM PASSES: 1 have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any faawe criteria not evaluated are Indicated below. COMMENTS: S. SYSTEM CONDITIONALLY PASSES:::. One or more system components sa described In the"Conditional Pass'section need to be replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health, w11I pass. Indicate yas, no, or not determined(Y, N. or ND). Describe basis of determination In all Instances. If'not determined',explain why not. je +The •ptic tank s metal, unless the owner or operator has provided the system Inspector with a copy of a Certificate of Comp anc•(attached)Indicating that the tank was Installed within twenty(20)years prior to the date of the Inspection: or the fi`apUc tank whtather.or not metal,Is cracked,structurally unsound,shows substantial Infiltration or exfUuation, failure is imminent. The system will pass inspection If the existingseptie tan Is'replaced with a complying septic tank as z,j approved by the Board of Health. Sewage backup or breakout or high static water level observed in the sulbution box s due to broken or obstructed pipe(&I or due to a broken, setdod'or uneve sulbutlon box. The system will pass Inspection If(with approval of the Board of Health). broken pipe(&)are replaced obstruction Is removed distribution box Is levelled or replaced The system faquirad pumpMg-more than•low-dmea-a yeardue to broken or obsuncted pipe(sY. The mystsm wKtj7s3s" inspection If(with approval of the Board of Health): - broken pipe(&) are replaced obstruction Is removed a revised 9/2/98 Page 2orit SUBSURFACE SEWAGE DISPOSAL SYSTEM[ASPECT1dN FORM PART A CERTIFICATION (continued) Property Address:. Owner:. Date of Inspection: ` s C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF.HEALTH:, Conditions exist which require further evaluation by.the Board of Health in order to determine if the system is failing to protect the 'public.health, safety and the environment., 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE EN UBONMENT: Cesspool'or privy is within 50 feet of surface water •Cesspool or privy is within 501eet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has aseptic tank and-soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. " water supply well. _ m and the SA S is within 50 feet of a rivals at pp y The system has a septic tank and soil absorption system P The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is.free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less ttian'5�ppm. Method used to determine distance (approximation not valid). 3) OTHER 5 . "This`' is -a 16wa•gP ystPra'Three separate systems . Main cesspuuIzs tdnks . Sottd e is being P held'pthe main cesspool and the waste water is passing g over to the overflows . System is in excellent working order at the present time . q a revised 9/2/98 Page 3ofII , . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) PropertyAddre": 1047 Route 28 Centerville ,Mass . Ownw: Associated Alarms Date of Inspection: 2/2 3/0 0 D. SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: I have determined that one or more of_the following failure conditions exist as described In 310 CMR 15.303. The basis for this determination is Identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No / Backup of-sewage into4scili"rsTstem component-dusCo an overloaded or.cieggedSA"r-cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. �L1d#I!'L Static liquid level in th distribution box Bove outlet invert due to an overloaded or clogged SAS or cesspool. ✓�_ Y-i ' Liquid depth in ceaspootis less than 6" below invert or available volume is less than 1l2 day flow. Required pumping more than 4 times In the last year NOT due to clogged or obstructed pipe(s). Number of times pumped : Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or,privy is-within a Zone I of a public well. 4Z Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for »coliform bacteria, volatile organic.compounds, ammonia nitrogen and nitrate nitrogen. F ` E. LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following- The following criteria apply to large systems in addition to the criteria above: 1 The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No J ._ the system is,within 400teet of.a surface drinking water supply the system is-within 200 feetof•e-tributary-toaaucfaoe-drwikirrg.wator+upialy _ -- the system is located.in a.nitrogen sensitive area(Interim Wellhead Protection Area=IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4ortl SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ` SYSTEM WFORMATION Prgm-tyAddraaa: 1047 Route 28 Cent.erville ,Mass . Owner: Associated Alarms Da'of kupectlon: 2/2 3/0 0 FLOW CONDMONS RESIDENTIAL- Design flow:V(fg.p.d.lbedroom. . Number of bedrooms(design): Number of bedrooms(actuaq:a Total DESIGN flow A111 Number of current residents: Garbage grinder(Yes or no):.N - . Laundry(separate system) (Yes or no)4- A If yes, sepacatoInspectlon.requlred Laundry system Inspected (ypa or no)A)� Seasonal use(yes or no):2,: gf �)�✓� Water meter*readings,If eve )able bast two year's usage(gpd): a Sump Pump(yes or no),4)� 9� Q Last date of occupancy: COMMERCtAUWDUSTRIAL• r Type of establishment: 13 Ill- &ItJS � Design flow: d ( ase�n 16.2031Q f� T Basis of design flow 7 V'; /7. -2' j� y �� ' " awl AJ1/"ct GF7_ —� Grease trap present:(y;a or no)_ Industrial Waste Holding Tank present:(yes or no)-AA Non-sanitary waste discharged to the Title 6 system:(yes or no)A) _ Water meter readings,if evoilobl8L Last date of occupancy: OTHER:(Describe) Last date of occupancy: ' GENERAL INFORMATION PUMPING 1 O RD S and source of I f d n- System pumped as part of Inspection:(yes or no) If yes, volume pumped: WA g no A Reason for pumping: Yni r- Lhf:C iH zv4Z TYPE OF SYSTEM eptic 1 Septic tank/distribution boz/soil.absorptlon system Single cesspool9 Overflow cesspool Privy Shared system(yes or no) (If yes, attach previous inspection records,If any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other �R Xl TEA �}all com, W nts, te install it w -and source*114wforrmtion:APf�Rq '-�'� � Sewage odors detected when arriving at the sits.(yes or no) �!V revised 9/2/98 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Prop"Address. 10 4 7 Route 28 Centerville ,Mass . Owner: Associated Alarms Date of Inspection:2/2 3/0 0 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No _ Pumping information was provided by the owner,occupant, or Board of Health. None of the system•eompoaants hawl»en prtaMwd4oi st-J"sttwoawoWwaadtba•system hubaeoasceiaiagwasaaai flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _ As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. _ All system components, luding the Soil Absorption System, have been located on the site. • '1 The -optic tank manhole ere uncovered,opened, and the interior of the se tic tan as inspected for condition of baffles or tees, material of construction, dimensions,depth of liquid,depth of sludge, depth of scum. The size and location of the Soil Absorption System orrthe site has been determined based on: Existing information. For example, Plan at B.O.H. _ Determined in the field(if any of the failure criteria,related to Part C is at issue,approximation of distance is unacceptable) (15.302(3)(b)) _ The facility owner(and.ocr-pants.H different from owner).waraprauidad.with inf�rMskt oaan.the_prapaz aaintan&Qc^^f SubSurface Disposal Systems. revised 9/2/98 Page 5of11 ,f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Addret": 1047 Route 28 Centerville ,Mass . Ownw: Associated Alarms . Data of Inspection: 2/2 3/0 0 BUILDING SEWER: (Locate on site plan) �J�1/ Depth below grade:.�2 Material of construction-. cast iron 40 PVC�other(explain). Distance frorp,� vate w er supply well or suction line Diameter '�jY/ Comments:(condition of Joints, venting,evidence of leakage,-etc.) - - Joints appear tight No evidence of leakage s0snc TANK A/C. (locate on site plan) Depth below grade. Material of construction'r( concret&4// metabG�FlberglasaA/i9 PolyethylenevtAother(explaln) If tank is Enetal,list age Js.age.confrmod by Certificate of Complianc (Yes/No) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee orbaftis Scum thickness:�t4 Distance from top of scum to top of outlet tee or boffio: A)A Distance from bottom of scum to bottom of outlet toe or baffle: Ahl How dimensions were determined: AA Comments: (recommendation for pumping, condition of Inlet and outlet tees or-baffles, depth of liquid level In relation to outlet invert, structurai-integrity, evidence of leakage,etc.) eptic tank is not prPsPnt GREASE TRAP: (locate on site plant Depth below grader Material of construction4o-concreteFnetal. FiberglassA/�PolyethyleneN�/ other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom.of.outlet tee or baffler Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level In relation to outlet Invert, structural Integrity, evidence of leakage, etc.) Grease trap is not present revised 9/2/98 Page 7ofIt SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIQ,N FORM PART C SYSTEM INFORMATION(continued) Property Address: 1047 Route 2 8_: C e.n t e r v i l l_a ,M ass . Owe: Associated Alarms . Date of Inspection: 2/2 3/0 0 TIGHT OR HOLDING TANK:�rf(Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grader Material of construction4concret%ametalO Fiberglasa4APolyethylene /&other(explain) w1�4 Dimensions: A4 Capacity: e,4 gallons Design flow:• A/A gallons/day Alarm present Alarm level: Alarm in working order:Yes44 No/� ' Date of previous pumping: Ali _ Comments: (condition of inlet tee, condition of alarm and float switches, etc.) ig 5r- hoiding tanks 7re . not present . DISTRIBUTION BOX-A� U (locate on site plan) ` Depth of liquid level above outlet invert: 4109 Comments: (note if level and distribution is equal, evidence of solids carryover;evidence of leakage into or out of box, etc.) — Distribution boxes are not present . PUMP CHAMBER: , (locate on site plan) Pumps in working order: (Yes or No)I ^ Alarms in working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) Pump chamber is not- present , revised. 9/2/98 Page 8ofII " SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ` SYSTEM INFORMATION(contirxred) Property Address: 1047 Route 28 Centerville ,Mass . Owner: Associated Alarms Data of Inspection: 2/2 3/0 0 Z SOU.ABSORPTION SYSTEM(SAS) (locate on site plan, If possible;excavation not required,location may be approximated by nonantrusive methods) If not located, explain: Type; leaching pits, numbsr:_j_ leaching chambers,number: leaching gallerles,number: leaching trenches,number, length: leaching fields, number, dime slons: overflow cesspool, number: Alternative system: Name of Technology: esspoo s prior 78 Code . Leaching Comments: was installed in 1982 l ote condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.) Eoamy sand to coarse Sand No s; gn4 nf hjTr1.-au1ic faall3r.e or ponding - 4n; 1 q nrA ri, All eesspeele Pit e . witn cast CESSPOOLS:_ (locate on site plan) Number and configuration: Depth-top of liquid to Inlet Invert: &AM IOU AjAl Depth of solids layer. Depth of scum layer: Dimenslohs of cesspool Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) -The in ow cesspools intrusion . Commanu: (note condition of soil, signs of hydraulic tailura,.level of ponding,condition obvegetation, etc.) + .—Same, as ahnva PRIVY: » (locate on site plan) Materials of construe on: �N� Dlmenslom: Depth of soUds: Commenu: h (not@ condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation;etc.) -Privy is not present - revised 9/2/98 Po¢r9orit SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(aonBnued) PropertyAd&*": 1047 Route' 28 Centerville ,Mass . ownw: Associated Alarms Date of k'i"t'on: 2/2 3/0 0 SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes Into house) xi . � • . f x� �' tSew�, y ; , ` Q \ P//4 a /•o o a p/�7iL^ „V 'revised 9/2/98 Page 10of11 Ills avir ct� • ''eao f-zf" �A'�► �►4.91�NS 1047 Route 28 Centerville ,Mass . V Y � Associated . Alarms REAR C7 #`! There are four catch Basins #4 # 1=5 ' x5 ' #1$#2 should be # 2=5 ' x5 ' cleaned out #2 . 4=-3=6,' x7 ' # 4=6 ' x7 ' '43 are dry #3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ` SYSTEM INFORMATION(continued) F6peirtyAddr—: 1047 Route 28 ;Centerville ,Mass . Owner: Associated Alarms . Date of kupection: 2/2 3/0 0 NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep _ SITE EXAM Slope Surface water Check Cellar Shallow wells i Estimated Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record , Observed.Site(Abutting property observation hole, basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps hecked pumping records --4zc :/Checked local excavators,installers }" Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) Used Water, contours map . Gahrety & Miller Model " 12/16/94 revised 9/2/98 Page II of II -•erne+•—nrrrT.-+-r— rnrmr•nn-rerns*rnrrnr�.�r++�►Jm-r�n nern•a+r+s�+vsr�n •rn-r-•r-�r-r-:..-. r—... TOWN OF Barnstable . BOARD OF HEALTH SUBSURFACE 9EHAGE f)ISF'USAL .SYSTEM INSPECTION FORM - PART D •- CERTIFICATION ••••l••t^T••.':'t—T.1tT.^.�TT11TT•!I•If.'fSI T'ilriRTlflTT►1'f—S•Ir'ItRT\iA��1'RIItAf1�fAll�Rt�T►7 7�1.111 ..�I`T•T•1• +..� -TYPE 0R PRINT CI.EARLY- PROPERTY INSPECTED STREET ADDRESS 1047 Route 28 Centerville ,Mass . 02632 ASSESSORS MAP, BLOCK AND PARCEL OWNER' s NAME Associated' Alarms . ' PART D - CERTIFICATION I NAME OF INSPECTOR Joseph P.Macomber Jr . COMPANY NAME J. P.Macomber & S'ulf 'INC . COMPANY ADDRESS Box- 66 Centerville ,Mass . 02632. Strout Town or City state LIP COMPANY TELEPHONE ( 508 1 775 - 3338. FAX ( 508 1 790 - 1578 R CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and omplete as of, the time of ,inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems:, jClec one ; Systeui PASSED The, inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public IiealLh or -the environment as defined in 310 CMR 16 . 303 , Any failure criteria not evaluated,-- Are as stated in the FAILURE CRITERIA section of this ' form . System FAILED* \ The - inspec`tion which I have con 'acted has found that the system fail-s' to protect- the public ,health and the environment in accordance with Title ` 5 ,' 310 CMR 15 . 303 , and as specif-ically noted on PART C - FAILURE CRITERIA -of. this inspection form . Inspector Signature 1,4Date _ eo copy of this certification must be provided to the OWNER, the 13UYER One where applicable ) and the BOARD OF HEALTH. * If the inspection FAILED, the owner or operator shall upgrade ' the , System within one year of the date of the inspection , unless allowed or required . otherwise as provided in 3.10 CMR 16 . 305 . partd .doc TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH O satisfactory 2.Printers 3.Auto Body Shops unsatisfactory- 4.Manufacturers ���NO ` (see"Orders") 5.Retail Stores COMPANY ��-�C� 6.Fuel Suppliers ADDRESS �ZI � Maxi • lass: 7.Miscellaneous QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors) MAJOR MATERIALS IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil(C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: - P6U0. , ace, - , pl 4& . - ICJ 4). o 0 JA"h' lr� I DISPOSAL/RECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply O Town Sewer Public Xon-site 0Private 3.Indoor Floor Drains YES N0 O Holding tank:MDC 0 Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: 0 Holding tank:MDC h O Catch basin/Dry well O On-site system v�.�c a 5.Waste Transporter ,,,,��,.,,����, 01 � � -41 YES NO am, 2. erson(s) Inte6idwed Inspector Date r TOWN OF BARNSTABLEFO OMPLIANCE: CL� 1.Marine,Gas Stations,Repair 2.Printers BOARD OF HEALTHsatisfactory 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS "�/1 I:f�Zl C BSS. 7.Miscellaneous QUANTITIES AND STOP GE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Drums Underground IN OUTI IN OUT IN OUT #&gallons Age Test Fuels: ,GaseRrre—,Jet FA)— e B-) Heavy Oils: waste motor oil (C) new motor oil(C) «.tr-ansmis nAwdr_auh,e Synthetic Organics: d*greasers- Miscellaneous: DISPOSAIJRECLAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply O Town Sewer Public f lOn-site Private L 3. Indoor Floor Drains YES N0� O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS:Q Holding tank:MDC _ _ O Catch basin/Dry well O On-site system 5.Waste Transporter 1. / Vp"- YES NO 2. n erson s) Int wed Inspector Date TGW, Nu OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH - 2.Printers satisfactory 3.Auto Body Shops O unsatisfactory- 4.Manufacturers MPANY G (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADD a 7.Miscellaneous QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALSam PER MW IN OUT IN OUTI IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel(A) Lc/ 4 Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil(C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: U DISPOSAU/REC;LAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply O Town Sewer $�Wublic NrlOn-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__k_NO O RS: O Holding tank:MDC Catch basin/Dry well O On-site system 5.Waste Transporter mom= YES NO 1. S-a-A 2. 10,7 Pe s Inte wed Inspector Date TQXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESSES �ti��� ���. ��TG ���'� Board of Health MAILING ADDRESS: U `�'Z �--o►�.w�c��"��-� �� , ff IVr Town of Barnstable TELEPHONE NUMBER: cL;>0b- -1-18r- 0 '9 P.O. Box 534 CONTACT PERSON: Hyannis, MA 02601 �Z. i.�0�7dL�Za'� S 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 characteristics and must be registered uo -,-[,s PNease 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 I 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 & 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, y 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 TOWN OF BARNSTABLE yCOMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers OA D OF HEALTH 3.Auto Body Shops �dn/ unsatisfactory- 4.Manufacturers COMPANY `, �t JC-! /V O (see"Orders") 5.RetailFuel Stores 21 I -7.Miscellaneous ers ADDRESS lr?/-�'`J1 FA/ li�ll�y'� �.0 Class: N y�NN�S QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors) MAJOR MATERIALS Case lots 1 ,. - , , IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: DISPOSAL/RECLAMATION REMARKS: /�/J) ���p� 1.LSanitary Sewage 2.Water Supply A(O (/I 6_k . ,9y) O,Town Sewer `Public n�7 V-6 G)eO 0 /A�� O On-site OPrivate 3. Indoor Floor Drains YES NO (-)n lF �7 JE� 1-, )A // OA( Sll_ - O Holding tank:MDC /rV Va ` / , V PC, / (�! � O Catch basin/Dry well ( /a�1`!(�/ / Y / n���'i rAT, llwvvl./ O On-site system 4. Outdoor Surface drains:YES NO ORDERS: / O1 C t' O Holding tank:MDC d O Catch basin/Dry well (_Q/tirz�-/ Plkin F, AIV O -fg1)rx) ' O On-site system � 2 1c; I C 5. Waste Transporter Name of Hauler Destination Waste Produc YES NO 1. 2. , Person (s) Interviewed Inspector Date .. �. � " k i 04 ee Oie eased 1047 FALMOUTH ROAD HYANNIS, MASSACHUSETTS 02601 (508) 778-0816 1-800-453-6444 PROCEDURES REGARDING FUEL OIL RELEASE • 3 i - 1 ) Driver or- Service Technician A . Stop the oil release from spilling or leaking at the , sourcpi ' by any means possible at ,your disposal . B . Contain the oil release that already spilled or . leaked froM.i, spreading ( especially into a sewer or waterway) i . e. sand,! f oil dry etc . C. Notify the Office IMMEDIATELY after securing the. area. 778-0816 775-0404 - 1-800-453-6444. D. Written .report to the office within (7) seven days of tle , incident . j l 2) . Office Personnel - Massachusetts Law ( 10) ten gallons or mo�e. isreportable . j,. A!. Notify Fire Department Official for the District in whichl' Ithe, '. release has occurred -B . Notify Envirosafe for standby response. Office' 1-888-�7$, E Numerical . Page Heather 488-1201 or Nick :488-06 1 . i C. Notify D. E . P. of the release 1-946-2850. D. Notify U. S: Coastguard if the release is by .a waterway . 1-800-424-8802 . E. Notify the local Board of Health for, thelTown in.: which release has occurred 1 ' ! F . Record the ,fol lowing : Driver , truck , time; pt,a`ce , weat r he a1.1 'out going and in coming phone cal 1.s regarding the':, release G'. ;Writte.n report must be filed with D.0 T. on Form 5800 .. 1k dupliclate within ( 30 ) thirty days of incident . , = H.: : As, a result of the incident a person is killed or 1njurxes that require hospitalization or property damage exceeds ) < < x . $50 , 000 telephone D.O . T. 1-800-424-5802 at the earliest practical moment after the incident . ABOVE ALL FOLLOW YOUR BEST JUDGEMENT j i Town of Barnstable Health Department 367.Main Street, Hyannis, MA 02601 Office 508-790-6265 Thomas A. McKean FAX 508-775-3344 Director of Public Health February 22, 1996 Briggs&Heino Plumbing& Heating Co., Inc. 1047 Falmouth Road Hyannis, MA 02601 Enclosed is brass valve tag #1305. Please attach to the fill pipe of your underground tank. You must do the following as indicated: ---- Remove your tank. I have enclosed information for you regarding tank removal. X Have your tank tested starting now. You must test during the loth, 13th, 15th, 17th and 19th year and annually thereafter. Removal in the year. I have enclosed information regarding tank testing. In order to have your tank tested you must first contact an engineering company (see attached) to have a monitoring well installed. Once the monitoring well has been installed you can then call 362-2511, extension 334 and ask for Charlotte Stiefel or George Heufelder at the Barnstable County Health Department, to have your tank tested via the Soil Vapor Analysis Test. ---- Due to the unknown age of your tank we must presume it is twenty (20) years of age. Therefore, you must remove your tank. If you have any questions,please feel free to call Health Inspector, Donna Miorandi, at 790-6265. Thank you. Thomas A. McKean Director of Public Health Encs. Note: All tank removals.require a permit through the local Fire Department. r v �THETo,� The Town of Barnstable 0`P 0 Health Department 1 D'n'n`n' 367 Main Street, Hyannis, MA 02601 rug ob 6�9 ` Office 508-790-6265 Thomas A. McKean FAX 508-775-3344 Director of Public Health date � 99 - m Dear Enclosed is ass valve tag # tr�oPlease attach to the fill pipe of your underground ank. You must do the following as indicated: ---- Remove your tank. I have enclosed information for you regarding tank removal. - Have your tank tested starting /V( / You must test during the loth, 13th, 15th, 17th and 19th year and annually thereafter. Removal in the year I have enclosed information regarding tank testing. ** In order to have your tank tested you must first contact an engineering company (see attached) to have a monitoring well installed. Once the monitoring well has been installed you can then cal 362-2511, extension 334 and ask for Charlotte Stiefel or George Heufelder at the Barnstable County Health Department, to have your tank tested via the Soil Vapor Analysis Test. ---- Due to the unknown age of your tank we must presume it is twenty (20) years of age. You must eve ��tesed— s bo-v-e--Lr�e e o. If you nave A ave any questions, please feel free to call me at 790-6265.:. Thank you. e o Health Inspector V�11 LS �6 A f6p A u, --rA ghgUc? L C' M7W F6 r � F.P. 292 t , l e Granntm*tnit� of . ssar4usetts - Department of Public Safety—Division of Fire Prevention APPLICATION FOR PERMIT FOR REMOVAL AND TRANSPORTATION TO APPROVED TANK YARD G.82 S.40 M.G.L. To: HEAD OF FIRE DEPARTMENT F. DIG SAFE, NUMBER In accordance with the provisions of Chapter 148, G.L. as provided in Section 38A Application is hereby made by -' v� ' Name oT erson, irm or orpora ion) 'P O :2 rn4.Yb Address For permission to remove and transport underground steel storage tank(s) from Q0 ;n,n \1,J;�,c y 1 4 3x�1N Street address (city or town FDID#0 -� to approved Tank Yard# Z.t7 107 State clearly type of Inert gas used in Co z steel storage tank ype of inert gas use Name of Person, Firm, Corporation disposing tank Tdnkon UVA,VV,Nq� Date issued - rejected' �\ , 19 87 By: r Date of expiration� paid/due ign e o pp c n -- - - - - -- - - - -- - - - -- - - -- - - - - -- - - - - -- - - - - - - - The Cammantaealtb of 01t0atbutetts DEPARTMEI IT OF PU13LIC SAPM—DIVISION OR FIRE PROMNTION PERMIT ,�► FOR REMOVAL AND TRANSPORTATION TO APPROVED TANK YARD C.68 S.40 M-GA., 010 SAFE NUMBER In accordance with the provisions of Chapter 148, G_l, as provided in Ek'7 a-LZ50 Zia Section 38A this permit is granted to Name: Taw1Fi� Ur�l ..r:, Vull name of person, firm or Corporation To transport underground steel storage tank(s) to Approved tank yard# � - - tate clearly type of „ Vhnert gas used in *� teel storage tank steel tank: (:lGrz r method DID#c:,-> � � �� Name and addrej.�..•of contractor ' ��+� disposing tank ter\%e_P lee paid $ 10-= location to which tank will be transported '_0 (D7FPpr ov ,y "71his permit will expire 1 Z ^ 19 IZD� � -� Signature of' icia7 gr-a- n�pe� r:t tIITLc) '(Head of Fire ]Dept.) ZO 39Vd 36Id SINNVAH 8PV98LLBOS 8Z:60 ZTOZ/81/90 06/18/2012 09:28 5087786448 HYANNIS FIRE PAGE 03 RECEIPT OF DISPOSAL OF UNDERGROUND .STEEL„STORAGE_ TA;it,-... . NAME AND ADDRESS APPROVED TANK YARD +•'. � -:^ .,.. APPROVED TANX YARD NO. Tank Yard Ledger 502 CMR 3.03(4) Number: 1 of law I have per$onelly � the umex� s stor I certify under Pena tY ra#on or PAP / l�iYl delivered to this "apprwe8 ark p,.d a�neank yard' by ��n,00nf=.W CR with yAS6c F�eva�tice► Steel S a dismantling Y�g- kegulation 502 CM 3,R) Prvvisiams for Approving rt was issued LOCAL Head of Fire Depart�ent FDip# to transpo A valid pernu.t � .. this tank to this Yazd- owner or owners authorized representative: � and official title of aRw&ed Yard Trnz DATE SIGNED fire t I r s ui of disposal mast be recut to the local hears of the departme� FDID# put t tQ 02 C2'st : 0- (EMM 7M MJST EMVE A ' �' DI.S'Q6AL) FCC F.P. 291 (OVM 1� SUM FIM I4�T.'S OIL= Now y.--.---.---•-. -��C=.+��..��4 �....3�.'��_ ^"^' HE COMMONWEALTH OF MASSACHUSETTS -\ BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration for Disposal Works Tonotrnrtion rtrwit Application is hereby made for a Permit to Construct ( ) or Repair ( )s an Individual Sewage Disposal System at: Associated Alarms Route 28 Hyannis __ ----•-_... ..._. ___-----•--••-- ••--•••---••..........-•--_._ Location-Address or Lot No. .Read Corporatmon. W J.P.Macomber Jr. owner Address Installer Address Type of Building Size Lot............................Sq. feet V Dwelling No. of Bedrooms............................................Ex Expansion Attic a g— p ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter.--------------- Depth................ x Disposal Trench—No. .................... Width._..........._____.. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I----------------minutes per inch Depth of Test Pit.................... Depth to ground water......................... fZ Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................ K ------------------------------------------------------------••••--------- ------_----- O Description of Soil............ a. x Sand' 8c Gfi �_iT v .-------------------------••-•-•------..___......._._••-_..------------....._-••-••.............•----••--------------....._..•-----......-••-•-----•----......_... x •----•---•-•-----------------------------------------------•-------•----------..._.---------•------•-----•---•-----.._.-----------------•-----------•........-•-- ...................................... V Nature of Repairs or A er t• —A er w n a licable.____.__ _________ -T66b ganflon Ifea�$zing pit packed in stone -""--""--""-------------"-------"--"---""--""--...-"----""-"-"-"---""-------"----"-".•..."""-"""""...---"----""----------"----------"----"-""-"--"-................................................... Agreement: • The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia ce has e n issued by the boa of health. 11/13/92 Signed ....------ . ..... - .......-------------- - ....-------------.I.......... ....................................... Dare Application Approved By ...... ---------- ------�..........- '� �� ..Date---'...-......-- Application Disapproved for the following reasons- - --------------- -------------------- ............................................................ ........................ - ---------------------------- ------...........-------------....-----.................-------------------------------------- --------------------------------....---- - ------------- / Permit No. ------- ........ 7.......................... Issued ........ .. ✓�.-- ��... Date �"A _. ._30-P O r— THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Apphration for Disposal Works Cnnntrudtun 11ami# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: -Associated Alarms Route 28 Hy. - - ---•---------.................................--....................................... Location-Address or Lot No. Reld Corporatdbon. W J.P.Macomber Jr. owner Address Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms............................................Ex Expansion Attic a g— p ( ) Garbage Grinder ( ) aOther—Type of Building -_-_--_------------------- No. of persons--------•--.---------____--_ Showers ( ) — Cafeteria ( ) d Other fixtures ---------------------------------------- W Design Flow--------------------------------------------gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length---------------- Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width-------------------- Total Length.................... Total leaching area...................sq. ft. Seepage Pit No----------------_-- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '~ Percolation Test Results Performed by.......................................................................... Date........................................ 1 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (LI Test Pit No. 2----------------minutes per inch Depth of.Test Pit...:................ Depth to ground.water......_................. •-----------------------•-----•---...--------------•-••---------•-•-----------------••-•-•-......---......................................................... 9 Description of Soil------._.___-__-_--- . ..._.._._ r WSand---- u"ray e 1----------•-------------------------------------------------------------------------•-•---------........-------•-•--. U ---•-------------------•-•-----••------....-••-----------------•---•....----------•--------------------•--------------•---•---------------------••--•--•--•---------------•---••----------...---•...... W • •----•------------------------•---•----•----------••---------•------•--------------•-----•-•---------------------------•----------•---•---------------------•--...•-------------...._....----------- V Nature of Repairs or Alterati s—An wer when applicable___________________________�...,____ ....._...................................... 1-1c�3C gai.�on lening pit I cKea in stone. -----------------------------------------------------------------•---------------•-----•-------------•--••------••------ % Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the boar8 of health. (, 11/13/92 Signed:?-- ------ - =!' Date ................ Application Approved BY ---r----------------------------------- -�� . a'` Date Application Disapproved for the following reasons: ---------------_ v-------------------------------------------------------------------------------------- -------------------------------------- -- ------ Date Permit No. �---.............. - ----------- Issued ' -2-. �� Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C�ex#tf r'ate of (funtylianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (XXX) by.J-,.P.Macomber Jr. -- ----------------- ---- -----------------........------------------------------------------------------....-----............................................................--------- at Associated Alarms Route 28 Hyannes ,Mass . - -- ----------------- ---- ---------------------- ------- -------------------------------------------....................--------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of he State Environmental Code as described in the application for Disposal Works Construction Permit No. ...:� dated ...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE... '-'-- L-"- 1.- z ---- -- -- ----------------------- Inspector --- - .-.-. .............. ........................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH NJ;- / TOWN OF BARNSTABLE No.✓..._�.: �1� FEE... ..30..00 J P Macomber Jr. Permissionis hereby granted--•-- -------------•------------------•-•--.•--•-----------••-----------------•--------•-----••--••---........-•---........................ to Construct ( ) r RepairX(XX) a Individual�S toe Dis osal System Associated Alarmstou-te i `y nni ,lvtass atNo---....................................----------•-•-•-----------------------•••....-••------•--------------------•---.......--------•-•--------•--- I Street as shown on the application for Disposal Works Construction Permit ?Dated....//r'' r�'��. .......... ------- Board of Health DATE-- --r / FORM 36508 HOBBS&WARREN,INC.,PUBLISHERS ' '. 55&t a TOWN OF BARNSTABLE BrcQ� _ r-(�PMs -& ok LOCATION tog 7 RTc- 2,-,z-, SEWAGE # VILLAGE ASSESSOR'S MAP & LOT D D O INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) J�.% (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER �. BUILDER OR OWNERS �,T A Q DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No L— % t s 3� 0 m � r - =y N r - "a 1� '-N ry -" TOWN OF BARNSTABLE LOCATION ZeO�' A64 AF SEWAGE # VILLAGE ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) 171 11,9446 NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater'Table to the Bottom of Leaching Facility Feet Private Water Supply Well Leaching Facility (If any wells exist on site of within 200 feet of leaching facility). Feet Edge of Wetland and Leaching Facility(If any wetland xist within 300 feet f le 'ng fac, 'ty) Feet Furnished by, ��' sx- O VIR i itQ 9 � 6� 66 r i Qo , o 0 TOWN OF BARNSTABLE UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS NAME Associated. Alarm Systems, Inc. ADDRESS 1047 Falmouth Rd.. VILLAGE Hyannis LOCATION OF TANKS: CAPACITY: TYPE OF FUEL AGE: TYPE: OR CHEMICAL 1047 Falmouth Rd.. 2000 gasoline 10 yrs steel (Give same information for any additional tanks on reverse side of card) DATE OF PURCHASE OF EACH: 1. '2.' 3. 4. DATE OF FIRE DEPARTMENT PERMIT: TESTING CERTIFICATION SUBMITTED: 1 PASSED - - DID NOT PASS IA l o HE�Ti TOWN OF BARNSTABLE (Il vOLS y OFFICE OF BA LI i >, M" BOARD OF HEALTH i63q. MAY `e0 367 MAIN STREET E� A.. HYANNIS, MASS. 02601 February 17, 1981 THIRD REQUEST Manager Childs Electric Co. Inc. Box 1148 - Rte. 28 Hyannis, Ma. I I Re: Your underground fuel storage tanks located on Route 28, Hyannis Dear Sir: On March 11, and September 30, 1980, you were sent a copy of the Board of Health Regulation for Underground Fuel Storage and a card to fill out and return listing information concerning your underground tanks. You have not returned the card nor acknowledged our letter. ` I Town records indicate that you have received' a permit to ;I store fuel underground. Please be advised that if you do not return the enclosed card within five (5) days, steps will be taken to. revoke your permit. Appropriate action will then be J taken to have your tanks neutralized or removed. li - I You are also reminded that any tank fifteen years of age or older must be tested by the Kent-Moore Pressure Test. An empty tank may be tested by a 5PSI Air Pressure Test. This testing must be done immediately. i The enclosed card must be filled out and returned immediately. Very truly yours, Mfl-7C irector of Health JMK/mm encl. 1 I "g . . r i 57 P '; i •;.'w, 'I v 5' r,,j,� ; '°° _ .t ♦ k «'- �.. l q + r ty .t r a j ♦i '"':,R i i - r ¢"` r . t T r r ,.9y f�;¢ ,'- d'v s`r .. xt.J r 6. 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S$ "`+ �� r r -r r'.! .h r }7 r Yx.23 .i 4 aI Zr 3' t-.M ° ,{s' �-.r.: r �r °'t. r. " J. X s �S ". .rc "' . v N ,r, yj'k rr f.� •x < t ,r tt r^ - �- •ik ¢ u t 'i^ ~7 r F' t a , % a ,n e k ,w x,,. r ' Y r 1,$I y X „`h t ` '�` w .. ,.{'� r r w T;+x �. . -x- t ., 1 ,,-, ' _ ,t. r; { ¢ �I + w� � e , d I i x F ¢ P Ala rv. �' „ .° 'w r ,i'�ti ;N k df{ :.� _ a w s * a,� ffl'' { s a - .+ -+ 4 t' N N k;J a s :,a, e 3 rnl� $¢ + ¢•, .. yw,•,. Y March 6 SS--Llcense cai-I U Pe CC1Ckk[xutc c:a i -114—i uu1- ucc:A NAME inlu a since summer , L,ACATION . , + r Childs Electric' Co. ,Inc Rt. 28 Box 1142, ,Rte. 2 Hyannis yannis, Mass. eid Corp — owner) BOOK &"PAGE DATE GRANTED AMOUNT STORED 77/207 September 2Q, l Under cOGC; gals: 6asoh.ne DATE .PAID 1973 March 22 r_ MAR 71974 v Jim t s Pump & ,Tank Service P .O. Box 224 Harwich, Mass. 02645 May 14,1985 Associated Alarm Systems Inc. Route 28 Hyannis, Mass. 02601 Gentlemen; The 2,000 gallon underground storrage tank in back of Associated Alarm Systems Inc. was air tested for a period of 24 hours and during this time 5 leis. of air was held. a - Sincerely Yours; ja= ase ,, � � :.� ^ , i �• '_ t �. J � 7 ` ) ) .j �i } 7 ' � ; �. .� � �, ,. , i -� �- . . ^� � � z' ,. �c �> �, ;. �• , .., , , :..i- � j e � t z -� r � �, =, .. ,. 3 i 1 r ,; < � ,• ', .-� '� � �� � February 13,.1985 Manager Associated Alarm Systems 1047 Falmouth Road Hyannis, MA. 02601 Dear Sir: Our records indicate that your_ 2,000 gallon gasoline tank located on your property at 1047 Falmouth Road, Hyannis, to be fifteen years of age,, Town regulations require all tanks fifteen years of age, or older, to be tested using the 'Kent Moore Pressure Test or if the tank is empty, a 5 PSI Air Pressure Test I may be used. A copy of our regulation is enclosed. 1 You are directed to have your tank tested by June 1, 1985. Please submit testing _ results and their interpretation to,this office prior to June 1, 1985. Failure to do so could result in legal action and the penalty of a f ine. Each separate day's failure to comply with an order shall constitute a separate violation. You may request a hearing before the Board of Health if written petition requesting same is received within seven (7) days.of receipt of this order. For your convenience, we have enclosed a listing of companies who perform this testing. You may utilize any other concerns qualified to perform this testing. ,Very truly yours, John M. Kelly Director of Public Health for Robert L. Childs, Chairman Ann Jane Bshbaugh Grover C. M. Parrish, M. D. BOARD OF HEALTH TOWN OF BARNSTABLE JMK/mm encl. 2 �. � �.r� f � `` c� l3. ,. .._ _ _,.. . _.._ .� r-_. ...a -� -- � �_ �_.- ----- •-- -� --- -- I