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HomeMy WebLinkAbout1031 MAIN STREET (OST.) - Health 1 311 MAIN� T_ _ CAZF AULT ROOFMG` � E YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $40.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in the Town (WHICH YOU MUST DO according to M.G.L. it does not give you permission to operate). You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st Fl., 367 Main St., Hyannis, MA 02601(Town Hall) and get the Business Certificate that is required by law. DATE a- Fill in please: /) APPLICANT'S YOUR NAME/CORPORATE NAME A v L- S C Z-����'� S +��✓S i C, BUSINESS YOUR HOME ADDRESS: / 0 M TELEPHONE # Home Telephone Number NAME OF NEW BUSINESS 4w— S EIN: Have you been given approval from the building division? YES NO ADDRESS OF BUSINESS v i= T as T��v��� +� MAP/PARCEL NUMBER 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 Barnstable. This form is intended to assist you in obtaining the information you may need., You MUST GO TO 200 Main-.St. — (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business . in this town. 1. BUILDING COMMISSIONER'S OFFICE 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 has been inform% h per i req Pnts that pertain to this type of business. Authorized Sign ture** COMMENTS: (ilus'T.,OMPLY WITH ALL 3. CONSUMER AFFAIRS (LICE SING UTHORITY) L r` This individual has bee i7for of a licensing requirements that pertain to this type of business. - Authorized Signature** Gt COMMENTS: Town of Barnstable Hazardous Materials On-Site Inventory and Inspection FACILITY INFORMATION: Business Name: (��iL_1=Atttf &&A,6,. Business Location: Id,3/' A6f/J ST. ®STEMVI&4,6 Mailing Address: AS 'fae✓t Telephone Number: Contact Person: Emergency Contact Telephone Number: Type of Business: HAZARDOUS MATERIALS (CHAPTER 108) Virgin Product Total Quantity Container Size(s) Storage Location Major Materials Gallons or Pounds: Quarts, gallons, Shed,retail store, drums,tank,etc... cabinet,closet,etc �e_r_i, �B�7�J�SS (?°ar�3osr - 1 - r' f Misc. Combustibles Misc. Corrosives Misc.Reactive Misc. Toxics Inventory Total Amount: 4 P p AOX►''`-tt 2M /a"! Hazardous Materials License Posted?Yes No Contingency Plan Posted? Yes No Fire District: Fire Extinguisher Service Date: �- Metal Covered Rag Bin: Yes NoN`Akbsorbent Material Available? Yes o Type of Absorbent: Speedy Dry Pads Pigs Other: MSDS on site Yes No Hard Copy Computer Access Hazardous Waste Handling Hazardous Waste Generator Identification Number: �/ A Type(s) of hazardous waste product(s): Date of last hazardous waste shipment,type of waste and quantity: , Hazardous Waste Transporter(s): Designated Hazardous Waste Facility: Hazardous Waste Storage Area Description: Is hazardous waste storage area labeled: Yes No Are tanks/drums/containers labeled with the words "Hazardous Waste",the type of waste and the associated hazard (i.e. ignitable, corrosive,reactive or toxic) Yes No If hazardous waste is stored out of doors is it covered from the elements? Yes No Is it in 110% containment? Yes No If hazardous waste is stored indoors is it on an impervious floor? Yes No J ' - 2 - s - r a i Lr FLOOR DRAINS (Chapter 381) Town Sewer Account Number: Indoor floor drains: Yes b If yes,circle one,does it discharge to'a: holding tank dry well on site septic. Outdoor surface drains: Yes If yes,circle one,does it discharge to a: holding tank dry well on site septic. FUEL AND CHEMICAL STORAGE TANKS (Chapter 326) Underground Storage Tank(s) on site? Yes ' No. Age: Is removal required? Yes o If yes,when? Is testing required? Yes. No If yes,when? Out of doors above ground storage tank on site? Yes No If yes,is it protected from the elements? Yes No If yes,.how? Is it on a foundation larger in size than the tank? Yes No COMMENT'S/RECOMM ENDATIONS/CORRECTIVE ACTIONS /S Nor f4 AZT Tv rYf S 7DKE UJE�/f p w c.r Lh-55 TfP,�VN /// CiA-I�AXU 00:�- 14 9& die fj ew's A-t A77VIAC. A-/S sZ-75 aA-J �� oN ,44�5-5 rD)ee-h CAI A AJ I.N/P C V �L�DO JQ• �f�'i�L� VUe?e 45 N o s-y ule erS l�r- / 7� 116 1�"n A, rMIA& xjaeE PA-9-77*1-1 EA-lhTy 'AW6 A ee t55W77A-z.�-y - [,&-fTa-�� FIK "A4P44---*7) cfo05• 1-7-IE /-tA-777er,-Z- IS STru- Mood AAA 6 /s use i SPILLS, Date: Public Health Inspector: Facility Representative: i - 3 - Massachusetts Department of Environmental Protection s Enforcement Notice: Bureau of Resource Protection Water Supply NON SE - 97 - Monitoring Violation Notice of Noncompliance M.G.L c.21A sec. 16, 310 CMR 5.00 General Information. 4 Please read carefully.This is an important notice.Failure to take adequate action in response to this notice could result in serious legal:consequences. '- COMMERCIAL CONDOMINIUMS PWS ID# 4172038 CLASS: NC 1030 MAIN STREET OSTERVILLE,MA 02665 Location and/or Source Code Where Noncomprance Occurred' INSTRUCTIONS 1. .Read all the ROUTINE SAMPLE LOCATION FOR TOTAL COLIFORM BACTERIA information on.thts- form carefully. FIRST, THIRD, FOURTH . QUARTERS (JAN,FEB,,MAR "AND 2 Submit the T :JULY—DECEMBER `199_ 6 attached Monitor ) .. .. ing Violation - _. _ -- Response Form and any required Description of Violations under;M.G.L c. 111 sec attachments to the . 159-160 and 310 CMR 22.00 DEP.Regional The Department of Environmental Protection,Division of forth in Section B "as required by 310 CMR 22.03(1); Office Contact 7 Water.Supply,has not received your system's monitoring resultsXX3• .failure to notify the public of your System's failure to monitor,in listed in Section F for violation of 310 CMR 22.16 the contaminant s and sampling , O . P 9 period specified above.As _, on the back page• such,your public water system is in violation of one or more of XX4. failure to notify the Department-of your.system's failure to the following requirements: monitor,in violation of 310 CMR 22.15. 3. Include the 4 xx indicates `violation; x e rtm ent records show that Pa _ NON number that X failure to report sampling results for the contaminant(s)and This W noncom fiance of this to occur appears in the the sampiing.period fisted above to the De P � . Park within the last 12 consecutive months. upper right-hand required by 310 CMR 22.15; Your system is a significant noncomplier(see Section G). comer of this X:?, failure to monitor for the contaminants and sampling period 'D See Section H for additional violation Information.notice on all correspondence and results forms Corrective Actions to Take and Deadlibe for Taking Such Actions ..:.you submit to . 1. f your system has already - .. -.DEP: � y collected samples for the.` ❑ Collect samples for the contaminant(s)fisted above dunng the contaminant(s)and sampling period set forth in Section S,you net sampling per, ��^ r µ-C«-_,, must subm it two copies of the sam pling lin resul ts Ks to 4. If you have any �) m ys 9 9 Y DEP ❑ Continue to collect samples for.the contaminants)fisted above Regional Office Contact within l0 da of receiving this NON. for the next monitoring quarter(s). questions,, You must include the attached Monitoring.Violation Response ❑ See Section I for additional corrective actions required .suggestions comments,or Form when you submit results. - , . please contact 2 If your system has not collected samples for,the XX 3. 1f your system has not yet notified the public of these your DEP Regional:�-contaminant(s)and sampling period listed above,you must:,`` violations,you must provide pubic notice within 30 days of receiving this NON. (Please m1hrto endosed sample-notrca.Office Contact. ) O Collect ample(S)immediately for thecontaiminant(s)fisted 4• f above and submit two(2)copies of the sampling results to of M applies only to significant noncompliers. your DEP Regional Office Contact within 30 days of receiving In addition to the above,you are required to submit"a plan detailing the specific actionsyou will take to prevent further noncompliance. this notice. You must include the attached Monitonng P This plan must be submitted with the attached.Monitoring Violation cc: <" Violation Response Form when you submit your results: :' Response Faint within 30 days of receipt of this NON. Bawd& X, r -Important Information , An administrative penalty may be assessed for every stay from now on that you are in noncompliance with the requirements , X described in this Notice of Noncompliance.Notwithstanding this NON,the Department reserves"the right to exercise the full extent of { la ows ewro^times its legal authority in order to obtain full compliance with all applicable requirements including,but not limited to,criminal prosecution civil action,including court4mposed civil penalties or administrative penalties assessed by the Department. . 2 copies g �_ Olfias of EnfCM@" of ( ` 7 ............ »...._.. _ Date L _7 Lawrence S.Day4n,Chief Rev. 9/95 Certified Mail Number(Return Receipt Requested) Weter Supply Section P.O. Box 1 121 ' West Springfield, MA 01090 P.O. Box 450 Phone: (413) 781-7474 Pocasset, MA 02559 (508)564-6607 Mason 21 South Main Street FAX: (508) 564-6610 Sharon, MA 02067 1-800-834-2330 Environmental Services, Inc. Phone: (617) 784-1326 October 15 1996 Mr. Robert Kearns, Case Officer DEP Emergency Response Section SERO - 20 Riverside Drive - `u Lakeville, MA 02347 ;® rp 7 . Reference: DEP Tracking No. RTN 4-12529 Dear Mr. Kearns: On September 27, 1996, at 3:05 p.m. the Department of Environmental Protection (DEP) , was notified of response actions being conducted relative to a release of approximately 20 gallons of hydraulic fluid from a BFI truck o Main Street, Osterville, MA. 1(t 03 J This release was caused by a broken hydraulic hose. Once the driver noticed the broken hose he turned off Main Street and parked on Fire Station Road, causing a small pool under the truck and a light mist on the pavement on Main Street. The spill was absorbed by 5 bags of speedi dri and sand which was scrubbed, picked up and contained in 55 gallon drums. The area involved on Main Street and Fire Station Road was entirely paved and no part of the spill reached soil or catch basins due to the early response action by BFI personnel and MES staff. Mason Environmental Services, Inc. , (MES) was contacted to provide cleanup assistance and Licensed Site Professional (LSP) services. A visual assessment by Gilbert T. Joly, LSP, determined that the hydraulic fluid had been adequately contained to pavement by response actions and that the potential threat to environmental receptors had-been removed. Waste material generated and contained in 2 DOT type H drums were temporarily stored at the RP's Yarmouth Facility. The drums were picked up for transport and disposed by- Cyn Oil Corporation on September 30, 1996 under Uniform Hazardous Waste Manifest No. MAD0621790236518R copy appended. Environmental Services Tank Services • 21 E Site Assessments Site Remediation Mr. Robert Kearns, Case Officer October 15, 1996 Page Two Attached is the required Release Notification Form BWSC-1031 also attached is the "Response Action Outcome Statement Form BWSC 104, the form states that response actions have eliminated the threat of release to the environment, there by achieving a Class A-1 Response Action Outcome. Sincerely, ON ENVIRONMENTAL SERVICES, INC. , i J Gilbert T. Jo l , L.S.P. , P.E. Vice President Of Operations Attachments cc: Mr. Robert Paltz Browning-Ferris Industries 61 Commonwealth Avenue S. Yarmouth, MA 02664 Barnstable Town Manager Town Hall 367 Main Street Hyannis, MA 02601 /Board of Health Town Hall 367 Main Street j Hyannis, MA 02601 Fire Chief Centerville/Osterville Fire Dept. 1875 Route 28 Osterville, MA 02655 J f :7CT-15-133S 10:19 FROM BF I TO 15,035-646S10 P.0 P.().0"IX 1121 Wect tipriVit-61.AIA(II Wit? P.O.Box 450 —7 Phunr:44►i)7141.7474 Focasset,MA 02559 (500);"-6W7 — 21 5uuth Main$ircni FAX:(5RI 564-6610 AR83)�� Nc�.wzx'i,,MA 0200 1-800 034-z330 Ea1►Wr0nMMTLAf Iq*l+lleM jnoC� (6171 7s4-I 26. October 15, 1996 or. Robert Paltz, iilan*W arOW&UM-Terris zadustries 61 ct]�.;S=al" OfW".- a. Tumath, x& 02668 f _D41¢laaatioa of Authorization )faiA tltireet, (JsUrvillm, NA Syfts4:3o oil spill c= 4- -:8 Dear Ilr. Paltat state requietiens that pezu" to the uncontrolled release of oillbazardous materials into the onvirozonamt are deziaed Wader 110 CXR 40.0000, tuv Massacha>aetts ContitV—�—i :"!= (Xc;?). Und3or 310 t--- 40.00t9(2), the owner/operator maw a11aw +a &3censed site Professional (UM) to act as as agent for the owner. Skis allows the MBF to sign documootatioa pertaining to rewired rssp6ase.actions) relative to the release of oil and/or hazard ms materials at 'ihe pr"ersys as =%udated imda MCW. ire intent of t121a declasati.00 will be t6 s.-edits the p«-Meseiag of Y.a,:s»;:».ssL.a n�'=�s Eavi zo eats2 9ror_-+ion ()ap) submittals, if reguirad. Please note that you will be provided wstb copies of all sumaittais provided to the DWEP. at xaso>a Mwirometfatal services, Gilbert T. ftl.g, LOP #5394, is licensed by the state plod try act on your behalf regllydi,ae the release of oil andior b&zarftus materials at tho property. Should yam A-662 to allow Kr. jolp :o Oct. " y=r =7=: piz:ra sign the deolaratir_ belay and return it to xaefon RnrrLYonmental. services; P.O. Ipox ASO. Pocasest, DMA 02SS9. if there are any questions, please call at (800) 034-2330. 1, sphert P lbsraby declare that Gilbert T. .rely, Licensed site professional., 05 '84, in ant mrizod as hey wjunt to *ign MM.. sad MCP associated a relating to the afcxetwatioaed propartj =ly. (Data) If yeu haver =' Westi;ona Cox acarulag thin matter, please teal free to call our CHice at or (566) 564-e667. Yotsts truly. S>!W=CStB, r3c., A cti :A l 01 rt T Joly, G.P.. V:LGe vrealmat Env mrwrxntal Services Tank Services a 21 E Site Auft$a r3nb + Site Kttme4atiun TOTAL P.02 • � ` A �I �rirs� �;,J �.,��Lfi";}�U�EaI��r'�s.dta psi z�4'� P/ ' " / • � tlisi�n'�-�t�di _ - �a r�ty aJ`r�#�7��`ti• ''��jC -•r�f.`�"a I ° ► � r a s�.l^'t'rsLF � r"r..vC ,Fx�.it S r E� � ii � i c ♦ � , .y ��a,'�...,,�`�x - �cu�fZa�r��ss;�4 r 'fpr �Y���'r�' A' •,,Jr 1t, 1 °`M1• :i! 3,. ..: i�x a s s°Rl�;r. c� ruE t �� rEc.�r ft�1 ' �r 5 V�3 �� •• � 1 � `�.' �,:7�IYf..c �� r t}• t � -c. v �! �y�^"•1`at.R i Fr ��� �J-��tr � • ,j � '`� �i� � � �f _ s IP a{�i 4.Yi r�r'} � k \ � i � �� #�„J�if„ Yi �+�. t.Jam, ��t�t t�' Jh 'F�'i.'�•.t�r xj � i Jt �MA 47. gR l �v OW JT �+-.isP T`' y y i s'� �,� 'J+ 1 , " ' /�tF�•.,�•.4y'$ °� '%a ;*t ..r � � t•'.;::t�l e '�,• t9 fA� ,1�„<,�� _ t� ^ ° N ra:>r i a{ ti i ;>" i•''� �'��,�:. �•!`' (� � E � �iT���4���1 i.�. 1�4 .� ��� ,I�J' 1.`t`J� iYS ii' R�7 .} �V �-Cew.C.i�ySf 3•`ci- .�- 1��� .Jg4�i!•� t1 i �'} 1 `�µ -i �...��� � � • e�'�, tr,e�'ra+k^'��-'�.j as r twy, l f� 1` }f \_.�>�:n-31.;iyS�x w�' � Si. .i �, .•1 � ip'•i C �tlt. 1 �y7 , •� , 1' �,"��kF4^C�D���l S G!ny� .t'a )t�ii� $.'+C' ,_ !; � ` Y= �.ii22'•vv��-'�.�"���q� •�O�t111�..1 •I Sl 4_�`y: 2 \ u �,,,. � �{a�r�i4,p� r•.r x pz u#,'� f r� `'' �sy, '� p �. .� {�T�ir',` •�c .a �.�..,',c. If}}� Sry y.tt - 5�i'ry1:9 BI♦ L�� � 0t�(r'-' 7 � Fmmpwvl �;� ° t 1!� ?'2�'wti'4��♦4�rk:� l:• •,y •�i"• � ��.�� - '�•Ili. WSW �/i'!`�"��:. : a�;�/ �.,) _ •fir• ���e : - c � �'��``=� R 7 e���� � 1'i, ♦: l � 1• ' '.1 1 ��, ,> rt t'Y Sys "�i in�.� n 6�6 r r 1'15'•��1.'�i.�•� •-y. . '� 1• �, '�•,JV/}��ii� � ri)1,P��t�'�l�,�y,'3"�' �r�A';. ,� .�'f_ :h^•:I s. '�•' �� �' ` `a.:.�•°� W�ic :•sue �+hc ,�u�d-...;. Massachusetts Department of Environmental Protection " BWSC-103 Bureau of Waste Site Cleanup Release Tracking Number RELEASE NOTIFICATION & NOTIFICATION RETRACTION ® - / j 2 FORM Pursuant to 310 CMR 40.0335 and 310 CMR 40.0371 art C Sub A. RELEASE ORRT THREAT �OF RELEASE LOCATION: (Subpart If assigned by DEP Street: A lLJ Z1 ► DAD Location Aid: F'� C-r+e<r....i City/Town: p g ZIP Code: 0 2 B. THIS FORM IS BEING USED TO: (check one) Submit a Release Notification(complete all sections-)f this form), ❑ Submi a Retraction of a Previously Reported Notification of a Release or Threat of Release(complete Sections A,B,E,F and G of this form). You MUST attach the supporting documentation required by 310 CMR 40.0335. C. INFORMATION DESCRIBING THE RELEASE OR THREAT OF RELEASE(TOR): Date and time you obtained knowledge of the Release or TOR. Date: 2 Time: L3 '(CO Specify: ❑ AM Q PM The date you obtained knowledge is always required. T-ie time you obtained knowledge is not required if reporting only 120 Day Conditions. IF KNOWN,record date and time release or TOR occurred. Date: Time: i Specify: ❑ AM PM Check here if you previously provided an Oral Notification to DEP(2 Hour and 72 Hour Reporting Conditions only). Provide date and time of Oral Notification. Date: Time: � :� O 5 Specity: ❑ AM Pf4 Check all Notification Thresholds that apply to the Release or Threat of Release: (for more information see 310 CMR 40.0310-40.0315) 2 HOUR REPORTING CONDITIONS 72 HOUR REPORTING CONDITIONS 120 DAY REPORTING CONDITIONS Sudden Release N Subsurface Non-Aqueous Phase • ❑ q .❑ Release of Hazardous Material(s)to Soil or Threat of Sudden Release Liquid(NAPL-)Equal to or Greater than Groundwater Exceeding Reportable ' 1/2 Inch Concentration(s) ❑ Oil Sheen on Surface Water ' Underground S ❑ 9 Storage g Tank(UST) ❑ Release•of Oil to Soil Exceeding Re rtabl Release e 9 Po ❑ Poses Imminent Hazard Concentration(s)and Affecting More than 2 Cubic ❑ Threat of UST Release Yards ❑ Could Pose Imminent Hazard ❑ Release of Oil to Groundwater Exceeding Reportable ❑ Release Detected in Private Well ❑ Release to Groundwater near Concentrations) Water Supply ❑ Release to Storm Drain ❑ Subsurface Non-Aqueous Phase Liquid(NAPL) Release to Groundwater near Equal to or Greater than 1/8 Inch and Less than 1/2 ❑ Sanitary,Sewer Release School or Residence Inch - (Imminent Hazard Only) List below the Oils or Hazardous Materials that exceed their Reportable Concentration or Reportable Quantity by the greatest amount. If necessary,attach a list of additional Oil and Hazardous Material substances subject to reporting. Name and Quantities of Oils(0)and Hazardous Materials(HM)Released: a T O or HM Released O HM CAS# Amount or Reportable Concentrations- check one Units Exceeded,if Applicable ( ) (if known) Concentration (RCS-1,RCS-2,RCGW-1,RCGW-2) A435 El El El El D. ADDITIONAL INVOLVED PARTIES: ❑ Check here if attaching names and addresses of owners of properties affected by the Release or Threat of Release,other than an owner who is submitting this Release Notification(required). XCheck here if attaching Licensed Site Professional(LSP)name and address(optional). You may write in names and addresses on the bottom of the second page of this form. Revised 3/1/95 Supersedes Form BWSC-003 Do Not Alter This Form Pagel of 2 Massachusetts Pepartment of Environmental Protection BWSC-103 Bureau of Waste Site Cleanup Release tracking Number RELEASE NOTIFICATION & NOTIFICATION RETRACTION FORM Pursuant to 310 CMR 40.0335 and 310 CMR 40.0371 (Subpart C) If assigned by DEP E. PERSON REQUIRM TO NO NY: Name of Organization: 6 f2 0 W 0 1'tN Ei �aJ�° I s hf Q LC-I- �^ Name of Cor`.act: 8 ) � Title:A, 12 .C!A Q Street: A.A 0 JAI t,Jl A LX R City/Town: y yASR nn o t-CT7" State: ZIP Code: Q 2 (p(o Telephone: Ext.: FAX:(optional) F. RELATIONSHIP OF PERSON REQUIRED TO NOTIFY TO RELEASE OR THREAT OF RELEASE: (check one) RP or PRP Specify: O Owner O Operator (V Generator O Transporter Other RP or PRP: Fiduciary,Secured Lender or Municipality with Exempt Status(as defined by M.G.L.c.21 E,s.2) Agency or Public Utility on a Right of Way(as defined by M.G.L.c.21 E,s.50)) Any Person Otherwise Required to Notify Specify Relationship: G. CERTIFICATION OF PERSON REQUIRED TO NOTIFY: attest under the pains and penalties of perjury(i)that I have personally examined and am familiar with the information contained in this submittal,including any and all documents accompanying this transmittal form,(ii)that,based on my inquiry of those individuals immediately responsible for obtaining the information,the material information contained in this submittal is,to the best of my knowledge and belief,true,accurate and complete,and(iii)that I am fully authorized to make this attestation on behalf of the entity legally responsible for this mittal. Itthe person or entity on whose behalf this submittal is made amrs aware that there are significant penalties,including,but not limited to, pos bl mes and imprison t,for willfully submitting false,inaccurate,or incomplete information. Yt,QiS O By: Title:V I r si For: Date: (print name of person or entity recorded in Section E) Enter address of the person providing certification,if different from address recorded in Section E: Street: p Y( 4S-b City/'Town: 'Po C-A SSsr--r State:VA SS ZIP Code:Og`'� —y-( b Telephone: 12611 S 836 Ext.: FAX:(optional) .,5b f 56 4 6(./o YOU MUST COMPLETE ALL RELEVANT SECTIONS OF THIS FORM OR DEP MAY RETURN THE DOCUMENT AS INCOMPLETE. IF YOU SUBMIT AN INCOMPLETE FORM,YOU MAY BE PENALIZED FOR MISSING A REQUIRED DEADLINE. Revised 3/1/95 Supersedes Form BWSC-003 Page 2 of 2 Do Not Alter This Form Massachusetts Department of Environmental Protection Bureau of Waste Site Cleanup BIINSC-104 RESPONSE ACTION OUTCOME (RAO) STATEMENT DOWNGRADIENT PROPERTY STATiiiUS TRANSMITTAL FORM Release Tracking Number Pursuant to 310 CMR 40.0180(Subpart B),40.0580(Subpart E)&40.1056(Subpart J) ® -k�i4D A. SITE OR DOWNG �IENT PROPERTY LOCATION: Site Name:(optional) L I I I't, L IL A L Street: �►w 1 ► � Cj(�!✓(� c�'T1 a n l 12en4 i� j Location Aid: Q� l�(/)I.Lz 9 7-/O� City/Town: �,SJ _�l1/L[.� ZIP Code: Check here if this Site location is Tier Classified. If a Tier I Permit has been issued,state the Permit Number: Related Release Tracking Numbers that this Form Addresses: If submitting an RAO Statement,you must document the location of the Site or the location and boundaries of the Disposal Site subject to this Statement. If submitting an RAO Statement for a PORTION of a Disposal Site,you must document the location and boundaries for both the portion subject to this submittal and,to the extent defined,the entire Disposal Site. If submitting a Downgradient Property Status Submittal, YOU must provide a site plan of the property subject to the submittal and,to the extent defined,the Disposal Site. B. THIS FORM IS BEING USED TO: (check all that apply) Submit a Response Action Outcome(RAO)Statement(complete Sections A,B,C,D,E,F,H,I,J and Q. Check here if this is a revised RAO Statement. Date of Prior Submittal: Check here if any Response Actions remain to be taken to address conditions associated with any of the Releases whose Release Tracking Numbers are listed above. This RAO Statement will record only an RAO-Partial Statement for those Release Tracking Numbers. Specify Affected Release Tracking Numbers: Submit an optional Phase I Completion Statement supporting an RAO Statement or Downgradient Property Status Su (complete Sections A,B,H,I,J,and Q. bmittal Submit a Downgradient Property Status Submittal(complete Sections A,B,G,H,I,J and K). Check here if this is a revised Downgradient Property Status Submittal. Date of Prior Submittal: Submit a Termination of a Downgradient Property Status Submittal(complete Sections A,B,I,J and Q. Submit a Periodic Review Opinion evaluating the status of a Temporary Solution(complete Sections A,B,H.I,J and Q. Specify one: For a Class C RAO For a Waiver Completion Statement indicating a Temporary Solution Provide Submittal Date of RAO Statement or Waiver Completion Statement: You must attach all supporting documentation required for each use of form indicated,including copies of any Legal Notices and Notices to Public Officials required by 310 CMR 40.1400. C. DESCRIPTION OF RESPONSE ACTIONS: (check all that apply) Assessment and/or Monitoring Only Deployment of Absorbant or Contaminent Materials Removal of Contaminated Soils Temporary Covers or Caps Re-use,Recycling or Treatment ❑ Bioremediation O On Site O Off Site Est.Vol.: cubic Yards � Soil Vapor Extraction Describe: EJStructure Venting System Landfill O Cover O Disposal Est.Vol.:' cubic yards Product or NAPL Recovery 'temoval of Drums,Tank;or Containers r- Describe: U Groundvrater Treatment Systems !.ir Sparging Removal of Other-Contaminated Media ❑ Temporary Water Supplies Q�JO Specify Type and Volume• � QnI $5i�g�h,r J Se gral DRY Temporary Evacuation or Relocation of Residents Other Response Actions P��s Fencing and Sign Posting Describe: Q Ccyu�������vM SECTION C IS CONTINUED ON THE NEXT PAGE. Revised 4l7�95 Supersedes Forms BWSC-004 and 010(in part) Do Not Alter This Form Page 1 of 4 z Massachusetts Department of Environmental Protection BWSC-104 Bureau of Waste Site Cleanup ' RESPONSE ACTION OUTCOME (RAO) STATEMENT & Release Tracking Number DOWNGRADIENT PROPERTY STATUS TRANSMITTAL FORM _ nn Pursuant to 310 CMR 40.0180(Subpart B),40.0580(Subpart E)&40.1056(Subpart J) ® �Ot C. DESCRIPTION OF RESPONSE ACTIONS: (continued) ❑ Check here if any Response Action(s)that serve as the basis for this RAO Statement i-,. ;ve the use of Innovative Technologies. (DEP is interested in using this information to create,an Innovative Technologies Clearinghouse.) Describe Technologies: D. TRANSPORT O`F' REMEDIATION WASTE: (if Remediation Waste was sent to an off-site facility,answer the following questions) Name of Facility: 7 1 nAQ 9QUd O Town and State: Quantity of Remediation Waste Transported to Date: �J 5` ��}1. % vyPE Al DRU 44 S . E. RESPONSE ACTION OUTCOME CLASS: Specify the Class of Response Action Outcome that applies to the Site or Disposal Site. Select ONLY one Class: Class A-1 RAO: Specify one of the following: Contamination has been reduced to background levels. 0 A Threat of Release has been eliminated. Class A-2 RAO: You MUST provide justification that reducing contamination to background levels is infeasible. Class A3 RAO: You MUST provide both an implemented Activity and Use Limitation(AUL)and justification that reducing contamination to background levels is infeasible. If applicable,provide the earlier of the AUL expiration date or date the design life of.he remedy will end: Class B-1 RAO: Specify one of the following: 0 Contamination is consistent with background levels 0 Contamination is NOT consistent with background levels. Class B-2 RAO: You MUST provide an implemented AUL.If applicable,provide the AUL expiration date Class C RAO: Check here if you will conduct post-RAO Operation,Maintenance and Monitoring at the Site. Specify One: 0 Passive Operation and Maintenance .0 Monitoring Only 0 Active Operation and Maintenance(defined at 310 CMR 40.0006) F. RESPONSE ACTION OUTCOME INFORMATION: ❑ If an RAO Compliance Fee is required,check hereto certify that the fee has been submitted. You MUST attach a photocopy of the payment. Check here if submitting one or more AULs. You must attach an AUL Transmittal Form(BWSC-113)and a copy of each implemented AUL related to this RAO Statement. Specify the type of AUL(s)below: (required for all Class A-3 RAOs and Class B-2 RAOs) 0 Notice of Activity and Use Limitation 0 Grant of Environmental Restriction Number of AULs attached: Specify the Risk Characterization Method(s)used to achieve the RAO described above and all Soil and Groundwater Categories applicable to the Site. More than one Soil Category and more than one Groundwater Category may apply at a Site. Be sure to check off all APPLICABLE categories,even if more stringent soil and groundwater standards were met. Risk Characterization Method(s)Used: � Method 1 Method 2 Method 3 Soii Category(ies)Applicable:&G k) S-1 U S-2 ® S-3 Groundwater Category(ies)Applicable:No i i y4 eA(g. GW-1 GW-2 NZ GW-3 > When submitting any Class A-1 RAO or a Class B-1 RAO where contamination is consistent with background levels,do NOT specify a Risk Characterization Method. > When submitting any Class A-2 RAO or a Class B-1 RAO where contamination is NOT consistent with background levels,you cannot use an AUL to maintain a level of no significant risk. Therefore,you must meet S-1 Soil Standards,,if using Frisk Characterization Method 1. R.vised 4/7/95 Supersedes Forms BWSC-004 and 010(in part) Page 2 of 4 Do Not Alter This Form ��. Massachusetts Department of Environmental Protection BWSC-104 Bureau of Waste Site Cleanup ' RESPONSE ACTION OUTCOME (RAO) STATEMENT & Release Tracking Number r ' . DOWNGRADIENT PROPERTY STATUS TRANSMITTAL FORM Pursuant to 310 CMR 40.0180(Subpart B),40.0580(Subpart E)&40.1056(Subpart J) 52�j G. DOWNGRADIENT PROPERTY STATUS SUBMITTAL: ❑ If a Downgradient Property Status Submittal Compliance Fee is required,check here to certify that the fee has been submitted. You MUST attach a photocopy of the payment. , ❑ Check here if a Release(s)of Oil or Hazardous Material(s),other than that which is the subject of this submittal,has occurred at this property. Release Tracking Number(s): O Check here if the Releases identified above require further Response Actions pursuant to 310 CMR 40.0000. Required documentation for a Downgradient Property Status Submittal includes,but is not limited to,copies of notices provided to owners and operators of both upgradient and downgradient abutting properties and of any known or suspected source properties. H. LSP OPINION: I attest under the pains and penalties of perjury that I have personally examined and am familiar with this transmittal form,including any and all documents accompanying this submittal. In my professional opinion and judgment based upon application of(i)the standard of care in 309 CMR 4.02(1),(ii)the applicable provisions of 309 CMR 4.02(2)and(3),and(iii)the provisions of 309 CMR 4.03(5),to the best of my knowledge,information and belief, > if Section B indicates that a Downgradient Property Status Submittal is being provided,the response action(s)that is(are)the subject of this submittal(i)has(have)been developed and implemented in accordance with the applicable provisions of M.G.L.c.21 E and 310 CMR 40.0000,(ii) is(are)appropriate and reasonable to accomplish the purposes of such response action(s)as set forth in 310 CMR 40.0183(2)(b),and(iii)complies(y) with the identified provisions of all orders,permits,and approvals identified in this submittal; > if Section B indicates that either an RAO Statemen4 Phase/Completion Statement and/or Periodic Review Opinion is being provided,the response action(s)that is(are)the subject of this submittal(i)has(have)been developed and implemented in accordance with the applicable provisions of M.G.L.c.21 E and 310 CMR 40.0000,(ii)is(are)appropriate and reasonable to accomplish the purposes of such response action(s)as set forth in the applicable provisions of M.G.L.c.21 E and 310 CMR 40.0000,and(iii)complies(y)with the identified provisions of all orders,permits,and approvals identified in this submittal. I am aware that significant penalties may result,including,but not limited to,possible fines and imprisonment,if I submit information which I know to be false,inaccurate or materially incomplete. ❑ Check here if the Response Action(s)on which this opinion is based,if any,are(were)subject to any order(s),permit(s)and/or approval(s) issued by DEP or EPA. If the box is checked,you MUST attach a statement identifying the applicable provisions thereof. LSP Name: ) L.B tl?r T' J It 01,� LSP#: �3� Stamp: t �� Telephone: �j() g 'J (o�. (� 07 Ext.: GILE-ERT FAX:(optional) O T. JOLY 0 9 No.5384 o n Signature: Date: 1151 '7 4 �SrEPi�O�` I. PERSON MAKING UBMITTAL: Name of Organization: W _ i Name of Contact: p ,�QT' Title: Af Street: (Q 1 0 M M 0 AJ W �rA /. H 4-V 9 City/Town: _ Y/4 2 A4 cV-rN State: --)A SS G �e S� ZIP Code: d Telephone: ( Q Ext.: FAX:(optional) J. RELATIONSHIP TO SITE OF PERSON MAKING SUBMITTAL: (check one) ❑ RP or PRP Specify: O Owner O Operator 1'�4 Generator O Transporter Other RP or PRP: ❑ Fiduciary,Secured Lender or Municipality with Exempt Status(as defined by M.G.L.c.21 E,s.2) ❑ Agency or Public Utility on a Right of Way(as defined by M.G.L.c.21 E,s.50)) ❑ Any Other Person Submitting This Form Specify Relationship: Revised 4!7/95 Supersedes Forms BWSC-004 and 010in art � part) Page 3 of 4 - Jo Not After This Form Massachusetts Department of Environmental Protection BWSC-104 Bureau of Waste Site CleanupI RESPONSE ACTION OUTCOME (RAO) STATEMENT & Release Tracking Number DOWNGRADIENT PROPERTY STATUS TRANSMITTAL FORM Pursuant to 310 CMR 40.0180(Subpart B),40.0580(Subpart E)&40.1056(Subpart J) K. CERTIFICATION OF PERSON SUBMITTING DOWNGRADIENT PROPERTY STATUS SUBMITTAL: 1, ,attest under the pains and penalties of perjury(i)that I have personally examined and am familiar with the information contained in this submittal,including any and all documents accompanying this transmittal form;(ii)that,based on my inquiry of the/those individual(s)immediately responsible for obtaining the information,the material information contained herein is,to the best of my knowledge, information and belief,true,accurate and complete;(iii)that,to the best of my knowledge,information and belief,I/the person(s)or entity(ies)on whose behalf this submittal is made satisfy(ies)the criteria in 310 CMR 40.0183(2);(iv)that I/the person(s)or entity(ies)on whose behalf this submittal is made have provided notice in accordance with 310 CMR 40.0183(5);and(v)that I am fully authorized to make this attestation on behalf of the person(s)or entity(ies)legally responsible for this submittal. I/the person(s)or entity(ies)on whose behalf this submittal is made is/are aware that there are significant penalties,including,but not limited to,possible fines and imprisonment,for willfully submitting false,inaccurate,or incomplete information. By: Title: (signature) For: Date: (print name of person or entity recorded in Section 1) Enter address of the person providing certification,if different from address recorded in Section 1, Street: City/Town: State: ZIP Code: Telephone: Ext.: FAX:(optional) L. CERTIFICATION OF PERSON MAKING SUBMITTAL: If you are completing only a Downgradient Property Status Submittal,you do not need to complete this section of the form. 1,— co 6 ✓-� 1 TZ t I attest under the pains and penalties of perjury(i)that I have personally examined and am fam i with the information contained in 19is submittal,including any and all documents accompanying this transmittal form,(ii)that,based on my inquiry of those individuals immediately responsible for obtaining the information,the material information contained in this submittal is,to the best of my knowledge and belief,true,accurate and complete,and(iii)that I am fully authorized to make this attestation on behalf of the entity legally responsible for this su ittal. I/the person or entity on whose behalf this submittal is made amAs aware that there are significant penalties,including,but not limited to, possib fines and imprisonment,for willfully submitting false,inaccurate,or incomplete information. in- Title: ymcd (sign e) l �1 For: Z. F Date: (print name of person or entity recorded in Section 1) Enter address of the person providing certification,if different from address recorded in Section I: Street: )R 0 g 4 S b Mig S City/Town: �p C— State: SS ZIP Code: WO Telephone: I�������Q Ext.: _ FAX:(optional) ,SAC� S(e��(�� 0 YOU MUST COMPLETE ALL RELEVANT SECTIONS OF THIS FORM OR DEP MAY RETURN THE DOCUMENT AS INCOMPLETE. IF YOU SUBMIT AN INCOMPLETE FORM, YOU MAYBE PENALIZED FOR MISSING A REQUIRED DEADLINE,AND YOU MAY INCUR ADDITIONAL COMPLIANCE FEES. Revised 4r7/95 Supersedes Forms BWSC-004 and 010(in part) Page 4 of 4 Do Not Alter This Form DIVISION OF HAZARDOUS MATERIALS One Winter Street ' Boston, Massachusetts 02108 Please print or type.(Form designed foe use on elite 0 2-pitch)typewriter.) ' UNIFORM HAZARDOUS 1.Generator US EPA ID No. Manifest 2.Page 1 Information in the shaded areas .WASTE MANIFEST lg,,A,0,016,212'i7191012131810gir nt�loof = is not required byFederaflaw. iiii !!GG •y,{; t�'•.s �•s�� tt�:a 3.Generator's Name and Mailing Address B fnS Fens iAiftistri � 3 61 Carmermulth AV62 ....aa -9�aa S. Yarmouth, 3�t266C it 4.Generator's Phone 150 5:-Tra sporter 1 Company Name 6. US EPA ID Number r ,. .: a girt rntta .aryrycq ?;' W 7.Transporter 2. Company Name 8. US EPA ID Number transport rte( v t rate ranal I� 1 9.Desi Hated Facility Name and Site Address;.. 10. US EPA ID Number NO $. �r � V �! 12.Containers 13. 14. 13 Ds 11.US DOT Description(Including Proper Shipping Name,Hazard Class,and ID Numbed Total Unit 1Nast ► .. 0 No. Type Quantity WtNol y y 00 a. STAT. E REG.ATO OlLY..SOLIDS ' N E d sue+'% 'J �.id .,~ ( .f.�'1 ';,f".• ��` ' >t.•• rrI p E f�, �f_l ��- (:. .,: :•!. rr_ r ,f v i-f o!i v. _ ? ; 7 J �! J r,_� rn IX A c. 0; rrl to r Z D ,y s. ,7ry<.. {'._ .rr.� is a,'-.••ry�ip-c R $.Y by is'! HE �f X•R- ¢. '.,tld'iv.1'W�`..v h+ 4[i._ 1,r C{^' <7 ..:i 4`t' T Z `LStBte aril '�D r.Mlatatia ''[s A vaJMm, 11 o�ico ? tr. In f a, 15.Special Handling Instructions and Additional Information y r �`:• ; 1, �j4�• m . . '� TM OIL.. tea- * > a 16.GENERATOR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by N proper shipping name and are classified,packed,marked,and labeled,and are in all respects:in proper condition for transport by highway Q according to applicable international and national government regulations. U If I am a large quantity generator,I certify that I have a program in place to reduce the vo!ume and toxicity of waste generated to the degree I have determined to be economically practicable C and that I have selected the practicable method of treatment,storage.or disposal currently available to me which minimizes the present and future threat to human health and the environ- . ment;OR,if I am a small quantity generator,I have made a good faith effort to minimize:my waste generation and select the best waste management method that is available to me end that I � can afford. - - -Date E' `; r .Printed/Typed Name � � Signature r Month Day„ Year' CD y F 17.f sporter 1 Acknowledgement of Receipt of Materials s..: Date I d,CO N Ppnted/Type�dNama Sit' tyre' - ;' Month, aye. Year c s �+` �. i.�j_ �wJ P�' .�,�... �, ..ate y P- _... Date 0 18.Transporter 2 Acknowledgemment of Receipt of Materials f E Pnnted/TypedName Signature ) Month .Day Yeai R 19.Discrepancy Indication Space F A c 1 20.Facility Owner or Operator:Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. Date T Printed/Typed Name Signature Y Month Day Year. Form Approved OMB No.2050.0039.Expires 9-30.96 - EPA Form 8700-22 (Rev.97"4 Previous editions are obsolete. COPY>8 : GENERATOR RETAINS y Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection Southeast Regional Office Off, William F.Weld Governor Trudy Coxe c« r ✓A Secretary,EOEA David B. Struhs Commissioner ¢ � URGENT LEGAL MATTER: PROMPT ACTION NECESfARY. plyCERTIFIED MAIL: RETURN RECEIPT REOUESTE � October 3 , 1996 BFI RE: BARNSTABLE--BWSC o 61 Commonwealth Road 1031 Main Street (� ��t�- South Yarmouth, Massachusetts 02664 RTN: 4-12529 NOTICE OF RESPONSIBILITY M.G.L. c . 21E, 310 CMR 40 . 0000 ATTENTION: Rob Paltz On September 27, 1996 , at 3 : 05 p.m. , the Department of Environmental Protection (the "Department" ) received oral notification of a release and/or threat of release of oil and/or hazardous material at the above referenced property which requires one or more response actions . A hydraulic line broke discharging oil onto the roadway. The Massachusetts Oil and Hazardous Material Release Prevention and Response Act, M.G.L. c .21E, and the Massachusetts . Contingency Plan (the "MCP" ) , 310 CMR 40 . 0000, require the performance of response actions to prevent harm to health, safety, public welfare and the environment which may result from this release and/or threat of release and govern the conduct of such actions . The purpose of this notice is to inform you of your legal responsibilities under State law for assessing and/or remediating the release at this property. For purposes of this Notice of Responsibility, the terms and phrases used herein shall have the meaning ascribed to such terms and phrases by the MCP unless the context clearly indicates otherwise . The Department has reason to believe that the release and/or threat of release which has been reported is or may be a disposal site .as defined by the M. C. P. The Department also has reason to believe that you (as used in this letter, "you" and "your" refers to BFI) are a Potentially Responsible Party (a "PRP" ) with liability under M.G.L. c . 21E §5, for response action costs . This liability is "strict" , meaning that it is not based on fault, but 20 Riverside Drive • Lakeville,Massachusetts 02347 • FAX(508)947-6557 9 Telephone (508) 946-2700 w -2- solely on your status as owner, operator, generator, transporter, disposer or other person specified in M.G.L. c .21E §5 . This liability is also "joint and several" , meaning that you may be liable for all response action costs incurred at a disposal site regardless of the existence of any other liable parties . The Department encourages parties with liabilities under M.G.L. c . 21E to take prompt and appropriate actions in response to releases and threats of release of oil and/or hazardous materials . By taking ' prompt action, you may significantly lower your assessment and cleanup costs and/or avoid liability for costs incurred by the Department in taking such actions . You may also avoid the imposition of, the amount of or reduce certain permit and/or annual compliance assurance fees payable under 310 CMR 4 . 00 . Please refer to M.G.L. c . 21E for a complete description of potential liability. For your convenience, a summary of liability under M.G.L. c . 21E is attached to this notice . You should be aware that you may have claims against third parties for damages, including claims for contribution or reimbursement for the costs of cleanup. Such claims do not exist indefinitely but are governed by laws which establish the time allowed for bringing litigation. The Department encourages you to take any action necessary to protect any such claims you may have against third parties . At the time of verbal notification to the Department, the following response actions were approved as an Immediate Response Action (IRA) : • Removal of Other Contaminated Media. ACTIONS REQUIRED Additional submittals are necessary with regard. to this notification including, but not limited to, the filing of a written IRA Plan, IRA Completion Statement and/or a Response Action Outcome (RAO) statement . The MCP requires that - a fee of $750 .00 be submitted to the Department when an RAO statement is filed greater than 120 days from the date of initial notification. Specific approval is required from the Department for the implementation of all IRAs and Release Abatement Measures (RAMs) . Assessment activities, the construction of a fence and/or the posting of signs are actions that are exempt from this approval requirement . In addition to oral notification, 310 CMR 40 . 0333 requires - that a completed Release Notification Form (BWSC-103 , attached) be submitted to the Department within sixty (60) calendar days of September 27, 1996 . ✓� -3- You must employ or engage a Licensed Site Professional (LSP) to manage, supervise or actually perform the necessary response actions at this site . You may obtain a list of the names and addresses of these licensed professionals from - the Board of Registration of Hazardous Waste Site Cleanup Professionals at (617) 556-1145 . i Unless otherwise provided by the Department, potentially responsible parties ( "PRP' s" ) have one year from the initial date of notification to the Department of a release or threat of a release, pursuant to 310 CMR 40 . 0300, or from the date ' the Department issues a Notice of Responsibility, whichever occurs earlier, to file with the Department one of the following submittals : (1) a completed Tier Classification Submittal; (2) a Response Action Outcome Statement or, if applicable, (3) a Downgradient Property Status . The deadline for either of the first two submittals for this disposal site is September 27, 1997 . If required by the MCP, a completed Tier I Permit Application must also accompany a Tier Classification Submittal . This site shall not be deemed to have had all the necessary and required response actions taken unless and until all substantial hazards presented by the release and/or threat of release have been eliminated and a level of No Significant Risk exists or has been achieved in compliance with M.G.L. c. 21E and the MCP. If you have any questions relative to this notice, please contact Robert Kearns at the letterhead address or at (508) 946- 2865 . All future communications regarding this release must reference the following Release Tracking Number: 4-12529 . Very truly yours, ,f ` Richard F. Packard, Chief Emergency Response / Release Notification Section P/RK/jt CERTIFIED MAIL #P606 845 487 RETURN RECEIPT REQUESTED Attachments : Release Notification Form; BWSC-103 and Instructions Summary of Liability under M.G.L. c. 21E cc : Town of Barnstable Town Manager Town Hall 367 Main Street Hyannis, MA 02601 -4- cc : Board of Health Town Hall 367 Main Street Hyannis, MA 02601 Centerville/Osterville Fire Department 1875 Route 28 Osterville, MA 02655 DEP - SERO ATTN: Andrea Papadopoulos, Deputy Regional Director DEP - SERO - BWSC ATTN: Data Entry w TOWN OF BARNSTABLE , l� LOCATION L� � ` ���• SEWAGE # 94 aRo P VILLAGE ASSESSOR'S MAP Q LOT ' ®� INSTALLER'S NAME & PHONE NO. yy— �t1 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) g - 'd )4 NO. OF BEDROOMS _PRIVATE WELL OR PUBLIC W-AZER BUILDER OR OWNER QkQVV Z) oql�, Ptik.�- DATE PERMIT ISSUED: 15 DATE COMPLIANCE ISSUED: 5T/ VARIANCE GRANTED: Yes No Ll _ 3b V 1 No.... FEB......� .. APPROWD THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' - 5� OWN OF BARNSTABLE 8 �sJ Allp irtt tvu fur Diripaiial Wi ork,i Tattitrurtinrt famit Application is hereby made for a Permit to Construct ( ) or Repair (VI)'*an Individual Sewage Disposal System at: ...../..''� to a.)....--- 1 ----- :..... .................................................................................................. oritin.::X•9 . r `_ ------ •—-•'"`.•,-------- -4 t-- o -••••--•-- 1 0 1V I tlddres Installer Add4ess UType of Building Size Lot............................Sq. feet ,.., Dwelling—No. of Bedrooms------------------- ----------.---.-----_.Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ---------------------------- No. of persons..-.--..-..---.-.--.-.------ Showers ( ) — Cafeteria ( ) a' 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 ( ) ►4 Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit....-----........... Depth to ground water..--.................... 44 Test Pit No. 2................minutes per inch .Depth of Test Pit:..-----............ Depth to ground water........................ a ----------------------------------------------•--•--••••----------••-•--------------......-••-••.••........................................................... 0 Description of Soil........................................................................................................................................................................ W V -----------------------------------------------------------------------------------------•-•----------•--------------------------------------------------------------------------•-•......-•---._...•••. U Nature of Repairs or Alterations—Answer when applicable... �......:....L .............. ... .:......�'t - ....VW ...-•---•--------------------------------------------••---••--•------•---------•---............•--•--••-•--•--------------------------------•--•----------------------------------------------•-•--..... 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 pl ce the ance system in operation until a Certificate of Comp a een iss by t board of health. �y gned - -- - -------- ------------ ----- ... .. ........ ... .. . .. .........7-Y... re Application Approved By ...b,� .. ...� ...... ------------- --- ----- ---.�.......................................... ................. _e Application Disapproved for the following reasonr: ...... . ........ ................................................................................................................. ......................................................... ...................................................................... . ........ ...... ................:.............:......... PermitNo. ��...... .................. Issued -----------.......................................................� Dare ..-�^.,,,�..�� .,..r.Jq;��r-..r.�^w-.-..,�+,�,r...rti-tit/•'ti.-.-.a-.....-.,;r•-�'vr.n-✓r-.....i'�`'1(:".._.,,�-:ai..v.rv-�.-++,,.n.,�...! `1d--.. ,w., v� -"tly ,,,, -••- w� a D - oob No...•-1-... _. I Fxs........ ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH j 5, TOWN OF BARNSTABLE lJ iri t` ,���rltrtttioit for Dt� �� �ttl Olarbi Togtfitrurttun frrmtt Application is hereby made for a Permit to Construct ( ) or Repair (Vj'__an Individual Sewage Disposal System at ... � 3 R . � .. .•-• ---•- ... •-•-- ... ..�... . ...�-..... ..... - . Locatio A •cs ......... .�_.. - _d d� -------------------------------- d -------------------------- Installer A Type of Building Size Lot............................Sq. feet .� Dwelling—No, of Bedrooms____________________ Ex ansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................. No. of persons------------------------.... Showers ( ) — Cafeteria ( ) dOther 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........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 ......................................................... ................ •..... •••---......-----.....----------------------- .... ...... •-------------------- . 0 Description of Soil.,....................................................................................................................................................................... V ..............................•..._.......••---•••...---•--••-•••-••••••-••------••--••••••••••-----••••-•-----------•-••-•-----••••-------•----••-•-•--••-•-••-----............•-•................-•--- ----••----------------------------------------•-------------------------------- ..._...... ,r U Nature of Repairs or Alterations e__. ._-_�.... ...........`t. . ._......... —Answer when applicabl ... -•..................••----..._..••••••---•••••-----•----••-----•-••----•-•-•-••-----•••••••-•-•-••-•----•••---------•---------------•--•-------•-----------------•-•-••---•••-•••••-•--•..........-••--- 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 Comp 'ante a een iss e by t board of health. Signed ....... . ....... 7..... ........................... ...... .. Application Approved BY J / -(!�-........ ._� :' � �%/ll.:,h..........................t.. .... ................ ...-----...... Date Application Disapproved for the following reasons: ..................... ._.............................................................................................. . ..... ....................... .........._..r.............................................................................................................................. --- ..------------Date..................Y PermitNo. ------------------ Issued . ...............................................---.............. / Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . TOWN OF BARNSTABLE V erttftrate of (ILlomplianre TFJTSNS TO CERXIF , . ha the Individual Sewage Disposal System constructed ( ) or Repaired by ........... P—\.�- ----— ----- --------- -------------------------------------------------- --- .............. .................. ...... ,1A.tauer n has been installed in accordance with the provisions of TITLE 5 of The 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. 1' DATE---- ..`'..'�'�✓ � ........ ....... Inspector = ... �J/� ....._........................ . - ------------........... ----------I-----°o—<_-----.-----o—_,—_.----_.---_,--------«----_:_ n , + . THE COMMONWEALTH OF MASSACHUSETTS /v I BOARD OF HEALTH TOWN OF BARNSTABLE r 0 No.�....1................. FEE........---............. lispD, 1 vrkg- trudinn Prrmtt Permission is hereby granted... C \....--•------. �1 �- 1 ----------------------------------••---••---.--------.-.--- to Construct ( ) or air.( �an.4nc4ividual SUa at isposal ystem Street J, as shown on the application for Disposal Works Construction Permit No __________ ___ ated--_-__---.,-_ ..__._,...... ..._.._........ J ------------------------ Bo°ard of Health DATE..-----=-�---•---;---.....� FORM 36508 HOBBS a WARREN.INC..PUBLISHERS � / � i �� ,. a.,.� — .�.�„ �r.i..., LLnw._._u�—u .._ aw1N .—_- _ i.�6+,y. � f�w`!d3tm.�.!'i+�.,s1kTe5�^4'°b.�'@4r_��aff�.... mL'�f�b: - �_ .. Number Fee 1293 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that CazeaultRoofing ....----------------------------------------------------------------------------------------------------------------------------- 1031 Main Street, Osterville, MA ..---------------------------------------------------------------------------------------------------------------------------------------------------------------------- Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Restrictions: •-----------------------------------------•-----......-----------------..........----------......------------......------------................--------------------• This license is granted in conformity with the Statutes and ordinances relating there to, and expires 06/30/2021 unless sooner suspended or revoked. ---------------------------------------- JOHN NORMAN DONALD A.GUADAGNOLI,M.D. 07/01/2020 PAUL J.CANNIFF,D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health �rd 4 ! • Town of BarnstablegMAI r Inspectional Services BARNSTABLE ��u"T'a'is wsis�`�-'2_nmi�°sia+nn"sins Public Health Division 639-2014 1 = Thomas McKean, Director 639. 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE ; HAZARDOUS MATERIALS ' IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 V ar potcfi K, CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ 2 *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? v"--YES_NO. IF YES,SKIP QUESTION 3. • 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: �5 5. NAME OF ESTABLISHMENT: �T l I 6. ADDRESS OF ESTABLISHMENT: 17 n�ikfv'j 16 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 0�� �-O'✓ �� 9. EMAIL ADDRESS: GRI Cf C�GZ Sl lJl l�� °s CU 10. SOLEOWNER: ✓ YES_No IF NO,NAME OF PARTNER: 11. FULL NAME,HOMEADDRESS,AND TE EPHON OF• CORPORAT N NAME PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS AIL: SIGNATURE OF APPLIC DATE Q:\Application Forms\Haz Mat Appli Draft Jan20l9.docx Number Fee 1293 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This.is to Certify that Cazeault Roofing 1031 Main Street, Osterville, MA Is Hereby Granted a License For: Storing or Handling 111 -499 gallons of Hazardous Materials. -------- --------------------------------------------- --------------------------- --------------------------------------------------- ----------------------- This license is granted in°conformity with the Statutes and ordinances relating thereto, and and expires 06/30/2020 unless sooner suspended or revoked. -------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A. MCKEAN, R.S.,CHO Director of Public Health e Town of Barnstable Inspectional Services BARNSTABLE FINE T(L_� �TSPuiu.s��^amL�'vi'u-iT 3k.-'Ii'tE:f a Public Health Division 9 BARNWABLE, Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 � Office: 508-862-4644 Fax: 508-790-6304 =Y' s: APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE Un HAZARDOUS MATERIALS 1143 IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 3 Oth). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT - 111 499 Gallons: $125.00 x S CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charize of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. I O Coy 2. IS THIS A PERMIT RENEWAL? .s,-- YES_NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANTV�� '1 Q � 5. NAME OF ESTABLISHMENT Ocauj2Q °� Y1S CSC` h 6. ADDRESS OF ESTABLISHMENT: 1 / 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT 9. EMAIL ADDRESS: I 10. SOLEOWNER: ✓ YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS.AND TELERIONE#OF: CORPORATI AME' ' 2e ,1�---4--� 1 PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLIC T, DATE / Q:\Application Forms\Haz Mat App Revised 09-10-18. ocx CI Number Fee 1293 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Cazeault Roofing 1031 Main Street, Osterville, MA �T Is Hereby Granted a License For: Storing or Handling 111 -499 gallons of Hazardous Materials. ------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2019 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2018 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health " owr� of Uns1tble a regulatoervces Richard V. Scali, Director Public Health Division BARNSTABLE ASTABLE, Thomas McKean DirectorDS '�•° °"F•� 4 MAS& A 16395--772014 --2001V1ain-Street Hyannis IVIA 02601_.-_- �...------------ Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD-QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS DULY 1 st-JUKE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00- ❑ CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 XV,S. CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by July 1st 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? VYES NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF aGREATER THANMOUSEHOLD QUANTITIES,(25 GALLONS)?-'_ YES NO..` 4. FULL NAME~OF APPLICANT: �/�y�-- �j C�2m.-T- 5. NAME OF ESTABLISHMENT: 7-4 All 6. ADDRESS OF ESTABLISHMENT: /J > /?'l��� �� �j /��//e-L 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: '9 } P 77 9. EMAIL ADDRESS: % 10. SOLEOWNER: 611 S NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME 2i"_ T PRESIDENT �- TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICAN DATE d� QAApplication Forms\HAZMAT APP 2017 REV Number Fee 1293 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Cazeault Roofing 1031 Main Street, Osterville, MA Is Hereby Granted .a License For: Storing or Handling 111 -499 gallons of Hazardous Materials. ------------------- ------------ --------_--------------------------------------------------------------------- ------------ -------------------------- ------ Sq relating there to and e and ordinances i with the Statutes This license is ranted in conform wi S , g conformity and expires 06/30/2018 unless sooner suspended or revoked. -------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI M.D. 07/01/2017 AWAYANA JUNICHI S G THOMAS A.MCKEAN,.R.S.,CHO Director of Public Health a, r� • •��r�� ��- cam owwl�, of B nstable � P =' egi%atory ervices Richard V. Scali,Director THE Tp� Public Health Division BARNSTABB M • fi4Rp5(MOIE•iExIlRVILLE•Canrt•NTasI:IS' MAS&— r Thomas McKean, Director 5 .�"�1639-2014 �� 1639-2014 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790- ,504 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE !" HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1st-JUNE 3Oth). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑. CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 V,S CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? YES NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. 0 4. FULL NAMEE OF APPLICANT -P PIV.1--. 5. NAME OF ESTABLISHMENT: PPv L 3 C. L- � S�a oJS / N L 6. ADDRESS OF ESTABLISHMENT: 10 7 k I�A-I NJ S i 1. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: '��FZC�� c►?�.�e y'1 L®cM 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME F14yl--0- GAZL-�ayc-�:F PRESIDENT y2c.ss _.c :Z Rv TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: - NAME: TELEPHONE#: COMPANY ADDRESS E i SIGNATURE OF APPLI J DATE = RD—F) �Application Forms�HAZMAT APP 20 S Anx Q: Number Fee 1293 THE COMMONWEALTH OF MASSACHUSETTS .$125.00 Town of Barnstable -Board of Health Thisis to Certify that fy Cazeault Roofing 1031 Main Street, Osterville, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2017' unless sooner suspended or revoked. S --------------------------------------- C WAYNE MILLER,M.D.,CHAIRMAN; PAUL J.CANNIFF,D.M.D. 07/01/2016 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health - <Z�po I 330,4, Town of Barnstable . °pT1HE rok, Regulatory Services ti Richard V. Scali, Director O * &UMSTABLE, ` Public Health Division BABSTABLE 9Q $ -pA 1639• erwis"aM usE"o��'ueCnWMeuAsi'aeu � rfD►"p'�s Thomas McKean, Director 1639�` r �Y 200 Main Street, Hyannis,MA 02601 = Office: 508-862-4644 Fax: 508-790-6304 f+ APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS DULY 1 st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 C � CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ A late charge of$10.00 will be assessed if payment is not received by July 1st. • ASSESSORS MAP AND PARCEL NO. // 4 0 DATE ZI FULL NAME OF APPLICANT: _ ��-vL T Gi�'Z/Pytrr` �j° ✓S. /�(� NAME OF ESTABLISHMENT: ADDRESS OF ESTABLISHMENT: /��' �' !`'� ��✓" 3 MAILING ADDRESS (IF DIFFERENT): TELEPHONE NUMBER OF ESTABLISHMENT: 6-0 CId--f7 -77 2 EMAIL ADDRESS: I/SSc (L SOLE OWNER: t, YES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME GAz f Ak c,o,.g �•c� PRESIDENT 2.v55� c&1-4=Ar/�i TREASURER �.vs S✓Yw-. z.i �.✓r CLERK /-y4.s fyw. IF PREPARED BY OUTSIDE PARTY: SIGNATURE OF APPLICANT Name: Company Address Telephone#: C:\Users\Russell\AppData\Loca]\Microsoft\Windows\INetCache\Content.Outlook\8ILBGKEX\HAZZAPP Revl6.docx Page 1 of 2 FTMEro� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMASS. 200 Main Street• Hyannis, MA 02601 Fo39. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: Cat;z a_v 14- Sc ns AOOQ� Date:4 2� /� Location/Mailing Address: 1031 Ma►vt S� D ►'tar/: - Contact Name/Phone: .6v45 c I I Ca_7e�v 1+ s�Og-y28- If-7-7 Inventory Total Amount: ti 21.5 � MSDS: 1��5 License �;�C�� Z- Tier II : f)o Labelina: Spill Plan: io oS Oil/WaterSeparator: Floor Drains: ►)o Emergency Numbers: ' Storage Areas/Tanks: 6,CV-- e �� vw�Hv t t, I f Emergency/Containment E ui ment: 'It "t ov, 6%tg_ Qe�os�1 s Waste Generator ID: Waste Product: Date&Amount of Last Shi ment/Fre uenc : Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS 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 requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid � Other cleaning solvents&spot removers y-r I Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives l Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: �-0 Caulk/Grout/Ad-k4-slwc.s Zo o k Z O insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes. Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes — Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons �y Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" 10 (including chloroform,formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: c.� t 6 \)l<ep O Jti�� o(2v -r .ti tN 5 . Inspector: 'hq c�I&I Facility Representative: �y�-- WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINf=SS PAUL J. ea eau I a SONS ROOFING and SHEET METAL Russell Cazeault P.O.Box 930 508-428-1177 Marston Mills 508-457-1141 MA 02648 800-698-5569 A Roofing Family Since 1927 f r TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair Satisfactory 2.Printers ` a BOARD OF HEALTH k 3.Auto Body Shops n unsatisfactory- 4.Manufacturers COMPANY rr,7;es �� r?0 � O (see"Orders") 5.Retail Stores _ 6.Fuel Suppliers ADDRESS 103 +Ala,,!,, S4' elt Class: 7.Miscellaneous 1741V, QUANTITIES AND STORAGE (IN=indoors;OUT_outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Under&n-ound IN OUT IN OUT IN OUT #&gallons Age Test Fuel Gasoline et Fuel(A) Diesel, Kerosene,Eli Heavy Oils: waste motor oil(C) new motor oil(C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: I0� K DISPOSALIRECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply (/�eS 6,,15( v-edv .7:) '� r� p/y.S A /I�1✓IS O Town Sewer Public "60 _On-site OPrivate �� s v l 3. Indoor Floor Drains YES NO X O Holding tank:MDC_ 0-1,�s O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES_NO_ ORDERS: O Holding tank:MDC 1a -0/y e._ , O Catch basin/Dry well O On-site system 5.Waste Transporter Narne of Hauler Destination' P waste o.d YES NO 1. 2. K( er on(s) erviewed Ins"P'ecta Date -, - .-.. ...wr.-..-.yc.,�,-•.,r.--.:.�•,......W.a.r.�.s-.r--..-.........r.�v"+""""4-rraw.�:1'^'„,r:-�.-r..-....,..-tifi..'...'��+`�.e.,,+-.cMr..-2-•.-.,.....,Q*--•-•-r^^..•^-�..-•-,...�,�,,.•....^.-,ti.r•:-.+r...^ .-,.-.�: TOWN OF BARNSTABLE BAR—W 5177 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager S5e- (perS.�_"2u1 Address of Offender MV/MB Reg.# Village/State/Zip y Business Name 0 yam/pm, on 20_ n J .-,- Business Address c54 - .��� �1 �} Signature of Enforcing Officer Village/State/Zip s If�✓'1� = , l` 1 �S7� ! Location of Offense `� � � 7' Enforcing Dept/Division Offense C� I� ` rJvly" I0 - r�iufiiC.-�L -e- `1(e'%.46Y'`"' �" 1VL j<� lI��YZ > f Facts O a 014" c"A V& I►al 1 t Pvt;-c . r< 1 e%eV,A-- 1.)1.41Vt V.—s, This will serve only as a warning. At thEs time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. ..---.,...,._. ,-.......,T.--.:...+...^+.�r^«•w.-..ivw+`,y,.�-,,..+......,-.--"'^n.,wa!^ -.�.w..:,,.-._.......,...�,. ,.. . ,„ ..::+..».Y...--...,-...-rr. -�.,+�: �^.ti^�'.M -..-..+�.h .,.,. TOWN OF BARNSTABLE BAR-w .9177 Ordinance or Regulation WARNING NOTICE Name of Of f ender/Manager Address of Offender MV/MB Reg.# Village/State/Zip Business Name ..k �? w r ; L I %r am/pm, on 20 �. + ,J �_ n ,,-Business Address - Signature of' Enforc ng Officer Village/State/Zip � +.i 3 : V' tr+,� . Location of Offense J Enforcing Dept/Division OffenseC$; Facts p f- , '. - rE '� ,, � I �, - � 1 � I;;t < , f lit- } 1 t .f This will serve only as a�warning. At this time no legal action has been taken. It is the goal` of Town agencies to achieve voluntary compliance of Town Ordinances, - Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. 4! Z rnal�- SMEAD v'rrINr vntl nprnnn�c^ M�, 1Q33A MAPF IN USA � r nPCANIZED AT SMEan-CC+�O