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HomeMy WebLinkAbout0339 WEST BAY ROAD - Health '339 WEST BAY DO., OSTEtKV1LLE A= 116.010 IM I/,,/ la4s Town of Barnstable �p THE Tp� Ins ectional Services Barnstable o Public Health Division 044meficaCiy ; Thomas McKean, Director * BARNSTasi.e. MASS. 200 Main Street 2007 SAT i639' s Hyannis, MA 02601 ED MA't 508-864-4644' Fax: 508-790-6304 r April 25, 2019 NAUTICUS MARINA 339 WEST BAY RD OSTERVILLE, MA 02655 As of October 1, 2006 a rental registration ordinance was put into effect requiring all property owners of rental units to register them with the Town of Barnstable Health Division. This also includes yearly rental inspections of each unit. You are being notified that the Town of Barnstable will be conducting rental inspections for 12, 21 & 30 Cockachoiset Ln; 14 & 17 Indian Trail & 321 West Bay Rd all in Osterville. The inspections have been scheduled for Thursday May 16th at 10:00AM. Please have a representative available to assist the inspector onto each property. If any of the properties are unavailable for inspections this day due to being rented please contact us to reschedule. Should you have any questions, please feel free to call 508- 862-4072. Thank you in advance for your cooperation. t omas . McKean, R.S., Director of Public Health Town of Barnstable F I / � GENTERVILLE-OSTERVIL.LE-MARSTONS(61%, .S; IFtf[Ugflk 1875 ROUTE 28 CENTERVILLE, MA 0 (508)790-2380/FAX#!(508)-2&% 16 PM 3: 38 I { OIL/HAZARDOUS MATERIAL R1i 1 I i LOCATION: I ADDRESS OF RELEASE._A G df t t'1. DATE OF RELEASE: _ PRODUCT RELEASED: vt c>Irfz ESTIMATED QUANTITY:,, M l CORRECTIVE ACTION TA N NrkE-- '19 9$A4T` 4. r10"1 0441 ! r NOTIFICATIONS: FIRE DEPARTMENT: YES( 4-lNO( ) DATE: C" TIME: _ NATIONAL RESPONSE CENTER YES( ) NO(j,' OATEI-TIME - DEPT. OF ENVIRONMENTAL PROTECTION YES(") NO(,,4-,DATE: TIME:- C OIL SPILL COORDINATOR: YES( } NO(„ ' DATE:___ -w__ TOWN BOARD OF HEALTH: YES( ) NO( _4. -" DATE: TIME._ ) TOWN HARBORMASTER: YES( ),NO( ) DATE; TIME:-.W „� OTHER AGENCIES: COMMENTS._,.,_, ..s�-.fit- 4—r1�--- ! REPORTED BY:� ` ',:._..DATE: P � I 1 WHITE COPY-FIRE DEPARTMENT YELLOW COPY-D.E.P. PINK COPY-BOARD OF HEALTH C-O-MM FORM#68 i 4 BATTER &. 9 me Professional Land Surveyors and Civil Engineers 812 Main Street •Osterville, Massachusetts.02655 Tel. (508) 428-9131 FAX(508) 428-3750 WILLIAM C.NYE,P.L.S.-President PETER SULLIVAN, P.E. -Vice President-Engineering RICHARD A. BAXTER, P.L.S.=Vice President RECEIV October 3 , 1995 OCT 1 6 1995 HE ALTiHn iJLP IT M R. Ed Barry TowN OF BARNSTABLE Town of Barnstable Board of Health 367 Main Street Hyannis , 'MA. 02601 Re: 84 : 1143 North Bay Realty Trust AKA Nauticus Marina Dear Ed : I have researched the septic permit for Nauticus and I have found the following : 1 . Proposed Plan Sewage Disposal . dated 11-12-84 . 2 . As-Built Plan of Sewage Disposal dated 8-14-85 . 3 . Letter from Braman dated 8-22-85 . I trust that the above is sufficient for you to issue the Certificate of Compliance. If you have any questions please feel free to call . I have attached a copy of each of the above for your files . Very truly yours , er & Nye In Peter Sullivan , P. E. V. P. Engineering 4 Attachment �cc,, MEMBERS OF C,4PECCJa19CIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS/AMERICAN CONGRESS ON SURVEYING AND MAPPING MASSACHUSETTS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGINEERS BRAMAN ENGINEERING COMPANY August 22, 1985 John Kelly, Health Agent Town of Barnstable 367 Main Street Hyannis, MA 02601 Dear Mr. Kelly: We have followed the requirements of the Board of Health and have inspected the installation of the sewage disposal system Inspections for Nauticus Marina Inc. at West Bay Road, Osterville. InspecThis were made on July 22, 23, 24, 25, 29 & 31 & Aug. 1 , 2, 1985. system is presently installed to service the main house only, but has been designed and will eventually service other buildings on the land. Enclosed with this letter are copies of the as both locationdated Aug. 14, 1985 showing the system as inst • chamber elevation. As the remaining units are tied into the pump we will add them to the plan. Sincerely, Robert A. Braman, PE RAB/lg cc: 4etorino Bros. Fred Curran, Nauticus Marina Inc. Richard Callahan, Trustee civil engineers &surveyors 258 main street buzzards bay,massachusetts 02532 759-8273/759-8148 v Tc INN OF B!.OSTABLE i: CATION 339 w Es, Pam,? a..�o SEWAGE # 84- 1 143 VILLAGE a 5 Lv +- ASSESSOR'S MAP&LOT 11 G /I o INSTALLER'S NAME&PHONE NO. V e r o!L r w o r�s dos. _,►Jc / 3 2-3 SEPTIC TANK CAPACITY 's o o G A L-_ C H - sa LEACHING FACILITY: (type) Tylo 1 i�LDs - 21 F�a�N '(size) D FPVSOL'S CAc.I-1 NO.OF BEDROOMS Foy R BUILDER OR OWNER --0-Fld PIA—( C CA L.T-Y''FAT A V-A "A vT I C,,-. M A 0-,`i A PERMIIDATE: COMPLIANCE DATE: !? Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) W/A Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) 1 00 ' Feet Furnished by 1!,Ax-r=0— -t ,mob 0 W C_. , I kiFeP_M,N Te a v t 4 c;,�.z kA r_1 P.P_ f�RSC---D.' A' (SUILT' ZC-,N ACa0 YLA4-% f-(L 0..1 14185'...ISM Q>Q.AAA AN C-NCQ. - - _ y- ..�-sue- -• j �. R.. SAG+-Iai-naE-=-T� A R A C 1 LA u7 �bLl.-r�l ,W=. o�ST Df3 � A-G. 23' tl Ho�f�C- A-D 34' �� � d f3-c 34' GM m 0. + k3l X R y 2i Flow D FFuSoQS C5b 12 A_ •�$merE g1DWS LJ Soo-vAc-L-e 2'G 2'�stctie E�.os �Tan ('SAY N-2c SecnG KC?f�cQ P—mP Gr)Am MCa- u-2o ASSESSORS MAP to ��4; PARCEL No: /D c THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ........................................OF........................................... ... Allp iration for DhiposFai Works T. nstrurtinat Frrutit Application is hereby made for a Permit to Construct ( ) or Repair. ( ) an Individual Sewage Disposal System at: PAQ-T G . 4 ?... r.�---..... -- --------------------........ `� C� J Location- d s f or Lot No. �J _!.__..._.._._G/7a��C.- JL2L<:..-...... ................•---...-•---•----.._............._........._..........---------.......---......... Owner �. �r "�......... .. Address �-- xy� Installer i Address �. Type of Building ���C,E Size Lot..............................Sq. feet p� �s U Dwellin No. of Bedrooms_________________ .Ex Expansion Attic a g— - ----------------------• p ( ) Garbage Grinder aOther—Type of Building /'�!4/�!n.o�Cd s l?M' of persons...._s_7______________ Showers ( ),— Cafeteria ( ) Oth.tcer fixtures --------------------------------------- W Design Flow..............................:.............gallons per person per day. Total daily flow.............................................gallons. W61,Septic Tank—Liquid capacity_Ji%allons Length................ Width................ Diameter.............._. Depth................ x Disposal Trench—No. .................... Width......f_1........ Total Length........ Total leaching area...f.02-S0....sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ' ) Dosing tank ( r ) ~' Percolation Test Results Performed by....A _AIA�-._..j6-_ �.-................................... Date...._...... a 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._____................... a -------------------------------------•--.......-------•---------...-----------------------------••••........................................................O Desc - ion of Soil.. .•._......-.16�_Q......................................................................................................................................... U Nature of Repairs or Alt rations—Answer when applicable............................................................................................... ................................................................---------•--------....----........---------•----•------------------------------------------------------......•-••••--•-........_-••••- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of L ITI:� 5 of the State Sanitary Code—,The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been isAe ;yt ty b r ealth. ApplicationApproved By---••-- --•••• •----= • .......... ... -• ............................... .................................. Date Application Disapproved for the,following reasons----------------•--------------•----------------------------•----------------•--=-----•----••--•-••---••••---•--- ..........................................................=.............................................................................................................................................. Date PermitNo.......................................................... Issued....................................................... Date -- --- --------- - No. Fxs......��-.�.............. THE COMMONWEALTH OF,MASSACHUSETTS BOARD OF HEALTH r, -.........................................OF........:..............................---------........, .._................. 1 Applirtation for Disposal Works Tonstrurtion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .F. L`7:'�f...�, _ ..�-------------------•--....................... - ........................... T Location-Address or Lot.No. ss ,.a ........................................ ------•---------.-.-----.------•---------�........................................ ........ .......----•-.............................. Installer Address d Type of Building Size Lot............................Sq. feet ra Dwelling—No. ofkBedrooms....:.......................................Expansion Attic ( ) Garbage Grinder (,, ) G4 Other,; Type of Building .............. No.� of persons............................ Showers — Cafeteria 0 Otherfixtures ................--------------------------------------.-------•-----------------------------------------------------............ •..................... W Design Flow......:.::..........- ------------------ --gallons per person per day. Total daily flow____......•............_....................gallons. WSeptic Tank—Liquid capacity.............gallons Length................ Width................ Diameter._._............ Depth................ xDisposal Trench—No...................... Width...................: Total Length.................... Total leaching area....................sq. ff. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.........................................................................I% Date........................................ Test Pit No. 1................minute% inch Depth of Test Pit.................... Depth to'ground water........................ 'per G14 Test Pit No. 2.:..............minutes per inch Depth of Test Pit.................... Depth to ground water........................ ...... --••••--•••-•-•-•••----•-----•---••--•--•..............•--.._......................-•-•••......-------- ---------.-------------..---------- ofSoil --------------• ---------- -------------------------- •--•---•---•-----------------------------•-•-••-•-•----------- U .............................. irations _ .... am jr" dc _0,1.4 iU Nature of Repairs or;A —Answer when app i�b e------------------------------- .�-------- ------..----------------.. ---------------------------------------------•.............._.......-----------------.........---------•----•-••--------------------------------------------------------------------------... ------- Agreement: f The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code:-The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued Eby the board of health. f Signed ................•--i R ------------.......................4..••-- ............ ............. Date Application Approved By. -- -- ; - ........................................... I. Application Disapproved for the f o owang reasons:- -- --------------------•----....----•----•--•--------...----•-----------•-••--••-•----------.....-•----•-•- -•-•---------•-----••-•------•-•---••-••-••••--•------•-•-----•-••••••-•---•---•--•--•--•....._ Date PermitNo........................................................ ' Issued_.................. .. Date _ _ K THE COMMONWEALTH OF. MASSACHUSETTS BOARD OF HEALTH x . . ..........................................OF................................................................................... 4 (9rdif iratr of ToattpliFanrr A THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( )'o'r Repaired ( ) by--� jI6 �s .......... .... Installer at................................................... _� ............ ..... '.��' has been installed in accordant! Iifl `the pro si$n- TITLd of Mate Sa�`i a�de as described in the application for Disposal Works Construction Permit No. .....1........................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALIIVOT (E NSTRIIE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......:s '.,G.€ .................... Inspecto �'�.-- -- ---•-• - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......................................OF..................................................................................... Disposal Works Tonsfrt ion rrntit Permission is hereby granted...........-.--••••--..A...---------•--I----------------•-------•---••-•---.........-•------------.........---"--...................... to Construct ( ) or-Repair ( ) an I!'iV;161N� 'rage•Disposal System at No. ----- .. `= -- --- as shown on the application for Disposal Works Construct& Pei-,RtNo.�_m..........:___"__. Dated.......................................... ................� v--------------- .------------------ .... ...,' «�.� ✓ J/� wyayd�of Health DATE---• ••-•-•......•-••..... .......:.....................•---••-......--- *`. FORM 1255' A. M. SULKIN, INC., ?D=ST077�` I�+ J < A No.. ..... .._.... Fps. ........ .......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OE HEALTH 010 ro.41,0K.............OF........... 'c/ /�6 lS .,1?'� ........................... Appliratinn for Ditipnoaal Workii Tumtrur#inn ramit Application is hereby made for a Permit to Constr ct ( ),or R 'air (X) an Individual Sewage Disposal System at: C�v�l ���+GYG 1 ................. ...... - ..•........---•-•---..� ...................... . Location-Address or t N �ea�. o. _�t...,FVk..V. ..-------•---------- -----•--��fr .46, �,f�.... �:._....-��t.�rr���.-••:- Owner Address ,wa �? d' =s--•------&C.::..................... --......, , `'c� .r ....C�11� "�-----Xf ... Installer Address Type of Buildin Size Lot-___-g.A��...........Sq. feet U Dwelling No. of Bedrooms.........t`L--.--_----_-••••.______.___.Expansion Attic ( ) Garbage Grinder ( ) `a Other—T e of Building ............................ No. of persons........_ Showers .2 — Cafeteria Q' Other fixtures -----•--•-------------------------------------................................................. W Design Flow___................................,,.,,•--�--,-FF_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........................ G Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -------------------------------- -...... -.......................:.............................................................................................. 0 Description of Soil........................................................................................................................................................................ x -----------•------------------------------------------------------------------------------------------------------------------------------•--------•-. •- UNature of Repairs or Alterations—Answer when applicable.-----4 �.L�Cr^ ��j c �� ---••-•••••--•---•••-•--•-•-------•-----••-••--•••---•-•-......--•--•---•-----•----•-•••-•••...................••--•----•--••-------------------------•-----------...------------------............--•. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is ued y th oard of healt Signed- --..1 / ' _ �Jta . ` 4e_ Da Application Approved By............... •---------------- ��.. Date Application Disapproved for the following reasons:..................... .......................................................=--•-••----------•-•••-••-••••---...........•-•-••-•••----•----•------•-••-•-•-•-••---••-••-•-----------•••------•------•••--•--•---••---•----•--- Date PermitNo......................................................... Issued-....................................................... Date No.---3... ......... Fis............................_ THE COMMONWEALTH OF MASSACHUSETTS BOAR® O�F HEALTH -a�1/e�,. ..............OF..........�:....�:..h-f ,. -------•----------------......................... Applira#ion for U44pusFal Warks Ton6trur#ioai Vanat Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage'Disposal System at: /r --•............._----•---..:....... ........-...................................r-••- .......------•-••---•-•-----------------------•--------............-••--•-•......... Lo.ation-Address or Lot No. �v � civ � ��r— fr1i ( a ' ram r . •-- - ---- ..... ........................•-.._..... ......................................................_... Owner _ Address _ /e Installer Address / `. Type of Buildin Size Lot..._._. ._.._......Sq. feet U Dwelling—No. of Bedrooms........ ............................Expansion Attic ( ) Garbage Grinder ( ) Other—Type e of Building No. of persons......... ............... Showers Ga YP g ---------------------------- P (•.;z) — Cafeteria ( ) a' Other fixtures ...................................................... W Design Flow.......................................1 gallons per person per day. Total daily flow............................................gallons. WSeptic Tank L 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 ( ) 1­4 Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 1� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ---•---•------------------------------------ •------------------ ------- ---------------•--------.--- ---------------------- •---------- -------------- ---------- 0 Description of Soil........................................................................................................................................................................ x U --••-------•----•----•-••••------------------•--•-----•--------------..._._._......-----------------••--•--•----•-•-•-••••••--•------------------•••-----------------------------.......----•-•--------- W ........................................•----------.._.......__.._...._..__.._.....................__.......----.._._............_........-....._....._..-. ... .........�.✓=................ U Nature of Repairs or Alterations—Answer when applicable.____.%J.-_'-------`�______-_---�f' !..� __.__.-%' �'% =_...... -•---------------------•---------...-------•----••-------------------------------------•---•........----•••....--------------•------•-•---•----------------------•---------•--••-------•----•-•••.•••--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITHE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i �ued•by the,board of health- , f Signed------ r ( X- _/ ✓! 3-�•.� �`' r. J..........................................--------••--•. a •_ Application Approved B -••................••- ........................................ Date Application Disapproved for the following reasons---------------------••---------•------•----------------------------------------•------------------•-•....._...-- ...............•----•----...•--•-•------------------------...........--•---•--------------.................--•------•---••---•---•---------•--- ---------------------------------------------------- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............O F.......b.1. ............................ (9rdifiratr of ft ampliaurr THr IS TO CERTIFY, hat the Individual Sewage Disposal System constructed ( ) or Repaired (l/S b 01 &-.................................... ------------• --.....--............. - ------•--------------------------------r Installer ; - == 1 has been'installed in accordance with the provisions of T TIF 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No. y.._. - 6 -•-•--•----•-•--• dated—...7---- /`/ - 7 -7= THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE....C ..V. . - ------------------------••-.••--- ...... .. --•-• ---�n .,: � THE COMMONWEALTH OF MASSACHUSETTS BOARD 9f HEALTH G ..... ? ?...............OF........ C1i1- No................7....... FEE... .........-...... Dispostal J orb %Txno moat prrmit Permission is hereby granted-_.---- 1,�-. ------------------------------------------•------•--.--.-.------•----•---•--- to Construct ( ) or Repair �) �a ndividual Sege Disposal S stem at Street No. __� = G > `� ------------------- : as shown on the application for Disposal Works Construction Per it No...............�... Dated...... -f.��_.-�.7............. /; Imo, 1J �} -�/- 1�� -------------------------- DATE_ FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS l" .jR T l �(///� /" (\ / . \. � t � l �-._ ._ -• w a FIKEroti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-7s0-6304 • BARNSTABLE. MASS. 200 Main Street• Hyannis, MA 02601 11/ t639. 0� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: �-Ar-L--15 r, Date: Location/Mailing Address: ,33 ( W,25 - ds-�e,ry�ll e Contact Name/Phone: Jrke4 �a I4- Y 2 0 -1 q b O .5-00 25 o �J e!. t7 Inventory Total Amount. MSDS: �oVIA- - o��tVV-<-4Le. . a,5 License#: � Tier II : o 7. Labelin : C a uk,),0"4 -v�owa5}-,e-SSpill Plan: Oil/WaterSeparator: Floor Drains: 1Jo Emergency Numbers: Storage Areas/Tanks: . 1 - any a1 C evV�ra•�w�r Emergency/Containment E ui me t: Ad Waste Generator ID: Waste Product: o WeAkf, Date&Amount of Last Ship ent/Frequency: 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. ?i Antifreeze I Z Dry cleaning fluids Automatic transmission fluid 22 Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers ft 5 e- Hydraulic fluid (including brake fluid) Windshield wash IAW-> Goa Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil t Disinfectants 1 Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents ---7 Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine I o Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible i Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: J�e C&<, a o Ado. vLvX o Inspector) , 1 Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS / TOWN OF BARNSTABLE �--�5 Date: `4 7 / l:V,ov` TOXIC AND HAZARDOUS MATERIALS FORM NAME OF BUSINESS: Nw%)k%co5 MC4-�<-% BUSINESS LOCATION: 16" ,Rct , INVENTORY MAILING ADDRESS: 5aw.,v TOTAL AMOUNT: TELEPHONE NUMBER: t Rlo D < it CONTACT PERSON: KP A. (TcI k EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: �Q. 0,)\. INFORMATION / RECOMMENDATIONS: --Irvsk vul�.r.t,l �,,,,,,� y �,� Fire District: s i PSO WMPcW x -y - AlM Waste Transportation: I`1ItA Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals(Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda ` Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison"labels (including chloroform, formaldehyde, 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 1 WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials l� o'l l to U' Of k S GPADE — . _ _ -- - - - 4-,' t>t.4, :�CHEp. ,. __._� 4" DtA• SG!-tEC7. q-•' t�tA a PIA, PVG�PIHPEO I _ _ ,.JI��;F4E.D CRUD Hlrt� STOrv� � r /{�' J 1! Mlr..t , 4C7 PYG Pt,Ps � 4t� hVC PIF�� � i2! 4 !+-t S' 3 S_ / ! r f © I vc, I I IN V,' E.L.,, Cn, � Z,, �' 1 �` 1. 1i7 LEvt.t... �' ! O { i • 3/4" TC7 I '12 " W�\SNEV tti# V. EL , tp, 'S 1 j Cc'Ua++EP STO .tC. CFI "r SEGT1C)ht OF - �LtTt _f+ �\t. 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