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3840 FALMOUTH ROAD/RTE 28 - HAZMAT
3840 Falmouth Rd Cotuit Landing 058-039-002 Marstons Mills i I� ' l r, ��� � � _�.� ��h � r �'� en "� J1 ��� i f f `� � " °FTHE Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 IiBARMAS-%. $. 200 Main Street• Hyannis, MA 02601 16,39. �ArEOMP+" TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: Dater lWAQ�D Location/Mailing Address: FTLIMOON Contact Name/Phone: ag-311- 7l01 Invento Total Amount: <�00 MSDS: License#: 006q Tier II : 110 Labeling: ACIL Spill Plan: Oil/WaterSeparator: A Floor Drains: Emergency Numbers: Storage AreaslTanks: (J� 0 011 Emergency/Containment Eq ipment: 141SI d� 1'�Laste Generator ID: Waste Product: Pr�06L1 t 4-Q0 Date&Amount of Last Shipment/Frequency: N 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 Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils V Miscellaneous Corrosives __Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: V Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages V Pesticides: Caulk/Grout 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 1/ Miscellaneous Combustible V aint&varnish removers, deglossers Leather dyes Miscellaneous Flarnmables Fertilizers loor&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: `is 4hre, Inspector: Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS `°F SME TOk4 Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 9 BARMAGLS E 200 Main Street• Hyannis, MA 02601 �A t6jq.A`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rE0 MPy II Business Name: J��1GVlD�, 6Z r/� a,r Date:jwa Location/Mailing Address: FC., air`"-, 5 M g Contact Name/Phone: 6 i Inventory Total Amount: 5OL? SIDS: C ovk �� �S'4� License#: b� Tier II : 0 0 cJ Labelina: C¢,`de,% t Spill Plan: Oil/Water Separator: fj1A Floor Drains: 0 Emergency Numbers: v 01$ c� Storage Areas/Tanks: 1000 r- C'o- O.W-C. e'.41,d-, to/,V_ w,er,Q,s +o Ix Emer enc /Containme t ui ment: t PP15, v a-'-- Waste Generator ID: Waste Product: Date&Amount of Last S ipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS 0 Pke-j 0<L" \V%- l-^VI v,ka<y I%xc4, 14e,-� �uts f�l'ion. NOTE: Under the provisions of Ch. 111, Section 31, of the General Law' of MA, hazardous material use, 1 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 Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives 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: Caulk/Grout 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 Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: C-oc k, r l W r v %v- e Co V\R.!', o a<- J C rd o " . O ' %\ \Jk S 54rlv ,44. O'dr 5 o x \vtw-ivy INFORMATION/RECOMMENDATIONS: VvlO J\C bv„t,, "ov%,0ac- s i S , &.CA e1 1 cp Qy DC e Aq ' , p6m-,46 . vl- Inspector: A 112� I Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS `°aTTok� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 B"",„ssa`E�' 200 Main Street• Hyannis, MA 02601 2639. prEDM , TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: Ao we-Lo, i4aLrf pew&<e. Date: 1 4 I Location/Mailing Address:_38'77- 5a\ L &X , M.M- Contact Name/Phone: c l,\a,.rS &w-,c. ,,,n,a,f S O$ k/Z b - -71 v O Inventory Total Amount: ti 0 q SIDS: COO&ZaIV A*l fie— License#: t 6 k eRA3-exe. Tier II : 0 17 Labelina: Ce-ka l Spill Plan: >�— Oil/WaterSeparator: Floor Drains: 0 Emergency Numbers: 2S Storage Areas/Tanks: oo a\ tKt, vk, A 4,K o-j3r S, Emer enc /Containment E ui ent: $,[W )k o Vl Ik e. V),�Ak, 6 tWO'L"k,5 Waste Generator ID: 1J Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS !V° ,�,1 a�v-t GKAWJ' -5 w 1�nv�ukof�� 6�����5 � ,�G ioc�• NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, 1 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 Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives 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: Caulk/Grout 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 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: I �t1 DS of.�5 w b �W s i1 5;Ak �osk, -7 °51 ,Q-M,a-%\ 541 it 1�Levt, c_� �Ia�� ca(,e— e Inspector: L o y�,,e(�y��e. Facility Representative: `mil CC WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS Number Fee 1069 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Aubuchon Hardware 3872 Route 28, Marstons Mills, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more 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. ---------------------------------------- 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 Town of Barnstable rq,,ti Regulatory Services Richard V. Scah,Director 0 C BARXAS& Public Health Division 0 BAMSTABLE BARpS•ROtE•O]1iFANLLF•mNn•4YarL:s a639. a�0 i 14Thomas McKean,Director 1639-20 � 200 Main Street, Hyannis,MA 02601 1 � 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 3 Oth). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 Y 'S • A late charge-of$10.00 will be assessed if payment is not receive byjulv 1st. In Q fn ASSESSORS MAP AND PARCEL NO. DATE FULL NAME OF APPLICANT: WE. NAME OF ESTABLISHMENT: Av�vcV.o. 1� sawv �Q # ►sq ADDRESS OF ESTABLISHMENT: 3$-72 4-v+e 16 AvsL, mlils CAv;{ A4 U2G"4$ MAILING ADDRESS (IF DIFFERENT): qS A,k,A -- pr�,c , („ " M iAskr, /AA OtgL 3 TELEPHONE NUMBER OF ESTABLISHMENT: S o%- 9 25. 7 l G 0 EMAIL ADDRESS: rv►�vine Ili a w��ant., e v�,/clnun. Com SOLE OWNER: YES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME W-E. A,,"., U d 1PRESIDENT W i t R aM C- Av h\j J,o-, 1 v, clF-o/TREASURER s�r!=64 IN. N,,►,,,t,, CLERK IF PREPARED BY OUTSIDE PARTY: SIGNATURE OF APPLICANT Name: Company Address Telephone#: Email: Q:Wpplication FormsViAZZAPP Rev I6.docx Page 1 of 2 L Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMASS. • 200 Main Street• Hyannis, MA 02601 i63 9 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rE0 MP'�a Business Name: �Jbv c�n,m,�. trt(tr��gal� Date: Q Z Location/Mailing Addres Contact Name/Phone: .r so - ,�- -71 00 Inventory Total mount: A- SDS: License#: Tier II : NO Labeling: Spill Plan: Nak os-kAc� Oil/WaterSeparator: MIA Floor Drains: o lEergency Numbers: Storage Areas/Tanks: 00 &C0 Dco Emer enc /Containmen E ui men?: ,I I k�k eel 4,k Waste Generator ID: Waste Product: MOM— Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS a �ht a1 c� �ltA �v�- 14ty-e A,71 I I Vkc- L4`r�' "t-) IP�-- NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous rfiaterial use, See;zo t< storage and disposal of 111 gallons or more requires a license from the Public Health Division. ► VUJv"4" Antifreeze Dry cleaning fluids �( Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives 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: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) 1I 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 Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: I ORDER : VQe, DA, e, ACC m. 4.— v , a I OR ATION/REC MME DATI N : .na SXQ(ILA Ova, %M&DZA - ��o�yq�o(Q5 i"< Inspector: Facility Representative: iJtf. cu WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS j Number Fee 1069 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that Aubuchon Hardware 3872 Route 28, Marstons Mills, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2016 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF, D.M.D. 07/01/2015 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health I � r Town of Barnstable Regulatory Services Richard V. SmIi,Director ` BAINSTABU, Public Health Division 61 Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee:$100.0.0 ASSESSORS MAP AND PARCEL NO. a -OQITE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT /1/, A Av6czLn Cam, I,c. NAME OF ESTABLISHMENT • ADDRESS OF ESTABLISHMENT M7Z Ro„4.1- 2$ /14des: A?US M4 6U49 TELEPHONE NUMBER SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. (:)q- JOS02-90 STATE OF INCORPORATION AAN FULL NAME AND HOME ADDRESS OF: PRESIDENT E_ A.,I,,.xln.n IV TREASURER CLERK C j"r" A jt,Lwn cr /)W,.Ou= SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# C:=he\Temporary Internet Files\0LKD3RAZAPP Rev2015DOC °*IKE A Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 B""M M�E.� 200 Main Street• Hyannis, MA 02601 2639. �'DrFO MP�P`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT _ Business Name: jDyC.tno ,Z7J C Date: 4 t Location/Mailing Address: S Z Fa.1v,-QM,- KM Contact Name/Phone: ,S01b-_1 Zb --71 oO P(\cw.. G-cr4,-�- S Inventory Total Amount: 4 2mt� MSDS: &A-Vm.¢- License#: ( 0(.2 Tier II : 5,� Labelina: Dk< Spill Plan: Oil/WaterSeparator: Floor Drains: tjo Emergency Numbers: Storage Areas/Tanks: bjl Emergency/Containment Equipment: ix wo( Waste Generator ID: 011k Waste roduct: 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 Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives 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: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes k� Wood preservatives(creosote) Asphalt&roofing tar �� ��c¢'E Swimming pool chlorine Paints, varnishes, stains, dyes-ar,A�\ 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 Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform,formaldehyde, 0 � nn hydrochloric acid, other acids) VIOLATIONS: foams �4\�- w��Go, DcD `\-�ov� ORDERS: 00 -2- C0\1'--( O'k Stil S�oc o.� Dots 4vky AAwit ,<zXo INFORMATION/RECOMMENDATIONS: v� d inspector`--'("L&' � �- Facility Representative: tit- WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS JAN-15-2015 12:50 From: To:15OG7906304 Pa9e:1 Branch Inv to Hazardous y F�Au�bbuc ry ardous Materials W■ on co■ Inc Office Heurg Man-Frf 4LI;ol1-16:30 85 Aubuchon Drive Phone (976)874-0521 Efi*rga^ay of How Con ct Numbers WesimirtsterMA 01473 Fax (978)874.2M8 M.Marcus Moran(978)a 4-0713 Daniel Aubuchon (978)ep-5 34 meflBrsncs+treaonatiaa ew tim Aubuchon �a re 159 Managers Name Alan AGrant MARSTON MILLS MARKET 3872 R U7E'2$ Off Hour Phone 608-259.6151 MARSTONS MILLS MA p,2648 Repot!Run Data and TLme Step Phone sm-428.7100 'Thursday,January 13,37 Hamad Cob: H&2Wd C 20n K ' itmm 0 lion ant FE$gNt to ORM-D ORM-D 5,056.53 72 OR161-1) ORM-D U.N,1011 FLAMMABLE GAS 2.67 a BUTANE FLAMMABLE GAS U,N.1044 NONFLAMMABLE 92.05 13 FIRE EXTINGUISHER. NONFLAMMABLE GAS U.N.1057 FLAMMABLE GAS 26,49 4 LIGHTERS CONTAINING FLAMMABLE GAS U.N.1060 FLAMMABLE GAS 31.60 5 METHYL ACETYLENE AND FLAMMABLE GAS U.N.1072 NONFLAMMABLE 8.53 1 OXYGEN,COMPRESSED OXYGEN j U.N.1075 FLAMMABLE GAS 186,22 27 PETROLEUM GASES, FLAMMABLE GAS U.N.1090 FLAMMABLE 50.67 7 ACETONE. FLAMMABLE LIQUID U.N.1193 FLAMMABLE 14,95 2 ETWL METHYL KETONE FLAMMABLE LIQUID U.N.1219 FLAMMABLE 8.26 1 ISOPROPANOL FLAMMABLE LIQUID U.N.126$ FLAMNIABL E 47.85 7 PAINT RELATED MATERIAL FLAMMABLE LIQUID U.N.1268 FLAMMABLE 53.37 a PETROLEUM DI57ILATES. FLAMMABLE LIQUID U.N.1830 CORROSIVE 38,33 6 SULFURIC AW, CORROSIVE U.N.1944 FLAMMABLE 7.68 1 MATCHES,SAFETY FLAMMABLE SOLIDS U.N.19$7 FLAMMABLE 14,95 ALCOHOL.,N.O.S. FLAMMABLE LIQUID U.N.2468 OXIDIZER 179.58 2 TMCHLOROISOCYANURIC OXIDIZER U,N2880 CLASS 9 50.10 CALCIUM HYPOCHLORITE OXIDIZED U,N.3084 CORROSIVE 15,40 CORROSIVE SOLIDS CORROSIVE U,N.3090 CLASS 9 1,40 LITHIUM METAL CLASS 9 U.N.3091 CLASS 9 0.41 LITHIUM METAL CLASS 9 U.W3285 CORROSIVE 16.75 CORROSIVE LIQUID, CORROSIVE U_N.3286 CORROSIVE 36.71 CORROSIVE LIQUID, CORROSIVE U.N.3480 CLASS 9 218 LITHIUM-ION BATTERIES CLASS 9 U.N.3481 CLASS 9 49.97 LfrHIUM ION BATTERIES CLASS 9 Total Weight in store 9,994.05 AN Weights are in pounds i l TOWN OF BARNSTABLE Date:Z /--40 l 5 Gov, TOXIC AND HAZARDOUS MATERIALS REFORM NAME OF BUSINESS: A �bv���►^-- `I'Iar�I..)a�� BUSINESS LOCATION: 3��2 �� -�� , d✓I M INVENTORY MAILING ADDRESS: Savx-e_ TOTAL AMOUNT: TELEPHONE NUMBER: 2,a --71 o D /000 Alto"-I- CONTACT PERSON: Ala►ti r.►►1� M r- C. ,C 1jdc� gs4- ,- ial iooO EMERGENCY CONTACT TELEPHONE UMBER: MSDS ON SITE? TYPE OF BUSINESS: �� a.l I et-�Z + o!a 0)A Ott/iK-e_ INFORMATION / RECOMMENDATIONS: °) of Fire District: b`61ore NA5iI& iA.),t�uqoi Iecaa,4N do4tqIrl(kez, ZN o C-0-4101 CartyL i 11 3 lJ a 2 a d o1 rZVrf— Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS — JVo w�A o(G�►q 5 /w IMV4,or, 1 ''`� � The Board of Health and the Public Health Division have determined that Ae following products exhibit toxic orl 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 WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials ,Branch Inventory of Hazardous Materials Co orate Information t/V, E. Aubuchon Co. Inc Office Hours Mon-Fri 08:00-16:30 Emergency Off Hour Contact Numbers 95 Aubuchon Drive Phone (978)874-0521 M.Marcus Morals(978)874-0713 Westminster MA 01473 Fax (978)874-2096 Daniel Aubuchon (978)874-5834 Manager Information Branch Information Aubuchon Hardware 159 Manager's Name Michael A Cannon Off Hour Phone MARSTON MILLS MARKET 3872 ROUTE 28 Report Run Date and Time MARSTONS MILLS MA 02648 Thursday,May 12, 15:05 Store Phone 508-428-7100 Hazard Code: Hazard Class Gross Weight Description Description U.N.1193 FLAMMABLE 28.00 ETHYL METHYL KETONE FLAMMABLE LIQUID U.N.2922 CORROSIVE 33.00 CORROSIVE LIQUIDS, CORROSIVE Q '�. L ccoU5�� 1 ORM-D ORM-D 9,447.00 ORM-D ORM-D U.N.1060 FLAMMABLE GAS 32.00 METHYL ACETYLENE AND FLAMMABLE GAS U.N.1090 FLAMMABLE 28.00 ACETONE, FLAMMABLE LIQUID U.N.1944 FLAMMABLE 13.00 MATCHES,SAFETY FLAMMABLE SOLIDS U.N.2794 CORROSIVE 39.00 BATTERIES,WET,FILLED CORROSIVE MATERIAL U.N.1987 FLAMMABLE 21.00 ALCOHOL,N.O.S. FLAMMABLE LIQUID U.N.1072 NONFLAMMABLE 11.00 OXYGEN,COMPRESSED NONFLAMMABLE GAS U.N.1011 FLAMMABLE GAS 0.00 BUTANE FLAMMABLE GAS U.N.2880 OXIDIZER 60.00 CALCIUM HYPOCHLORITE OXIDIZER U.N.1268 FLAMMABLE 58.00 PETROLEUM DISTILATES, FLAMMABLE LIQUID U.N.2468 OXIDIZER 350.00 TRICHLOROISOCYANURIC OXIDIZER U.N.1830 CORROSIVE 182.00 SULFURIC ACID, CORROSIVE MATERIAL U.N.1263 FLAMMABLE 18.00, PAINT RELATED MATERIAL FLAMMABLE LIQUID 1*10>J kmc-/S1"141 PP�� U.N.1075 FLAMMABLE GAS 249.00 PETROLEUM GASES, FLAMMABLE GAS // U.N.1824 CORROSIVE 26.00 SODIUM HYDROXIDE, CORROSIVE MATERIAL U.N.1057 FLAMMABLE GAS 0.00 LIGHTERS CONTAINING _ FLAMMABLE GAS U.N.1044 NONFLAMMABLE 48.00 FIRE EXTINGUISHER, NONFLAMMABLE GAS Total Weight in store 10,643.00 All Weights are in pounds planogram prodcode proddesc QTY hazard code haz_class weight 5 U.N.1268 FLAMMABLE LIQUID 6.4417 ggQ_2 274951 FUEL, COLEMAN, GAL. \ CORROSIVE MATERIAL DECK-CARE 126404. FLOOD STRIPPER, GAL#FLD138 3 U.N.2922 1 DRAIN-CHEM 245258 CLEANER,SEPTIC TANK #25-1650 2 U.N.1824 CORROSIVE MATERIAL 13..1625 . DRAIN-CHEM 249680 OPENER, DRAIN, QT. #25-1010 _ 33 U.N.1830 CORROSIVE MATERIAL 3.8333 DRAIN-CHEM 249995 OPENER, 1/2 GAL. #25-1020 5 U.N.1830 CORROSIVE MATERIAL 7.3667 DRAIWCHEM 249698 OPENER, DRAIN GAL. #25-1030 1 U.N.1830 CORROSIVE MATERIAL 15.3375 HEARTH 456640 MATCHES,STICK,FIREPLACE,40-PK 7 U.N.1944 FLAMMABLE.SOLIDS .4375 HOMESECURE 250951 EXTINGUISHER, FIRE#FE3A40GR-6 2 U.N.1044 NONFLAMMABLE GAS 8. HOMESECURE 252510 EXTINGUISHER, FIRE #FE1A10GO 3 U.N.1044 NONFLAMMABLE GAS 4. 333 3333 HOMESECURE 166413 EXTINGUISHER, FIRE #KFE2S5 1 U.N.1044 NONFLAMMABLE GAS 2.2 HOMESECURE 252098 EXTINGUISHER, FIRE #FESA5 3 U.N.1044 NONFLAMMABLE GAS 2.2 MOWER-TRIM 112070 BATTERY,LAWN/GARDEN U 1 L 165CCA 3 U.N.2794 CORROSIVE MATERIAL 12.56 PLMB-TOOLS 227892 TORCH KIT,FAT BOY,TRIG.#TS3000 4 U.N.1075 FLAMMABLE GAS 2.9083 PLMB-TOOLS 225466 TORCH KIT,FAT BOY,STNDRD#UL100 3 U.N.1075 FLAMMABLE GAS 2.225 PLMB-TOOLS 604797 TORCH,KIT MAPP/OXY. #OX2550KC 2 U.N.1060 FLAMMABLE GAS 5 PLMB-TOOLS 600527 GAS,OXYGEN 1.1-CU.FT. #OX9 11 U.N.1072 NONFLAMMABLE GAS 1.4208 PLMB-TOOLS 121244 GAS,MAPP,14.1 -oz. #308432 11 U.NA D60 FLAMMABLE GAS 1.9 PLMB-TOOLS 273300 PROPANE,CYLD,TALL 14.1 OZ#TX9 67 U.N.1075 FLAMMABLE GAS 1.8208 PLMB-TOOLS 274654 PROPANE,CYLD,SHORT 16.4-OZ. 46 U.N.1075 FLAMMABLE GAS 1.7958 PLMB-TOOLS 119098 -TORCH,KIT TS POWERCEL#TSPC8KC 5 U.N.1075 FLAMMABLE GAS _ 1.3667 POOL-CHEM 170035 CHLORINE,3TABS,15-LB. #11055 12 U.N.2468 OXIDIZER 16.275 POOL-CHEM 284059 CHLORINE,GRANULES,5-LB. #11104 7 U.N.2880 OXIDIZER 15.1833 _ POOL-CHEM 284034 CHLORINE,3TABS,25 LB. #11057 3 U.N.2468 OXID IZER 26.1 POOL-CHEM 291765 CHLORINE,GUARDIAN,24-LBS#11105 1 U.N.2880 OXIDIZER 25.05 POOL-CHEM 291070 CH LORIN E,3TABS,4-LB. #11051 12 U.N.2468 OXIDIZER 4.3583 POOL-CHEM 105452 CHLORINE,TAB-A-DAY,4-LB.#10579 8 U.N.2468 OXIDIZER _ 4.2 PYRO-PANEL 121522 LIGHTER,RONSON,JETLITE,TORCH 10 U.N.1057 FLAMMABLE GAS .1667 PYRO-PANEL 121520 LIGHTER,RONSON,REFILLABLE,3PK. 17 U.N.1057 FLAMMABLE GAS 1938 PYRO-PANEL 252916 MATCHES,STRIKE ON BOX,3 PK. 6 U.N.1944 FLAMMABLE SOLIDS .507 PYRO-PANEL 659298 MATCHES,STRIKE ANYWHERE 7 U.N.1944 FLAMMABLE SOLIDS .82 PYRO-PANEL 256750 FUEL,BUTANE,RONSON,MULTI-FILL 7 U.N.1011 FLAMMABLE GAS .2667 PYRO-PANEL 247718 LIGHTER,BIC,MULTI-PURPOSE 48 U.N.1057 FLAMMABLE GAS .225 PYRO-PANEL 114853 LIGHTER,BERNZOMATIC,FLEXIBLE 11 U.N.1057 FLAMMABLE GAS .465 PYRO-PANEL 121521 LIGHTER,RONSON,WIND RESISTANT 14 U.N.1057 FLAMMABLE GAS .3458 SOLVENTS 277475 ALCOHOL, DENATURED, GALLON _ _ 3 U.N.1987 FLAMMABLE LIQUID 7.475 SOLVENTS 102087 ACETONE, GALLON _ _ 4 U.NA090 FLAMMABLE LIQUID 7.2375 SOLVENTS 1108977 JVM&P NAPTHA GALLON _ _ 4 U.N.1268 FLAMMABLE LIQUID 6.9 SOLVENTS 1169573 M.E.K. SOLVENT GALLON 4 U.N.1193 FLAMMABLE LIQUID 7.475 SOLVENTS 103077 1 STRIPPER,ECONOMY ZI P-STRI P,GAL 2 U.N.1263 FLAMMABLE LIQUID 18.625 Page 1 of 1 P�pf IKE T°N� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 V BARMAN,';_ ! 200 Main Street• Hyannis, MA 02601 1659. �ArEO MP'�p`00 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT-- Business Name: -J0dAav% Date: Location/Mailing Addres . 3 U Contact Name/Phone: 50E—y 1'SW Inventory Total Amount: < bp MSDS: d License#: TO Tier II : i� La.elina: tAl Spill Plan: Oil/WaterSeparator: IVIA Floor Drains: 0 V 0 Emergency Numbers: Storage Areas/Tanks: Emergency/Containment Equipme t: .) � i dW .Waste Generator ID: Lim Waste Product: Date&Amount of Last Shi ment/Fre uenc : Licensed Waste Hauler&Destination: Of nKX Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS n0 cl ih NOTE: Under the provisions of Ch. 111, Section 31, of the( nera Laws of Whazardous 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 Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives 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: Caulk/Grout 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 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: Inspector: Facility Representative:T�;J WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 9 BARMA�BLE.9` 200 Main Street• Hyannis, MA 02601 �A1 6 54 �`eVV11 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rE0 MAy Business Name: Date: Location/Mai ling Contact Name/Phone: sO% W-iS 3SlS Inventory TotalAmount: MSDS: VVS License#: Tier II : Labeling: Spill Plan: Oil/WaterSeparator: NIA q FloorEmergency Numbers: Storage Areas/Tanks: Emergency/Containment Equipmen : IT KIWI Waste Generator ID: i O Waste Pro uct: rn%5CfA1flrVoLA Date&Amount of Last Shipment/Frequency: rA nW eA _ Licensed Waste Hauler&Destination: R �� AV1V e Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS no e*nV 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 Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives 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: Caulk/Grout 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 Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATON/RECOMMENDATIONS: ' I wa InspecCtor: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS C�s& calG r - `�Vi. rnLti l5 S M E AD II KEEPING YOU ORGANIZED No. 10230 H163 SUSTAINABLE MIN.RECYCLED 1NmnTNE CONTENT 1095 ceroam'no POST-CONSUMER ,,:::r omG snoiaao MADE IN USA GET ORGANIZED AT SMEAD.COM f T V 3?0 Cape Associates, Inc. BUILDERS • PAINTING • SERVICES 4 WES LOHR 64AVN P,,,oVthpod, Wtm' rw ;� .362.9770(o) ;/h 0.:566.0973(M) o r@capeassociates.com J 1 ` Ir _, No. O I ` Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS YeS ftpfication for bisposal 6pstem Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon, ❑Complete System ❑Individual Components Location Address or Lot No. , 5 `1 .j1Cv �E d Owner's Name,Address,and Tel.No. ZS'�0, in y 1.. Assessor's Map/Parcel )�� © ► "�. ( on ' Installer's Name,Address,and Tel.No. -a 1_3q0 qo� Designer's Name,Address,a el.No. .� 5 — y d T Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow providedAZI-7-141— gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the con truction and maintenance f the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the E ironm tal Code and no place the system in operation until a Certificate of Compliance has been issued by this Board of 2 Signed Date ' f! f J Application Approved by Date — 3 Application Disapproved by Date for the following reasons Permit No. o2-G d( Date Issued `- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned(k)by at i_ v has been constructed in accordance 2 with the provisions of Title 5 and the for Disposal System Construction Permit No.�j3 o bL( dated _1 J Installer Designer #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector VNX-J-� .� ,1p �` , No- �Iw..l r vI r - ' Fee v ` - '�`' ' "THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ` Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplitation for bisposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon ❑Complete System ❑Individual Components Location Address or Lot No.� � f,���{p Owner's Name,Address,and Tell.No. Z S�eg ��.d(�/,oq W r� Assessor's Map/Parcel -S� Z f ``� Edo k oP C.C. q 0#A!5 JM# O Z`% Installer's Name Address and Tel.No. — Designer's Name Address and Tel.No. 7 �bfi -.LNG- �JD�y , , V r. I G+ o7IST- -� I zao �1 y/ r z S� st/83s"6 Type of Building: Dwelling'. No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures A 4s Designt Flow(min.required) gpd. Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil 4 Nature of Repairs or Alterations(Answer when applicable) c Ai Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal sys4m in accordance with the provisions of Title 5 o4theE ronm tal Code and not, place the system in operation until a Certificate of aCompliance has been issued by this Board f Signed �, Date ;I ` f 3 Application Approved by Date' — r3 Application Disapproved by Date for the following reasons Permit No. 02 G I —` d( ' Date Issued -------------- - -- - - — = - - --- ----- ----------- --- - THE COMMONWEALTH OF MASSACHUSETTS 1 r BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Cohstructed( ) Repaired( (Upgraded( ) Abandoned(�by 9 o # at t has been constructed in accordance with the provisions of Tit1e,5 and the for Disposal SystemConstruction Permit No..)613 6u I dated 0— ( Installer J ` Designer_: /V #bedrooms ,� � '� Approved design flow 14 gpd The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date ' Inspector r No. �G I �� 6q� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS 30isposar *pstem Construction Permit ,-Permission is hereby granted to Construct( ) Re� ) Upgrd'de( ) Abandon System located at -_;-�C(c) if and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. _ l Date �,' j —' .� °Approved by ��' No. -vL1 Y e Fe N a THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Mispo8Al *pstrm Construttion 3permit Permission is hereby granted to Construct( R a' ( ) Up de( ) Abandon System located at � and as described in the above Application for Disposal System Construction Permit. 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[!� ,.`Gt X r' '".+ 4 .I.,y„. rp�•,r� .�Ij .�... �K` �1 i +� li r r F OCT-13-2006 09 :41 AM JCENGINEERING 508 273 0367 P. 01 r - - FACSTMIL .E COVER SHEET .,} Sik:•11 i 9.�. r I•i.r I:�hrrJ.I i..uLl it I I-�'pl':': 1141.1.1�..li�i91 N, � 511 �:PI'17�I""""'''a'�Ip,,`i,,,�.,vi�r..laiip.ryai pn.•I�•:rid'i:.'��i i�i 15'�.�. , i�p' ;n.l�,i r,JJL�- 7,f u i�ti„'..L.. .�i��iu'.-� ,� "'.�•I r�.l� �uf,9,y.;L �l 19 11 9 hF14I9 i r,iy,.,i ri1iS,.yi,it„ .,9.�.�I .�1.4',I �I 1pt5'I,1I i d'i''I I hi ii'li�''' rlpl L.�,I�,�..�,.�W��a�f�9�ul„Iti,�l„I.,,,�.,. lil%�6,.ai,�•:�;r�,#lyj„I,,;��r�b,cl�!rd;i'Irl'yl"".d-'�.������,G,L'LI �.��.��,�.1. �,19 :�:n�Sl'It�,' i:iu ,'�'lltllci''I,�: f�ll'r�lil�{�!I,Is I I� y ;1�I9�lay���:leili''I• JC .Engineering, Inc. Civil & Environmental Services 1 1'elephone:508-273-0377 2854 Cranberry Highway Facsimile:508-273-0367 East Wareham, MA 02538 91tijei•.s . - !,rr�lr•I+•)iS:r ver�....:,��•u• / rr.:rm:nr;,,,,.,�...:•rya„r ,:b 1 �I�11r I�� pllli.��'4bp•.y. �i,.d�n-1,dl''I ..{,I�„yl i�.. �$si. :ill ' i.Lliii r�tlP"„ih!i19llil�iriitiCyrq� il•! i.p•.!.: ,q�.y;l Pi 57t {'IIg''ItiQ�1 m�,i§t{.��h&�9..PI�1�4I�IL11.I��GIr�,nS,l]�,.�il..lhl„•::I,.dd�,take,2�,!91��!I�d.l6!n�El,':11h u4,s,,.,.�t1.�.,RU� i��. i ...1 �L. 11-1 ii. � Irlr",:'., II , to`I:dl<��1,15i-I'L'lldlah,,.I,i VL,:II.�,L.r~1.�la�:II,,.II,L.I�h.,,ll�k1171....,�:,.,.,u�IW�'aIV11 V:..MJ�1,1Iht1��11..,tal1���61!I II,.LIIla.91!Yhl�llll!•�I: TO: Thomas A. McKean FAX #: (508) 790-6304 PH 4, (508) 862-4644 FROM: Michael Pimentel, E I.T. DATE: October 13,' 2006 PAGES (including Cover): 10 RE: 3840 Falmouth Road, Marstons Mills (Holding Tank Regs) Tom: As discussed today, please find attached 314 CMR 18.00 regulations concerning the requirements for industrial wastewater holding tanks, See section 18.08 for "in-ground"holding tank requirements. Should you have any questions or comments, please feel free to contact our office. Thanks. •ICE P l065 This message Is Intended only for the use of the Individual or entity to which it is addressed,and may contain information that Is privileged, confidential;and exempt front disclosure under applicable law. If the reader of thle message la not the Intended recipient,or the:omployeo or agent responsible for delivering the message to the Intended recipient,you are hereby notified that dissemination,distribution or copying of thle communication is strictly prohiblted. If you have received this communleetlon in error,please notify us Immediately,by telephone,and return the original message to us at the above address vla the U.S.Postal Service. OCT-13-2006 09 :42 AM JCENGINEERING 508 273 0367 P. 02 14 C'MR: DIVISKJN OF WATER POt.1,)TION ("ONTROL 314C'MR 18.00: INDUSTRIAL WASIt-WA"r t. 1•iOl-DING -TANK AND CONTAINI;It C'ONSTRUCTI(K OPERATION,AND RECORD KE TING REQUMEW.-N'I;S Section 18.01: Purpose 18.02: Applicability 18,03; Exemptions 19.04; Delinitions I K OS: Partial and General Prohibitions fbr lndustrinI Wastewater I IoldinE;'I'tinks,Mobile'Tanks and Conudilers 18.06: Design Lind Operation Requirements Ibi-Co(atauners 18.07: Dcsfgp and Operation Requirolncnts for Above ground I-loldingTanks 18A: Design and Operation Requirements lire Ira-ground Hokling;'Tanks 18.09: Record Kcepnig 18.10; Celtihcalion 18.1 1: Holding T`ailk i ucotlatalf5nioning;Requirumenu l .Li.2a nose 'Ilne purpose of 314 CMR 18.00 ei sec/.is to Protect the public heakh,satety and the environment by providiing;canstnktion,(.aperalian,anti record I(ccping;requirements for holding oinks,mobile tanks,, and containers that accumulate or store industrial wastewater prior to oil-site recyCIi1l&treatment or disposal. 314 CMR 18.00 tweets owners and operators of industrial wastewater holding;tanks to comply with these starldnrds, submit a performance-based compliance certification, and keap necessary records. ,L&U Applicability (1) 314 CMR 18.()0 alpplies to all pel%ons when Awn or operate a holding tank, mobile: tank, or container that meets nil ol't1w fi llowing criteria; (a) tfu;haldingt.ank,mobile tank,m-container iv L.t,Red exclu ivelyto accl,"u1mc or store industrial waStcWater generated(in-site ur off-site; (b) the industrial wastewater in file holding lank, nxlbile tank, or contatincr will be transpolted d4utl) to an off-site facility lbr recycling,treutnxnt,or disposal;and (c) tilt:wn,tewatcr accun111hLed ur stured in the holding tank,mobile tank,or container is non- harnrdous Lion-domesti(:indllStrital wnslewater. 314 CNIR 18.00 upplies to rtew an(1 exulingholding;tanks,mobile tanks,and containers, Holding tanks include abovc-ground holding lanky and in-ground holding tanks. Hogging tanks also il1ClUde tanks crci ed by the conversion ul'scptic tanks or oil and water separators lbr exchisive utie as f ldusu'ial wastewater-holding;tanks. (2) 114 C'MR 18.00 does not apply to: (a) 4�nks or contuincl,used for production processes,industrial wastcwuta u•etxt.rnent systerTtk, non-contact cooling water.and heating or cooling cundensate: (In) saulitaty tfg&tanks regulated by 310 CM It 15.260; (c) ho.ding tanks and corxainerS that arc used 1;X lusively 1.0 aCCLanUlatC and store nun-hazardous indu u•,al wa,tewttter prior to shipping to a liconsed'Pretauncnt, Storage and Disposal Facility (TSDF) and that rTaett holding tr:tnk and container standards contained in the Mussachuscrts Huardous Wastc Rcgtulatiotls nt 3111 CMR 30.000:and (d) hazardous waste holding tanks and containers that Eire subject to the Massachusetts Hazardous Waste Replations at 310 CM1k 30,000. (3) '1"hc mquircmctus in sections 314 CMR 18.07 through 314 CMR 18,09 also apply to leachate collection tanks at solid waste facilities, provided that the lcodiate Collection tanks also sluill be constructed in accordance. with an approval issued by the DepattrTrent pursuant to the solid Waste Managmu-nt Rugulations at 310 C'MR 19,000. 1 R.03; Eit2m»tions Owners and operators offiwilities migula tcLl pursuant to the following regulations arc exempt from the provisions ot'314 CM It 18.00: OCT-13-2006 09 :42 AM JCENGINEERING 508 273 0367 P. 03 114 C'MR: i,)IViSK)N C.)1=WA'I'R IIOLi.t!'iiON CON'I'RO1.. 1 S.03: continued (1) 110 CNIR 72.04, Perfiwiniva-t,StunthUY1 Jar 1)ry C.'lecwlern•; (2) 310(NR 71.06; 5u���rlenianml Rr:grriramanii.r/fir Phuru Prnrca�.rors rrnr./Prnut•r.r';and (3) 310 CNIR 40.0000: A1us,cnchu.rcirs C.:unrin�rent i. Plus. JE,04; Definitions The fbllowinl;words and phrases.estccpt as otheiwise required by the context,have the following nncanings when used hereof Ahave-0und Flokiii tnl:• Imam any holding tuck constructed and positioned completely on or above the plane of the nrljttt:ent wiTauruling surliicc. .C.PMM)11�y-In Inuins the C'oirnnxnnweakh of MassachuscwC. Cqimatib A tzk nxtms materials that arc suitublc for mixing or contact without causing containment corrosion,degradation,or tun undesirable chemical reaction, Cgivainei means any portable device used to accumulate, Ur lrU mporl industrial wasacwtitcr. except rnobilc tanks as ciciined in 3 14 C:MR 19.04. Decommissioning 1t1-Ground Iloldirut'f'ank means itmovingan in-ground holding crook ti-om the site, filling an in-I rood holding tank with an inert nkaterial(Stich as Clark sand or soil). nr permanently chan&g the litnction of an in-ground holding trunk fi-om accumulating and storing inclustrittl wastewater to any other use. Department nx:aty the Massachusetts Department ofFnvironmcntal llrotection. No= means the discharge,deposit,onjection.dlunput6,spilling,leaking,incineration,orplacingof any industrial wastewater into or an any land, water, or treatment Iacility so that it may enter the envu'onrrx.nt,be emitted into the air,or be discharged into waters,including groundwater. 2g ,tt?.c Wastewater or Sanitary Wi) ji; ;t or Sewage rruana ma water containing human or aninnisl wastes fi,om residences,buildings, industrial estahlisluncnir•or odtur places. Doubk;wulled'1'ank mean,a holding tank that io un uucprul tank structure drat incltuiet;an inner tank and an outer shell.'Ilse inner tank shall be complctciyenveloped within an outer shell Sn that any it-lease from the inner tank shall be contained by the outer shell. EnjM, Lt_,!Lr,u Lion means it temporary situation caused by non•routine or irregular incidents, Existing I_ist1 �jjik means it holding tank installed before November 15, 2002. A holding Lank converted Irom it septic tank or oil aricf water separator is considered an existing hulling tank it'llint septic tank or oil and water separator wus converted to a holding uink belbre N ovcmber I S.2002. EUj& means any site or works where induus(rial wastewater is ur will be generated,stored,treated. dewatered,refined,incinerated,reclaimed,stabilized,solidified,disposed,or otherwise processed. !{a 4rdot.I Waste means a waste considered Iwardmis pursuant to the Massachusetts Fla? MOUs Waste Regulations,310 C;MR 30.000. OCT-13-2006 09 :42 AM JCENGINEERING 508 273 0367 P. 04 I 314 CMR: DIVISION Oh WATE-Ak POLLUTION CONTROL IN.11•�� cunlinued 11gkipu"fU-1 rrleans a stationary device,constructed afnon-clrrthcn inat.erials (e.g., concrete,steel or plastic)that provides Stnrctln•al suppOrt,and is used to"min rkite or store industr•i;11 wastewater. Tanks that are transportable and not mounted on a wick or trailer, tint merely placed on a truck or trailer.are considered hoding wanks,Tllc t.eml holding oink does not Include rnobilc Umiks as dc'l1ned in 314 CMR 19.04,but do❑s inchxlc in-ground and above-ground holding tanks. H•20_I.-tr�d,tU means a standard lirading as Npecilicd by the American Axsoclatlon of Highway 011icials. For rel&ericc purposes, 1-1-20 Loading is a standard that has been developed by the American Association of'Smic iIiglawoy tend Transportation Officials (AASI-ITO) and is essentially equn ilent io the load that a elo,00o pound truck 14 feet long exerts its it travels over❑ given point,See Specifictitioos for 1-ligliways Oridgcs,AASHTO, 199(1,pp.21-21 Inn Lyiout I.,iaicl•mcanz a ct,ntinuuus kiyor ol'impervious material completely covering the bottom and side suiiacc.s ofa holding tank. ba)jn2atiblc ateria immix materials that are not suiiahlc fir mixingor contact because the mixing; or contact may cause containment corrosion,degradation,or rin undcsimble chemical reaction, Ind tl�triul Was ewatcr means wtistc in liquid loan rvsultuif; li'om any process of industry, uvde or business,mprdless of volume or pollutant content. Waste in liquid form consisting of only sewage Lv not industrcal wastewater. n- nxuad Holdinp,Tank means any holding tank positioned paartiully or completely below the plane of the adjacent surrounding surface. M.G.L. rneam the Ma68 OUSetlS General Laws, Manually E'illed_I-lold n iLi 1s means a holding tads that can be filled only by manual operation.The tank that can be tilled through a piping system by jy-aviry or pump is not a nvuxully llled holding tank. Mobile J�� means .1 transportable tank mounted on n trued: or trailer that meets applicable Department of Traisport;ition(1)iYl)standards. including equipment to load industrial wastewater. Mobile tarsi"do not includo tanks merely placed on trucks or truiler-�. Such tanks merely placed on trucks or wailers are defined as above-gromid holding tanks under 314 C;MR 19.04. New Huldm&lank means a holding tank that is installed,or n septic tank or an oil kind waterseparator that is converted to a holding tank on,or titter November 15,2002, OMI= ro ilm the person responsible for the oper.Itkm,including,but not limited to filling.cltnptying and rriaaltpining a holding lank,mobile Beek,or container for utdttsu i;tl wastewater. Q2 ner n-eans a person who has etleclivc control, or legal or equitable ownership, alone or with others,ofany site where a holding tank,riulbile tank,or container for industrial wastewater subject to 314 CMR. 16.00 is located, including but not limited to any Ligem, executor, administrator, trustee, lemce,or guardian of the.vjtate fiar the holder ofthc lcgt,l title. Pe- rscm means any agency or political Subdivision of the Commonwealth,the federal govern••ment,any public or private corporation or authority. individual, partnership or association, or other entity, includiung any officer ofa public or private agency or organizntion,upon whom as Chuy may be imposed by or pur,uant to any provisions of M.G.I..c. 21, §5 20 through 53. JjQLQ1L1L1j nVeans any clenroznl or property of sewage. agricultural, industrial or commercial waste, nunofl; Icachiitc,heated elllucru,or other matter,in whatever h,rrnl and whether originating at a point or major non-point Source,whielt is or may be discharged,drained or otltctwise introduced into any sewerage symem.treatment works or waters or on to;any land of the Comtrxmwcukh. &URI Invoras to act in response to another mbstince to prodme a chemical change. OCT-13-2006 09 :43 AM JCENGINEERING 508 273 0367 P. 05 314('.MIk: DIVISION, OF WATER PC)L.UFYION CONTROI., 18.04: continued W,gv;_S,'' .uairuTlcm means techniques that~hall rise either an imporvious liner,it vault,or duublc- walled tank i0 contain~pills firm a holding tank to prevent a release to lie environment, Site Irie'llis a geographically Contiguous property in sing)c owner-ship which irmy be divided by it public or private right-nl=way,provided the enti-ance Lind exit betwmi the Nvu properties IS at a cross-roach intel'Secdon,shut access is by crn�sing as opposed to going;slung the rigtht-oi=way. Non-contigitunis properties(.synod by the same person btu cotvtected by:t right-of-wily controllcd by such person.and to which the public does not have access,arc considered oft-site propel:y. jgEfilSle Waters irlems ❑II witrcl;s other than ground waters withal the jurisdiction of the Cotronunweplth, including without. IIl11Rat'ion, I'ivcl's,itrca im, lakes, ponds, springs, ;mpoundlilcntt, estuaries,wetlands,vernal pools,and constal waters. ]'i i'l jilt inenns it water light vessel havii'ig till inlet w rccelvc raw sewage but net Nutlet and which IN designed and tiscd to collect and store sewage until it is relu•ived l'or disposal,iutd which is regulated uncle.110(,mR 15.000. Tret�unent Facility ut Wty!Li Imams anyand all devices,processes and properties.real and personal, to be itsed in the collection,transmission,storagc,h•ctitmcnt,disposal,recycling,reclamation,or roust: of waterborne pollutants,bul not includ'ulganyworks receiving;a litzardous waste ftorn ofFthe site o'l' the worlts tin-the ptu•pose(if tivitment, storagc or disposal, or holding tanks regulntcd under 314 . CMR 19.00. Vault means an unperviolls nrtderground compatYnwra,u-ucture:. 7.one A ii- ails the following;land area; (a) the land arcs between the surface water source and the upper boundary of the bank; (h) the land arcs within a 40(1 liar latunl durance li nm the upper bouulely ofthc bank ofa C4txs A surl'uue wnter source,its dclincd in 314 CMR 4.05(3)(a);aM (c) the kind area within a 200 Riot lateral dismicc from the upper boundary of die brink ol'a tributal�'or cISA0LkltCd surl79Ce water body. L-QM1 mea ns the protective.rildiw required irou1d it public water supply well or wclltiekl.Fur public water system wells with approved yields or 100,000 gpd ur greater,the protective radars is 400 lest. Tubular welitields requite a 250 font protective radius.Proict:tivc rndii for all other public water tiystein wells are determined by the following;equation;Z,onc I radim in li:et== (150 x log;of purnping rate in gpd)-350,This equation is cquivnlcm to the chart in the Division's Water Supply Guidelines.A default Zone 1 rWILIS or it Zone I radius otherwise computed and dctcrinined by the Deparnnent shall be applied to IrarLsient non-community('rNC)sand non-transient non-community(NTNC)wells when there is no metered rate orwithdrawal or nil approved pumping rate. The dei5ult Zone i radiwq slulll be 100 feet ibr T'NC wells unt.1 250 toot 11.11,NTN(' wclLs, In no ciasc~hall the Zone I radius be Icss than 100 feet. 18.05; j1grjW aji&j Genoel Prohibitions Industrsll WastewaLgj-jgJ t�' 'tnku Mobile'i"ank.s-aalid mainers (I) No hlcility may use a holding;tank to ac cunillaic ur store un-%ire generated or oIr-site geI it:rated industrial wastewater p6oi to shglping;ktr off-site u•eaunent or disposal il'it Ls or becomes teasiblc to discharge the industriltl wastewater to n sewer system.except when;the lucilky,is requested ill wntiag by Use local sewer authority to use it holding tank prior to shipping off-site in order to ineet;fewer opcnitiona i or 1Tlaintemanct:requirenx;nts;there are cnxrgency or episodic sitmations;or,the Industrial wastewater Ls shipped to a lice nscd'freatinent,Storage and Disposal F scility(iSDF). F'or the purpose of 314 CM I S.05(I), tllc critcrut fear determining the ti:anhility of dischar!3ing the Industrial wavLewate•to it sewer system ore when, (n) a facility has en existing sewer lint:connection to the%ewer collection system,and the industrial wastcwltter discl,nrge can be hydraulically acecpfe(.I by hoi.h tliu sewer collection system and local µ•astcwater trcatnxnt plant;or (b) a lilcility nuets Lill uflhe lbilowing;conditions: 1. an existing;sewer line abuts the facility botundaricn; OCT-13-2006 09 :43 AM JCENGINEERING 508 273 0367 P. 06 314 CMR: DIVISION OF WATER POLLUTION CONTROL 18.05: continued 2. the discharge ofthe industn.tlwastewater can be hych•aulicnlly accepted by hoth the sewer c011cction system and local wastewater treatment plaint;and 3. the distance fi-orn any building generating in<hlstrial wastewater to the closest sewer connection Inanholc is 250 leet or less. A mcilih that meets the libove li:asibihty erit;)60,bill fuses;a severe financial hardship,iTuiy request an excrnption li•ona this reg1tircnhnt in order to maintain an exiting holding tank tit-install a new tinkling tank. All requests InuSI liv Submitted to the Dcpertmcnt ill writing and contain all necessary docull)Cntatlon to dernollstriltC the SCVere flitatleial li<lydshIp.Tlic Department shall review and provide a dCciSiorl on tine Ix quest.in writing,kill 11 erase-by-catie basL'.'llx r.')epai•IrIWnt naay reLlucttt any acility owner to update intbi-rivition as necess:uy. which rimy result in a revocation or contiri ultiin of the exemption. (2) Ownel'S n111'1 Oj)erctt(>rs Of h1)Idlllj;l;lllkti,ni0blle tillll(ti,(11'l'UI'ilnlnel'R lLC(`(l l(J(1L't L11711.1131L'UT slol'e i industrial wimcwnter prior to oil-site recycling;,trcntrricnt or disposal shall not; (a) st:lrc incollillmible Ivallerials in the industrial wastewater holding; tarok, mobile wink or Go nta illc 1'; (b) stoic haurdous waste in the industrial wilStcwatcr I)(lkling tank,nu)bilc tank.or container;or (c) install or rriaultain such holding,lanl<s within the%one i or the Lone A ot'a public water stq)ply in violation ofthe requirements of310 CMR 22,2I(3)(b)and 310 CMR 22,20B'(2),respectively, ol'the Departircril's Drinking Water Regillations. 1Y,Q i inn. cc�LL ircrncnts fit Containers (owners lied CIpCI•CiIC'II'S USillg l CL)ntuinL'r to IICClITr1(1111tL'UI•stork!irILIL StriAl WJSlcWatCI'pt'IoI'to OX site recycling,treatnnent or ditiposal shall,at a minimum.. (i) Constructor line the cuntauler with conlpatiblc materials; (2) I ocan:the container in a secLINd storage area over an impervious siu•face that is five oferacks and leaps; (3) If the container is stored outside ofa building. locale lllc containcr within a spill contaiiurtent Sze LICIII'o w Ih i I O'i.Capacity untie largest single containcror 1011/6 ol•total possible colimincd vOhlnx of all the Containers,whichever is greater,and provide nCCCSSnry measures to prevent storm waccr collection; (4) Keep the Container closed kit all tines except when industrial wasteiv;ater iti being added or rcrnovcd; (5) C,olllply With applicable: regllirelncilts sm by the U.S. Department of Transportation 61- transportation ofwasic ofl-sit(:,;is may be amended froln tithe to rillic; (6) Label dic containcr with the words."Non.Flami'dous industrial Wastewater';and (7) Implerrilnt spill prevention and conm)l measures for trnnsfi rring any uidustritil wastewater to or fi'nrn coitlainel'S or u'ansportinj�n containcr to Ininimirc potential release to the cnvirunrnent,and repent to proper nl.irhoritieE reg aiding spills relcasccl to the onvironme:nt as required by lixieral,state Lind local laws and regntlations. (H) 1'rurlLlc.as mininlun),either a pi,rhnhle a6arm yyslCm cap;abk:ui'scnclinKan alarm signal to a stall'i:d location or loc(:ue the conlailler within a spill conminnlent area during;filling operations for containers which are'. (a) iroveable only by motorized mechanical ClcvicCS;,and (b) rumutely or automatically lillc(I• 18.07 1tind On l jp,p 2) C iretrients fief(1 v roundJ��I. ninI'I'!n!c Owncry and operann•; using an above-ground hokting rank to accumulate or store indumrial wastewater prior to off site.recycling;,trCatnlcnt ol•disposal Shall,tit 11 minilruun; OCT-13-2006 09 :44 AM JCENGINEERING 508 273 0367 P. 07 314 CMR: faIVISI(')N (:)I WA'l'Iuit,1101..I,,.U'1'iON ('ON'i'RO1.. I8.07, continued (1) Conso•nct ur line the holciiiip.think with conlpat.tilllc nlstteriils; (2) Equip the holding tank with the filllowing: (a) f O(a ltcrttotely Or 6jitonwfit;ally Filled 1•loldiq "t I k,a Icvel rncnsttring device and an audio and light 0.11111 system located 111 a st:atded location. The alarm system shall be activated when the Icvcl of industrial wastewater reaches 7514 capacity ol'tle holding tank and the altrin signal shall he trans•nitted to a stand locution;or (b) I'nr a MEt ttllrliyS Fj�yi IWj jUj4 s1 vivt4tl or sigltl l lttcc type pt'Icvcl trickisurelncnl; �. (..) t ovic ct ode?t'control ulcavi.uis necessfll•y to present nu.k:utec cunilitiuns; (4) Loeatt thc:holding tame within U spill cpnl'aitinwni Sirticture with i I OIX, capacity of the largest -inglc holding tank or 10c%, of total possible eontnincd volume of all the holding tanks,whic:hevur N greater, an(: provule yell•-round access for visual inspectiun liar the entire holding tank. The containment structure shall be located in n secured area owr an impervious sualnce that is fi'ec of mocks and lylpx to contain leaks and spills. Ifthe holdingtank is located outride of a building provide necess,iry measures to prevent storm water collcctiotr (5) Kecp the holding tank closed it(all times except when industrial wastewater is heing added or removed: (6) Label ilia holding tank with tho words."Non-l•kzardous Industrial Wastewater" (7) Implcrxnl spill control and spill response masures tbt'rransterring any incdusiriall wastewater to or li(tmabove-gltluund ttuldinb oinks to ntininlizc potential t'cicese t(?the environment,Fuld report to the proper authorities mgarding spills released to the environment as required by federal, state kind local laws and regulations;and (9) Construct new on site (lhriented holding tanks or asso cinLed structures in (lccordunce with engineering plawn stamped:end signed by a Massachusetts ltcgiswrud Professional Engineer with ilia appro11reue specialty(including but not limitcd to chcrnical,civil,or environnutnull engineering). 1 A()f Dcsi and. c }� lii4 cs 'r ln. mulid f lokli g Tanks (I) Ownel s and operators ofany new or existing in-ground holding tank used to uccunn.tlate or store industrial wastewater prior to off site recycl tig,trcmincnt or di pawl shall,at a rnirm im: (a) conmroct the holding tank so that; I. the inner surface or the luting of the holding tank is cu(llpadble with the industilal wa iiewater; 2, the total holding,tank capacity is greater Chart 5UlP%a pf the avarage daily flow of induslnal wastenVOIC1'gcncl'a1.ctl li'oni the fincility. 3. the holding tarok dues not lcalc Q7roupj1 its sides,bouon-L seatrls or top; 4. the holding tank withma»ds 1-1-20 loading ifthc hulling tank is coinplctcly below j'oun(L S. the holding tank 1bundation is capable of supporting the holding lank when it is; full tit' o'iduitriul wastewater and preventing uphill wlhcn it is empty;and 6. there is no entnince for sutrlace or stook water Ilows into the holding ulthk; (b) equip the holding rank with tic Billowing: 1, a Illuid level nicas(aing device coralected to in audio and light aY.t1111 syst.cm located 11 at staflcd location.The aL?rm system shall be activated when(tic level of Induslrtill wmtewiltel' reaches 75%ofthc holcdinktank capacity and the alarm signal shall be n•tlnsmitted(o n swIfed location:and 2. ()(lot-Control tile):isures accesmiry to prevent nuisanec conditions; (c) keep the holding tank closed at(Ill tIn1L•,s excl:pt wllcll tlldtl5trial watsiewmer is being(added or removed: (d) comply with all pc111liL4 ur other 111LI11(at('d by the local authorities pcitai ping to industrial was(ewater holding tanks: (e) label the holdingia nk(x•place it legible sign iairno(liately ncliacent to the holding tank with the words,"Non-Hazardous industrial Wastewater;and OCT-13-2006 09 :44 AM JCENGINEERING 508 273 0367 P. O8 31�� f.'MR: (.:>IVISI(')N OF 1V�'fCR PUL.1.(.1'1'ION ("'C)Nl"RUI. 1 V.0s: continued (1) inlplciru;nt~pill conrit,land Shill responSC measures fill•uxtll,tcrring ally indUS'Viall Wt15tCWWCr to or front in-grc7wld huklirlHtanks to minimize potentitll releaser to the t:nviroru,,eru,1111(1 IC1)ort l0 the proper authorities regarding spIlls released to the environment ns required by ledei;il state arld local law•;and rcgubLiuns. (2) (hvllcrs.+r uperutors ol'any existing ill-ground holding lank that WiIs llot Col1So'ucled at-convet,ed according to a Massachusetts Itcgistered plan is required to obtain art integrity assessment before November 15, 2003. 'lhu integrity assesslrlent shall be prepared by a Masvachuscus Registered frulcssiumil Engineer with the appropriate specialty(includingbut not(united to Chel+lical,civil,or environmental engineering),and skull statc how Icaks,cn)cics,corrosion•erosion, and uplift ore to be properly nv+nagcd. !file integrity assessine.nt indicates any potentW nr actual deficiencies,;nchid ngbw not limited to leaks,cracks,corrosion,erosion,or uplift,then the owner shall take all nece:;Salr•y actions to correct such deficiencies or dccommission the tank. (3) Owners or operators ofany new ui-ground holdingtank dial!.in addition to 31.1 C'MR 18.060) (it) consil'Ut the l,oklirtg t:tale in accordance with engineering pluns stamped, and signed by a Massachusetts Registered Professional l:rlginecr with the apprupriatc specialty Orickding but not limited to chcntu al,civil.at environmental engineering); (b) eurmruct the holding rink with secondary containment that meets the lilllowing nlinimurn requirements: I, the secondary containment shall be five ream any leakage to or from the environment, 2. the secondary cuntatnmcnt 9111111 be constructed qr lined will)compatible material; 3, the li7unda+tu)n or ha.c of the secondary conlairuttent slv,ll be Capable ofhruviding support to ilr:set:ondnly to?nt,ainn,�ni anti resist the presstu•c yadit:nt ubovr.and below the system;imd 4. the secondary Contuinn+cnt structure Sluill provide Space and access (including access thr•cnlgl+mechanical or electrical detection(ICNiccs)In detect and renlovC any leakage fi•on,the. holding t;uik; (c) inspect the holding lank ii+r Icukugc on n weelclybnsis at rninirnurn,1'C1111!ve the lealCa�C,ifrany, and reprir and restore the holding tank as$oon ns possible. 18,(t•,�e�t�1 K.cnning All persons who owr+or operate a Itulding funk, inobile tank. or container that accurnulates or stores t?ri-site generated or all=site gcnci-atud industrial wastewater prior to off-site recycling,tr,;amlent or disposal shall comply with the fiillowing record keeping requireltlents: (I) Ntuinta:n the li)Ilowing rccurds at the f lenity for the rctcntion tir.)e,pccificcl herein,and mike these records available to I)Cparu,rnt prrsunnel uptrn request: (a) holding tank Construction and installation records mairtUhled until holding uink decomrlh:ioning, including but not limitcd to; I, holding tank engiricering plan. stamped and signed by a Massachusetts Rcgislered Professional Engineer, if applicable;and 2, any applicable t+ernlii fi-um the:local municipal approvitig authority: (b) operating records for holding tanks ai,d containers maintained for three years li)r each shipment of industrial wastewater,including but not fultitcd to: 1. the nan x of holding lank operator; 2. the date of sllipillenl; 3, the volwlle anti description of file inclustrial wastewater hurl each sourcc,including both on-site sources and oll=site sources.ifany; 4, the name and m1dre s cif the receiving Jaciliry,and verification ofdlc shipment,by rneautir ol'a document, fr()tn the receiving kicility;and 5, the nano:and vehicle rcgisu•ation number oftlic hauler; (c) operating records for mobile links rrlaintaliricd fior three years ti)r each shipment of industrial wastewater, including but not limited tug 1. the n,uric ofthe mobile hulk operator; 2. the Blatt:of�hipnlent; 3. the volume and description oftlll:inclusti-kil wnswwwcr tram each source; OCT-13-2006 09 :45 AM JCENGINEERING 508 273 0367 P. 09 314 CMR, DIVISION OF WATER POLLUTION CONTROL I S.09: contilulcd 4• 'he.natne.and address of the receiving fiacility,and wrifieation ofthe shipretent,by rncnns ofa dacurnent,Fi•nrrl the receiving taeiliry,il'thc mobile funk is tht:only holding tank aced at the laci:ity. (2) •[11e re•.ention tintc rot•these records shall extend autonuilically for the dllt'ntion of'aiiy unresolved cnl'olrerncet Vd011 against the lilcility related to fedenal,state or local cnvirontimmil rcquu•errmnts. K..� C'ettification (1) 134dimaig on November IS,2002 either the uwnt:r or opcl•ntur ufun existaag or new holding tank shall be required to submit it ot1C-time complitmcc certification to the i:)epa rtment in accordance with the I nvivortmental Results Program Certification t�:gtlutions raider 310 C"MR 70.03(3) oil Ibrrn Prescribed ny the Ucparnnent within thu hallowing time line: (a) 1=01•I:xlsting 1-01ding Tanks: submit the certification on or belbre February 15.2003; (b) For New Holding fatit": submit the certilu aliun within 60 days of 6astallation. (c) a e'Cl•tlfiCali0ll shall be dvcmc.l approved tulles the owner or open+tor is notified in writing by the Dcparunern ofdeticiemics in the submittal within 60 days of'reccipt ofthc certification and ii:c pursuart to 310 CMR 4.1O(1 (2) 111e owner or operntor of the 1611Owin6 IhCilitics are riot atquirul to submit such certification, (a) a facility that uses conrtiners or anobile tanks only and clocs not use holdung t<itllcs to accumulate or store industrb I wastewater; (b) o filcility that has a Department-issucd hulding tank plan approval, (3) any subsequent owner or operator tlfa holding tunic is not required to submit a certification it A prior owne•car operator ofthat holding unik Submitted the CCl'tifiCtlliOlI to the Dcpariment as required by 314 CMR I S.10(1),or obLlincd n written holding tank plan approval fi•orn the Depart»lent. (4) Any,.ubSCquent owner•ar clperntor ot'n holding tank is subject to the holding lsuilc regulations under 3 14 CMR 18.00 upon acquiring uwncrshga or initiating operation ol'the holding mrlk. .l�,�, Ilt�ltiina:f��;?S;C0117•missionin>',Rc:ctuircn>Cnts Beginning on November 15,2002.owners and opermon,decomrnusioning,it holding tank:hall: (I) For above-ground holding tanks; (a) pump and haul away the entire contents ofthe tank;rand (h) clean the holding tank and related areas as necessary. (2) For iii-ground holding tanks: (at) pump and hall away the entire contents ofthe tank: (h) clean the holding lank mid related areas as necessary; (c) dvcoln6ssioll the in-Wound holding tank wish one oftlic Ibllowin6 options; 1. mmove the holding tank from the Vvind:or 2, fill the holding tank with clean sand,soil,or other inert material;or 3. chonge the Ii.mtaion ofthe holding tank penllanently; (d) notify the Department ill Widlig within 30 clays of alccommissioning with the IbIlowing itllimnitiun: �i f OCT-13-2006 09 :45 AM JCENGINEERING 508 273 0367 P. 10 3 4 CMR: DIVIslON Oh WA'rmt rou.0 noNl C'ON'I'R(.')I_ 18.11: continued I. (he name and tiddress ofthc !acuity, Elie rrunc ol'thc trtvnct.or oporuiur: 2. r•he(titre oi'holding utnk ticconvnissioning; 3. Iic imst recent.hil;m,cnt record us Kpccilicd in 314 C'MR 18.09(1)(b):auttl 4. .t hriel'description ol'how the holding tank was dectanntisionecl, REGULATORY AUTHOJtJ'J'Y 314 CMR 1 K.00: M.0.1... c.21, �5` 26 through 53. C LIMIT OF WORK _ ups OMIT CCB UNTILf� TOP COURSE 2y�r5 � �� k € = ram` �rr�_ _ ,. -_ — i y S IS PLACED77 ✓ � i t r7S f DEMOLISH L LIMIT OF fit- G � REAR PORTION } E 9ti OF STRUCTURE CCB 4:t OF-"ISW3:BINDER COURSE '�y��-'? .h3�RJ'-/�": -. ./- �� - ,y �G_-- sue? 'ii.'T`G-� `4„w,•'`� 1 t'y?_�� � iAR?,. ? ti Jy,j�/ i�1/� �.H^'� S'Y.;;I:,� f`:✓2"Pt;.:` ``':t G; gest +��t' z ' '� .fix- } I �y�. '� !'i�J✓r/l ' -j „� �rati9. ,..Z .4. �-.'41`- a3 -"=�s�'F.-s'r__",_ .s w ni: 1 ;, } f \\ SIDEWALK/RAILING l� ; J CIA * � .i' ,r a.r,'A �1. w wn<� '� . 'Xt:.; ` C is :E9 �i-`?✓,>i/-irl 111l f� ��s - dip l '.'. '"'fr t-'p_ p a DEMOLISH �.j n-I�RDE'v /° ' vc>_, r ti FSTRUCTURE 1 d-A /fjl�! FIl. r2S t C ,.'. J r Ar O V S,?�"i7`'�v ; i !ljlt/.!�/ �`<'//i s. ?`: p.:. < , _' /� ;moo. !'% y v d� !"IC WR�_F; - a T `n: c _ ! CONCRETE WALK CU A3�aK:vG f `T^;,\IZVii i� > ri:� ,8E'I!ILn T''r. ':l_...---'-' :." .. .�i•-.,"L� -7® lam h<Tr¢r�j��t rf' ., _ `�'i':n °`w a 't ?r..,a_ ,Y,^.lv t7 -C'µ� 7 6' STOCKAD FENCE > C. j •.' 0� 1j h Gv iY - �� �^ (�? 6' / ',.t'7E 'c.'�-.'i... ";y-. •3'w {.:'• �.,� .> f !• r.r._' ... �y- Z �. `i f li-t.F tA ✓ lfj��> yF '� _ •` 4'Y'fey "_~--� ��I�. 1,,. } .... � S .._ --^ysl,r K �ls3h -•-•+-" J• ,----'t .i '\.y- -�•- 0`- YY "``-� N t- _ ! !f` Jul.^,u� '!/ ...! r2i,' ,, - , .`.®� .o. TEMPORARY . PAY( ENT, MARKINGS � ` . -� _ '• y,:..i.-a-�_ _i--' r7 �•- � i �4�.:�5 a � 9 >!f C�'!, i 1 S- `� WAN-CRTE -TEMPORARY PATCH � LK BETWEEN MCC.-AND LIMIT - WORK 4 - - --OMIT OF WORK (TYR) �� LIMIT OF -_-,,°}` - - -- - ;�'"--_ . _, - _-j!k-___ ���{�'G-''�- ` ��.� '�'���i `�``�-" --.j � s • �\\\ \` �N�._.� � 4;1 .._ . < BINDER COURSE-- t -- _ ' � --- ' .._-- - E; ..._l --,.�i'�S:iY..�, cD ' '---� i�__ \ (; a //�`ar, f��,T \ � �'•tvt�:%,�w`�4N`y'nv+l"�i / i - `_ - + �1`E — .._._._ _.._.--_.._...-_.__..__..-.._.._. u _T.OF NDER COURSE ._._..-- 1' / '- Rc MAINTA AND PROTECT EXISTING-P'ARRING SPACES f T 6 co Ne Commonwealth ot\Massachusetts 91r Executive Office of Environmental Affairs B Department of � Environmental Protection ` William F.Weld J e9� Governor Trudy Coxe Semi. ,EOEA David B. Struhs Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM T MAP# OS8-b3�j.Q0� PART A PAR# 3P CERTIFICATION Co#u,'+L�snp��5 (C3A�k 6 f C3os�dr,� Property Address: P-+e .28 Address of Owner: Date of Inspection: a— )—9b (If different) Name of Inspector: -J_{>r,-,p_-, 2S Company Name, Address and Telephone Number: A & B Canco 350 Main Street West Yarmouth, MA 02673 (508) 775-2800 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems, The system: y Passes Conditionally Passes Needs Further Evaluaiion By the Local Approving Authorit% Fails Inspector's Signature: Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the.system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to ;he system o .ner anti cop,(•> >ir,; ii, lire uj�er, 11 app;lcablc an(l the app!o,inn aji�orih. INSPECTION SUMMARY: Check A, B. C, or D. A) SYSTEM PASSES: have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY PASSES: A One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not) The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 8/i5/95) 1 One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone (617)292-5500 A J Printed on Recycled Paper r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: B)SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced If obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C) FURTHER EVALUATION 15 REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The systen) nas a septic tank anci soil ab5oiptiUn bysLtfm and is within 103 foci to a sur-acE water supp!'j or tr"butar" to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm• D) SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS of cesspool. (revised 8/15/95) 2 i. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: DJ SYSTEM FAILS (continued): Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 112 day flow! Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. Ej LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design flo%v of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: _, the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area (IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 8/15/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Rye a 8, Property Address: &Tu14 LAnr__.inG ( e)d9o4K o-� QOS�dN� Owner: Date of Inspection: i Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. _✓None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. ✓The facility or dwelling was inspected for signs of sewage back-up. ✓e system does not receive non-sanitary or industrial waste flow The site was inspected for signs of breakout. f/AII system components, oicluding the Soil Absorption System, have been located on the site. _✓The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. _✓The facilii� w;,d uccuij.:-ib, if d here:„ frOr,. ner' ,ve.c Provided v,ith information on the proper maintenance of Sub- Surface Disposal System. (revised 8/15/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: E'+e .2 Co't'a-& f-.Rrvp(N I` c-(\ . Rasrd� Owner: Date of Inspection: —2 FLOW CONDITIONS RESIDENTIAL: Design flow: gallons Number of bedrooms: Number of current residents:_ Garbage grinder (yes or no):_ Laundry connected to system (yes or no):_ Seasonal use (yes or no):_ Water meter readings, if available: 0283 Oct6 Ga-fLoAJS Last date of occupancy: COMMERCIAUINDUSTRIAL: Type of establishment: ?:d- tJ (C — 0V-rtC LAC , Design flow: 191) gallons/day Grease trap present: (yes or no)LX Industrial Waste Holding Tank present: (yes or no) NO Non-sanitary waste discharged to the Title 5 system: (yes or no)JI6 Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: eprrlu (�Mn,e�) ro System pumped as part of inspe ion: (yes or noor no If yes, volume pumped gallons Reason for pumping: TYPE 0-F SYSTEM I/ Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool. Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other (explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no)IL� (revised 8/15/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C p� SYSTEM INFORMATION (continued) Property Address: �TC $ 12D-ry 1+ 1,f)rn c:i I N(o �g�}N►C °f (3r3 S`TO(� Owner: Date of Inspection: SEPTIC TANK: (locate on site plan) i U Depth below grade: Material of construction: V concrete _metal _FRP —other(explain) Dimensions: /68!n 6N1/oti precAsT Cayezi lou 8e/ocj 6rg0e Sludge depth: f>?i' Distance from top of sludge to bottom of outlet tee or baffle:.3o" Scum thickness: V Distance from top of scum to top of outlet tee or baffle: Ja NN 4 Distance from bottom of scum to bottom of outlet tee or baffle: 15 Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) I Atjr, 13 RT io6rkiAle, LezraL- jofI.e+ - oorle-f- AaFGf,es (42e it1 place CdNcre--t-e "vets ow -roiMic Arm GREASE TRAP:_ (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP _other(explain) Dimensions: Scum thickness: Distance from top of scum to too of out et tee or baffle: Distance from botlo^ <r,im 1,, hntlnm Of otltlar tee or baffle Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, et(.) (revised 8/15/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: ��C -2$ �'o�i„r ygnp t n� �3{�rt tc o (osTor,, Owner: Date of Inspection: TIGHT OR HOLDING TANK:_ (locate on site plan) Depth below grade: r Material of construction: _concrete _metal _FRP —other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_✓ (locate on site.plan) Depth of liquid level above outlet invert:__ Comments: (note if e\el and &st-ibu::c- i, e �::', e,idcnce ol. er, evidence of leakage into or out of box, etc.) scR tN (A6 s cQ X a t d is -21 c.e PUMP CHAMBER:_ (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 8/15/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: N+e ag CcTu�* Lfz)l'Dl n G C9F'r'S1'z_ C'F BOsTon, Owner: Date of Inspection: o? — I -- �'►(� SOIL ABSORPTION SYSTEM (SAS): [ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: leaching chambers, number_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) oeD o nl /'S 8" o r 7 e- is D 'r ,- 'tji / S 5'T L CD✓22 O G K P CESSPOOLS: _ (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, sign_ of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY:_ (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments:-(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 8/15/95) 8 1 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C p SYSTEM INFORMATION (continued) \ Property Address: 1�• — g Co v 1�np I N C— coplq �, o F (3 osTor Owner: J Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' �T a � j - Nk 53 0 DEPTH TO GROUNDWATER N1 Depth tcvgroundwater:1 _feet method of determination or approximation: e y vPAAN S/�yiv s /V A T (revised 6/15/95) 9 i 3Search for Map/Parcel ; 058039002 T -77 own of Barnstable 4W / my, �,I! ffi i rr/rr )�- For Pa�cei Number 058039002 r s ....- _;: WOW � Business Name � Zone of�Contibution(YIN Area Number r , r ' ContammBnt Rel(Y/N) Phone 000 0000000 I FuelStorage TankPerm�t Iflu Vn Dis alWV1 s `i, ep est� '4YYet�Peri... `,Construction k ` i�lePermtNo✓pQ:F /-WAW " ✓ i r / ,. . 4 �sd v8. Issuance Date. (�� 03/10/1995 � {iompletlDnDatQ .. �vrFar r Sae off Septic Type/SI a of SAS Tank 3 i�ommen ��ts ,,,�:r ��� - -� i s Q tr REPAIR T 5 r,,,i as°t s,�J,adr✓swrr nri✓ ;;,,,,,, ,, -..�,_,...,,,, ,...... Want,v,,,,,; asmN mappar ;058039002 Ownerf CAPE COTUIT CENTER LLCproploc 3840 FALMOUTH ROAD/RTE 28 � ou t f �l yy/r,�/ d nv✓ > ssrur✓ � y9�� EJr= 6 Innovative/AiteAlm rnate�T€�shnologi SpbcS stems Sm 1e or �w/I/A Type IfA�Service Type r ad_d records ��` �� r deplete records? I � � > sx �n7>rr>a MIN r a` "ft .,_....._._.�,.MI N - 1 Commonwealth of Massachusetts Executive Office of Environmental Affairs ' R�Cf Department of PAR g® Environmental Protection 19 William F.Weldy � `h Govemor Trudy Coxe , Secretary,EOt:A y Davld B. Struhs g e` commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM MAP# 058 03`-001;;L PART A PAR# �j �y� CERTIFICATION C0'rut-rL nJArNG Property Address: �-e IT Co(rU,*,' Address of Owner: �C 2 npe. LeASvre� Date of Inspection: a-f_Q(o (If different) Name of inspector: ,J-p(me-r, b. SeAr-S Company Name, Address and Telephone Number: A & B Canco 350 Main Street West Yarmouth, MA 02673 (508) 775-2800 CERTIFICATION STATEMENT I certify, that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: ✓ Passes Conditionally Passes Needs Further Evaluation By the Local Approving Aulhorit\ Fails Inspector's Signature: Date: 2-2.1 - c , The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this Inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the repor, to the appropriate regional office of the Dcparmeni of Environmental Protection. The cnginal should be sent IU the System. ov.ner an(i copse x:.i to the bi)e;, If app+,Cab:: and dw a;-,pro,ing authow\'. INSPECTION SUMMARY: Check A, B, C, or D. A) SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not) The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. xr.. (revised 8). 15,/95) One Winter Street • Boston, Massachusetts 02108 • FAX(617) 556-1049 • Telephone (617) 292-5500 A Ce} Primed on Recycled Paper l SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: B) SYSTEM CONDITIONALLY PASSES (continued) _ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced _ The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT 'THE'SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Im, sysiem nas a septic wni: anU SUn dUSUlPuuii died is witllin iw fcEi to a surfacE "ate, supp!) or tributarr, to a surface water supply. _ The sysien) has a septic tank and soil absorption system and is within a Zone I of a public water supply well. _ The systenl has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The systenl has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm• DJ SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS of —': cesspool. (revised 8/15/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: Dj SYSTEM FAILS (continued): Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 112 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspocl or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E]LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design flow of system is 10,OCO gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one:or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply the system is within 200 =eet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area (IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 8/15/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Il c o28 Co-rol+- )-AnTDIING (G4Pe Lei%urn' Owner: Date of Inspection: c — I—9(o Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. ✓The facility or dwelling was inspected for signs of sewage back-up. ✓The system does not receive non-sanitary or industrial waste flow J[The site was inspected for signs of breakout. ✓AII system components, eAcluding the Soil Absorption System, have been located on the site. ✓The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. '✓The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. _✓The iaciiiiy oNNr�e: ia.,d occup. ,,�, if d :fever,; fr,;c. o„ne:; -,,ere provided ith information on the proper maintenance of Sub- Surface Disposal System. (revised 8/15/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C p SYSTEM INFORMATION Property Address: 1\� �g eoTv� f— LAnAr�1G ��lgrJe 1—�tS��e � Owner: Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: rtallons Number of bedrooms: Number of current residents:_ Garbage grinder (yes or no):_ Laundry connected to system (yes or no):_ Seasonal use (yes or no):_ Water meter readings, if available: Last date of occupancy: COMMERCIAUINDUSTRIAL: Type of establishment: Re--m; I Qu I i n c, Design flow: 75b gallons/day Grease trap present: (yes or no)__&o Industrial Waste Holding Tank present: (yes or no) 1.10 Non-sanitary waste discharged to the Title 5 system: (yes or no)-h�fj Water meter readings, if available: a.144 O od Go,11 On.-s 199 Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPI(VG RECORDS and source of information: \ 4e,�)rlu System pumped as pan of inspecti n: (yes or no) NO If yes, volume pumped. gallons Reason for pumping: TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool. Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other (explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: 53—8��( Sewage odors detected when arriving at the site: (yes or no) N D (revised 8/15/95) 5 SLBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1 jc Cc-ry f+ L4�Nov I N C, (UPQ 1--63ure�) Owner: Date of Inspection: SEPTIC TANK: (locate on site plan) Depth below grade: 3" Material of construction: ✓concrete _metal _FRP —other(explain) Dimensions: lAno GAL"o PrzecASr Sludge depth: .2" Distance from top of sludge to bottom of outlet tee or baffle:T Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle:_ Distance from bottom of scum to bottom of outlet tee or baffle: Isu Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) �A Nk IS g-F Le-ve-L C-+ •+- 6Ui-let -r-cS Am- W place • TAtyC NAS S-re_eL Cove2S PrND ftR-Q Pr-r GrA"De GREASE TRAP:_ (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP —other(explain) Dimensions: Scum thickness: Distance from top of scum to too of outlet tee or baffle: Distance from botio^ <r,n+i to hnnom of oU?t?r tee or baftle Comments: (recommendation for pumping. condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integri,v, evidence of leakage, etc.) (revised B/15/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: &-c 6 (CPf e kC 1Su re� Owner: Date of Inspection: TIGHT OR HOLDING TANK:_ (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP _other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm a-id float switches, etc.) DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribu::f•- e:,:.::', e'.'Idrncr `< of r;, ca..,,r,,,.e. evidence of leakage into or out of box, etc.) 1.S-rf1(3uTIDn tKew MOT' p ONE oLAK� CoLdef nor LoGA•re o2 oP Tflt� t� )43 " l3e-LzLo Graff t,t•+� c+ furs '--i'�tcrr-,ew'rioc' you 4n S' Uh aL-F",ctL — pP Dri%fe PUMP CHAMBER:_ (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 8/15/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: i'_ o2 8' t o i o 1T L_Anz i')N G CC t4ipe Le-t 3 u r-&- Owner: Date of Inspection: o?- SOIL ABSORPTION SYSTEM (SAS):- (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: .,,:leaching chambers, number:_ "leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) t-r -*- I is 4 ' ec- r&T- t-_� t+ - wA-re.(c- J4' Prer A-sr tj1 rr4 3' w&'rL2/ t+ S ('recPcs-r +- ll N ftu - sT ooe.rs +c> 6�ADe CESSPOOLS: _ (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, sign= of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY:_ (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised.8/15/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) 1�fProperty Address: g CD i U c1' l.An i�IBC, ecA�e L ei s u ce� Owner: Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks O locate all wells within IGO' i I O O 0 - 0 Y DEPTH TO /GROUNDWATER Y" V 1 Depth towoundwater: 4- feet method of determination or approximation: �Lff� Sfi/o�v S �£S % oL t_ A'o f,e- (revised 8/15/95) 9 I �C-0h Commonweatth of Massachusetts �q e�Vz Executive Office of Environmental Affairs of 8 IV Department of r�9� Environmental Protection ` William F.Weld L] Gmemor Trudy Coxe Secreln 'EOEA David B. Struhs Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM MAP#�CM,a39 PART A PAR# ��D CERTIFICATION n — Shay,,-MA(r_�C'-H P"Z A Property Address: �+�ag' l-.r� v'c.�.. Address of Owner: Date of Inspection: .?-. ) —q� (If different) Name of Inspector: `j pu�'eS -t, SeQrs Company Name, Address and Telephone Number: A & B Canco 350 Main Street West Yarmouth, MA 02673 (508) 775-2800 CERTIFICATION STATEMENT I certify- that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete,as,of,the time of inspection. The inspeclion was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: _Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authoril\ _ Fails Inspector's Signature: Date: —2-21 -9� The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flog+• of i0,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent iu ine sysien, ov.ner anti cop�(,> 5cr;1, :o th(- 'bj)c'r, ii app;icab;c aru thc aprro,ink au;honty. INSPECTION SUMMARY: Check A, B, C, or D. A) SYSTEM:PASSES: �I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below, B) SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not) The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 8/15/95) 1 One Winter Street • Boston, Massachusetts 02108 • FAX(617)556-1049 • Telephone (617)292.5500 A " Primed on Recycled Paper r — - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: B] SYSTEM CONDITIONALLY PASSES (continued) _ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced _ The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed CJ FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRON'MEN'T: _ Tnp wsten) nas a septic ldnK dnui Sun aWurpuun *-Mein dnd a within ,03 feEi to a surface water supp!) or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. _ The systen, has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The systen, has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. DJ SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS of cesspool. (revised 8/15/95) 2 f �a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: D] SYSTEM FAILS (continued): Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E]LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design flow of system is 10,000 gpd or greater (large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area (IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised '8/15/95) 3 i y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1l ,-C o2g �I U r f'�P►�`G�I nct _Q}A2 M f3rKer + PL -Z A Owner: Date of Inspection: a_ 1 _ q(o Check if the following have been done: -I Pumping information was requested of the owner, occupant, and Board of Health. _✓None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. VAs built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. _V4e system does not receive non-sanitary or industrial waste flow The site was inspected for signs•of breakout. jZAII system components, R Icluding the Soil Absorption System, have been located on the site. _✓The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. IZ The size and location of the So I Absorption System on the site has been determined based on existing information or approximated by non-intrusive .methods. Zhe iacihi) o�%i,r: id;-,d uccutj.:.,; , ifd ffe:en; it n, ne:; ..ere prodded ,ith information on the proper maintenance of Sub- Surface Disposal System. (revised 8/15/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION p Property Address: ate `�$ (2&-I-v,-+ L 4:v\ol. n� > Yn A C K e:'" Owner: Date of Inspection: _ C FLOW CONDITIONS RESIDENTIAL: Design flow: eallons Number of bedrooms: Number of current residents: — Garbage r Garbage grinder (yes or no):_ Laundry connected to system (yes or no):_ Seasonal use (yes or no): Water meter readings, if available: Last date of occupancy: COMMERCIAUINDUSTRIAL: Type of establishment: e-T i Q u 1 A r (� Design flowut""` allons/day Grease trap present: (yes or no)y�2S Industrial Waste Holding Tank present: (yes cr no)— Non-sanitary waste discharged to the Title 5 system: (yes or no)-ALp Water meter readings, if available: /945— 39 J,, 060 Gar CKI-5 Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: �N,CO 2f yTPv_mP iTf -t �N, System pumped as part of ins ection: (yes or no)_Ajj} If yes, volume pumped. gallons Reason for pumping: TYPE F SYSTEM Septic tank/distribution box/soil abscrption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other (explain) 2 G re.4�-s 2 Trq — #20 WX O STATI Dn APPROXIMATE AGE of all components, date installed (if known) and source of information: 117E Sewage odors detected when arriving at the s te: (yes or no)'& (revised 8/15/95) 5 e• SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C p SYSTEM INFORMATION (continued) Property Address: l� a2E (2C-ru ,1- dCe�no�/N 5-�p,�(tilo�2acer PEA Owner: Date of Inspection: 02— 1 --9[v SEPTIC TANK:✓ (locate orf site plan) Depth below grade: 5611 / Material of construction: ✓concrete _metal _FRP —other(explain) Dimensions: WOO 6HLA,4#J P2eCR-21rr Sludge depth: 6," Distance from top of sludge to bottom of outlet tee or baffle: 4R 0UTd.2r Pipe IJ07- IrJ oFenl�, Scum thickness: c2" VNRr3Le. TO see- P;PC-oQ- -� Distance from top of scum to top of outlet tee or baffle: N A Distance from bottom of scum to bottom of outlet tee or baffle: KL I& Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) TF-9N< (S AT u_)Or Icjn G i.e Qe-L UnlAat.e- T-o see, iN1.9-+ -I--ze. aC oyTl --� r?iA,-_ �j A nt IC A A-S -_->TVe_( Co•t e-(2S —t-o G r'PR D e GREASE TRAP: -�"wo�a� 6h� -stR�01Pr�ke / one - h^a=)C.IV_ oue,N (locate on site plan) Depth below grade:S CG reJ'G�e:TrAPS . Material of construction: concrete _metal _FRP _other(explain) Dimensions: >ofl, A 1000 GAI(OnS Scum thickness: 62 " Dist?nce from top of scum to too of outlet tee or baffle:5a11 tt Distance from bottom <r,im t- hotlnT Of OUtlat tee or baffle' I Comments: (recommendation for pumping. condition :)f inlet and outlet tees or baffles, depth of liquid_level in relation to outlet invert, structural integrity, evidence of leakage, etc.) __Y)jet- -I- ooT e+ +y e_-,, flZe. IK�' P(ACC -0� r e.F-,s e -T C-F"nS P,n1 D T'A Plrr I.10 2EG irk G Ise V e_I.. (revised 8/15/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: � ' $ &+u;+Lfmc( ,'7 G S+n Y11,19 2K�'t' Owner: Date of Inspection: TIGHT OR HOLDING TANK:_ (locate on site plan) Depth below grader 1 r Material of construction: concrete metal ZFRP other(explain) Fi d e C G L.Pr-S 5 — Dimensions: // D" Ro u n d Capacity: 3ozrz!� gallons Design flow: gallons/day Alarm level: A)O Comments: (condition of inlet tee, condition of alarm and float switches, etc.) ::J:j3Pr-'L IS A NO(ef,r-.G? Ar— -P6x- LAnJNiKiG An t,> g IA)µ1 cj4 w 5 e rr C� r s.s —Tke-re- is Oo A(Arm [OA+s DISTRIBUTION BOX:- (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if le\ellaandd dis:rib:;ir.~ i< e:; ::' e.ide-ce of so! d> cz �.r,•.e , evidence of leakage into or out of box, etc.) I J t STc k 6u+' 0 (N 66Y •I S 1 R 110 C-I, A Y) S a t z -1>-C ►.t�.s srf�r—L ca ue(Z- -ro GCA,>e PUMP CHAMBER:_ (locate on site plan) Pumps in working order:(yes or no) S Comments:_;, - (note cotrv%o tion of pump chamber, condition of pumps and appurtenances, etc.) f'sS Z S FiLL i�io&t> s 1 ¢ {' A S Q3 (revised 8/15/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C OO SYSTEM INFORMATION (continued) Property'Address: LNtC a$ w r0 4- lA iNb l n-s Skg�,r- mvh r(-Q-T 14- Owner: Date of Inspection: SOIL ABSORPTION SYSTEM (SAS):, (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: C) leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, conditio of vegetation,etc.) tSi S t' vft I q- - 5 CESSPOOLS: _ (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as pan of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: _ (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 8/15/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART C ...; SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: _ l—4 to SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' 0 V � r i3• C---- 0 O-__.-- - �----- O C DEPTH TO GROUNDWATER 4 Depth toKroundwater: _feet method of determination or approximation: S f% Ae e- dl., £v o.v ��8�✓ i (revised 8/15/95) 9 �TOWN OF BARNSTABLE o' Y� LOCATION �T�� ✓?��� �'P-?��� �c! SEWAGE# VILLAGE M• M ill ASSESSOR'S MAP&LOT G©2- INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY I 0 D o LEACHING FACELUY: (type) / o ° ° �'04, G/7—(size) S i9yk- _or- d osTiv BUII..DER OR' oT � .� H�1ti� PERMITDATE: r- ?® COMPLIANCE DATE: 7 G 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) Feet Edge of Wetland and Leaching Facility(If any wetland within 300 feet of leaching facility) A Feet Furnished by Q C fl/v C 0 0 JI S' 3 ►�� ►}'� 0 TOWN OF BARNSTABLE LOCATION 6'l T o ✓r9,1 "o"x4- RQY SEWAGE # VILLAGE e a�! ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. z '4/�A!" SEPTIC TANK CAPACITY 7 a a O Aek A/m o - LEACHING FACII.TTY: (type) �//,� (size) / a 0 ''DL�-r £,o BUILDER OR OWNER �a!u! ��✓��N� PERMITDATE: 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) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished.by . r �1. c-a 's),"r�, �v�� d ��` <.ltiJev� `1� �f`r9'yrc�s o �� Z� �� s\ Cyr a ���f`� ®��°99r 1 A o 0 � sr � ��c z a o 3 �� -L �.► �_ l0CAT1,.! ! SEWAGE PERMIT NO. VILLAGE Vt�e fvA INSTA LLER'S NAME & ADDRESS IUILDEIt OR OWNER DATE PERMIT ISSUED IVY /M3 DAT E COMPLIANCE ISSUED - � J. V; Cape isco G�1. a-zn D-f3o)s t1-z� N...... ...... FEs........................... . THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ....--- .._(.0 wo..........OF..... i . A ................................... Applira#ion for DhiposFal Norkii . ustrurtion Prrmit Application is hereby made for a Permit to Construct ) r Repair ( ) an Individual Sewage Disposal y System at: ................-_............... .Uri:... ........ ....... -- .......Z! ................................................................... Location-Address ++ or Lot No. Owner �i�ress IF Installer Address QType of Building Size Lot.................... .....Sq. fe t U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder Other—Type of Building -__ of persons____________________________ Showers ( ) — Cafeteria ( ) P4 Other fixtures -------------------------------- . W Design Flow............................................gallons per person per day. Total daily flow-------------1-00......................gallons. WSeptic Tank—Liquid capacity�O(Zgallons Length................ Width-____-_-__-_-- Diameter................ Depth................ x Disposal Trench—No..................... Width----l---------------- Total Length.................... Total leaching area-------............sq. ft. Seepage Pit No.........1---------- Diameter....__'_ -------- Depth below inlet..... .......... Total leaching area.... ?. ....sq. ft. Z Other Distribution box (V� Dosing tank ( �f j `" Percolation Test Results Performed by �--�l'.t�l �._1 :.__.d '.:,�a __ : Date....�bkbr............. 1.4 Test Pit No. 1.__ _4___.__,_minutes per inch Depth of Test Pit___--_1:1n...... Depth to ground water------------------------ f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---_-__-.-_-___.--____- Q+' --------•------------- 0 Description Qf Soil.....z-------- 0 - ... W ----------------------------------------------------------------- -------, ------------------------------------- UNature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'T T L_ y g g p - y 5 of the State Sanitary Code— The undersigned further agrees not to lace the system in operation until a Certificate of,Compliance has been issued by tjpe board of health. Ilate Application Approved By----- �1 �Da Date Application Disapproved for the following reasons:----------- -------------------------------------------------------------------------------------------------_ --------•-•---•-------------------•--------------------------......------••-------------•--•-•--------------•------------------------------------------------------------------------------------------- ��// Date Permit No......................................................... Issued...... d Date No........... �....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH F�o W_ ----- ---OF...... ................................. ialirtt#Marc fir Uh4p aiicc1 ork.5 nn�nrfinn Permit Application is hereby made for a Permit to Construct (A or Repair ( ) an Individual Sewage Disposal System at: PV a 1 .................................... Q ��I':?—( ---•--- y V�� -......._. • {� IT.,cation-Address or Lot No. .., _ Owner Address W ! e _.__.. uAtry,{m - ------ -------•---- ......_..._....... ��"+�s�` �tt+�+�_________•�������.,iy..� r rr _......��:�:�.,a a ++ - p v-�3•"-: Atldreas 61 w:`•" /t o r Ins a ler - Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder MI) Other—T e of Buildin �~t ._€ �_._.________ Showers — Cafeteria YP g ,,tGs�~`, =of persons ( ) a Other fixtures -----•--------- ----------------- -- -- W Design Flow............................................gallons per person per day. Total daily flow............. ......................gallons. WSeptic Tank—Liquid capacity V .gallons Length................ Width................ Diameter---------------- Depth........... x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area.........._---------sq. ft. Seepage Pit No......... Diameter____.!'' Depth below inlet..... t Total leaching area.... ...sq. ft. Z Other Distribution box (VI Dosing tank ( ) - ''' Percolation Test Results Performed by. ,_% ..:fTt � sF.- :� � , Date___.'` _ rg Test Pit No. L__-%,. _____minutes per inch Depth of Test Pit...... 7 ______ Depth to ground water________________________ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_______________________. r --------------- ........ Description of Soil------------.. .......... -- "� t _ < t t W ---------------- --------------------------------------------------------------------------------------------------------------•-------•••-----•-•••---------•-----------•••=-•-•-------•-••••--•--- UNature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------------ ------------------------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'T`:-.. p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Sig ed........ —- A Date Application Approved BY......;/ .fx� _ ____�/.>. i ate Application Disapproved for the following reasons:-•-------- ............................ -•------•---•------•------ ......................................... -•----•--•------------------------••-•-----•---•--•-------•--•--•----••.._..•----•---.....---- Date PermitNo......................................................... Issued-...............................................------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH t.......... --. "J .. .-.-...••.............•..--........-.......... . ... Tntifiratr f Tautplianre THIS I C TI fT the Indivi ual Se a e Disposal System constructed (44or5r Repaired ( ) -----•---- ---------•---•----- staller at... _� __.. y yL_ `r�..---- _ ` 1 ` --------------- 1 m accordance with the provisions of 1 _ . of The State anitar Code as described in the has been installed p > Y application for Disposal Works Construction Permit No- - ______________ da.ted_....__ „_... - - - THE ISSUANCE OF THIS CERTIFICATE SHAL OT BE CONSTRUE® AS A G�ARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. . DATE................................................................................. Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 0�� ............ .........OF....._..... ...................... ✓- 1 � e i� Permission is hereby granted_r - ...... `---••-- .,�. . . ...........................•--•----- to Constru ( or Repai ( ) an In v .u Sevtrag Dispos4 System at No._-. -- �2 --•c::--- "" yC-yr-"--j � ee��t-6r-;---- '-.- -'`- - -................-•-............... as shown on the aeon for Disposal Works Construction P it o_______ _ _________ Dated__f...,2 ............ DATE.......... 1� FORM 1255 HOBBS & WARREN, INC., PUBLISHERS �, -pen.,1 CIV-I ALA -CT 1- �J I G/ d•� IAM Ll z r N p , Wt �° p S y _ NYE t7N` 5100 v1i` SEPriG T71 K. , No. 15?'ar'. . .� Q E A r T s i Of 13, gv--T-a tit = 5v '�� C:' I GjSF _�•�'v _ G�'p .. . , : ... 4 . _ . . ;-. .. ; ZYz dlst =3�s ;�1p t 1ecp L1CQl,Box l Qpp► C t ST 1 G : P%SS'� f3u�t_O►U� ,�x Inc ?� i 1 tacs7 Tcyw ►.1 _ 'o� .. ._. ... .. ,. L . -. Oij r� t TEST_ 77- • ►Jv` t1..1V t NNE A-U 1, �? 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