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0445 OST.-W.BARN. RD - Health
Barnstable Fence Co- �� Number Fee 1309 THE COMMONWEALTH OF MASSACHUSETTS $50.00 Town of Barnstable Board of Health This is to Certify that Peacock Painting -------------------------------------------------------------------------------------------------------------------------------- 445 Osterville-West Barnstable Road Unit#6, Osterville, MA ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Is Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. ------------- ------------------------------------------------------------------------------------------------------------------------------------------------------ Restrictions: .------------------------------------------------------------------------------------------------------------------------------------------------------------------. This license is granted in conformity with the Statutes and ordinances relating there to, and expires 06/30/2021 unless sooner suspended or revoked. ---------------------------------------- JOHN NORMAN DONALD A.GUADAGNOLI,M.D. 07/01/2020 PAUL J.CANNIFF,D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health C"� Town of Barnstable Inspectional Services 04�, • Public Health Division B sA" = Thomas McKean, Director MASM 2639. 200 Main Street, Hyannis,MA 02601 � Office: 508-862-4644 Fax: 508-790-630.4 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE - HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10 00 will be assessed if payment is not received by July 1st: 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL?V YES_NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIE1 S(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: D►�tn �� IU2 C 5. NAME OF ESTABLISHMENT: e?Q.0— TCL, r,6 6. ADDRESS OF ESTABLISHMENT: IAAJS O.AwALP- WLR1Din; I�o 02� 7. MAILING ADDRESS(IF DIFFERENT FROM O MIA 8. TELEPHONE NUMBER OF ESTABLISHMENT: 51 y2A`�2 9. EMAIL ADDRESS: \nU 12P�atc tx,��� � amr , � torn 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS, TELEPHONE#OF: CORPORATION NA PRESIDENT +rer Rd 1AU TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: • SIGNATURE OF APPLICANT DATE W Q:Wpplication Forms\Haz Mat Appli Draft Jan2019.4x Number Fee 1294 THE COMMONWEALTH OF MASSACHUSETTS $50.00 Town of Barnstable Board of Health This is to Certify that DC Tree Service 445 Osterville West Barnstable Road, Osterville, Is Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2020 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF, D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A. MCKEAN, R.S.,CHO Director of Public Health � i f 0 Town of Barnstable Inspectional Services :Public ARNSTABLE pptHE� Health Division �:su5. 2014:'as-Zn:a �—i BARNMBLE, Thomas McKean, Director iOrEn.59..�e`0 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 r ' 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 R VsT edche CATEGORY 2 PERMIT 111 —499 Gallons: $125'.00 ❑ �. CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by Jules 1. ASSESSOR'S MAP AND PARCEL NO. a — 2. IS THIS A PERMIT RENEWAL?J1 YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS • ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: 04,11A LMA"wJ5 5. NAME OF ESTABLISHMENT: A L 6. ADDRESS OF ESTABLISHMENT: / 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: �� 15ax 71 C 8. TELEPHONE NUMBER OF ESTABLISHMENT: TV 0 9%3 q 9. EMAIL ADDRESS: 6, ✓ "� 10. SOLEOWNER: AS NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICAN DATE Q:\Application Forms\liaz Mat App Revised 09-10-18.docx L Number Fee 1295 THE COMMONWEALTH OF MASSACHUSETTS $50.00 Town of Barnstable Board of Health This is to Certify that Rogers and Marney Builders .-------------------------------------------------------------------------------------------------------------------------------- 445 Osterville West Barnstable Road, Osterville, MA .----------------------------------------------------------------------------------------------------------------------------------------------------------------------- Is Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. Restrictions: .------------------------------------------------------------------------------------------------------------------------------------------------------------------. This license is granted in conformity with the Statutes and ordinances relating there to, and expires 06/30/2021 unless sooner suspended or revoked. --------------------------------------- JOHN NORMAN DONALD A.GUADAGNOLI,M.D. 07/01/2020 PAUL J.CANNIFF, D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable Inspectional Services BARNS LE Public Health Division X`r _-i639-2014 ..,X.S MA2S70tl5 XYlS•OS•ERVILLc•YFSf B..WVST.49LE ']639y-72014 BAMWABM KARK Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 I`v:1 w% Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE; HAZARDOUS MATERIALS cri IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS DULY 1 st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 Cl v5 1..0 CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ ,� '� CATEGORY 3 PERMIT 500 or more Gallons: $150.00 L7 *A late charge of$10 00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. /1 Z Doi 2. IS THIS A PERMIT RENEWAL? ✓ YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONINGBUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF . GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: 5. NAME OF ESTABLISHMENT: ZS /eta = 6. ADDRESS OF ESTABLISHMENT 415 n�Lr 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: O.3ox. BtO os�_P_V U _ 1AA 02.C-55 8. TELEPHONE NUMBER OF ESTABLISHMENT: Sob YZ.B Color-0 9. EMAIL ADDRESS: OF✓�1G c �OCa=Z�S/��•ie7/�AQe►�c`�6���L�=QS.0 O/� 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TE EPHONE#OF: CORPORATION NAME l�Y1.1J IJL PRESIDENT A TREASURER WA, CLERK rJCti 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE Q\Application Forms\Haz Mat Appli Draft Jan2019.docx Number Fee 1294 THE COMMONWEALTH OF MASSACHUSETTS $5o.00 Town of Barnstable Board of Health This is to Certify that DC Tree Service ....----------------------------------------------------------------------------------------------------------------------------- 445 Osterville West Barnstable Road, Osterville, .---------------------------------------------------------------------------------------------------------•---.....--------------..........----------------------------- Is Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Restrictions: -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and expires 06/30/2021 unless sooner suspended or revoked. ---------------------------------------- JOHN NORMAN DONALD A.GUADAGNOLI,M.D. 07/01/2020 PAUL J.CANNIFF,D.M.D. THOMAS A.MCKEAN, R.S.,CHO Director of Public Health r Town of Barnstable Inspectional Services BARNSTABLE QFt ow.11 m1 �9-cEn� ,Kn cour•eran 5 Public Health Division � 'SM�1639-201 FR��� i639-2014 • 1 BARNgrABM Thomas McKean, DirectorMAS& D z6gq �� 200 Main Street, Hyannis,MA 02601 } Office: 508-862-4644 Fax: 508-790-6304 ti APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES'THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 30th). APPLICATION FEES / �Pd�.Vti CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 CATEGORY 2 PERMIT _l 1.1 -499 Gallons: --- $125.00 ❑ _ l gepa CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL?V YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: 5. NAME OF ESTABLISHMENT: �n ✓t �'C 6. ADDRESS OF ESTABLISHMENT: 5 54 0.1116UNA 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 04 655 8. TELEPHONE NUMBER OF ESTABLISHMENT: � y !' 9. EMAIL ADDRESS: �G fx t,-c il-T ®" C c),4 10. SOLEOWNER: �'l YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE# OF: CORPORATION NAME PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICAN DATE Q:V\pplication Forms\Haz Mat Appli Draft Jan2019.docx Number Fee 1297 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that A Concrete Answer ........................................................................................•........................................ 445 Osterville-West Barnstable Road, Osterville, MA ........................................................................................................................................................................ Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. .................................................................................................................................................................... Restrictions: .................................................................................................................................................................... This license is granted in conformity with the Statutes and ordinances relating there to, and expires 06/30/2021 unless sooner suspended or revoked. ---------------------------------------- JOHN NORMAN DONALD A.GUADAGNOLI,M.D. 07/01/2020 PAUL J.CANNIFF,D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable Inspectional Services BARNS LE QFt r � • • hM40.0 M+<M�L5 OSFBVILLCONK BFPNYRST.4BLE Public Health Division 1 639 0 4 1 mmsziBm 1 Thomas McKean Director w Ep.39. e 200 Main Street, Hyannis,MA 02601 i� 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, E HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ XATEG.ORY 2 PERMIT 1.11 -499 Gallons: $125.00 V(V S r � CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ i *A late charge of$10 00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. /Z.z-/0D S .2. IS THIS A PERMIT RENEWAL?_&YES—NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS • ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: 6� bb wc— 5. NAME OF ESTABLISHMENT: V� COA(a_1P a w&mgq? ,T-1 c. (( ff 6. ADDRESS OF ESTABLISHMENT: ��{� ✓���� �° L1aU IGN Sh b!P_ Y1 �yl��, 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: PO 9#X GUS(_PA�JrUl/lr S. TELEPHONE NUMBER OF ESTABLISHMENT: 5AP Z 0=1 ff17 7 9. EMAIL ADDRESS: C ee he 0 Vl% eAi 70 �1 E 10. SOLEOWNER: YES_)�,NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT t 1 �12. 6 0 sal Z�6 TREASURER1-hjh t --,0 FILL 1:7 ra�ke r4 W W lea►2 H d L6 6nkA 6z �yV 5`6z? CLERK 17Ynp 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE -� � � Q:\Application Forms\Haz Mat Appli Draft Jan2019.docx Number Fee 1294 THE COMMONWEALTH OF MASSACHUSETTS $5o.00 Town of Barnstable Board of Health This is to Certify that DC Tree Service 445 Osterville West Barnstable Road, Osterville, Is Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. a4 ------- ------------------------------------------------------ ------------------------------------ ----------------------------------- - ---------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2019 unless sooner suspended or revoked. ---------------------------------------- • PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2018 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health h R row of B nstable - egulatory Services Richard V. Scali, Director " OFTME Public Health Division 41WANTARM * B NSfASM.CBRfl .[Of11R.HYA M - BMWSrABLE. Thomas McKeanMAR& , Director N"S 0H5 N"�i s o 4 --- - - -- --'6 ,•� -- ArEo a -- — 2Va Se A 75- inet,, i , Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st-JUNE 30th). APPLICATION FEES -D CATEGORY 1 PERMIT--_26--110.Gallons: _. _$ 50,00- ,. _ �/S • to _ CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 ❑ 1 (.910 CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? VYES_NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUAN ITIES (25 GAL ONS)? YES NO. 4. FULL NAME OF APPLICANT: 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: .qq� 7. MAILING ADDRESS DIFFERENT FROM ABOVE: Pv :7 I 8. TELEPHONE NUMBER OF ESTABLISHMENT: �0-- 6• -7 l -D y� 9. EMAIL ADDRESS: 10. SOLEOWNER: /YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: �/57)SIGNATURE OF APPLIC RE &�/ DATE 7 Q:\App(ication Forms\1AZMAT APP 2017 A= Number Fee 1309 THE COMMONWEALTH OF MASSACHUSETTS $50.00 Town of Barnstable Board of Health This is to Certify that Peacock Painting 445 Osterville-West Barnstable Road Unit B, Osterville, MA Is Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. ---------------------------------------- ---------------------------------------,------ -- -------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2020 unless sooner suspended or revoked. --------------------- ---------- PAUL J.CANNIFF, D.M.D,CHAIRMAN DONALD A.GUADAGNOLI, M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A. MCKEAN, R.S.,CHO Director of Public Health Town of Barnstable Inspectional Services BA��tllk F T t/'1• ."To�Public Health Division BARNSrABLE, Thomas McKean, Director 16 39. NO r 61 200 Main Street, Hyannis, MA 02601 a N, car Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE �= HAZARDOUS MATERIALS ci IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 Vsw Cfl� }- CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ I L4 65' *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 12n�] WJ 2. IS THIS A PERMIT RENEWAL? YES_NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS, INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? n YES NO. 4. FULL NAME OF APPLICANT: 5. NAME OF ESTABLISHMENT: �YeQ C 12 Lk .6. ADDRESS OF ESTABLISHMENT: 7. MAILING ADDRESS (IF DIFF NT FRO ABOVE: ILI - 2 8. TELEPHONE NUMBER OF ESTABLISHMENT: ►t �,; ,C lm 9. EMAIL ADDRESS: 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRES AND TELE NE OF: CORPORATIO NA PRESIDENT TREASURER 1 CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICAN JL DATE Q: Application Forms\Haz Mat App Revised 09-10- docx 1 V JY Number Fee 1295 THE COMMONWEALTH OF MASSACHUSETTS $50.00 Town of Barnstable Board of Health This is to Certify that Rogers and Marney Builders 445 Osterville West Barnstable Road, Osterville, MA Is Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. - ------------------------------------------------------------------- - ------------ ------1 --- ------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2020 unless sooner suspended or revoked. ------------------------------------ PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI, M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A. MCKEAN,R.S.,CHO Director of Public Health f Town of Barnstable �a. A .AH ,, ta , o Inspection�il Set-viccs B���Z�!STABI, FIKE Tp Public Health Division . HAii srAnLE. Thomas McKean, Director 9 MASS. 1639. 200 Main Str.CCt, Hyannis,MA 02601, Office: 508-56'_..-164-1 Fax: 508-790 6304 APPL,ICA`I'IO:N FOR PERMIT"TO STORE ANWOR UTIL.IZE I AZARL)OUS NlWrERIAL IN ACCOR17ANC'E.\\IT11 `I'l IF:'T'O N OF' L:3AR\STAI3LE C,I,NF'.RAL.ORDINANCE..C;IIAI'TLR l08, HAZARDOUIS NIAT RIALS,ALL I3tIS1\F;SSLS'I'I•IA'I'IIANDI..E.OR STf)R.E HAZARDOUS NIATERIALS GREATER THAN HOUSH IOL D(,UAN IIFII S ARf: Rl'Ot.1IRF:D'I'p 013TA1\ A\ ANINUAL PF-RMIT(Rt.:"\S JUL..Y Ist -JUNF a0th). APPLICATION FEES CA"1 I'A"JORY .I PEJIUMF';'.. _2r i 10..0 l!ons:._ :0.0..0 _......... ,_..,� 5�... CA 1 E ..7n12Y 2 1'I"12YI1'I' 1 1 1 •499 Gallons: $125.00 CAI 1;COII)'3 .PI.I7\;11'1' 500 or more Gallons: 5150.00 10 D51ca8(o *A late charL'e of'SI0.00 will be assessed irpavnient is not received by July Ist. 1. ;XSSI SSOIt'S IlAI' AN I)1'AItCf:I..NO. 2. IS 'l'.IIIS s\ PERMIT RENEWAL?�YES�NO. I1, YES,SKIP QUESTION 3. 3. FOR AL.L,NEE' INDICATE WHETHER BUSINESS'.HAS - ZONINGIBUIL DING APPROVAL,FOR'IIAZA.RI)Ot'S �'1A"I'ERIALS STORAGE/USE OF GRL:ATE11'rHAN Iiot SFIR:)1..1') QLIA:NTII II?S (25 GALLONS)'? YES N0. 4. FUL..L.NAME OF AI'PI.1CANT: — 5. N ANT1 OF ESTA13L.ISIIIIENT: 6. ADDRESS OF ESTABL.ISIEM NT: ��.�s T_=1ZVtt�=�'� ?. \IA.ILI\(; .1D1)R_f:SS(lI7'1)II FE171 \"I' FROM ABOVE:' 111 Cp, Y. '1'L:L,I:I __..... 9. EN-I.kIL A1)1)RESS: 10. SOL. "OWNER: VES N0 IF N0, NAINIE OF PAI?TNE11; 11, FULL. NAAME, I103II: ADI)R1 SS,AND'TIA I'I-IONE 11 OF: CORPORATION;N:MIS,. PRESIDENT TREASURER CLERK 4 12. NAME: -- _ TELEPHONE#: COMPANY ADDRESS EMAIL: S .;NA`I'l. Rt-: OV APP1.1 ;,A; DATE_^ • 1`d. • I or::::,1 kv X,1x App K twd 10 do's v e i Number Fee 1297 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that A Concrete Answer 445 Osterville-West Barnstable Road, Osterville, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2020 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI, M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health c Town of Barnstable THE ARN Inspectional Services BSTABLE of bid, gfiSNtC"SflNIL. LL= T3wA.'cE Public Health Division BARNgrABLE. ` Thomas McKean, Director N.1 Argo 39.�6. 200 Main Street, Hyannis, MA 02601 C} Office: 508-862-4644 Fax: 508-790-6304 tt C5 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS DULY 1st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ - CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 RV61- CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. /ZZ 00 2. IS THIS A PERMIT RENEWAL?4 YES_NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: DW) 1OrfW/F 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: "lq$" vLl t9 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: AQ. &X 8. TELEPHONE NUMBER OF ESTABLISHMENT: 5M �{J,lj �I f f 7 4. EMAIL ADDRESS: `xrZDYI 10. SOLEOWNER: YES J�NO IF NO,NAME OF PARTNER: fI71Glf D i�l f%G� 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME crek- mnswIme. PRESIDENT 1 K 1 ��L_ . T 1�" 0 Zr& TREASURER ,�k - MltGL_ 17 Ca.✓*&4 144e . w- Aajrasl,6� A'+ O-zht"o CLERKS i-p 7a i fry` zL 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT412 DATE Q\Application Forms\Haz Mat App Revised 09-10-18.docx Number Fee 1309 THE COMMONWEALTH OF MASSACHUSETTS $5o.00 Town of Barnstable Board of Health This is to Certify that Peacock Painting 445 Osterville-West Barnstable Road Unit B, Osterville, MA Is Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2019 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2018 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health �A 10weg8at0ryVrv1cesof Bns able � 40N(e tKE Richard V. Scali,Director 014 13V 2 Public Health Division BARNSTABLE enFns,ne .ra,ramuF.mruvMxr.:us 4a HARNSrABLE. Thomas McKean,Director � 16 9°a;1639. "� $ : iOjfptA 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS ' IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 3 Oth). APPLICATION FEES - CATTEGORY 1 PERMIT, _26---1-1-0 Gallons: $-50.00 V.S. CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. i22 1003 2. IS THIS A PERMIT RENEWAL? IVI YES_NO. IF YES,SHIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: o" .v�, -R-Coc 5. NAME OF ESTABLISHMENT: 'p-e-C cock ✓1�"11't 6. ADDRESS OF ESTABLISHMENT: tIA5 % UvJ11e, IRA- 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: PL ��� � .' �A S. TELEPHONE NUMBER OF ESTABLISHMENT: I- �192, 9. EMAIL ADDRESS: _ 1C>" pea eucI 'in.6-)\ A (z gahat 1. Gwy) 10. SOLEOWNER:ZYES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME .. ""y, ." PRESIDENT 63tA 16un, Wrt.- J '1 lA ®?. 5< TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE Q:\Application Forms\I-IAZMAT APP 2017 REVI .docx Number Fee 1295 THE COMMONWEALTH OF MASSACHUSETTS $50.00 Town of Barnstable Board of Health This is to Certify that Rogers and Marney Builders 445 Osterville West Barnstable Road, Osterville, MA Is Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. ------------------------------------------------------------------------------------------------------------------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2019 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2018 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health • c� c-h K� a53 g I d Vowof Bnsxable egulatoryYervlces Richard V. Scali,Director THE Tp,_ Public Health Division BARNSTABLE B&MgABLE-CE rtmwu•CDM-Wu BARNSTABLE, Thomas McKean, Director "'�16 9 a;�� S"�� 94iArEp 659. s`0� 200 Main Street, Hyannis,MA 02601 �Dg Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 S CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. lZL ZOOM 2. IS THIS A PERMIT RENEWAL? ✓ YES_NO. IF YES,SHIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: Q�� A.►V XAgr-j-q %.,%LjF- /G�gQ,/ �z�► 5. NAME OF ESTABLISHMENT: Zc*mzs /,,Av-.L 14c-. 6. ADDRESS OF ESTABLISHMENT: V MAtiZwiS AftLE &a!�.tv cyst=¢,nu= /A.^. 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: ?c.3ox 3t0 8. TELEPHONE NUMBER OF ESTABLISHMENT: S74:,8 4LS cototo 9. EMAIL ADDRESS: OPPIC LQQ,E --XS4,,4A CD 10. SOLEOWNER: X YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE# OF: CORPORATION NAME PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: • NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE Q:\Application FormsUiAZMAT APP 2017 REVISED.docx Number Fee 1297 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that A Concrete Answer 445 Osterville-West Barnstable Road, Osterville, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. ---- ----------------------------------------------------I----------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2019 unless sooner suspended or revoked. --------------------------------------- - PAUL J.CANNIFF, D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2018 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health �a of B nstable�towegi2atory Services TME Richard V. Scali, Director Op hy,- Public Health Division- - --- - ArEo a,•�--- - - - 200 IVl - BANSTBLE— -.A � Thomas McKeanMASS. , Director 4 ;HyM 02601-- - --ainStreet � -- - - Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS 3�- IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st-JUNE 30th). APPLICATION FEES CATEGORY.1 PERMIT_ 26- 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 X V.S. CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. I,7Z-led 3 2. IS THIS A PERMIT RENEWAL? X YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: 5. NAME OF ESTABLISHMENT: C 0 0 C 12e"E /I*.[Svc'w— Sq C . 6. ADDRESS OF ESTABLISHMENT: q q Q4wVt(I..t- 1 t.1+2a1 C c 1.c KJ PA-VA. VGA- d Z04 v 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: M,Wj . 144 t v qt p 8. TELEPHONE NUMBER OF ESTABLISHMENT: - q u - 1117 9. EMAIL ADDRESS: _ (k(,6AGZ6T-6#4911yY1r0 kiP-i oA .t(I0 10. SOLEOWNER: X YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME A- Cak t dv(suy/t, --rN C• PRESIDENT 10 4tZ TREASURER 57-,n9 -Z'7,l k<JIK b CLERK �2;VIKEJ M d]Q 12. IF PREPARED BY OUTSIDE PARTY: • NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT e 4 DATE � Q\Application Forms\HAZMAT APP 2017 REVISED.doc Number Fee 1309 THE COMMONWEALTH OF MASSACHUSETTS $so.00 , Town of Barnstable Board of Health This is to Certify that Peacock Painting 445 Osterville-West Barnstable Road Unit B, Osterville, MA Is Hereby Granted a License C, For: Storing or Handling 26 - 110 gallons of Hazardous Materials. -` ---------------------------------------------------------------- ----------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2018 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health ' Qw11_of B nslable Regu a t o ry ervlces S v �TKe r Richard V. Scali, Director BARNSTABLE • Public Health Division � L 9ARH8TAHLE. Kusms ra•.0•rs�`v�u[•.::neunsa•.. Mass Thomas McKean,Director W19.1014 s679• 6. 200 Main Street Hyannis,MA 02601 t 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 HOUSEHOI.,D QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY Ist--JUNE 30th). APPLICATION FEES CATEGORY I PERMIT 26— 110 Gallons: $ 50.00 CA'I'.EGORY 2 PERMIT 1.11. —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by July Ist. 1. ASSESSOR'S MAP AND PARCEL NO. ' 2. IS THIS A PERMIT RENEWAL? VYES_NO. IF YES,SKIT'QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGEIUSE OF GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS).." YES NO. 4. FULL NAME OF APPLICANT: 5. NAME OF ESTABLISHMENT: d t'Ct n1 i C 6. ADDRESS OF ESTABLISHMENT: 4A" � i I �,;. f"n`� �t I'f . 1 t�l' " B 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: ' C j� �;' kn, V, it 8. TELEPHONE NUMBER OF ESTABLISHMENT: _ P ON �j�. 9 2-61 2- 9. EMAIL ADDRESS:� 1,�.: -tom.C_i t rtc ag�;J- C.€. W) 10. SOLEOWNER: '> ES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEI' , NE#OF: CORPORATION N E PRESIDENT "(' n ie W � TREASURER ,C.T.ERK I2. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: iSIGNATURE OF APPLICANT DATE Q:\ApplicationFomis\HAZMATAPP2017RE ED i i Number Fee 1295 THE COMMONWEALTH OF MASSACHUSETTS $5o.00 Town of Barnstable Board of Health Zni 4 This is to Certify that Rogers and Marney Builders 445 Osterville West Barnstable Road, Osterville, MA 41 Is Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2018 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health f JUL-27-2017 13:21 From:BARNST HEALTH 915088624713 To:5084203550 P.1/2 of rust able vy�VY�� O uz-02 l�aJ egLllatol� 41'ViC�B Richard V. Scali,Director Public Health Division. BABSTABn J� co-xJ3+ g = Thomas McI(ean,Uircccor �— .,RNRrenLe, MA x6]a. 200 Main StrCet,Hyaiu'is,'MA 02GU9 ~ II/-?",;?0/� vux: 508790-0.4 Office; 508 862-1644 APPLICATION FOR PERMIT TO STORE AND/Olt UILT-LIZE HAZAitDOIJS MA'i'1ffl,RiALS 1N AC:COTLI�ANCR WiTiI'CHTi'I'OWN�jN SS.E T.1IAT I AND E UR STORE HAZARDOUS 108, I IAZARDOUS MATERIALS,AIX BUS MATERIALS GREATER THAN HC)UST?HUT,D QIJANTf'1TES ARE RT✓(,IUII�T)'i'0 U$TAiN AN ANNUAL pERMI'f(RUNS JUf,Y Ist-.ITJNE 30th)_ APPLICATION FEES $ SU.oO C;A E(=ORY I PERM-IT 26=110 Calla CATEGORY 2 PE1tMI'1' 111 =499 Gallolls; $125.00 a CATEGORY 3 PERMIT 500 or more Gallons: $150.00 � *A late chf►r c of$10.U0 wi11 be assessed if a n,ent is not received b .Tu1 1st. 1. ASSF,SSOR'S MAP AND PA1tCEL NO. 2. IS T RS A PFRNOT RENEWAL? X YF.S,NO. l.F YES,SKIP QUESTION 3. 3. FOR ALL NEW PFRMIT APPLICATIONS, WfIETF FOR HAZAR OVS MATF•1tIALS STORAGE/USE OF "ZONTNGIRUILDING APPRO GREATER THAN HOUSFHOLD QUANTITIES(25 GAI,LUNS)' NO. . X YES. • 4. FULL NAME OF APPLICANT: g. NAM.F OF FSTABLTSIjMFNT: Rb erS Zh r j 1 _�2r G. ADDRESS OF ESTABLISHMENT: ?. MATLIIVC: AllDRE IS(1F DIFFE1tENT FROM ABOVE: $O 1 V 8. TELFTHONE NZJMI3FR OF ESTABLISHMENT, 9. EMA.IL AIyDRESS: r C 10. SOLEOWNER: X YES,NO IF NO,NAME OF PARTNER: .11. FULL NAME,TIOME ADDRESS,AND TF,LEPIIONE 9 OF: CORPORATION NAME 1'RF.SWF',NT TREASURER CI..E11K 12. IF PREPARED BY OUTSME PARTY: TELEPHONE#: NAME: / FMATT.: COMPANY ADDRESS '� �DATE z� SICTNATURP,OF APPLICANT rT- Q:1AppI10,16on FonpslllAZMA'r APP 2017 IZH.VTSED. ncx ja Number Fee 1294 THE COMMONWEALTH OF MASSACHUSETTS $so.00 Town of Barnstable Board of Health This is to Certify that DC Tree Service 445 Osterville West Barnstable Road, Osterville, Is Hereby Granted a License � For: Storing or Handling 26 - 110 gallons of Hazardous Materials. ----------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2018 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health pd ' Roof Unstable eg atory ervices Richard V. Scali, Director I A �t►+�ram, .�t • "� Public Health Division BARNSTALE 6n Swis l6•ci.+tR•n�k•cmun�inneus BARNEMABLE. ' Thomas McKean, Director �1SH 1639- 4 +` �A i63q. \ Ten3�a 200 Main-Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790, 6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE. HAZARDOUS MATERIALS IN ACCORDANCE.WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1st—JUNE 30th). R APPLICATION FEES CATEGORY 1 PERMIT 26 — 110 Gallons: $ 50.00 �.s CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? 'V/ YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: 6vwt /NAL 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: j 'S 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: (P(9 �i6 tj 11#� 1,601 a a 6 5 5 8.. TELEPHONE NUMBER OF ESTABLISHMENT: �Z 4 V C S 9 9. EMAIL ADDRESS: h�� c �� +r?,�j� 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS A EMAIL: SIGNATURE OF APPLICANT DATE Q:\lpplication Fonns\HAZMAT APP 2017 REVISED.docx • R. t Number Fee 1297 - THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that A Concrete Answer 445 Osterville-West Barnstable Road, Osterville, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2017 unless sooner suspended or revoked. ---------------------------------------- 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 Regulatory Services Richard V. Scah, Director 1Jus•osreaw '"R"AS& ' Public Health Division BABSTABLE wasrora 1639. 0� fiuws a -osmv •mnm•mmms ♦ ue•wsenrxzrrs �f0 MA't A Thomas McKean, Director 1639-201 4 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS a6/& - 7_�L IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ 113a� CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 >J�<V' I"pa�K� CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ • A late char a of$10.00 will be assessed if paMent is not received by July 1st. ASSESSORS MAP AND PARCEL NO. /aa 14p 3 DATE UI/O FULL NAME OF APPLICANT: ST15 ItjMI (Mft2�� NAME OF ESTABLISHMENT: Id itLW1 z I ADDRESS OF ESTABLISHMENT: ��S 2�l�le, /��/1►� ��_ r{lI YI�I�'s � y� MAILING ADDRESS(IF DIFFERENT): 7q 12��L�' 1. l� j�LtV1YLS �11 IS vet oZGy� TELEPHONE NUMBER OF ESTABLISHMENT: �fj ^yZ0 — `j EMAIL ADDRESS: {}��✓1G�2� r9�LSu1L7L� I2GVl. �l°+ SOLE OWNER: YES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME tg CCW(pLe7Z 1,4A(Sc Vr e r_h/C . PRESIDENT TREASURER CLERK � .� ll� act • IF PREPARED BY OUTSIDE PARTY: S G-N40F fnLlANT Name: Company Address : Telephone#: Email: Q:\Application Forms\HAZZAPP Revl6.doex Page 1 of 2 Number Fee 1294 THE COMMONWEALTH OF MASSACHUSETTS $50.00 Town of Barnstable Board of Health This is to Certify that DC Tree Service 445 Osterville West Barnstable Road, Osterville, Is Hereby Granted a License For: Storing or Handling 26 - 100 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2017 unless sooner suspended or revoked. ------------------------- ------------- � 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 G y I Town of.Barnstable BIKE►� Regulatory Services Richard V. Scali, Director ""MS&R"B '4 Public Health Division BARNSTABLE' 1639 A�e nw°AP"i-msrs�osm`anu CDw'"sre Fxsmee ' Thomas McKean, Director 1639-20` 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6308, APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 CATEGORY 2 PERMIT 111 -499 Gallons:-- $125.00 ❑ CATEGORY PERMIT 500 or more Gallons: $150.00 ❑ • A late charge of$10.00 will be assessed if payment is not received by 1st. ASSESSORS MAP AND PARCEL NO. DATE FULL NAME OF APPLICANT: Olcl f` NAME OF ESTABLISHMENT: C �' G`� ✓G G ADDRESS OF ESTABLISHMENT: c/ `G ,lam �' '�`�`� �� �j �✓1` IBC MAILING ADDRESS(IF DIFFERENT): >0 x -1 I t� y`i i V✓l MCL d TELEPHONE NUMBER OF ESTABLISHMENT: �E -7 I—Oct 3 q EMAIL ADDRESS: b C1kC13 a Y4 00J( SOLE OWNER: YES JINO IF NO,NAME OF PARTNER: Lvl bl-456� FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK IF PREPARED BY OUTSIDE PARTY: ; SI ATJJRW0F APPLICANT Name: Company Address : Telephone#: Email: Q:\Application Fonm\HAZZAPP Revl6.docx Page 1 of 2 W� Number Fee 1295 THE COMMONWEALTH OF MASSACHUSETTS $so.00 Town of Barnstable Board of Health This is to Certify that Rogers and Marney Builders 445 Osterville West Barnstable Road, Osterville, MA Is Hereby Granted a License For: Storing or Handling 26 - 100 gallons of Hazardous Materials. ------------------------------------------------------------------------------------------------- -------------------------------------------------------------- ---------------------------------- -------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2017 unless sooner suspended or revoked. ---------------------------------------- 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 • FT NE►o Regulatory Services + ; Richard V. Scah, Director 9 MASS. ' Public Health Division BAMSTABLE 1639. `.COML•M' IS f�e MNSONS YLLLS-OSfE0.:LLE•W5i BWISTABtF 1f Thomas McKean, Director 1639-2019 �.. 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 F~.. APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1st—JUNE 30th). 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 ❑ • A late charge of$10.00 will be assessed if payment is not received by JulYlst. ASSESSORS MAP AND PARCEL NO. j j& 02•Z d I DATE I i i i f V FULL NAME OF APPLICANT: 4=qAr,4 NAME OF ESTABLISHMENT: —ZS ! ADDRESS OF ESTABLISHMENT: V-b /^A oZcosS MAILING ADDRESS (IF DIFFERENT): ?-o. TELEPHONE NUMBER OF ESTABLISHMENT: SOS 4z-s &oit>(e EMAIL ADDRESS: wi SOLE OWNER: YES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE # OF: CORPORATION NAME PRESIDENT TREASURER CLERK IF PREPARED BY OUTSIDE PARTY: SI U AP LICANT Name: Company Address : ul�"q Telephone #: Email: QApplication FormsTIAZZAPP Rev I6.docx Page 1 of 2 I_ (ME Town of Barnstable -� Office:508-862-4644 •P`CI' tyti . Public Health Division Fax:508-790-6304 • BA LE.MASS. • 200 Main Street• Hyannis, MA 02601 039. MASS. g A�FOMP��`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Basiness Name: .e I14 [Ati y e,y » i.� r Date: 113f_ 7-'4 �! Location/Mailing Address: w-f �5tf��v ',ice iJn,� << .�, 'r�>,1G '-! re v, 11 h Contact Name/Phone: `-,vr�-i 1 5 a\O J lV S"•o-P P-) 2" InventoryTotal Amount: !. �� 'i' License#: _, MSDS: E Tier II : N)o Labeling: •) I=_4a�-' w� Spill Plan:_ate+ Oi I/Water Separator: � Floor Drains: )' Emergency Numbers: Storage Areas/Tanks: I`,) Jv;Iy '�:C<r. •� - ! S ,x I `,ryy,A,. V-,-,- CA u-y Emergency/Containment Equipment: Waste Generator ID: 1 W \1 k Waste Product: AJJ ,4 Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: ?kh Iv\: t e/"< ('cg, ?L?Ae, ,e. 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 14 ` 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 oil Miscellaneous Corrosives s 2- 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 t Pesticides: I 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 ,,J4{, Swimming pool chlorine '-'b Paints,varnishes, stains, dyes r� �� x Lye or caustic soda Lacquer thinners Miscellaneous Combustible 14 I Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables ,< i Fertilizers Floor&furniture strippers , �.e�� PCB's Metal polishes ";r 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/RECOMM'iENDATIONS: �':' - 'at-t a..TRT , -C n L in \ z \+ '. 7 >'� ti'� d ).J V1 y'�l� k �:A. !� ;�,�, U c�-1 ' ^v;_ 1..1 t'l:V� vl '� r f,..LL Ll < � r 1 1 (9�•i 1 -rt �•�n." 5�{�ter`C-+} �e i�0V- V; )vtiLr'..� } - k sL`.h>��'.1✓`c�� r.>; , `.� �L�9_� ; `� Inspector:`< /` Facility Representative`: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS Number Fee 1309 THE COMMONWEALTH OF MASSACHUSETTS $so.00 Town of Barnstable Board of Health 2 This is to Certify that Peacock Painting 445 Osterville-West Barnstable Road Unit B, Osterville, MA Is Hereby Granted a License For: Storing or Handling 26 - 100 gallons of Hazardous Materials. ----------------------------------------------------------- ---- -- ------------------------------------------------------------------------------------------------------------ --------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2017 unless sooner suspended or revoked. -------------------------------------- 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 Regulatory Services "o Richard V. Scali, Director Ar Public Health Division BARNSTABLE Thomas McKean,Director 1678-",200114 i� 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fag: 508-790-6304 �W APPLICATION FOR PERNUT TO STORE AND/OR UTILIZE x HA7ARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1st—JUNE 3-0th): - - y APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 CATEGORY 2 PERTTNUT---H 1 -49.9-Gallons: ...$125.00 -_ ❑ CATEGORY 3 PERMIT 500 or more Gallons:'$150.00 ❑ A late charge of$10.00 will be assessed if payment is not received by July 1st. • ASSESSORS MAP AND PARCEL NO. DATE 1 f V FULL NAME OF APPLICANT: o b n NAME OF ESTABLISHMENT: le CZ pa ADDRESS OF ESTABLISHMENT: I,� y ►J r 1 ► \C� v'r MAILING ADDRESS(IF DIFFERENT): TELEPHONE NUMBER OF ESTABLfiSHMENT: (46 EMAIL ADDRESS: SOLE OWNER: L VES_NO IF NO,NAME OF PARTNER' FULL NAME,HOME ADDRESS AND TELEPHO #OF: CORPORATION NANM . , TA J C— PRESIDENT TREASURER — CLERK IF PREPARED BY OUTSIDE PARTY: • S N F PLIC Name: c Company Address : Telephone#: Email: plication Fonns\HAZZAPP Revl6.docx Page 1 of '-''_ .. -..r.ti.. ,r....-"l,-.y�..,,-�.. ....r ^.^ , ..n+>,.._-•'s-�,,+-.+.vr+-+wxa,.w,+.+,rw,.,T-Fi'.,.-...-.:.,r" - r�-^..."r-..�,:✓`^''+v-"-"-a_OJT...n...---„-.-.._..�-..:e--.r:,.-.,..,'-�....-., TOWN OF BARNSTABLE BAR-W Ordinance or Regulation WARNING NOTICE Name of Offender/Manager Address of Offender MV/MB Reg.# Village/State/Zip Business Name MG • of 1, (3 "."C� ,a /pm, on �r1 20 f y r r Business Address y QO_. ,"-/,1�.p-IJ.��4 6,,ro,1 R'r Signature "of/Enforcing Officer Village/State/Zip Location of Offense .r_S the Enforcing Dept/Division P -- Offense V A + r3�t, k I(� ,- JJJJ , t y t J r : Facts �ll 'flt+lEKU+l> �. 111 � +il ', /� ►` [��"� t� ! I�r yt;w, , i�15 ►y�L This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. _-s•"--- � .....-, ten.-`w..�-.^+-r.^.�•:d+..,. arm- .ewe-�--^+... .f - e ^z..r"•ws.,,..,�a..'- .....T..,ti..,..,.-....-..<...y n++-w.�.-..... TOWN OF BARNSTABLE BAR-W r 1 Ordinance or Regulation WARNING' NOTICE Name of Offender/Manager ;MI, t Address of Offender MV/MB Reg.# Village/State/Zip tt Business Name f '� -} . ,.! ',+ r r' am/pm, on ��1. 20 1(, r Business Address Wy!f 4d t1, w ` ,, y°s r,a Signature of/Enforcing Officer Village/State/Zip �'.'�,:/_ „ < _ '" - ` . Location of Offense t Ilk. Enforcing Dept/Division Offense fit ' ' } ° - r� '�. - 1, d• <. r -F �, '' =J.,,, w :r t � Facts This will serve only as a warning. ' At this time ,no legal action has been taken. It is the goal of Town agencies to achieve. voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-,ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE BAR-w 15230 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager Dot\P (Y 'V My A1vk-4 l Address of Offender MV/MB Reg.# Village/State/Zip Business Name 10'0`)famm/pm, on, Ahl'i 20 17 o r� Business Address �" k 4fV45-f le w R) �`�. Signature of Enforcing Officer Village/State/Zip 4-je»`cy + lllf , MA JZbTo" Location of Offense V+e.4-5 Enforcing Dept/Division Offense IU�re� i o t'evCG." Facts ► Eu i.J,- tt , i wt,�►�t�<�{ �rrt a �1 :. 1G` ~�a � r tt 05 This will serve only a"s 'a warning. At this time no llegal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance.. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE BAR-W Ordinance or Regulation WARNING NOTICE Name of Off ender%Manager r�w�` : '{ - a Address of Offender , MV/MB Reg.# Yy Village/State/Zip =- t ; d c :� ra . . am'/ m on 20 Business Name �_.� �..�_xr. I P � _ Business Address .- Signature of Enforcing Officer Village/State/Zip - ; Location of Offense Enforcing Dept/Division Offense '. . ;� rl: � .. C✓ a3tr�j Y� ?" t. ' '1 "J 1r ,•t (,' � i (s. t a` �..+1. Facts ,#•.L9 ;� !Lh "c �'. , �< �.. :,. '-�''"T 4 1...� .�'3�t,, f �. y' '`a 1,,,,1 .E X t t�.-'!>` s. This will serve only a"s `a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. �d� PINE TO Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 � BARNSTABLE. MASS, p 200 Main Street• Hyannis, MA 02601 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT fFD MAC Business Name: A Co Date: 3 �' Location/Mailing Address: C i� - we, e Q P0 �� ' q 4�t63� Contact Name/Phone: 0 - J - <III y Inventory Total Amount: MSDS: Q License#: 10 Tier II : A Labeling: Spill Plan: (Ae Oil/Water Separator: AJIA Floor Drains: 6 Emergency Numbers: Storage Areas/Tanks: Emergency/Containment Equipment: Waste Generator ID: Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. 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" P�' faneod (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORM TION/RECOMMENDATIONS: S49 PonP cleanezq- Do r K AMU W WA, Atil Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM <b NAME OF BUSINESS: Mail To: BUSINESS LOCATION: aai -� �� ` Board of Health MAILING ADDRESS: ( {`( ��P �P t Town of Barnstable- - �,< P.O. Box 534 TELEPHONE NUMBER: Hyannis, MA 02601 CONTACT PERSON: M ArA to y EMERGENCY CONTACT TELEPHONE NUMBER: Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totalli g, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS.MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume: Please estimate the quantity beside the product that you store: Quantity/Case Quantity/Case Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes I Cesspool cleaners Hydraulic fluid (including brake fluid) ! Disinfectants Motor oils/waste oils I Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages t Printing ink Battery acid (electrolyte) 1 Wood preservatives (creosote) Rustproofers E Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners t Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) ! Paint & lacquer thinners I I PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers yy Any other products with "Poison" labels 9 { Metal polishes (including•chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy- Health Department/ Canary Copy-Business TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OFIEALTH 3.Auto Body Shops 5,V Q unsatisfactory- 4.Manufacturers COMPANY (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS (/ es-7_7Af 91 ,t?4 Class: 7, 7.Miscellaneous N QUANTITIES AND STORAGE (IN= indoors; OUT-outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers W C.;) / Miscellaneous: .414 AO DISPOSAIJRECLAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply ;3"'t3 64'7., l01- O Town Sewer oPublic/11 , On-site OPrivate 3. Indoor Floor Drains YES—No O Holding tank: MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES N0 Z,� ORDERS: O Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product YES NO 2. Person (s) Interviewed Inspector Date 3 ok- 0jW%00N0V-N I r Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 \eARMA,';- 200 Main Street• Hyannis, MA 02601 o39. a�. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: `� e.� tv. `e.5 Date: 9> /q- Location/Mailing Address: k ko: P616Qk-t(b Contact Name/Phone: `fat• cQ u m y, ,k w,S �� '-771 - d(t 3 9 ay1��J�1�� Inventory Total Amount: I MSDS: License#: Tier II : N)o Labelina: 0 K Spill Plan: Oil/Water Separator: A Floor Drains: N o Emergency Numbers: o K Storage Areas/Tanks: OA Emergency/Containment quipment: -�-e-r' Iry 8 k. 5 4,e., Waste Generator ID: tJ h Waste Product: Date&Amount of Last ih pment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: 01 coy, ` 0' 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 IEngine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives J 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 a`l`-- a v -40 Ate-` . wok 6 01 0� A- A- ko O ro ,, �J Inspector: Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS No. I v G;L l Fee �N THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Ye 01pphLatlon for Disposal 6pstrm Construction 3pPrmit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System 9'(ndividual Components Location Address or Lot No. l.l,c�, ��9..� ice,r�5�d�. a.II Owner's Name,Address,and Tel.No. Assessor's Map/Parcel {`� ©�"� I`ll ems` -� �`�q`rtr TAW-T L-Lli Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. TDJJY 61"Bra Td YIL' `A'r<)1AM.-V- r,)O A Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building S? t)J ec., sti+s No.of Persons Showers( ) Cafeteria( ) Other Fixtures 1 p►l-F AftToy Design Flow(min.required) 14 l ► gpd Design flow provided gpd Plan Date l r 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) 1!F P J12 (�Dl4v�.A Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not tg...place the system in operation until a Certificate of Compliance has been issued by this Board e Signed Date �(� Application Approved by 2 Date Application Disapproved by Date for the following reasons Permit No. U U a- Date Issued I �t No. O 0 , Fee THE,COMMONVEALTH OF'"MASSACHUSETTS Entered in computer: d � PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Rpplicatibn for Disposal 6pstem Construction permit Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon( ) ❑Complete System ©'Individual Components Location Address or Lot No. !,.},ice ��?W- l,v. (i,4ta1,),0,10. Owner's Name,Address,and Tel.No. Assessor's Map/Parcel , �, ( (� I �t�'ti M� �R �Si~ 1�tn i Lwti✓�iic 'r �T rs+,�'1- 1_C-�, Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling Noofed4= C+ ; Lot Size sq.ft. Garbage Grinder( ) - Other Type of Building _ No.of Persons Showers Cafeteria( �.,.n�P� Ca ete a YP g M+, ( ) ( ) Other Fixtures -` H AL-- 8A-f H f Design Flow(min.required) A)1/1 gpd Design flow provided tj/A- 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: dr. The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boa�rd{�,o{�ealth. Signed[„/�`�, Date Application Approved by- � f t2 Date Application Disapproved by < y Date for the following reasons Permit No. U ()e Date Issued r r THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the-On-site Sewage Disposal system Constructed( ) Repaired k Upgraded( ) Abandoned( )by at .has been constructed in-accordance - i with the provisions of Title 5 and the for Disposal System Construction Permit No. f)?J dated Installer th r r / . �. ,..�,�� �" •A ...1",Designer )J!1 #bedrooms 'A-- � Approved design flowit� PV gpd The issuance of this permit shall not be construed as a guarantee that the system will�f lnction as designjed. Date Z 1 1 Inspector No. a a W-3. Fee THE COMMONWEALTH OF MASSACHUSETTS (�Q PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS ,G✓�f r Mi4 oral stein Construction permit Pern ission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at. L,/L/ 0,1,)- - W. 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. Date % i 5 4 / Approved by I ASSESSORS MAP PARC,w! 6 a,q V/C) TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,'Repair 2.Printers BOARD OF HEALTH O satisfactory 3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANY r4? �1 S �" ? pl r�/lil (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS �` "" � 3�.�- '/�� .r�'�.t� Class: —7 7.Miscellaneous /-`.QUANTITIES AND STORAGE (IN= indoors; OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) , Heavy Oils: r waste motor oil (C) r new motor oil (C) 'transmission/hydraulic Synthetic Organics: degreasers / Miscellaneous: i 1 i r DISPOSAL/RECLAMATION ` REMARKS: 1. Sanitary Sewage 2.Water Supply 0 Town Sewer 4 Public f 0 On-site OPrivate / 3. Indoor Floor Drains YES NO 0 Holding tank: MDC O Catch basin/Dry well 0 On-site system 4. Outdoor Surface drains:YES NO ORDERS: 0 Holding tank:MDC O Catch basin/Dry well 0 On-site system 5. Waste Transporter Name of Hauler Destination Waste Product YES NO 1. 2. r , Person (s) Interviewed Inspector Date No..-- Fes$. ........_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..-- .Town _..................OF........Ea x.stable . ....... ..................... Xv,phration for Bh4vooaf 19orko Tonstrurtion rvormit Application is hereby rpade for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: (��1'. - j . Gt/�1S ��L \�A QA West Barnstable,Rd. , Ostervill e, MA fJ�A4 ll..l� ............... 1 ............. ........................:................................................ ................................GL................(p.T................ ......./. ............ j Location Address or Lot, Charles D. Ro ers & Edison C. Marne .............._............ ,..... ................................_............ Y....-........... ................ ..... ................................ ..... ......... Owner Address a Alfred Fuller... atonsMls, MA 026_48 . . Installer Address Q Type of Building Size Lot...4 `ACI'e 5....Sq. feet v Dwelling—No.Xl-ZXdt ............................................Expansion Attic ( ) Garbage Grinder-(N'o Other—Type e of Building Who$ frame Pa YP g --•"••------------•-----•-•- No. of persons............................ Showers Cafeteria 1q0") Pa Other fixtures ------------------------------------------------------.. W Design Flow............................I............__..gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacityl`OOQ-gallons Length....:........... Width---------------- Diameter---------------- Depth................ x Disposal Trench—No..................... W&osing _..... . :. ML ngth---------_. _ Total leaching area....................sq. ft. Seepage Pit No100Q_......... Diameter_ ......._ Deptiinlet._.... . Total leaching area .Lt. . ft. Z Other Distribution box ( ) tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1------------_---minutes per inch Depth of Test Pit.................... Depth to ground water.................... 44 Test Pit No. 2................minutes per Inch Depth of Test Pit.................... Depth to ground water------------------------ Ix -------------- ----------•--- •---- -•--- -------- ....... ................................... 0 - - 0 Description of Soil___....... Sand & Gravel --------•------------------ W -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•--•--_...-- U Nature of Repairs or Alterations—Answer when applicable................................................................................................ -----------------------------------------------------------•----•--------------•--•----•------......------------....------------------------------------------------------------------------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The unde igne ur)ier agrees not to place the system in operation until a Certificate of Compliance has bee ' s by e rd h th. Sign - . :---- --• . D Application Approved BY-------- - - ---------------------- -- -- -�'-.=� ---"......... ----------• ..... . - - -------------- Date Application Disapproved for the following reasons:..................................................................... ............. -•.........................•---.......-----------------------•-----...-----------......-•-------•---•--•------------------------•---------------••------------•-----•-------------•--------------....... Date Permit,No......................................................... Issued........................................................ Date t _ _ •�.. No.—.... Fxs y............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town- .... --- --. . OF_.....Barnetable....:.......... ....:.........................• Applid iivu for Bi-viposal Marks Tonotrrurtion ramit Application is hereby inade for a' Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: --...:� eSt---B0XX1 tSb1A-*.Rd-,-v--- t'6rVA-1:18-r- IMA--•-•--••----------•--.-----#144------------------------------------------------------ w Location.Address or Lot No. �...& -ra�r f 1...(9 ...Riem e .......................................................................... Owner Address W :�3rP..d...Fuller- �&l�b`�aE9�i+9.,.������ • 's. ��b����---------.---.----•---- a s, Installer A dress Type of Building Size Lot--- .AeMS.....Sq. feet Dwelling—No. uid �............................................Expansion Attic ( ) Garbage Grinder (N a —Type g -.ftXt&-e No. of persons............................ Showers (4 ) — Cafeteria�jo )Other—T e of Building Otherfixtures --------------------------------------------------------------------------------------------------------------------------------------------•-------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 04 Septic Tank—Liquid capacityl.00-gallons Length................ Width......_......... Diameter................ Depth................ Disposal Trench—No_____________________ Wit _ (t; �5�' o t1�T ngth..__..___ ... Total leaching area . sq. ft. Seepage Pit No. Diameter !!._ ' Depth below inlet..... :........ b sq..00r�--------- j�..._... Total leaching area_...._......• ft. z Other Distribution box ( ) Dosing tank ( ) a Percolation Test Results Performed by-- ----------------• ------------------- -........ .......... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_-__-_---__--_.-_---._. 44 Test Pit No. 2................m' utes per 'rich Depth of Test Pit.................... Depth to group water_-..___-_-____-_______-. ''� � Description of So "`�L ---------------k? "8 '" 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 Article XI 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 ---••-- _ 1 --------------------------------------------------- j_lA Application Approved B .......................... `" Date Application Disapproved for the following reasons:-................................................................................................................ .............••--•-------••-•-•-•••------•-------•---------•--•-----•----......•••••--•----•------••-••--------•------•-•---••-----•---••----. ......................................................... Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD 9f HEALTH .. � ............ .............OF..... ... _ .. ...'............I...?.......................... (Intifiratr of Tilutpliattre THIS, 0 C I�,T. Y at the Individual Sc«age Disposal S,stem constructed or Repaired ( ) �_ by . .... .. .+ :``i~_._ at...............--.-•_.. .. -- --- - -- - -- has been installed in accordance with the provisions of Article XI of � Sanitaryr' 7r{ in the application for Disposal Works Construction Permit No......................................... dated.--_.____---___-_- _:_____..___._............. TIME ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..................•-•--••---•----.......------------•---••-•---................. Inspector.................................................................................... THE COMMONWEALTH OF MASSACHY,5j;TTS BOARC� F HE ,L�T .........7.1!;; IL...............OF .................................................................. .2� No... . .. ------ FEE........................ i .. a ' rmit Permission i ted- .� . .... ._..__.._..Y gran ........ ... ............. to Construe or a >r n Iudlvl al e �)D' osal S°`'st �� P Y atNo....... .... ... e..••... ....:._.._....:_ ......................................................t tr. ....................................................` ��.....v ee as shown on the application for Disposal Worla Construction �e_ nIt N , Dated.___ ......................... 114 --� Board of I3calth DATE_ _ -----••---•-..._.... ..._..-•--------•---------------------------•--......... FORM 1255 HOBBS & WARREN, !NC.. PU3LISHEPS - Paul Candito Free in Home Estimates Barnstable Fence Co. Residential • Commercial Custom Wood&Chain Link (508)428-4200 445 W.Barnstable Rd. • Box 502 • Osterville,MA 02655 i COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PAR T A CERTIFICATION Property Address: 445 Osterville-W. Barnstable Road Osterville. MA 02655 Owner's Name: Rogers&Marnev Builders Owner's Address: Date of Inspection: July 28, 2006 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O.Box 49. Ostervllle,MA 026S5-0049 Telephone Number: (508) 862-9400 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 the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. g P y I am a DEP approved system t pursuant inspector p p o Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes l -71 e a Conditionally Passes Ne Further Evaluation by the Local Approving Authority Fai s } Inspector's Signature: Date: _ July 31, 2006 The system inspector shall sub t a copy of this inspection report to the Approving Authority(Board!of Health'"or DEP)within 30 days of completing this inspection. If the system i a i ,P y s shared system or has a design flow of 10,000 ' gpd or greater,the w stem inspector and the system y owner shall submit the report to the appropriate regional 'office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Co►mnents ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 445 Osterville-W. Barnstable Road Osterville. MA Owner: Rogers&Marney Builders Date of Inspection: July 28, 2006 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not.determined",please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 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 ND explain: I 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPE CTION N FORM PART A CERTIFICATION (continued) Property Address: 445 Osterville-W. Barnstable Road Osterville, MA Owner: Rogers&Marney Builders Date of Inspection: July 28, 2006 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 public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,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 any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance **This system passes if the well water analysis,performed at a DEP certified laboratory, 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,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 445 Osterville-W. Barnstable Road Osterville, MA Owner: Rogers do Marnev Builders _ Date of Inspection: July 28, 2006 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to 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 or cesspool ✓ 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 %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 SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of 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. [This system passes if the well water analysis, performed at a DEP certified laboratory,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,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No 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 If you have "yes"« y e answered yes to any question in Section E the system is considered a significant threat, or answered yes to Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 ✓ OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 445 Osterville-W. Barnstable Road Osterville, MA Owner: Rogers&Marney Builders Date of Inspection: July 28, 2006 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ — Pumping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out in the previous two weeks? ✓ _ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A) — ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ _ Was the site inspected for signs of break out? ✓ _ Were all system components, excluding the SAS, located on site? ✓ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes No ✓ _ Existing information. For example,a plan at the Board of Health. ✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. 5 Page 6 of 11 J OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEW AGE DISPOSA L SYSTEM INS PECTION FORM PART C SYSTEM INFORMATION Property Address: 445 Osterville-W. Barnstable Road Osterville MA Owner: Rogers&Marnev Builders Date of Inspection: July 28, 2006 RESIDENTIAL FLOW CONDITIONS Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no): [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use(yes or no): Water meter readings, if available(last 2 years usage(gpd)): Sump Pump(yes or no): Last date of occupancy: COMMERCIAL/INDUSTRIAL Type of establishment: Otrce building Design flow(based on 310 CMR 15.203): -- gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): No Industrial waste holding tank present(yes or no) No Non-sanitary waste discharged to the Title 5 system(yes or no): No Water meter readings, if available: Unavailable Last date of occupancy/use: Currently occupied OTHER(describe): Pumping Records GENERAL INFORMATION Source of information: Unavailable Was system pumped as part of the inspection(yes or no): No If yes, volume pumped: gallons--How was quantity pumped determined? 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) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Unknown Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of I l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 445 Osterville-W. Barnstable Road Osterville. MA Owner: Rozers&Marnev Builders Date of Inspection: Jul v 28, 2006 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC other(explain): Distance from private water supply well or suction line: Comments (on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Cesspool acting as a septic tank Depth below grade: Material of construction: concrete _metal _fiberglass _polyethylene other(explain) If tank is metal list age: Is age confinned by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 6'x 6'(1000 awl pit) Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: I" Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: — Measuring stick Comments (on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.). The nit had 6'ofliguid on the bottom Liquid was up to the outlet tee A steel cover was to grade GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet,and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPEC TION FORM PART C SYSTEM INFORMATION(continued) Property Address: 445 Osterville-W. Barnstable Road Osterville MA Owner: Rogers&Marnev Builders Date of Inspection: July 28. 2006 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: allons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Connnents(condition of alarm and float switches,etc.): DISTRIBUTION BOX: None (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarns in working order(yes or no) Conunents (note condition of pump chamber, condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAG E DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 445 Osterville=W Barnstable Road Osterville MA Owner: Rogers&Marney Builders Date of Inspection: Jul v 28. 2006 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: I -6'x 671000 gal) leaching chambers,number: leaching galleries,number: leaching trenches,number,length:, leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments (note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): The leach Dit had 2.5'li uid on the bottom. The scum line was approximately.3'upfrom the bottom. There did not gypear to be any sijzns o failure. The bottom to rade was 8.5'. A steel cover was to grade CESSPOOLS: None (cesspool must be pumped as part of inspection)(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(yes or no): Coir ments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: None (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.): 9 .� Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 445 Osterville-W. Barnstable Road Osterville MA Owner: Rogers.&Marnev Builders Date of Inspection: July 28, 2006 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. i FronT t700 r a\ o� Q i �s ya a sa 33 10 j. Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 445 Osterville-W. Barnstable Road Osterville MA Owner: Rogers do Marney Builders Date of Inspection: July 28, 2006 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 25 +/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain:_ Topographic and water contours Wraps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high groundwater elevation: Using Barnstable topogra site. phic and water contours mans the mans were showing approximately 25'+/ to ground water at this This report has been prepared only for the septic system and components described herein. This septic system has been inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the septic system, the inspection, this report and/or any components of the septic system which have not been located and inspected. 11 Date: gj:&� lqq TOXIC AND HAZARDOUS MATERIALS REGISTRATION FO M NAMEOFBUSINESS: I-V Xc9,RX Au To Z,-Anc--B` 1 �l BUSINESS LOCATION: ��� � • ���S 7� �i..� �c� • �,s-r��c.� <<r-P- /� . MAILINGADDRESS: 5,4m it Mail To: TELEPHONE NUMBER: s e F--4(z � 7,V a Board of Health Town of Barnstable CONTACT PERSON: �� ,A "� !�iurv� �� �s� P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: Hyannis, MA 02601 TYPE OF BUSINESS: o-ro Does your firm store any of the toxic or hazardous materials listed b low, either for sale or for you own use? - YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site otherthan your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antifreeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants i Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Any other products with "poison" labels Paint brush cleaners (including chloroform, formaldehyde, Floor & furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers Other products not listed which you feel may be toxic or hazardous (please list): (including bleach) �) Spot removers & cleaning fluids a �'OA-7r70-T CQ v.A e��" (dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: ����� Pv� �® Mail To: BUSINESS LOCATION: y -, U�Ike GNU• /��S/A Board of Health MAILING ADDRESS: l�•� � D�e���/� /ylf�;Q �6ff Town of Barnstable P.O. Box 534 TELEPHONE NUMBER: _ �/ONZO Hyannis, MA 02601 CONTACT PERSON: lJ /�� EMERGENCY CONTACT TELEPHONE NUMBER: 41_�1 Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES NO � This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store: Quantity/Case Quantity/Case Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners --' Hydraulic fluid (including brake fluid) Disinfectants Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes _ Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) ^� Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) Other cleaning solvents t Bug and tar removers Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business J' TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH x satisfactory 2.Printers 3.Auto Body Shops /�`-- O unsatisfactory- 4.Manufacturers COMP (see"Orders") 5.Retail Stores p 6.Fuel Suppliers ADDRESS� � r,�/ �P�t�t� ass: 7.Miscellaneous K= QUANTITIES AND STORAGE (IN= indoors;OUT-outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Undergro'undTan IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: - 0j, c DISPOSAL/REt;LAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply 4 r O Town Sewer Public t On-site OPrivate 3. Indoor Floor Drains YES N0—p— c, O Holding tank:MDC O Catch basin/Dry well mo O On-site system 4. Outdoor Surface drains:YES NO 1Z ORDERS: O Holding tank: MDC O Catch basin/Dry well O On-site system 5. Waste Transporter DestinationName of Hauler YES NO 1. 2. ep Person (s) nterviewed Ins•ector Date "'R /. e,4,11 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓✓/ Yes PUBLIC HEALTH DIVISION —TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for Mi!6pozaf *proem Construction Vermit Application for a Permit to Construct( )Repair Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Lt ,_ I Owner's Name,Address and Tel.No. Assessor's Map/Parcel ��(1rkes 0esc-s 1Ra�e"g 1,hAr—Ac �S�C����� I 00 4X6-6 k ob Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 'Z?"L sl Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building 6 rit�I No.of Persons Showers( ) Cafeteria( ) Other Fixtures -r Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank JS'h 6c.1 a x� Type of S A S 2 FWD d eLr w�tlS Description of Soil Nature of Rep 'rs or A Iterations(Answer when applicable) G) SIT �u1t e ' C \ I In r e \`Icy ST��C S(a'� t�� n q0d 6 i Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Enviro ental Code and not to place the system in operation until a Certifi- cate of Compliance has been issWd by thi and of Signed Date `0,I7 198 Application Approved by Date Application Disapproved for the following reasons r Permit No. - Date Issued 12- )7-9X Fee w t �= THE COMMONWEALTH OF MASSACHUSETTS Entered in�egmputer: Yes• PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for Mi!6poal. *pgtem Construction J)ermit 'Application for a Permit to Construct( )Repair(Upgrade( )Abandon( ) ❑Complete System ❑Individual Components P Location Address or Lot No. Owner's Name,Address and Tel.No. '� � S ost• w Assessor's Map/Parcel �S \��..�t c C v\ \"�c s %�0a / ) 3r A I y is oo ti;.&- bka6 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ru c e bC c5 \" !C_ s 65T, Lip 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 gallons per day. Calculated daily flow gallons. Plan-Date Number of sheets Revision Date Title 'y Size of Septic Tank Type of S.A.S. Description of Soil t N Naiure of Repairs or Alterations(Answer when applicable) 41).4) ?X 1 r. 0"x • oT \��� Sao rc' '- ��a � �Tc he COIJ�r A 1 c4ad50o re C 1^ �elast inspected: \� Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Enviro mental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss by thi and of Signed Date >r• 16, S8 Application Approved by Date / ,7—/7—'fir Application Disapproved for the following reasons"* Permit No. 7 'S Date Issued ------------- ;----------------------- THE COMMONWEALTH OF MASSACHUSETTS I BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed Repaired Upgraded P Y ( ) P (� ( ) Abandoned( )by at t-{L_� O 51 f v _ 1 ✓�t,n. — C3sT, has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No._9 E-7" dated I)- 1-7 - 9 k Installer-ru ce 6Gccj�', Tc r Designer The issuance]of tgis permit shall not be construed as a guarantee that the sys m will function as d signed Date I()I �l/��D Inspector n1 1� ! .P ' No, / � /��� --------------------------Feel THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE: MASSACHUSETTS Mi!6Pogal *pgtem (Construction Vermit Permission is hereby granted to Construct( )Repair(`/)Upgrade( )Abandon( ) System located at 4 d 5 T - u,, and as described in the above Application for Disposal System Construction Permit. The applicant recognizes 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 thi e tt. Date: 2 ' l 7—� 7 ` Approved by 9C / - I s 10/9/97 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) pq /,a o© 3 1, a,CA,`1 stir hereby certify that the application for disposal works construction permit signed by me dated `D ECG l t i [Oi gC 8 , concerning the property located at LAW- os erg'-l te. meets all of the following criteria: • There are no wetlands located within 100 feet of the proposed leaching facility • There are no private wells within 150 feet of the proposed septic system • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • If the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S.map) �J`^ B)Observed Groundwater Table Elevation(according to Health Division well map) 0 aea°y SIGNED : DATE: r. LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. q:health folder:cert L YIN- S 6 �Gay`1 3t o ` l�S�a nC 1 1 -' i'i M lwa- 1im ,&W m m • MZ v W TOWN-0FBARN 0 STABLE- LOCATION 7= W,734/?A/. /20.1 t, SEWAGE i �,L VLAGE - ASSESSOR'S LOT_. IL _ 6:5 it I -- : 1. .MAP &_LOT INSTALLER'S NAME&PHONE N0. L 112 TIC' K AiiX= .:-)150 C)� - EX 0 SEP TAN C LEACHING FACILITY, W44 �e 50 6 6 type), x 2z NO.-OFBEDROOM5' VIA PERMITDAT COMPLIANCE DATE: E. -:".: COMPLIANCE epahti6h bistahc'e Bit' een�the::,�- S ..e w Maxiffi'u'n:A dj.p#ed,Gr.btindw. ater Table to.the B tiornoft66in Fa cility Feet Privat6 Watdr;S.upply-Well an d-Leaching Facility (If anyW Us T. eet: on site or within.200 feet of leaching facility F ity(If. Edge any wetlands 014,', e,of,Wet.land and Leaching Facil 'It within 3 .!teLt f Pqfe�tbf 16 khin facilit g . Furbished by if L 3Li �Ovt�e� 4St6y ��'sr 1�3a>L �,0�� "78 SNE lo�4• Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARNSTABLE. MASS, q 200 Main Street• Hyannis, MA 02601 A t67 q.s�0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rF0 MPS Business Name: � 0�r.rs + m Date: 1 J oZ d Location/Mailing Address: y y j UJnh:.T►,y 1 -Wt r3,8,, ,S! " get U'4ije*_ Contact Name/Phone: C,"ct-,- k 1 ' ,n tj ��Ot+w- 616q, 6-(f V ' 6-6 Inventory Total Amount: 01WIS MSDS: License#: Tier II : hm Labeling: t-5,�-J Spill Plan: Pe-s e.a Oil/WaterSeparator: tV A Floor Drains: fVon r,� Emergency Numbers: it Storage Areas/Tanks: rV0 Emergency/Containment Equipment: S at W Ati Waste Generator ID: t%/f lk Waste Product: N I !I Date&Amount of Last Shipment/Frequency: �^ Licensed Waste Hauler&Destination: — Other Waste Disposal Methods U r u S c' tnJa& Cs 1lc P �• (���cks�W S l a� 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 V a 6 z- I 11LY) 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 4 Pesticides: :3 6-7_ 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 z Sveq Paints, varnishes, stains, dyes Lye or caustic soda - p Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes I 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, C°da9�-ti•°�`i"'A IL hydrochloric acid, other acids) VIOLATIONS: e i('r�s 1 c,� o !� t-A.0. 1Z 1 S C—v,'W LOS- S i `P ' J( I`1 ! r7 ✓3yc ORDERS: INFORMATION/RECOMMENDATIONS: Inspector: �GJ ✓ ��l� Facility Representative: i WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS I °Ft►� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMASS. • 200 Main Street• Hyannis, MA 02601 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: Date:4Z / Location/Mailing Ad ress: 44.5 0esr 9---ewiWoke_ 12 5f4,rv, l"lam Contact Name/Phone: rI it- Sr,o,J r-Gl( Sob-(,42>- "16 S oc, �aJr�Sow a So$-y 2%-t,1010-oq's,e-c.- Inventory Total Amount: 9&1 MSDS: h� License# Tier II : tJ o '__ Labeling: �a-kkA (cky-0,`^ Spill Plan: Oil:/WaterSeparator: ►J A Floor Drains: NO Emergency Numbers: Storage Areas/Tanks: v " VIV �Ot - l S xt Emergency/Containment Equipment: 5�O }� q e ,09 Waste Generator ID: Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: eA"' 5 41Ar,o�- ,ke vt�e— k& ;z wtRX 0,� ay.. G,t.e— 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. Ali Antifreeze 14 ' 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' k Z 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 1 Pesticides: I 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 tarS� Swimming pool chlorine - k-%� Paints, varnishes, stains, dyesX %'b'c Lye or caustic soda Lacquer thinners �� 2� Miscellaneous Combustible 14 Paint&varnish removers, deglossers Leather dyes 5 Miscellaneous Flammables 3 V-oeol5cW"l Fertilizers Floor&furniture strippers k - 1'"4 PCB's Metal polishes .I t 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: e. VVI�•� C, . c_,ak k A 0.. v,5 11I GoW w Wlaw kJ-1+f,,- kaw(-vl.>. ,cr5 1 h. S Ino 3• Inspector: ,w�-� Facility Representative ( /-3 C—S WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS IKE A ' Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 ' B""M �. ' 200 Main Street• Hyannis, MA 02601 / 039. �0� 8���1�q. ' TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT JJ Business Name: RoJ&rg `l a<►^e-y , Y . Bu,\seT-5 Date: Location/Mailing Address: 4'{S W. Y(Ue , 01 � � Contact Name/Phone: C�60f'11c Syo,-) <<\ 5'0g-Ioq9�-&2(,$ 6ra..rJ SoOZ.A. I 'w Inventory Total Amount: \ MSDS: &k License#: Tier II : Labelina: Spill Plan: MIA Oil/WaterSeparator: tJJA Floor Drains: 0 J Emergency Numbers: OK, Storage AreaslTanks: ok \ c 1 S &A Emergency/Containment Equipment: Waste Generator ID: Waste Product: \)\ky C pc"Jus�X Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: u o S 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 VDegreasers for engines&garages Pesticides: Ca6lk/Grout/aA-1u-s.V-c.7 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: °1�-\1 Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS r � l ��� _ . . . �� %I '�� •4, F `, •� { :S •. , � ' I►�To Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMASS .. g' 200 Main Street• Hyannis, MA 02601 \0\rFOMA'�a,00 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: � Date: ! V� Location/Mailing Address: gV15r US+"vfV trt��9*,ws+a6 Y'-L P Contact Name/Phone: e� .. ... SCE$- 30 - 29170 Inventory Total Amount: �cnr MSDS: I MCm 1; ►� License#: Tier II : Labeling: r-C*ck o Spill Plan: Oil,Water Separator: 1�) It Floor Drains: [Voy1(—� Emergency Numbers: Storage Areas/Tanks: Emergency/Containment Equipment: Waste Generator ID: IV I A Waste Product: lyl A Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: "' Other Waste Disposal Methods: v'-Cs r t4-3 4C-e S-I-ct r� �e �� var 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: Z 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, dyesSee Se Idw 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: Oy 't7� ORDERS: r,� �c u�. sib e II ORMATION/RECOMMENDATIONS: C> - -)- s y l30 Q`}eI Inspector: .6 t I r3¢S� Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS TOWN OF BARNSTABLE BAR-W Ordinance or Regulation WARNING NOTICE # . Name of Offender/Manager 1 „� r�r r ., ..} Address of Offender -PA t�,, /_ t,.,0 MV/MB Reg.# -- Village/State/Zip f ,�,r.rr,1k r1�► ? _/ Business Name 10,c �� `, l,r t'r, r„f , V,-, a Ipm, on di"T 20 L7 Business Address 4I0! Signature of j En'forcing Officer Village/State/Zip /' %L V) J,., � �--/ Location of Offenseo _., f Enforcing Dept/)Division Offense }Renee Atli( r � (� -fi b-. r �" r- � I) it � i� !',IG r/ n / ,4� �/ .�. // �i�ra Facts P.h �A 14 17 4,r,(A t ' -'eft r `�'.�'.e 1 14 ),)6 )1/ry This will-serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE BAR-W Ordinance or Regulation WARNING NOTICE Name of Offender/Manager LJ Address of Offender MV/MB Reg.# Village/State/Zip U m, on 20 am'/pm,Business Name 1-7 AS14ress 711�I j 1� B u s in e_sq Signature of Enforcing officer (Ij 3 Village]/Staff/Zip N V t J1-1 'Location of/jOffente Enforcing Dept/Division Offense V __yFacts M IL This will serve only as a warning. At this time no legal action has been taken. It is the 'goal of Town agencies to achieve voluntary compliance. of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PRO-G /oPINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. 3� �' C -� � '^1 1-) �D �� ��> � � � Sy�f ( 3 ��f � 1.����. � � 1°FT ►okti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARNSTABLE.� 200 Main Street• Hyannis, MA 02601 '6 79 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rFD MPS Business Name: 7Qacoe[c. �� n+, Date: 1 b Location/Mailing Address: yy-5'-0 e("v,Jl-p-- a CO 66H Contact Name/Phone: -3b - — c -Co! a 05t6," )�P— Inventory Total Amount: n! D MSDS: 1 fAlkw 5�1 License#:" Tier II : o Labeling: (t,'���1 Spill Plan: o► -M4K-5P Oil/Water Separator: [Pc Floor Drains: ►J mergency Numbers: OK Storage Areas/Tanks: � AA!nl 4VW--&kw 5-44o Emergency/ContainmentZErAent: 5A' x kkk� .oW 54 V4, iw�-1(,c,L 6ALoe' jy "'S.�Waste Generator ID: Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: VrA &JJ , 1a�tax/�,Ar. �r .� �A1A -F lb,.Oo-11- s co LIZC1 1 o„�, \A y Go.9wJ-r A,1 4-'rooA, 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 I 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 i 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 30�ap Lye or caustic soda Lacquer thinners Miscellaneous Combustible I Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: 0 liiv-o J iar 15 Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS k tME roy� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 (BARS .MAS. e` 200 Main Street• Hyannis, MA 02601 ,659. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT FFD MA'S Business Name: Date: '— --2C� Location/Mailing Address: 14 Contact Name/Phone: (04n r 4 d Inventory Total Amount: S a) MSDS:Q v, I ►;c License#: Tier II : o Labeling: : I Spill Plan. 1 Oi]/Water Separator: di A Floor Drains: )YonC Emergency Numbers: `` Storage Areas/Tanks: /r-) S a I iN-&4:h ay,w�elf Emergency/Containment Equipment: Waste Generator ID: hl I IA Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. 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 t aoZ 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: P/C V ORDERS: INFORMATION/RECOMMENDATIONS: C°gyiS s r r-L-YmdVe� was a(c I Inspector: a� Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS Ft Tow Town of Barnstable Office:508-862-4644 ~o� Public Health Division Fax:508-790-6304 BARNS TABLE. MASS, � 200 Main Street• Hyannis, MA 02601 f639 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT RFD MP'�s Business Name: rivkt f")OW— Date: Location/Mailing Addre s: 44 S e� ,I Contact Name/Phone: a v Inventont Total Amount- `�5��1 SDS: 04 I I bu.- A6441A License#: Tier II : 0 Labelino: (It. wk%\ Spill Plan: +' Oil.VVaterSeparator: Floor Drains: D Emergency Numbers: Storage Areas/Tanks: i Emer enc /Containment ui ment: Ck-rc Waste Generator ID: A to( Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. 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 kPaints, varnishes, stains, dyes 115� Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes 7, Miscellaneous Flammables L 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: fl c1sls&ft A * AD < time Inspector: �, 6t\Ac\ Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS IB*o Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 ' "MARS- ' 200 Main Street• Hyannis, MA 02601 "r1639.+"�� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: &,tb+ fi&Ac e, C,o Date: 7 Location/Mailing Address: yy,!r Os4zf ,Ile, - �. Q Contact Name/Phone: Sew\ Caat+o Sod- Soo Inventory Total Amount: j t 1 MSDS: License#: Tier II : 0 Labeling: OK Spill Plan: — Oil/Water Separator: AA Floor Drains: t3o Emergency Numbers: Storage Areas/Tanks: I NIA Emergency/Containment Equipment: Waste Generator ID: tJ JA Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. 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 7— 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: 1 ���kS -t .n.g � •� 2 wt S v r o� u r Inspector: �l- Lo-velte, Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS t \ME rokti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARNSTABLE. MASS, 0p, 200 Main Street• Hyannis, MA 02601 �'DTED MA�p`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT e Business Name: A CDnc Date: 0 I Location/Mailing Address: LH5 L,*S� [WA*AMZ ' `n ' 90 Ow - 60%- Ctn+eri/JkA W,6,31 Contact Name/Phone: 50$,y2[)—I 7 Inventory Total Amo nt: ` S% License#: 9� Tier II : Labelin Spill Plan: e - Oil/Water Separator: Floor Drains: IV n Emer en Numbers:_ qea Storage Areas/Tanks: J S rlO*t'aW Sl.W 57 Emergency/Containment E jlpmerk I'llKil i Ao6eO, Waste Generator ID: a A Waste Product: Date&Amount of Last Shipment/Frequency: nil Ilk Licensed Waste Hauler&Destination: N LA Other Waste Disposal Methods: r'eG d 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 cleani g fl6ids. 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: V Road salts grease, lubricants, gear oil Refrigerants Degreasers fo engines&garages Pesticides: ---Vl"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) aQ &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" r 4W�G Poi U4wle ✓ (including chloroform, formaldehyde, 1 hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFOR ATION RECO END IONS: reXMft4AA&W3S WWiX 4iii6e -5 Inspector; Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS `�Ft►w rokti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 200 Main Street• Hyannis, MA 02601 \ FOMA�A`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: A C et.c re+-e- Ass+ .Y-5:v,c. Date: Location/Mailing Address: q14 s +er ,I 14E- Oes arvt5f"1e. 8'f . M41 I: Contact Name/Phone: yogi- 1420- 11 CO 1 InventoryTotal Amount: �- j(o'1 0 MSDS: f-5 f 4 Co(�eC� License#: af� Tier II : o Labeling: 5�5 Spill Plan: Oil/WaterSeparator: Floor Drains: D Emergency Numbers: Stcrage Areas/Tanks: I_6S god V)"F. Q&t: o&A.e, Emergency/Containment Equipment: ` a ®tt*�-aw\ Waste Generator ID: 0 00 1A20 I �i'j Waste Product: }�lawtv�al9)e_ M�x�i�cGk Date&Amount of Last Shi ment/Fre uen : I te 59-1 a t-2 K Licensed Waste Hauler&Destination: -P 90S15<1A(-1V=:2Cf�k- Other Waste Disposal Methods: 0 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) S Windshield wash t Motor oils 1 Miscellaneous Corrosives 2, t Gasoline,jet fuel, aviation gas I Cesspool cleaners Di'eseTfuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: � CaulWGrout/4-dk.c5,+J-P-5 lo-+3 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 tto Swimming pool chlorine �,o Paints, varnishes, stains, dyes 30+1.0 Lye or caustic soda Lacquer thinners I Miscellaneous Combustible I Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables sl v)kqW Fertilizers Floor&furniture strippers u,S�LA00 PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil&stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" 1.0 Ape,%vts eL�( Q,k,.�c s '1,0 (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATI N/RECOMMENDATIONS: -L of t e&C e -7 ems. Inspector: o I%A- .6 tiJe s r,vi.� v(a�aQe'-1140«+d ,ems Q�5 ©����� �� 1 A_ F cility`Rlprresentative: A.4�JA—" Wl E COPY HEALTH D PAR MENT/CAN��Y COP BUSINESS�' `/ `�`} �c �-71\ i k j T►+E roy� I Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMASS. .g• 200 Main Street• Hyannis, MA 02601 163 9. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT ATED MPS a Business Name: C If "1 C6 Date: 919,716 Location/Mailing Address: qJS W 'a�( � mRD 80,( S Contact Name/Phone: 309-771 - Q939 Inventory Total Amount: <�. _ SIDS: - e5 License#: Tier II : Labeling: Spill Plan: uPG�tA Oil/Water Separator: Floor Drains: Emergency Numbers: Storage Areas/Tanks: Emergency/Containment Equipment: PC,B Waste Generator ID: Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination- 0 ther Waste Disposal Methods: CA kc 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) ar 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 V 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: ORD=RS: INFORMATION/RECOMME'NDATIONS: !htll SKIIL',- Inspector:. tility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS °FIKE r Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMAT E. MARS ` 200 Main Street• Hyannis, MA 02601 . p �ArFDMn+°� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: �>L Date: /tI?619-x Location/Mailing Address: yy�0 +ems ", e - �i ©s -. c ,Ile_ '76b Contact Name/Phone: _Cvv,'_ �I✓ASo r%- arm C..w..�•,..g 5 5 99--7"7 1 -0q 3 9 Inventory Total Amount: 't0 SDS: License Tier II : o La elinci 1 Co Spill Plan: 05 Oil/WaterSeparator: Floor Drains: 1,%0 Emergency Numbers: Storage Areas/Tanks: &e.�W 00-5�i o, 1 dt � . �,2g `[-e�.x.L.d� o.�4C Emergency/Containment Equipment: k aK- k Waste Generator ID: Waste Product: o, A-0 Date&Amount of Last Shipment/Frequency: {` Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. -I Antifreeze <wki*4- � I k t Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes i Bug and tar removers \o Hydraulic fluid (including brake fluid) Windshield wash bb Motor oils k Lo --V- x'1 Miscellaneous Corrosives Gasoline,jet fuel, aviation gas 4b 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 ti Battery acid (electrolyte)/batteries ti 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 1 Lye or caustic soda Lacquer thinners Miscellaneous Combustible 3 `I-1 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: 2A.vk- p\7 W#tepk-e-D, INFORMATION/RECOMMENDATIONS: t-e- a \t". <, ..�, 0 '50,1k M, e,JIAJ 1 Ppm-mv�bc.C� �� Inspector. C \o Lam.\ \,A- kovS F51ity Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS 1 IME►o Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BAPMA&,';- . 200 Main Street• Hyannis, MA 02601 16,39. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: 641 1�l a S&A-r Date: I1 10 Location/Mailing Address: Yys"L9 - 2515wrVul'p-, a s.+Ji�k,sw✓ ..t, 4cic oy Contact Name/Phone: t✓ r1 5 JSa,rs.c.,r Sf�-�'77-3233 Inventory Total Amount: '� 2 j MSDS: License#: Tier II : A)o Labeling: m K. Spill Plan: Oil/WaterSeparator: 4 Floor Drains: o Emergency Numbers: Storage Areas/Tanks: 211 A Avy 4',K. s�-�c'aAA- C� .ram I Aa � Emergency/Containment Equipment: Waste Generator ID: Ili JA Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers CLR. 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 fo engines&garages Pesticides: CaulWGrout� ►��x��oKcte- �� �� 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, dy s Lye or caustic soda Lacquer thinners `,3e-r"��5 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. I . L ��L Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS / t' Town of Barnstable Office:508-862-4644 ~°� f Public Health Division Fax:508as0-6304 BARMA.R ' 200"Main Street• Hyannis, MA 02601 ,6,9 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: 8q r,t",' 44 Sav r Date: 1 a ll o/if, Location/Mailing Address: yy ci �/- Oe-,� d,-,rvts;zb/e. ,�, , :54erv,// Contact Name/Phone: CiAr-� 5 aq,- ,cr .S'Z)A- 7 - 23 3 5` 1 i Inventory Total Amount: 2 �i MSDS: License#: Tier II : a Labeling: b K Spill Plan: ► Oil/WaterSeparator: w PA Floor Drains: A o Emergency Numbers: r Storage Areas/Tanks: �- li k /v,Zs 44 o 4- Emergency/Containment Equipment: y r Waste Generator ID: hJ)A Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid f Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers it -' Hydraulic fluid(including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Dieserffuel, kerosene,42 heating oil Disinfectants Miscellaneous petroleum products: Road salts f grease, lubricants, gear oil Refrigerants A Degreasers for engines&garages Pesticides: Caulk/Grout/Aeew'x (!,fA6f-eJtJi4l insecticides,herbicides, rodenticides Battery acid (electrolyte)/batteriesr` 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: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS °F IKE Ao� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508as0-6304 BARNSTABLE. ' 200 Main Street• Hyannis, MA 02601 +'��� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: 4< �",�n\k5°`'-^<^ Date: $ Location/Mailing Address: y45 fl+ 05+ Contact Name/Phone: �l o 1 11 r0 -y,1 -4525 Inventory Total Amount: 4 14 MSDS: License#: Tier II : 0 v l Labeling: Spill Plan: Oil/Water Separator: 11) Floor Drains: /l�d Emergency Numbers: Storage AreasJanks: � A Emergency/Containment Equipment: Waste Generator ID: f�)to Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. 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 7— Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants VDegreasers for engines&garages Pesticides: Caulk/Grout�a�L1a�5,•,�5 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: v d � � ak vc.Ll • � 1n.e. ���5. Inspector- 1 , L.aw4\-e- Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS d 0;�3 1/72 -3--) -141 7N. (<111 Gallons) Landscapes Unlimited 182 West Barnstable Rd 182 West (Barnstable Rd Osterville 10/2/2013 6 120 f <111 Gallons Bush Gardens 192 West Barnstable Rd 0-92 West? Z , Barnstable Rd. Osterville 10/2/2013 6 120 '771,�g3 � DC Tree Services 445 West Barnstable Rd 445 West Barnstable Rd Osterville 10/24/2016 8/27/2019 6 122 11 R(rnstable s & Marn Buil ers est B nsta 445 West B Oste 10/24/2016 �6�-122 A nc st Barnstable Rd 445 West Barnstab q Osterville 11/2/2016 8/23/2019 6 122 �,. 11 IV q (<25 Gallons) Barger Masonry 445 West Barnstable Rd 445 West Barnstable Rd Osterville 11/10/2016 6 122 v <25 Gallon Barnstable ence Co. 445 est Barnst e Rd 445 W tfl f Ba d Ost i e 11/10 16 6 2 E. 0 H 138 Wes Barnsta s erville 11/21/2016 8/23/2019 6 120 i/ Peac ck Painting 445 Wes am able st am 'ble Rd ste vi 1 6/2016 122 ) lam ) rub � d6veAs � Johnson, Chester ( Gus ) From: Sue Rogers <sue@rogersandmarneybuilders.com> Sent: Friday,January 10, 2020 8:36 AM To: Johnson, Chester (Gus) Subject: RE: Hazardous Material License Inspection That would be fine.See you on the 15cn! ` From:Johnson, Chester( Gus)<Chester.Johnson@town.barnstable.ma.us> Sent:Thursday,January 09, 2020 3:41 PM To:Sue Rcgers<sue@rogersandmarneybuilders.com> Cc:Johnson, Chester( Gus) <Chester.Johnson@town.barnstable.ma.us> Subject: Hazardous Material License Inspection Hello I stopped in the office today and spoke to a very pleasant girl that was more than helpful;Your company currently has a license (#1295) for 26410 gallon of storage of materials. The license is active until September of this year, but I still need to visually check premises. I was wondering if next Wednesday around 11AM would be ok for this. It will not take long at all and there is no charge at all,this is just to make sure that you are in compliance with the license. E-mail is fine or you can call 508-862-4645 and leave a message Have a nice weekend Gus Johnson Hazardous Material Inspector CAUTION:This email originated from outside of the Town of Barnstable! Do not click links, open attachments or reply, unless you recognize the sender's email address and know the content is safe! i ROBS t mArmi OWN OF BARNSTABLE LOCATION Yy� vST W• �Af� � R C SEWAGE # VILLAGE eCV'' ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO.SEPTIC TANK CAPACITY �G pAtI, 1"T l UUb h LEACHING FACILITY: (type) P �'X�� (size) NO. OF BEDROOMS ' BUILDER OR OWNER R 0 M 111rl, 13l)�I c� /-S PERMITDATE: - COMPLIAN DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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 IFurnished by ?/1 e�7ly� For 1 �ronT t'�o0� Q o` 1 '13 ya a5;i. 33 TOWN OF BARNSTABLE L0CA'I SON CAST /, -23,1Rnf /,?O,! SEWAGE # '28S— VILLAGE O 6 15-t--. ASSESSOR'S I'AP & LOT_ . I d.INSTALLER'S NAME&PHONE NO. ff -� SEPTIC TANK CAPACITY i — LEACHING FACILITY: (type),f-00 64,_ GcOe 11i(QJ (size) /o?X NO. OF BEDROOMS BUILDER OR OWNER. v r.2ts Hnm t PERMITDATE: , -/ 1� COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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 o� Y z 5 .T s M EA® KEEPING YOU ORGANIZED No.10334 2453L MADE IN USA GET ORGANIZED AT SMEAD.COM �1